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19 Technical and Technological Instruments for Application of VM2G – Vojtova metodika 2.generace

19 Technical and Technological Instruments for Application of VM2G

Three types of mats for supporting the cervical spine

It is extremely important to provide the patient with the best conditions possible during VM2G therapy. The mats of various thicknesses have proven to be beneficial for positioning the head on the back and on the side to prevent the head from being in reclination or lateral flection. Adequate firmness and elasticity of the mat is also important.

Two types of inflatable Activa-Discs

To simultaneously position and labilise the pelvis, the implementation of firm and elastic discs has proven beneficial. When laid under a patient’s pelvis, arm or leg in position on the back, side or stomach, they can achieve both facilitation of the reflex activation (supporting the flection of the pelvis in the supine position) and labilising the supporting points, i.e. intensifying the course of the reflex significantly.

Two types of supporting mats for supporting the arm

Supporting mats for supporting the arm enable the support of the occipital limb in the supine position of a patient. It prevents the hyperextension of the arm with subsequent pain in the shoulder joint. It simultaneously allows the patient to support the occipital arm safely and comfortably in the physiological position. The mat allows the patient to pull him/herself into oblique and torsional positions. The two sizes of the mats have proven to be beneficial in children and adult patients.

Fig. Various types of elastic bandages

Elastic hose bandages of various widths are beneficial for affixing stimulating balls to the patient’s body. According to the width of the torso and the limbs, width of the bandage can be selected from three centimetres (e.g. for infants’ limbs) to twelve-centimetre wide bandages for the chests of adult patients. The bandages are elastic enough to provide the reflex stimulation in active zones.

Anti-skid mats

Anti-skid mats have proven to be highly beneficial during the therapy of the infants, older children and adult patients. They prevent the undesirable slipping movements of the body and the limbs supported by the mat during reflex stimulation. They improve adhesion of the supporting points significantly and thus increase the effect of the reflex. Anti-skid mats are used at the same time in the therapy of infants to prevent excessive movements of the limbs.

Fig. Elastic exercise bands

Elastic exercise bands are used as aids in VM2G therapy to temper the reflex movements of the limbs. It enables the forming of supporting points of the limbs that are elastic and at the same time unstable. Thus, it facilitates the reflex stimulation.

Wedged underlay

A wedged underlay is suitable for facilitation of the reflex stimulation predominantly in patients with impaired function of the lumbar spine. Underlaying the pelvis with the wedge eliminates the pain in this spinal region. The wedge could be used to support the ribcage in oblique and torsional exercising positions.

Mat with space for a disc

A mat with space for a disc has proven to be beneficial for gradual increase in intensity of reflex stimulation, particularly in the supine position. It allows the head, the ribcage and the pelvis to be straightened in one plane, but the pelvis could be underlaid with a disc. It results in stable support at the side of the head and the ribcage, while the pelvic side is completely labilised. Moving the disc to the sidewalls of the space provides oblique support of the pelvis, which at the same time represents labile surface. The mat allows the performance of reflex stimulation under longitudinal and transverse tilt of the medical lounge. It also simultaneously influences the torsional mechanism of the muscular loops of the body.

Therapeutic dress for VM2G reflex stimulation

Implementation of this dress is beneficial in patients of all ages, particularly in those, who need to be provided with intensive stimulation (e.g. infants at risk of a high degree of central coordination disorder or patients after spinal cord lesions and other severe conditions). It is also useful in cases, where the implementation of the stimulation by a home therapist is problematic. The dress provides activation of at least twenty-two active points. Mechanical stimulation through pressure provided by elastic balls is complemented by the stimulation with micro-vibrations. The intensity of the vibratory stimulation could be comfortably regulated through electronic means.

Video – Therapy in stimulating dress

Elastic stimulating balls

Elastic balls of various sizes and degrees of hardness are used for reflex stimulation within VM2G. Stimulation with balls is very well tolerated and offers higher comfort to the therapists. Thanks to the stimulating balls, concurrent activation of several reflex zones is possible.

Small weights for infants and preschool children

Use of 125 g and 250 g weights has been beneficial within the therapy of the infants and the preschool children. Their utilisation increases the reflex stimulation by shifting the centre of gravity of the limbs. They could easily be attached with an elastic band or Velcro.

Large weights for school children, adolescents and adult patients

0.5 kg, 1 kg, 1.5 kg and 2 kg weights are used. Their utilisation increases the reflex stimulation by shifting the centre of gravity of the limbs. They could easily be attached with an elastic band or Velcro.

Adjustable medical lounger for children

An adjustable medical lounge for children is used within the therapy of infants and preschool children. It enables comfortable and continuous elevation of the tilt of the surface of the medical lounge. The surface of the medical lounge is highly adhesive and provides safe positioning of the child without risk of the body sliding on the tilted surface.

Over ball

Very soft inflatable balls have proven to be beneficial for the labilising of the supporting points of the torso and the limbs during the VM2G therapy. Variable inflation intensity changes the hardness and the way the points are exposed to lability.

Special stimulating balls for the therapy of new-borns and infants

Stimulating balls made of pliable foam rubber are used in therapy of very small children. Their main features are high adhesiveness and softness. These balls are also used in older patients with low perception threshold and for stimulation of orofacial zones.

