Vojta7种姿势反射.pdf
Vojta7种姿势反射.pdf
Diagnostic -- Fundamental aspects
Fundamental aspects of normal and disturbed child development
within the first year of life within the neurokinesiological diagnostic framework
according to VOJTA.
The developmental concept
The neonate already has a clearly definable and predictable supply of movement patterns
available to it. These are an expression of human phylogenetic development.
Even at birth, these so-called "motor programmes" are made available by the CNS,
however initially they are limited in their ability to provide purposeful goal directed
movement. Therefore the neonate, for example, cannot sustain lifting it's head, cannot
support itself on it's elbows in prone, cannotroll, cannot reach and grasp in a goal directed
manner.
The full availability of innate movement patterns is apparent in the healthy infant, normally,
within the first year of life, as a consequence of it's continual ambition to reach progressive
targets. As a result of it's pursuits, it must constantly deal with the effect of gravity in
continuously differentiated ways.
The extent to which these movementpatterns are acquired within a specific developmental
timeframe, is determined by the maturity of the uprighting process. Various stages of this
uprighting process are: symmetrical elbow support, single elbowsupport, sitting, standing
with support, independent walking, hopping on 1 leg etc.
The respective stages of uprighting are characterised by a precise relationship between the
postural and movement components. In the evaluation of movement, the postural
component is of the utmost importance. Unfortunately this is commonly neglected in
movement assessments. MAGNUS (1924) stated "each and every movement begins and
ends with a posture. The posture follows the movement like a shadow". This statement
remains valid today. The postural component constantly increases with each successive
stage of uprighting against gravity in contrast to the movement component.
The examination process
In neurokinesiological diagnostics according to Vojta, the postural and movement
components are seen in their entirety (the so-called "global patterns") against the
background of the attained level of uprighting.
The child's spontaneous movements are assessed initially only in supine and prone.
Quantifiable evidence of a child's stage of uprighting as well as the quality of the global
movement patterns is gained through testing seven postural reactions. On this basis
acorrelation is made between the test results and the highest possible quality parameter -
the "ideal pattern". Deviations from this are termed a "central co-ordination disturbance"
of varying severity.
The third essential diagnostic element taken into account is the dynamic interplay of the
neonatal reflexes (also described as primitive reflexes). Under normal developmental
conditions these important reactions of the nervous system are only observable within a
specific period of time (the so-called validity periods) over the first few months of life (eg.
Moro reaction, rooting reflex, extensor reflexes, palmar and plantar grasp reflexes, Galant
reflex etc.)
Physiotherapy treatment according to Vojta is based on the prognostic significance of the
examination findings. One distinguishes between three main categories; a disturbance in
central coordination that is potentially changeable, the threat of a cerebral paretic
development and a manifested cerebralpalsy.
Consequences of the examination
With the assistance of an assessment procedure it is possible within a relatively short time,
to acquire a clearand reproducible developmental rating of a child that successfully
determines the current developmental age and the extent of the developmental
disturbance.
Precise identification of the absence or limited availability of segmental partial movement
patterns (according to Vojta: a blockade to a partial pattern), viewing both posture and
movement, is crucial for therapeutic intervention.
Therapeutic intervention is then focused by means of a targeted input of stimulation to the
central nervoussystem to remove the "blockade" and gain access to the
movementpatterns that are considered normal or approximate normality.
Treatment effectiveness is dependenton: early initiation of treatment, the extent of the
impairment, the extent of the "blockade", the intensity of treatment, how effective the
exercises are being carried out. As a rule, parents are instructed and supervised in the
treatment techniques for their child by aspecially trained physiotherapist. The parents take
on the major portion of the therapy which extends over a period of at least several weeks.
At the beginning of treatment goals are formulated on the basis of above cited diagnostic
process. They are orientated around the clinical findings.
In patients with a manifest movement disturbance of cerebral origin the stage of uprighting
can be explicitly described. It is then possible to show analogues to normal developmental
stages occurring in childhood within specific timeframes. Such a way of working is helpful,
for example, in the construction of a rehabilitation plan, where both its' goals and
effectiveness can be objectified over the course of time.
