Cerebral Disorders of Movement and Habilitation by Vojta Method

Transcription

1 Cerebral Disorders of Movement and Habilitation by Vojta Method Ajsa Meholjic, Tanja Knor Pediatric Clinic, Clinical Centre of Sarajevo University, Sarajevo, Bosnia and Herzegovina Dermatology Clinic, Clinical Centre of Sarajevo University, Sarajevo, Bosnia and Herzegovina Original paper SUMMARY Cerebral movement disorders resulting from damage to the immature brain is manifested by mild or severe impairment of motor development of. Terminology cerebral movement disorders is taken from the German school of development by Vaclav Vojta. Goal: The aim of this paper is to highlight the importance of early rehabilitation by Vojta method in with cerebral movement disorders. Material and methods: The study was conducted on a sample of with cerebral movement disorder in age from to who are habilitated at the Department of Developmental Habilitation and Rehabilitation of Children Pediatric Clinic, Clinical Center of University in Sarajevo in the period of three years. A prerequisite for the selection of was the fact that there is a cerebral movement disorder. Conducted clinical study is retrospective. Each child was examined by a physiatrist and diagnosed as cerebral movement disorders, and then included in the rehabilitation program by Vojta method. Treatment started at the age of -, regular check-ups were carried out in two intervals. Results: Out of who were identified with cerebral movement disorders, are male and female. In of the test group treatment has begun at an early age, which is essential for the results of habilitation treatment. In of the treatment started later, and in very late. Differences in the number of infants, at the start of treatment by sex, were not statistically significant as confirmed by Chi square test. To achieve rotation from back to belly, the average duration of therapy was and at the age of with a statistical significance of p <.. Statically is proven that the average age when learn the self seating, and in whom therapy is initiated early, was, while the in whom the treatment was started late self seating was achieved within. In the group with early onset of therapy creep has been achieved with an average age of, whereas in the group with the late beginning of therapy creep is achieved with. To walk independently in the group with early onset was achieved with in the group with late starting it with either. The difference in the average number of between the treatment of infants with early onset of therapy (- ) and infants with late beginning of therapy (- ) is statistically highly significant. A value of t test is: t =. at significance level p <.. Conclusion: An early habilitation of with cerebral movement disorders leads to faster motor training in relation to the late start rehabilitation treatment. Key words: cerebral movement disorders, Vojta habilitation.. INTRODUCTION Cerebral movement disorders resulting from damage to the immature brain and is manifested by mild or severe impairment of motor development of. Terminology cerebral movement disorders is taken from the German school of development by Vaclav Vojta. In newborns and infants the deviation from normal development shows a disorder of muscle tension and significantly reduced the natural diversity of the movement that replaced poor, the same kind of movement or excessive movement caused by any stimulus. In addition, it can occur excessive irritability, disorder in rhythm of wakefulness and sleep, excessive crying, feeding difficulties, and sometimes fever with or without convulsions (). The clinical picture of cerebral movement disorders depends on the presence of risk symptoms. This is not the final image of motor disorders. Formerly the term cerebral movement disorders using the terms risk or symptomatic neurological infant or child (). Depending on where and what symptoms occur, cerebral movement disorders can be divided into the following forms: tetraparesis form when symptoms are present risks to all four extremities, hemiparesis form when they are present on the arm and leg on one side of the body, paraparesis (diaparesis) form when the symptoms of risk are present only on the arms or just legs (much more common only on the legs), dystonia syndrome when the risk of prevalent symptoms are in the form of dystonia, atetoid form when the worm-like buckling is visible arms or legs (, ). It is important to emphasize that cerebral movement disorders must not be confused with cerebral palsy. Cerebral movement disorders have several possible outcomes: the normalization of development, with a normal child walk with a possible delay of motor development, motor retardation minor disturbances ( clumsy child, frequent falls, disordered posture, fine motor skills, balance, etc.) and development of the clinical picture of cerebral paralysis, which can range from mild to almost bor- vol no MARCH