Case Study – Illustration of the Problems with Soft and Gross Motor Skills and Superior Nervous Functions

A nine-year-old patient was placed in our care because of a disorder of the fine motor skills. His mother described her son as extraordinarily clumsy. He wrote and drew incorrectly, had problems making things from modelling clay and building with children’s blocks. She noticed these difficulties during his preschool age. In that time, he grew poorly, he was generally clumsy and he couldn’t tie his shoes. At school, his problems became more apparent. He was very clumsy during physical exercises and often ran into objects as if he couldn’t guess the right width of the doorframe. He slept with an open mouth and snored. His mouth was opened in his conscious state when he was focusing on something. He didn’t undergo any rehabilitative care in childhood or later. He attended Educational and Psychological Counselling for specific disorders, namely dysgraphia and dyslexia. The school results were rather under average, although according to the tests, his intelligence was slightly above average.

Description of the Problem
(Clinical Findings)

The medical history revealed a problem during the delivery. It was prolonged and the subsequent adaptation wasn’t optimal. Development during the first year of life was delayed. He started to walk without assistance at about two years of age. The patient had clearly visible dyspraxia during dressing and undressing. He showed problems with lateralisation while standing and in the supine position. Standing on one foot was too complicated and unstable for him. When standing, there was an obvious severe disorder of autonomic regulation of the posture of the body. There were misalignments of the pelvis, the chest and shoulder girdles. His head was pulled forward; his mandible ran backwards, and his mouth was slightly opened. The abdominal wall was relaxed while standing. In resting supine position, the lumbar spine was still bent into hyperlordosis and didn’t touch the surface. There was an apparent rotation of toes of both feet inwards, more pronounced on the right side. A slight ulnar deviation was also apparent on the right hand in this position. He couldn’t breathe into the abdomen while standing or lying in the supine position. He turned the toes of his feet inwards while walking, more on the right foot. He hadn’t been recommended the care of the physiotherapist yet.

Expert Explanation of the Problem

Aetiologically, we can track down the disorder of the autonomic regulation of the posture of the body, impairment of the gross and soft motor skills and the impairment of the basic stereotypical movements up to the period of the development of the programs regulating this fundamental locomotion. Kinesiological development of the first year was prolonged and, subsequently, had “wrapped up” several substitute movement mechanisms. These imperfections were apparent both in autonomic regulation of the posture of the body, basic stereotypical movements of gait, grip, breathing and in gross and fine motor skills. Whole lower limbs showed obvious inward rotatory posture, most pronounced in the acral parts of the limbs. The impairment of the posture of the lower limbs and impaired stereotypical gait resulted in inward rotation of the toes when walking. While running, the patient stumbled over the toes. The pelvis stood in remarkable anterior flection. Consequently, there was impaired coordination of the superior nervous activity especially manifested in dyspraxia and impairment of fine motor skills – impaired graphic motor skills specifically, aggravated by the ulnar deviation of the hand. Disturbed coordination of the gross motor skills was most visible in the pursuit of equilibristic performances like standing on one foot or standing on the toes. The disorder of the anterior posture of the head was accompanied by retrogenia resulting in incorrect dental occlusion and impairment of the stereotypical movement of the whole orofacial region. It was highly probable in this patient that without adequate therapy, there was the remarkable risk of deepening and fixing of the above-mentioned disorders of the locomotive apparatus, including possible development of spinal scoliosis and chest deformity. The disorder of regulation of the posture and stereotypical movements in the orofacial region resulted in impaired development of teeth in terms of crookedness and irregularity. Because of the rather difficult dental care, the teeth were prone to carious lesions and the development of gingivitis. Occlusion defects cause problems with chewing and deteriorate articulation.

Disorder of the body’s automatic posture, condition in 2011

Disorder of the body’s automatic posture, condition in 2011

Illustration of the Solution

For four and half years, the patient and his mother have attended our outpatient department monthly. We can gradually increase the load very slowly.

For a long time, we couldn’t create a stable regulation of the position, but recently, it’s been possible to perform the exercises on the tilted table, balance underlays and gradually increase load. Overall posture of the body has gradually improved, the anterior pulling of the head subsided and the posture of the mandible also normalised completely. The patient has learnt new abilities requiring good balance like riding a bike, skiing and skating.

Dyspraxia improved remarkably, especially during the common daily activities, and the ability to perform accurate and measured movements normalised. Reading normalised, including reading aloud. Slight opening of the mouth during sleep vanished and in the conscious and focused state. The gait has become regular and coordinated. The toes have been placed in the normal slightly outward rotated position. Ulnar deviation of the right hand subsided and the grip normalised. The posture of the pelvis, ribcage and shoulder girdles significantly improved. The stereotypical breathing normalised and the overall physical condition of the patient as well. While the complete ideal normal posture and motor skills haven’t been achieved yet, the patient stays in our care. VM2G has proved to be highly effective on the motor skill problems and also, on the above-mentioned problems that are closely related to motor skills and significantly influence the life of the patient. Costs reimbursed from the health insurance include the monthly rehabilitation.

Disorder of the body’s automatic posture, condition in 2014

Disorder of the body’s automatic posture, condition in 2014

Explanation of the Solution

Correction of the complex disorder in quite complex condition of the patient would be manageable, if the system of basic autonomic regulation of the posture of the body and the basic stereotypical movements were involved. Concurrently, the therapy has been targeted on the correction of the regulation of the coordination of fine motor skills of the hand and the orofacial region. Also in this case, developmental phases could be used, i.e. the potential provided by the growth of the locomotive apparatus.

Normalised posture of the spine also led to concurrent normalising of the posture of the shoulder girdles in the frontal and sagittal axis. Configuration of the chest also normalised, as well as the posture of the head and mandible. Function of the stereotypical breathing normalised too. Despite the initially complicated status, the condition of the patient has been returning to normal function in terms of motor skills, superior nervous functions and morphology of the locomotive apparatus. According to the previous course of therapy itself and the cooperation of the family we can make the excellent prognosis of the overall upcoming development of the patient.