Diagnostic -- Postural reactions
The postural reactions within the concept of developmental kinesiology.
Postural reactions have played a major role in developmental diagnostics for many years and are
provoked reflex-postures and -movements as a result of specific changes in bodyposition. The
responses are continually modified depending on the acquired developmental stage ie. they
proceed in various phases. These phases are objective developmental milestones.
Because they involve complex responses rather than a simple reflex, it is better terminology to
speak of postural reactions rather than simply postural reflexes.
In normal development, the various phases of the postural reactions correspond to the attained
developmental stage of both: phasic motoricity (voluntary movement) and locomotor
ontogenesis.This must be stressed because the postural reactions can quickly provide an
illuminating view of a child's developmental status during a paediatric neurological examination.
All seven postural reactions are used together and are evaluative from the neonatal period. These
are described, their order being based on their evaluative strengths.
Vojta Reaction (Vojta 1966/ 67/ 69)
Traction response (modified by Vojta)
Vertical suspension response according to Peiper (Peiper-Isbert 1927)
Vertical suspension response according to Collis (Collis 1954)
Horizontal side suspension response according to Collis (Collis 1954)
Landau reaction (Landau, A., 1923)
Axillary suspension response
Diagnostic -- Vojta Reaction
Vojta Reaction (Vojta 1966/ 67/ 69)
Implementation:
A quick tilt of the child laterally from the vertical into the horizontal position.
1st Phase : 1 - 10 Weeks
For clinical use, evaluation of the upperlying extremities is more important.
Moro - like "embrace" pattern of both arms. Hands open.
Flexion of the upper lying leg at both the hip and knee joints with dorsiflexion at the
talocrural joint.
Pronation of the foot and toe extension with fanning.
Extension of the underlying leg with dorsiflexion at the talocrural joint, supination and
flexion of the toes.
1st Transitional phase: 11- 20 Weeks
The "embrace" like posture of the arms diminishes, the arms are still abducted with the hands
open.
Nearing the end of the 1st transitional phase:
The arms are held flexed at the elbow (It is only on repeat manoeuvres that the Moro-like
extension at the elbow is seen ).
The earlier differentiated postures of the legs disappears. Both legs become gradually more
flexed.
The toes of the upper lying foot are no longer fanned open.
2nd Phase from around 4.75 months until the end of the 7th month
All extremities take up a flexible flexed posture.
The hands are open or loosely closed.
The feet are dorsiflexed and for the most part supinated.
The toes lie in neutral between flexion/extension or flexed.
2nd transitional phase from the 7th until the end of the 9th month
Initially the arms are flexed, and later extend forward and abduct away from the body.
The legs are extended in front of the body - there is flexion at the hip whilst flexion at the
knee diminishes.
The feet are dorsiflexed.
The toes are in neutral.
3rd phase from the 9th until the 13th/14th month
The upper lying extremities are extended and abducted.
The feet are dorsiflexed.
Around 18 months of age in a normal developing child, the Vojta Reaction is hardly usable any
more as the child can modify it's body position with volition.
Important
Before carrying out the manoeuvre one must ensure that the child's hands are open. Failure to do
so especially in the perinatal period or in early infancy, can result in a stereotypic flexed posture
of the arms. The upper lying arm would therefore demonstrate an abnormal pattern, which must
then be evaluate dartificially as abnormal.
Diagnostic -- Traction Response
Traction response
People have used this test for years indiagnostics, where the infant was pulled from supine to the
upright sitting position. The head was observed. Here the infant is taken into an oblique position
(approximately 45 degrees to the horizontal). It is possible in this labile position to observe the
reactions throughout the entire body including the extremities.
One must ensure to utilise the palmar grasp reflex. For this, a finger is inserted into the infant's
hand from the ulnar aspect. The other fingers fasten around the distal end of the forearm,
ensuring that the dorsum of the hand is not touched. This extereoceptive information may inhibit
the grasp reflex.
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