2 ders with minor motor disturbances, to extremely serious leading to complete dependence of the child. What will the outcome of cerebral movement disorders are depends on several factors: the severity, time of initiation of therapy and quality of treatment (, ).. GOAL The aim is to underscore the importance of early rehabilitation by Vojta method in with cerebral movement disorders.. MATERIAL AND METHODS The study was conducted on a sample of with cerebral movement disorder in age from to who are habilitated at the Department of Developmental Habilitation and Rehabilitation of Children Pediatric Clinic, Clinical Center of University in Sarajevo in the period of three years. A prerequisite for the selection of was the fact that there is cerebral movement disorder. Conducted is a clinical study which is retrospective. Each child was examined by a physiatrist and diagnosed as cerebral movement disorders, and then included in the rehabilitation program by Vojta method. Treatment started at the age of - of age, regular check-ups were carried out every two.. RESULTS There were no statistically significant differences by gender and age structure in the study group of with cerebral movement disorders at the start of treatment by method according to Vojta. There is a significant difference in the achievement of turning from back to tummy and vice versa in relation to the time when the treatment began (p <.). The duration of therapy for age of - was., while for the age of infants when they turned their backs on the abdomen and back was.. The duration of therapy for age of - duration was., while the age of infants when they turned their backs on the abdomen and back was.. Child age at the beginning of therapy in Male Female Total Very early beginning. - -, Early beginning.,,.,,.,, Total early., χ. Not significant Late beginning.,,.,,. - -,.,, Total late.,, χ. Not significant Very late beginning.,, Total.,, χ. Not significant Table. Gender and age distribution of subjects at the beginning of treatment by method according to Vojta Child age at the beginning of therapy in Therapy was significantly longer in duration for infants who have had treatment in the early beginning (- ) compared to infants with beginning of treatment at age of -. It has been shown that independently sitting of with cerebral movement disorders, early treatment by Vojta achieved faster and safer (p<.). It turned out that crawling in with cerebral movement disorders with early onset of therapy is achieved faster than in with late beginning of therapy. Age of a child when rotation from back to tummy and vice versa begun Total early Total late Total.... Table. Rotation from back to tummy and vice versa in with cerebral movement disorders after treatment by method according to Vojta, according to early and late start of therapy Original paper vol no MARCH

3 Broj dojenčadi The difference in the average number of of therapy between with early onset of therapy (- ) and with the late beginning of therapy (- ) was statistically highly significant. The value of t-test is: t=., significance level p<.. Significant differences are in favor of a group of with cerebral movement disorders with the earlier application of treatment by Vojta method.. DISCUSSION Cerebral movement disorders resulting from damage to the immature brain and are manifested by mild or severe impairment of motor development of. Terminology cerebral movement disorders is taken from the German school of development by Vaclav Child age at the beginning of therapy in Starost u mjesecima Vojta. In newborns and infants it is deviation from normal development which shows a disorder of muscle tension and significantly reduced the natural diversity of the movement that are replaced with poor, repeated movement or excessive movement caused by any stimulus. In addition, can occur excessive irritability, disorder in rhythm of wakefulness and sleep, excessive crying, feeding difficulties, and sometimes fever with or without convulsions (). cerebral movement disorders have several possible outcomes: the normalization of development, with a normal child walk with a possible delay of motor development, motor retardation minor disturbances ( clumsy child, frequent falls, disturbed posture, fine motor skills, balance, etc.) and developing Age of a child when starts to sit independently Total early.... t-test. Significant p< Total late.... t-test. Not significant.... TOTAL.... Table Independent sitting of examined after application of the method according to Vojta, according to early and late start of therapy Muška dojenčad Ženska dojenčad Ukupno Figure. Gender and age distribution of subjects at the beginning of treatment by method according to Vojta,,,, Starost kada se okreće sa leđa na trbuh (u mj.),,,,, Figure. Rotation from back to tummy and vice versa in with cerebral movement disorders after applying the method according to Vojta, according to early and late start of the therapy,,, clinical picture of cerebral palsy, which can range from mild to almost borders with minor motor disturbances, to extremely serious leading to complete dependence of the child. What will the outcome of cerebral movement disorders will be dependent on several factors: the severity, the greater the deviation from the physiological motor development, the prognosis is worse, since the time of initiation of therapy a therapy is begun early, the prognosis is better and the quality of treatment (, ). In this study of who have identified cerebral movement disorders of which () are male and () female. In of the test group treatment is begun at an early age, of which male and female. In of the treatment is started later, where there were male and female, and in with very late therapy onset where there was the same number of male and female. Chi square test proved that the differences in the number of infants at the start of treatment by sex were not statistically significant. To achieve rotation from back to belly, the average length of therapy was and age with a statistical significance of p <.. Statically prove that the average age when learn the self sit, and in whom therapy is initiated early, was while the in whom the treatment is started late self sitting is achieved with.,, vol no MARCH

4 Starost kada se samostalno posjeda,,,, Starost bebe kada počinje puzati (u mj.),,,,,,,,,,,,,,,,,,,,,,,, Figure. Independent sitting of examined after application of the method according to Vojta, according to early and late start of therapy Gajewska E and colleagues examined the motor development of with cerebral movement disorders up to three years in which to record deviations are used Vojta diagnostics and Munich functional development of diagnostics and treatment was the method according to Vojta. They found that significantly better results are achieved with early involvement of in the rehabilitation treatment (,). In the group with early onset of therapy in this study, crawling was achieved with an average age of, whereas in the group with the late beginning of therapy crawling was achieved with. To walk independently in the group with early onset was achieved with in the group with late early to be with. The difference in the average number Child age at the beginning of therapy in of of treatment among infants with early onset of therapy (- Age of a child when starts crawling Total early Total late TOTAL.... t-test. Not significant t-test. Significant p<. Table. Children with cerebral movement disorders and start of crawling after treatment method according to Vojta, with early and late beginning Table. Independent Figure. Children walk of with cerebral with movement cerebral disorders movement and start disorders of after Vojta therapy crawling after treatment method according to Vojta, with early and late early and late beginning beginning Child age at the Mean duration of Mean age of at th Mean duration beginning of therapy in of therapy Mean age in of at the of end the therapy in mont Child age at the beginning therapy in of the therapy in of therapy in X S.D. X S.D Total early.... Total early Late beginning. of the. therapy Total late TOTAL Total late t-test. Significant p<. Table. Independent walk of with cerebral movement disorders after Vojta therapy, with early and late beginning ) and infants with late beginning of therapy (- ) is statistically highly significant. Values of t-test are: t=., significance level p<.. Samatha P and Hayasi M, during the years examined motor development in with cerebral development disorder. Infants were examined and as a group as infants with very light motor disorders, moderate motor impairment, infants with severe motor dysfunction, with suspicion on the possibility of developing cerebral palsy. The were between the ages of to one year. All are included in the treatment method according to Vojta. After a year of treatment they have come to the conclusion that a significant number of with normal motor development in a group where they Original paper vol no MARCH