Disorder of the body’s automatic posture, condition in 2016

Disorder of the body’s automatic posture, condition in 2016

The View of the Role and Solution of the Problem with Fine and Gross Motor Skills and Superior Nervous Functions (SNF)

In terms of the actions of SNF, it’s necessary to take the periods of development of basic motor programs into account. Impaired regulation of the programs responsible for control of the locomotive apparatus often manifest in programs responsible for the regulation of SNF. This interconnection is most apparent in children with flagrant disturbances of motor programs, i.e. the children with diagnosed cerebral palsy. The manifestations of impaired SNF have been well described in them and the approach must take them into account, including education. Such intensive care hasn’t been practiced yet in children with motor clumsiness, dyspraxia and specific learning disorders. Originally called motor development disorder, it originated in the first year of life and gradually established itself in other regions of the brain and disturbed several functions and common daily activities. Concurrently, it restricted complex development of the patient’s personality and made harder his education, speech abilities, development of sports activities and the possibilities to learn to play the musical instruments or sing. The former central coordination disorder led to impairment of the regulation the balance and the regulation of the interplay of straight and oblique muscle chains. This disorder was further manifested in impairment of bone growth and subsequent development of deviations of bone and joint axes, basically of the whole skeleton. The developed disorder of regulation of the muscle chains resulted in a defect in the regulation of the diaphragmatic function. The impairment of the coordination of the stereotypical breathing developed along with the disturbance of the regulation of the muscle tone of the chest musculature. This subsequently resulted in gradual collapse of the sternum and the impairment of the configuration of the chest. Another interlinking of the disorder was apparent in the impairment of the posture of the head in terms of anterior pulling. This disturbed posture of the head appeared in developed retrogenia and concurrent disorder of orofacial coordination.

Therapeutic intervention by VM2G involves both normalising of programs responsible for the regulation of motor skills, and the programs controlling the SNF.

It can be observed that the following growth of the locomotive apparatus has happened under the formative influence of normalised programs. The goal is to achieve normalising of the locomotive apparatus completely, of the autonomic regulation of the posture of the body including its basic stereotypical movement as well as the normalising and development of the potential of SNF.

My Daughter’s Story – Case Study on Morphological Changes of the Hip Joint Influenced by VM2G Therapy

“When a phenomenon is heretofore inexplicable, if it really exists, then there’s no reason to deny it. If the phenomenon exists, what’s the point in denying it? They must be studied, not denied.”
“The absence of evidence is not evidence of absence.”

Carl Sagan, Astronomer

At four years of age, a severe developmental disorder of the right hip joint appeared in our youngest daughter Kateřina. It manifested in acute pain during her first attempts to ski. She gradually stopped walking because of the pain, and her right leg was visibly shorter than the left one. An X-ray image confirmed the diagnosis of Perthes disease (morbus Perthes), which is classified among the most severe and most common avascular bone necroses.

The necrosis that develops within the bone is caused by impaired blood supply to the upper head of the femur. The centre of the bone, which is supposed to ossify, dies (undergoes necrosis) and is re-built by living bone tissue. As you may have guessed, this bone is of a worse quality than the one that would have been formed originally. Thus, it leads to premature deformities in the joint and to arthrosis and more frequent fractures. It usually occurs in boys from 3 to 8 years of age. It is bilateral in about 10 % of cases. The causes of the low bone blood supply haven’t been identified yet, but ongoing research indicates that the disorder of blood clotting could be the cause.

The diagnosis is based on an X-ray or MRI that shows dilation of the joint space and irregularities within the joint structure.

There is a conservative therapy based on the disengagement of the limb to reduce the muscle tension, or there are surgical treatment options. After surgery, walking with the exclusion of sports activities is permitted for the next three months. [1]

Traction therapy with an Atlanta splint aimed to remove the contracture (see photo) is among the other options of conservative treatment.

At five years of age, the same problem appeared in Kateřina’s left hip joint. She had tried treatment with the support of an Atlanta splint for a year, but the results weren’t too promising. Therefore, surgical intervention was the next obvious step. Surgery on the right hip joint was carried out first and after a year the surgery of the left hip joint took place at the orthopaedic department of Motol Hospital. The goal of these interventions was to enlarge the roof of the acetabular fossa of the hip joint and improve the supporting surface for the movement of the femoral head. The surgical interventions were followed by many months in plaster casts reaching from the hips to the toes. After the casts were removed we began to carefully exercise with the classical Vojta method, and Kateřina returned to normal quite quickly.

When she was twelve, a quite sudden pain in the left hip joint reappeared.

X-ray images showed that the development of the head of the left hip joint is not favourable at all.

Kateřina hobbled on one leg while walking and after a while her leg and back started to hurt. In Motol Hospital, after looking at the MRI, we were told Kateřina had an troubling variant of Perthes disease. We were expected to deal with the fact that Kateřina would limp, wouldn’t be allowed to play sports and when her growth would be complete in her eighteenth year, she would have to undergo total joint replacement. I found the same information in the existing professional literature. It is easy to imagine what this impairment of the joint “bearings” could do with the motion of the body in general. Moreover, Kateřina had such misfortune: besides the oval-shaped deformity of the head of the hip joint, the neck of the femur (tubular part beneath the head) significantly shortened. Therefore, her left leg was shorter by 5 cm. These changes in configuration and morphology of the whole hip joint cause its remarkably limited range of motion in all directions. The perspective of my daughter going through adolescence disabled, missing the possibilities to play sports, to dance (she had danced ballet quite nicely before her condition started), to run or even walk normally because of pain, came as a real shock to me.

