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Illustration of the body lying in the position on the side beginning to turn. View from below the lying body. -
History of the Vojta Method
“I haven’t invented it, I’ve just discovered it!” This sentence, with which Dr. Václav Vojta used to introduce his lectures, has become a well-known saying.
The Vojta method, often called “reflex locomotion”, is a therapeutic system elaborated by Dr. Václav Vojta together with his colleagues and pupils. The beginnings of the method reach as far as the turn of the 1950s and 1960s. In the former socialist Czechoslovakia, in the seclusion of the neurological clinic of the famous academician Karel Hener, a brand new approach to physiotherapy began to take shape. Children affected by cerebral palsy were the first patients of the new method and soon, thanks to early diagnosis, the therapy has also proved to be highly suitable for children threatened by motor development disorders.
The basics of the method come from the rational and logical principles of developmental kinesiology.
Repeatedly, Vojta used to humbly point out that he hadn’t “invented” the principles, he’d “only discovered” them. Several other authors had discovered the aforementioned principles before Vojta. Indeed, his undeniable credit lies in the systematic connection of theory and practice, which brought these theoretical principles to the wider awareness of the professional public, and in the remarkable influence on the thinking of other specialists.
As early as in the mid-fifties, Dr. V. Vojta discovered during his observations the possibility to invoke the muscular reflexes that could spread throughout the whole body. He called them global reflexes and started to use them to treat children suffering from cerebral palsy. The method known as “reflex locomotion” or the Vojta method has spread into several countries and its use has appeared to be successful in many other diagnoses.
Theoretical Foundation of the Vojta Method
Reflex stimulation that induces movement response within the VM represents brand new stimulus in terms of the psychological experience of the infant. Stimulation of active zones evokes reflex movement response. The child begins to experience very intensively that something is happening to its body. Something, it cannot influence with its will. Observations that I’ve made both during the stimulation and by analysing the video recordings of the therapeutic interventions, clearly show, that the initial surprise of the child is quickly replaced by displeasure expressed by the child crying and even screaming and with an effort to escape from the situation, which is uncomfortable mentally, physically and psychosocially.
In the first year of life, the child is equipped with a so-called “omnipotent” way of communication. Prof. Papoušek precisely addresses this kind of communication between the infant and its parent. 1
During this period, the child communicates using a varied range of nonverbal expressions, movements of the whole body and hands, touches, facial movements, eye contact or conversely avoidance of eye contact, but most often through facial expressions and gestures. This kind communication on the part of the child conveys for all intents and purposes orders and aims to satisfy its actual needs. The ability to understand the communication of the infant by the nursing person is biologically given as it is triggered during the adolescence. It allows the parents and nursing person to practically and quickly comprehend the needs of the infant and to focus the behaviour towards their fulfilment. Performance of the reflex stimulation therapy, as it has been utilised within classical VM, leads to frustration of the infant by “disregarding” its omnipotent communication pattern. In this period, the child truly initiates, manages and accomplishes the communication with inherited nonverbal communication patterns.
I find the current way of performing the Vojta method therapy quite rigid, lacking sufficient and above all comprehensible communication with the child. If the child didn’t receive a proper and comprehensible explanation that there was nothing wrong about the VM and that the parent had everything under control, it would become insecure and anxious. Resulting frustration is expressed by unease, crying and even screaming. And it is crying, which demands an explanation and reassurance that the parent has the situation under control. It is necessary to communicate with the child throughout the exercise, although it is just not in mood for the exercise.
It often happens that neither the parent nor the child are not in the mood for exercise. It helps the therapy a lot when the parent is actively prepared to create a positive atmosphere without anxiety. He/she should be familiar with a sufficient repertoire of nursery rhymes, songs and poems. It is always useful, if there is someone else, e.g. a sibling, who can distract and deflect the attention of the child during the therapy. Regularity of the exercise also helps the child to get used to the mental and physical stress regarding its biorhythms.
Another unpleasant result of an approach that neglects the psychological needs of the child is the repetition of a frustrating situation, which leads to and reinforces the aversive reaction. Based on the negative conditioning, the undesirable phenomenon relates to unpleasant experience. Thus, mere preparations before the exercise become the impulses for crying and reluctance of the child to obey the exercise. Naturally, similar feelings begin to occur in the parent, who performs the therapy, and in the environment.