5 started with an early rehabilitation treatment according to Vojta method (, ). Recent research by many authors support the conclusion that in with cerebral development disorder is very important to begin early rehabilitation treatment to motor development of the child walked in the direction of normal or to deviations were less pronounced, as confirmed by this study (, ).. CONCLUSION An early habilitation of with cerebral movement disorders leads to faster motor development in relation to the late start of rehabilitation treatment. Much earlier achieve physiological motor patterns such as turning from back to tummy and vice versa, independently sitting, crawling and walking. Vojta method is very useful rehabilitation treatment in a motor development if timely applied in with cerebral movement disorders, so that we can expect a normalization of development, with a normal child walk with a possible delay of motor development or minor motor disturbances in the terms of clumsy child frequent falls, disturbed posture, fine motor skills, balance, etc.,, Prosječna dužina trajanja terapije (u mj.) Starost na kraju terapije,,,,,,,,, Starost na kraju terapije Figure. Independent walk of with cerebral movement disorders after Vojta therapy, with early and late beginning,,,,, REFERRENCES. Robertson CM, Watt MJ, Yasui Y. Changes in the prevalence of cerebral palsy for born very prematurely within a population-based program over years. JAMA. ; (): -.. Deon LL, Gaebler-Spira D. Assessment and treatment of movement disorders in with cerebral palsy. Orthop Clin North Am. Oct; (): -.. Robertson CM, Watt MJ, Yasui Y. Changes in the prevalence of cerebral palsy for born very prematurely within a population-based program over years. JAMA. ; (): -.. Gajewska E, Samborski W. Application of Vojta s method for early detection of developmental disturbances in very low birthweight infants with regard to Apgar score and asymmetric body positions; Annales Academiae Medicae Stetinensis. ; Suppl : -.. Charkaluk ML, Truffert P, Fily A, Ancel PY, Pierrat V. Neurodevelopment of born very preterm and free of severe disabilities: the Nord-Pas de Calais Epipage cohort study. Acta Paediatr.. May; (): -.. Futagi Y, Toribe Y, Ogawa K, Suzuki Y. Neurodevelopmental outcome in with intraventricular hemorrhage. Pediatr Neurol.. Mar; (): -.. Gajewska E, Sobieska M, Samborski W. Correlates between Munich Functional Development Diagnostics and postural reactivity findings based on seven provovoked postural reactions modus Vojta during the first period of child s life. Annales Academiae Medicae Stetinensis. ; (): -.. Costi GC, Radice C, Raggi A, Kron AM, Angrisano A, Busato E. Vojta s seven postural reactions in the detection of neuromotor disorders in infants. Experience with subjects. Medical And Surgical Pediatrics [Pediatr Med Chir] ; (-): -.. Samatha P, Maiya P. Predicting Neuro-Developmental Outcome at Months of Age in babies with Hypoxic Ischemic Encephalopathy by Vojta s Neurokinesiological Examination. Indian Pediatrics ; : -.. Hayasi M, Arizono Y. Experience of very early Vojta therapy in two infants with severe perinatal hypoxic encephalopathy. Division of Pediatric Neurology, Yokohama Rihabilitation Center. ; (): -.. Sarkar S, Bhagat I, Dechert R, Schumacher RE, Donn SM. Severe intraventricular hemorrhage in preterm infants: comparison of risk factors and short-term neonatal morbidities between grade and grade intraventricular hemorrhage. Am J Perinatol. Jun; (): -.. Hielkema T, Blauw-Hospers CH, Dirks T, Drijver-Messelink M, Bos AF, Hadders-Algra M. Does physiotherapeutic intervention affect motor outcome in high-risk infants? An approach combining a randomized controlled trial and process evaluation. Dev Med Child Neurol. ; (): e-e. Corresponding author: ass prof Ajsa Meholjic, MD, PhD. Pediatric Clinic, Clinical Centre of Sarajevo University, Patriotske Lige, Sarajevo, Bosnia and Herzegovina. Meholjic.ajsa@gmail.com. vol no MARCH