I had previous experience that the Vojta method could improve several conditions like a crooked back or concave chest, but I couldn’t find any mention that it could repair such a severely damaged joint. Still, something had told me that if the rule “Organ is created by its function,” was valid, it had to always be valid; otherwise, it wouldn’t have been a rule. Therefore, if I could evoke “the proper function”, I would have been able to force the damaged hip joint to repair itself and possibly, to influence the shortened leg of our Kateřina. I tried to discuss the problem with some of my colleagues, but I couldn’t find anything new.

So, we started to exercise Kateřina with the Vojta method. I gradually learnt I was probably following the right path, but the existing way of induction of the stimulation reflex to evoke the “right function” seemed to be too weak.

After six months, the check-up visit in Motol Hospital proved that the former significant restriction of the range of movement of the left hip joint decreased. The stereotypical gait improved and the pain while walking reduced. This reassured me that I was on the right path, but I needed to force the stimulation. I gradually attained it by adding foam balls to other reflex zones, by inclining the body on the tilted surface of the medical lounge in the longitudinal and transverse axes, by labilising the centre of gravity of the body and all limbs and, finally, by hanging the weights on the limbs. I prolonged the time of stimulation and, thanks to the balls, I could put many times more pressure on the reflex zones than I used to through digital stimulation.

So, we trained every day for months and years. After about two years, the stereotypical gait normalised gradually; the pain subsided, and the difference in length between the legs decreased to 2.5 cm. After another year, Kateřina began to attend athletic trainings and the year after that she competed in athletics at the Youth Olympics in Bahrain. Then, she grew bored with athletics and began to dance competitively. At the same time, she was playing the piano and singing.

In 2016, a check-up with X-ray and MRI showed that the head of the left hip joint was reformed into a spherical shape but was larger than the right one. The overall length difference between the legs was 0.5. Today, Kateřina is 21 years old. I think she had quite a pleasant childhood and adolescence. We train sporadically only to “tweak the form” for the dance. The eight month long preparations for the marathon run and the run itself represented an extreme test of the “quality” of not only the hip joint. Kateřina ran the race without greater problems. The hip joint has proved its function 100 % in this test.

I gradually came to realise how great the instrument for the repair of our musculoskeletal apparatus we possess. Nevertheless, the implementation of this therapy is connected with the hard work of the therapist, who must be highly motivated to endure such enormous difficulties. Since my father was a designer and I’ve seen him invent several improvements in my youth, I told myself that I should use the same method.

The process of implementation of the Vojta method I introduced several years ago is fundamentally identical to the process Dr. V. Vojta introduced for infants. Adult patients or older children exercise the therapy at home with a trained person (parent, patient’s partner). The patient and his/her “home” therapist attend regular check-ups where the intensification and “adjustment” of the further therapy take place together. The very effect of the therapy in adults and older children intensifies many more times over.

Influence of Function on the Morphological Tissue Remodelling

In his book “Rehabilitation in the Clinical Practice”, pages 411 and 412, P. Kolář has written:

“This process could be explained by an example of functional adaptation (remodelling) of the bone under pathological situations. Although many, particularly older, nomenclatures classify the bone among the inactive components of the locomotive system, it is, in fact, among the most active tissues of the human body. It not only contributes to statics and locomotion, but also to the process of permanent exchange of the very tissue and to the creation of other structures, concurrently. Bone is a highly active organ and its activity could be observed metabolically and morphologically. Arrangement of the trabeculae of the spongiosis corresponds with the trajectories, i.e. the lines connecting the places of the highest pressure and pulling tension. This finding constitutes the fundament of the bone transformation principle, as it’s been first defined by Julius Wolff. His principle is a part of a law of functional adaptation, which applies to all organs. According to Wolff’s law, deformities of the bones appear as a functional adaptation to the changed shape or a changed function. Thus, the shape of the bone is secondary and co-decided particularly by the function. Consequently, the prevailing load of the bone leads to changes of intrinsic architecture and, secondarily, to changes of the outer shape of the bone. At this point, it is necessary to distinguish the adequate – physiological load and the inadequate – pathological load. The load of the bone is dependent on the external forces involved, particularly the most relevant weight force, but the intrinsic forces induced by muscles have to be taken into account too. We assume that the influence of the intrinsic forces is more significant, but difficult to measure. The tension of the muscles forms the axes of the bones and their shape and their posture within the joint. This process is of particular importance during the growth when the muscle forces have remarkable formative influence on the development and shaping of the whole skeleton as they affect the growth zones. Therefore, the muscle balance is extremely important for the development of the skeleton; the balance could be impaired because of a central disorder (CCD, CP, weak palsies etc.) or mechanical overload. This formative influence of the muscular imbalance is totally characteristic of the children with CP, in which the spasticity leads to predictable changes in the development of the hip and knee joints, the spine and other parts of the skeleton. In the case of the hip joints, there are insufficiencies of external rotators and abductors (mainly their posterior parts) and the predominance of the adductors that lead both to anteversion and to the valgus posture of the proximal femur. Mechanical overload in children and adolescents has an important role in the development of the osteochondrosis and epiphysis growth impairments. In adults, the overload leads to an increase in bone remodelling apparent on the X-ray images. The bone is made denser – we speak of a so-called looser zone of remodelling. If the overload persisted, stress fractures would appear. The function has a fundamental influence on the balance between the processes of bone formation and reabsorption. It is a lifelong permanent exchange. The processes of formation and reabsorption are entwined and limited by physiological conditions of stimulation. To reach the balance, the mutual ratio of dynamic and static components must correspond. In practice, it means that every activity must be bilateral – dynamic-static. In ordinary practice, it could be demonstrated by the muscle activity during the isometric and isotonic movement of the muscle unit. Nevertheless, it couldn’t affect the bone directly this way. Dynamic stimulation is represented by changes in the position of the body and its individual parts; the static stimulation maintains them. Under physiological condition, there is no separated dynamic or static stress. The preponderance of the dynamic load occurs in a decreased gravitational component – in antigravity, in motionless patients and, partially, in asthenic individuals. Conversely, the predominance of static load occurs in all cases of excessive weight and obesity or secondarily increased body weight (some professional and sports activities or the regular carrying of bags). Of course, this principle projects into the therapy as well. On one hand, we increase the static component – e.g. jogging in asthenic individuals by utilising the possibility of increased pressure on the load-bearing limb or by secondary pressure in the underlying surface, by carrying the load kept in a still position. If this component was outbalanced, we would have to reduce it by not only therapeutic interventions reducing the bodyweight, but by movement within the space with the decreased influence of gravity.