1 PAPOUŠEK, Mechthild. Regulationstörungen der frühen Kindheit. Bern: Verlag Hans Huber, 2004. ISBN 3-456-84036-5.
Stimulation that triggers an inadequate response in the child is also a source of its body’s motor distress. It is manifested by the effort of the child to escape from the uncomfortable situation. Through these flight reactions, the therapy becomes even more difficult. It is possible to keep the child in the reflex position only through an inadequate increase in pressure on the reflex zones. The therapeutic pressure, which is rather small in the resting infant, must be quite strong in the excited state. Concurrent effort to keep the child in the position and to control the course of the reflex leads to insufficient control of the pressure on the zones. Except the physiological reflex movement response, the increasing pressure on the reflex zones provokes an unpleasant or even painful sensation. Before this unpleasant feeling, the child increases its escape efforts, which repeatedly increases the effort of the parent to keep the child in the therapeutic position through increased pressure. This sequence becomes a cycle as the child gradually grows, gathers strength and begins to use its body more ably thanks to the therapy.
It is necessary to explain a neurophysiological mechanism involved. The child in its first year of life does not have a completed basic program of motor skills. Thus, it is not able to resist the reflex stimulation. The reflex “overcomes” the child in this period of life. For several months, the performance of the therapy becomes the source of considerable frustration for the child, the parents and the relatives.
You could find a large number of written and recorded evidence on the internet, which would accurately document these joyless situations.
Implementing the Vojta Method Psychological Specifics in Toddlers and Preschool Children
Video – Child performing the classical Vojta Therapy
Performing the classical Vojta method with toddlers and preschool children is quite difficult. The basic motor skill programs have been finished in this period. Thus, the reflex locomotion induced by the stimulation of active zones does not have such “power” over the child as compared to the previous infant stage. From the toddler stage, the child has been able to interrupt or even completely stop the induced reflex with its voluntary motor activity. For this reason, it’s so difficult or even impossible to carry out the Vojta method using the classical approach in many cases.
Between one and half to about four or five years of age, the cognitive abilities of the child are immature. There is practically no possibility of rational comprehension of the reason why the reflex stimulation should be endured and not disturbed. The child resists and escapes from the positions because the pressure-induced reflex movement is inconvenient for the child as it is not able to understand its meaning. If the intensity of stimulation increases to hold and fix the child in a given position, so does the induced reflex.
At the same time, the child begins to feel the pressure on the site of stimulation as painful. Thus, its effort to escape increases in this mentally and physically inconvenient situation. Soon, the parent usually gives up the whole therapy, because he/she does not find it meaningful to continue under these circumstances. Unfortunately, this approach leads to number of misunderstandings and to subsequent therapeutic “nihilism” accompanied by all the unpleasant consequences. To avoid inconvenient and frustrating situations even for them, some physiotherapists use “compassionate lies” and say that the Vojta method cannot work in this age. Afterwards, quite illogically, VM does work again, as soon as the child is grown enough to establish reasonable cooperation.
Again, the internet provides a large body of evidence and many videos about the effort to implement VM in this age.
Video – Child performing the classical Vojta Therapy
Psychological Perception of the Therapeutic Stimulation by Parents Performing the Treatment by Close Relatives of the Child
Parents may have quite ambivalent experience regarding VM. On one hand, they feel that the development of their child is somehow threatened, particularly if the expert and objective findings were cause for concern. On the other hand, the stress of reflex stimulations performed three to four times a day is mentally and physically exhausting as they restrict leisure time and relaxation. Besides the common care of the infant, there is challenging, repeated and long-term therapy in addition. Moreover, the impossibility to delegate the care to other people (as with e.g. baby-sitting) induces chronic exhaustion.
The therapy is largely upon the shoulders of the mother. Fathers usually participate less. Generally, men don’t tolerate the therapy of the infants well. It is caused by a physiological mechanism. The crying of the infant increases their blood pressure as it forces the action “of rescuing the child”. Conversely, the therapy requires them to endure the crying and, in some cases, to contribute to the screaming through their own actions. Grandparents usually have less tolerance for the crying and screaming of their grandchildren. If they do not criticise and denounce “the treatment” as “child abuse”, they usually quickly leave the area, where the therapy takes place.
dheit. Bern: Verlag Hans Huber, 2004. ISBN 3-456-84036-5.
2 Doporučení prof. Komárka k pregraduálnímu vzdělávání pediatrů, dětských neurologů a fyzioterapeutů ve včasné diagnostice kojeneckého věku.