The process of the bone remodelling itself is launched by static stress as a component of the bilateral activity. (Every movement, although clearly dynamic, ostensibly contains a static component.) There is an activation of the mesenchymal cells that gradually develop their functional speciality. Concurrently, osteoclasts are also activated. (These are cells that participate in the degradation of the non-functional bone cells.) Activated mesenchymal cells differentiate into prosteogenitor cells and then into pre-osteoblasts. Osteoclasts partially die and partially stay in resting phase. During the parallel dynamic stress, the process continues, so that the osteoblasts develop from pre-osteoblasts by modulation. In this transformation process, several hormones play important roles (parathormone, calcitonin). Calcitonin, for example, decreases the number of osteoclasts and potentiates the transformation of osteoblasts. Osteoblasts produce new bone tissue to an extent that corresponds with the extent of the old bone tissue disposed of by the osteoclasts. This is how the above-mentioned process of new formation and concurrent reabsorption takes place. The pathology could mostly manifest itself here, e.g., as a result of inadequate stimulation. The physiological and qualitative load in terms of an optimal ratio of static and dynamic components is determined by the body mass index (BMI) 18 – 25 and the environment. Besides the above-mentioned secondary influences, it is necessary to respect the contribution if the bone axis and the type of motion concurrently. The process of stress-dependent remodelling is often rather underestimated or even neglected in ordinary practice. The monitoring of the hormonal and enzymatic contributing factors dominates. It is particularly caused by the fact that the majority of the problems with bone structures is related to critical physiological phases of life – growth, adolescence and later, menopause. Nevertheless, some other pathological changes cannot be omitted since the issue of bone remodelling could be dominant in them.

If we applied the rules resulting from the influence of the stress on the bone remodelling, we would definitely find out that the stimulation with increased load is adequate within preventive and treatment measures. While rehabilitative care commonly involves both types of stress, the primary care, and thus everyday life, doesn’t. They both appear in the education and promotion issues, but they still haven’t become the routine part of the daily regimen. The introduction of jogging as a form of stimulation with a higher component of static load is typical (landing of the foot while running increases the load on the supporting limb three times more than a regular step). Conversely, swimming decreases the static component and could improve the dynamic domination. A targeted or spontaneous increase in antigravity effects may negatively influence the musculoskeletal apparatus: the joints develop the overload syndrome resulting in a higher risk of degenerative changes and in problems with circulatory and respiratory systems.”

Jan Kolář has correctly stated that it’s not so simple to “distinguish the adequate – physiological and inadequate – pathological (stimulation).” In terms of VM2G therapy, the form of physical activation with quite special, let’s say, physiologically formative influence seems to represent the specific type of load on the whole musculoskeletal system. This type of physiological formation happens with the aid of central regulatory programs that are primarily responsible for the development of the skeleton in the first year of life.

A very important notion stated by Kolář is that the processes of formation and reabsorption are entwined and limited by physiological conditions of stimulation. To reach the balance, the mutual ratio of dynamic and static components must correspond. In practice, it means that every activity is bilateral – dynamic-static.

Based on many years of clinical experience with children and adult patients with a diverse spectrum of diagnoses, I think that through a conscious, active exercise method, it is practically impossible to achieve the ideal cooperation of dynamic-static load that could have had long-lasting and relevant influence on the formation of the musculoskeletal apparatus. I’m convinced the most essential influence is implemented through the activity of innate central programs of autonomic regulation of muscle tone, autonomic regulation of joint centration and autonomic regulation of muscle coordination. These genetically determined programs could not be changed or controlled voluntarily. They implement their physiological formative influence on not only musculoskeletal apparatus, but also the other organ systems. Under physiological conditions, the influence is clearly apparent during the development of the infant in the first year of life, when the general reconstruction of the body from the new-born to one-year-old walking child is most intensive. These programs and their formative influence could be therapeutically utilised within VM2G at every patient’s age and in an extremely wide and growing spectrum of diagnoses.

Video – Parta maraton

The View on the Therapy
of Daughter Kateřina

I was born with healthy hips. I’d been a healthy child until the winter of 1999, when on a skiing trip a sudden pathology appeared in my hips. Overnight, one leg became shorter and I felt a stinging pain in my hip with each step. From that day, my life and that of my parents became a long merry-go-round of examinations and X-rays with the final diagnosis – morbus Perthes. Doctors selected an Atlanta splint as a temporary method of preliminary treatment. I guess you all know the famous film Forrest Gump with the main character literally screwed together in splints. I looked like him, except I hid my “iron” beneath the skirts of a princess dress for about a year. Unfortunately, the leg didn’t improve and a more radical solution was adopted. So, I took a long trip to the surgical department of the Motol Hospital. I came back home unrecognizable – wrapped in a plaster cast from the waist down, except for the shin of the healthy leg. I was supposed to keep lying motionless in the plaster cast for two months, but while I was an active child, I used to jump around or at least, tried to walk on my healthy leg when my parents were of course out of sight. I guess they still haven’t found out that I climbed up on the chair with my plaster cast and unlocked the safety lock in the upper corner of my sister’s door. Luckily, none of my “illegal” plaster activities influenced the outcome of my hip surgery. Therefore, we could finally breathe, thinking it was all over. Unfortunately, it wasn’t. The congenital defect appeared in the other hip, too. Thus, I had to go through all the days spent in a hospital room, at the surgical theatre or in plaster incarceration again. After two years in which I missed out on a “normal” childhood and one year of school, I could finally stand on my own feet again. Literally. The problem was that all my muscles had atrophied and I couldn’t remain on my feet. My parents began to exercise the Vojta method with me and my condition improved quite quickly. Unfortunately, this was only until twelve years of age. At this point, I started to limp again and my left hip started to hurt so badly after a short walk that I had to sit down. We were at the Motol Hospital again. My parents were told that I was unlucky because I should limp until adulthood and undergo left hip joint replacement at eighteen years of age. Of course, it seemed possible to live this way and I wouldn’t have been the only child in this situation. But I had one great advantage compared to the others: my parents. The fact that they spent almost every day in the hospital with me, completely sacrificed 2 whole years, were able to take care of me and my three sisters at the same time, was just the beginning of what was going to come. I knew my father exercised with babies. But I wasn’t a baby when I was seven let alone at twelve years old. So, when he decided he would exercise with me, I protested strongly – after one year, after three years, after five years, I just kept on protesting exactly the same way. Not only did I find it unfair that the others didn’t have to exercise, but it was uncomfortable. When your own dad was your physiotherapist, you dared to try much more with him and vice versa. Each time, something pulled, hurt or stung me, I made it clear. And my personal physiotherapist and loving daddy, who were one in the same, adjusted the therapy to make it as comfortable for me as possible. He used to place underlay there, so it wouldn’t be cold. He placed the ball here, so it wouldn’t pull. He put the rubber here and the pillow there. And it really worked. I got better faster than anybody had expected. After several months, my mother, who used to talk me into it every single day for many years, was not the only one who could exercise with me – the whole family could. Someone held my hand, someone held my foot, somebody had to sit there and eventually swap with someone else because after a minute I overpowered most of the participants. Fortunately, there are so many of us.

As I look back, I don’t think that there was anything wrong with my childhood. I couldn’t sledge every winter, and I had to repeat the first grade at school, but I don’t know anybody who got as much parental care during their childhood as I did. That is the most important for me, and I remember it more often than I would remember running around our house. And now that we’ve come to running, I can move to the present day. After eight years of intensive Vojta method exercises, I don’t have joint replacements and I don’t limp. Except for about thirty stitches on my hips, you wouldn’t recognise I had my hip joints broken into several pieces for a certain time. To put it briefly, even with such a diagnosis, one can dance competitively for several years. It is possible to train at the athletic club and fly to the Youth Olympics in Bahrain. One can train for a marathon on a daily basis and complete it successfully. One can exercise CrossFit and become a fitness coach. One can achieve what doctors couldn’t even imagine. All you need is a devoted and kind mum and a great and intelligent dad who has thought outside the box and achieved the impossible.

Thank you, Dad.

Case Study Šárka – VM2G Therapy in an Adolescent Girl with Acquired Developmental Disorder of the Skeleton

Illustration of the Problem –
The Patient’s Father Testimony

Our daughter had one slightly dropped shoulder since she was 11 years of age. Occasionally, we pointed out the problem to the paediatrician. He referred us somewhere else. We were advised to perform a few rehabilitative exercises by a specialist, but it was all somehow unsystematic – a few exercises and that was it. As time went by, the shoulder dropped even more. When our daughter was 14, an orthopaedist diagnosed her with spinal scoliosis. Examination at the specialised facility in Plzeň and the treatment with a corset followed. Though she just wore the corset for the night, it was still something we simply couldn’t come to terms with. Standard rehabilitation was supposed to be part of the treatment. While we hadn’t been satisfied with the previous course, we were looking for something different. We got the recommendations from our friends and visited Mgr. Krucký. This was something different – he offered to us long-term systematic care reimbursed by a health insurance company. We started unobtrusively with the Vojta method of 2nd generation at the earliest possibility. First, there was exercising with balls on the body under clothes and with the weights on the limbs. Then other balls were used, followed by more and more weights, rubber belts and underlays under buttocks. When we thought we had enough equipment, a request for a home rehabilitation adjustable medical lounge came. But we cheated and exercised on an old closet door placed and supported on the bed. The exercises changed gradually, and the weights on our daughter’s limbs became larger. The daily home exercises didn’t take very long, 10 – 15 minutes at the most. “Dressing” on the aids maybe took the daughter even longer. And so it went day after day for 4 years. About every 4 weeks, there was a check-up visit with Mgr. Krucký to check the “quality” of the implemented exercises and to correct them if necessary. Just this long-term care and his real concern were two of the reasons that made us persevere for so long.

The spine corrected itself gradually, as it was possible to show in the pictures with the plumb line next to the spine Mgr. Krucký regularly took. The problematic shoulder almost normalised. Today, our daughter is 18 years old. The exercises have finished, and our daughter stands straight. Everything is behind us.

Thank You, Ladislav Weber.


Illustration of a striking posture disorder of the right shoulder blade before the commmencement of therapy.

Description of the Problem
(Clinical Findings)

The patient Šárka was admitted to our care at 14 years of age because of impairment to the posture of the body. According to X-rays, she was diagnosed with 25° scoliosis and the impairment of the posture of the right shoulder. The right shoulder stood 8 centimetres lower viewed from the frontal perspective. The over­all posture of the shoulder girdle was moved significantly ventrally (see photo). The related impairment of the body posture also involved the posture of the head in the anterior shift and the posture of the mandible in retrogenia. An orthopaedist recommended the treatment with a corset supplemented by strengthening exercises. The parents decided on intensive rehabilitation with the Vojta method of the 2nd generation. In the first year, home therapy was performed by the patient’s mother. The father, subsequently, took care of it because of the physical demands. They attended the regular monthly check-ups together. The exercise itself took place at home and took about 10 – 20 minutes. The asymmetry of Šárka’s posture of the shoulders was apparent when wearing dresses, which had to be adjusted so that the shoulder strap didn’t slide from the right shoulder. This naturally increased the patient’s awareness of the discomfort. She was particularly worried about the future, which was the rather pessimistic because of medical prognosis regarding the normalisation of the condition of the musculoskeletal apparatus.

The Expert Explanation of the Problem

The physique of the patient inherited from both parents was rather gracile and slightly above average height. The musculoskeletal apparatus configured in this way is rather prone to development of impairments of the autonomic regulation of the posture. In Šárka’s case, the development of the shoulder girdle was impaired yet in childhood following the incor­rectly healed fracture of the clavicle and its subsequent shortening. Without doubt, this error in the treatment of the fracture of the clavicle was later manifested in the development of the impaired autonomic regulation of the whole body, particularly the scoliotic posture of the spine, slight deformity of the ribcage and protruding posture of the head with mandible in retrogenia. The effort to improve this condition with mechanical adjustment through a torso brace combined with strengthening and stretching exercises would probably lack efficacy. These interventions could hardly lead to restoration of the physiological growth of the shortened bone matrix of the clavicle and change the secondarily impaired regulation of the muscle tone and muscle coordination responsible for the scoliotic deformity of the spine and the chest. We can reasonably think that without adequate therapeutic intervention, the development of the musculoskeletal system of the patient, which was supposed to continue for about three years, would be accomplished under very unfavourable conditions. This impaired both the static and dynamic component of the locomotion.

Illustration of the Solution

The patient and her parents decided to undergo intensive VM2G therapy. The mother became the home therapist in the first year. In the next two years, it was the patient’s father. They were all highly motivated, and the course of the therapy was exemplary. They bought an adjustable medical lounge, underlays, discs, balls, weights, antiskid mats and exercise rubbers. Home therapy itself was intensive and relatively short in duration, lasting for ten to fifteen minutes. Regular check-ups took place once a month and practically every time it was possible to increase the intensity. For example, the load on each limb in the end of the therapy reached two and half kilograms. Similarly, the tilt of the surface was fifteen degrees in the longitudinal axis and seven degrees in the transverse axis. This stimulation intensity was only possible because of the very good physical fitness of the patient’s father. The overall duration of the therapy was three and half years. Throughout, we took photographic records of the changes in the posture of the patient’s body from the posterior and lateral views. The possibility to monitor the improvements every six months was very encouraging for all participants. Similarly, the X-rays of the spine proved the improvement from former twenty-five degrees of the scoliotic deviation to twelve, and the last measurement showed only five degrees of deviation from the ideal posture of the body. The therapy was accomplished together with the graduation from grammar school and the admission to the university away from the patient’s home. It was about time because the intensive daily home therapy would no longer be possible.

Explanation of the Solution

For patients with developmental disorders of the musculoskeletal apparatus, it is extremely important for the therapy to be initiated during the period of the growth. The repair of the regulatory programs is manifested during the therapy so that the growth of the body runs under the influence of the repaired program. The resulting effect is ossified, and there is no risk of future development of the difficulties with the musculoskeletal apparatus. With this patient, careful monitoring in the frontal and sagittal plane took place, which was photographically recorded. Gradual improvement in the posture of the right shoulder was apparent, from the former ventral and drooping posture to practically normal symmetrical and axially balanced posture. Similarly, the posture of the protracted head and the posture of the mandible in retrogenia normalised into physiological autonomic regulation of the posture of the head and mandible. After a year and a half, radiological monitoring showed the improvement of the spinal axis from the former twenty-five degrees to twelve; after another two years, the orthopaedist couldn’t find any deviation of the spine. Achievement of this complex normalisation of the severe disorder of the posture of the body was successful because of excellent cooperation of the patient and her motivated parents, who well understood the possibilities of the VM2G for them and that the chances for improvement were limited to the period of their daughter’s growth. The therapy was successfully accomplished with the graduation of the patient from grammar school. Despite the unfavourable prognosis, the condition of the patient has completely and successfully normalised. The therapy happened to prove as highly effective, and the costs reimbursed from the health insurance consisted only of rehabilitation consultation once a month, i.e. many times less than the price of the treatment with a corset would be.

The View of the Solution of the Developmental Problems with the Musculoskeletal Apparatus in Terms of VM2G

Repeated experiences with patients, who came with developmental problems with the muscoskeletal apparatus, has shown that the optimal approach would be focused primarily on the normalising of the regulation of the muscle coordination. This approach seems to be effective in various types of developmental disorders including those accompanied by acute and chronic pain. The positive effects of VM2G therapy were proved in patients with only functional impairments and in patients with clearly proved morphological changes as well. The ongoing period of growth is an extremely positive factor as it helps to “utilise” the therapeutically achieved changes. If the changes were built within the growing locomotive apparatus, it would be highly improbable that the locomotive apparatus would demonstrate any problems in the future. It’s also very encouraging that other restrictions, such as painful conditions of the musculoskeletal apparatus, obesity, asthenic habit and decreased physical condition unlike in the fitness exercise and strengthening, do not represent any obstacles for VM2G therapy. A program of reflex locomotion is able to solve various restrictions through the intrinsic control and to find the optimal way to normal function of the muscle coordination.

The therapeutic interventions themselves are successful under conditions of respecting the regular stimulation by the home therapist and attending regular check-ups. During adolescence, the therapeutic leadership of the adolescent teenage patient and the motivation of the parents to endurance and persistence in the home therapy can be quite challenging. Technical possibilities of the VM2G allow sensitive regulations of the stimulation load and setting of optimal initial therapeutic conditions. The susceptibility of the adolescent patients in the period to accelerated growth is an undeniable factor. In this period, certain disproportions occur between the sudden enlargement of the size of the body on one hand and the insufficiently adjusted “efficacy” of the CND on the other hand. Certain folk sayings describe the uncoordinated and ungainly movements of the quickly growing children. Temporary insufficiency of cerebral motor programs in this period is manifested in the therapy by the necessary reduction of the reflex stimulation. Therapeutic involvement of the coordinated muscle chains to activity has the formative influence on the musculoskeletal apparatus and its reconstruction. Other side effects of the stimulation consist of the inhibition and cessation of pain and the gradual improvement of physical condition including an increase in lung capacity. Gradual increase in the intensity of stimulation by tilting the medical lounge, labilising the supporting surfaces and adding the weights on all limbs proved to be very useful. Weights on the limbs stimulate force muscle loops responsible for the transmission of the forces between the pelvic girdle and the chest. Because of the labile supporting surfaces, the regulatory system is forced to intensive joint centration, particularly the spine itself.

Reflection of the Father in the Role of a “Home Therapist” – It’s not simple, but it works!

I met Mgr. Václav Krucký at his expert lecture for hockey coaches, in which he introduced his view of the function of the human body. His method and philosophy completely impressed me, so my wife and I visited him with both of our sons (9 and 11 years). They both suffered from some obvious impairment. The older son Vašek had remarkable kyphosis and lordosis. Tomáš had them, too, as well as a unilaterally collapsed chest, which looked quite scary in combination with his body posture and “rachitic” build.

At that time, we had visited several orthopaedists, including the specialised facility at the Plzeň University Hospital. We got practically the same answer everywhere: “This is common and there’s nothing that can be done about it.” They told Vašek that one of his legs was shorter (when he stood, he bent one of his legs) and that a high insole would solve it. Supposedly, absolutely nothing could be done about the visibly collapsed chest of Tomáš, but it didn’t matter because it had no influence on pulmonary functions. Naturally, we were not satisfied with this “diagnosis” and the meeting with Václav Krucký changed our “lack of hope” to high hopes.

Since the very beginning, I’ve been very impressed by the way Václav Krucký has talked to us all the time, how he has patiently explained what to do and why, where the therapy should go and what we should want to achieve together. I like the way he studies the method and improves it in cooperation with various experts. He warned us openly about the fact that the older the children are, the longer the correction of each impairment takes. Thus, we knew what we were getting into and believed particularly that it would help the boys. What a change in approach and communication compared to previous doctors! Moreover, right during the first examination he found that Vašek didn’t have a shorter leg but suffered from scoliosis, which has been subsequently verified by an X-ray.

We exercised daily with both boys for 15 – 20 minutes and after about a year we went to our paediatrician for a preventive examination. Although she had several hundreds of children in her care, she spotted the changes immediately. When the boys appeared at the door, her eyes widened and she said: “Hey boys, what happened to both of you? You’re completely different!” She shook her head and couldn’t believe what she was looking at and inspected our little boys with pleasure from all angles. You can imagine how we felt when our thorough doctor told us this, although she hadn’t known that we had been exercising with Mgr. Krucký.

The boys “straightened” gradually. The changes were slow; exercises weren’t fun anymore, but the idea of finishing and gradual improvement pushed us ahead. As time went on, we had to motivate the boys more cleverly, make compromises, but we kept on exercising quite regularly. When they finally began to grow, the changes appeared almost overnight. Today, they are handsome boys Vašek is practically perfect; Tomáš’ back is nicely straightened. His winged scapulae and the collapsed half of his ribcage have begun to elevate.

At the age of 16 years, after about a year of resistance, Vašek refused to exercise any more. After consultation with our therapist we stayed with Tomáš, who keeps on exercising without any resistance. Because of chronic back pain, I’ve started to exercise as well, so I got an idea of what it’s like. I must admit that the boys’ achievements during those 5 years of systematic exercise are admirable. I am really looking forward to the moment when Mr. Krucký would say to us: “We’re finished, you don’t have to exercise anymore.” And while this method functions through irreversible changes, it means that the repaired body and its software, respectively, could not impair again and will stay tuned forever and we can rest until the end of our days.

In finishing, I would like to say this demonstrably effective method is absolutely unique in our healthcare system, not to mention the approach and manners of Mgr. Krucký. And because the boys want to look good too, the exercise hasn’t represented such a restriction for them. It’s not free; it definitely isn’t simple, but it is certainly worth it!

Zdeněk Kubálek