Functional Outcome of Vojta Therapy as A Postoperative Protocol for Surgically Treated Patients with Cerebral Palsy

Authors

  • Phoemlap Phongprapapan, MD Department of Orthopaedics, Chomthong Hospital, Chiangmai, Thailand
  • Jiraporn Boontawrach, PT Department of Orthopaedics, Chomthong Hospital, Chiangmai, Thailand
  • Nath Adulkasem, MD, PhD Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
  • Perajit Eamsobhana, MD Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

DOI:

https://doi.org/10.56929/jseaortho-2023-0183

Keywords:

cerebral palsy, orthopedic surgical intervention, Vojta therapy, 6MWT, ETGUG, gait analysis

Abstract

Purpose: To evaluate the efficacy of postoperative Vojta therapy in children with cerebral palsy (CP) who have undergone orthopedic surgical interventions for lower limb deformities.

Methods: We conducted a prospective case series on children with ambulatory CP aged 3 to 15, indicated for orthopedic surgical interventions (contracture release and deformity correction) between January 2020 and December 2022. One month following these interventions, all patients were scheduled for Vojta therapy sessions. Ambulation capability was evaluated using video gait analysis, an expanded timed get-up-and-go (ETGUG) test, and a 6-minute walk test (6MWT) at 2, 4, and 6 months postoperatively. A multivariable multilevel linear regression analysis was employed to demonstrate the adjusted effect of Vojta therapy during the postoperative period.

Results: A total of eleven eligible children with CP were included. Of these, seven were boys (63.6%) with a mean age of 6.3 ± 3.1. The majority of patients were classified as gross motor function classification system (GMFCS) level I (45.4%). We observed a significant improvement in ETGUG (-14.1 sec, p = 0.011), 6MWT (6.3 m, p = 0.014), cadence (2.1 step/min, p = 0.033), and stride time (-0.1 sec, p = 0.027) after being adjusted by baseline function, age, and GMFCS level during the follow-up period. Sub-group analyses revealed no significant difference between patients with GMFCS I and those with GMFCS II to III.

Conclusions: This study demonstrated a significant ambulation capability improvement in surgically treated patients with CP who underwent postoperative Vojta therapy.

Metrics

Metrics Loading ...

References

Jan MM. Cerebral palsy: comprehensive review and update. Ann Saudi Med 2006;26:123-32. DOI: https://doi.org/10.5144/0256-4947.2006.123

Sharan D. Orthopedic surgery in cerebral palsy: Instructional course lecture. Indian J Orthop 2017;51:240-55. DOI: https://doi.org/10.4103/ortho.IJOrtho_197_16

Thamkunanon V. Orthopeadic surgery in children with mobility impairment. Thai J Pediatr 2019;26:33.

Damiano DL, Longo E, Carolina de Campos A, el al. Systematic review of clinical guidelines related to care of individuals with cerebral palsy as part of the world health organization efforts to develop a global package of interventions for rehabilitation. Arch Phys Med Rehabil 2021;102:1764-74. DOI: https://doi.org/10.1016/j.apmr.2020.11.015

Senthilkumar S, Swarnakumari P. A study on Vojta therapy approach to improve the motor development of cerebral palsy children. Int J Med Sci 2011;4:39-45.

Bäckström B, Dahlgren L. Vojta self-training: Experiences of six neurologically impaired people: A qualitative study. Physiotherapy 2000;86:567-74. DOI: https://doi.org/10.1016/S0031-9406(05)61361-2

The Internationale Vojta Gesellschaft [internet]. Germany: [updated vojta 2023]. Available from: https://www.vojta.com/en/.

Gajewska E, Neukirch B. Vojta therapy for a 12 years-old child with cerebral palsy. J Phys Ther Sci 2012;24:783-5. DOI: https://doi.org/10.1589/jpts.24.783

Wall JC, Bell C, Campbell S, et al. The Timed Get-up-and-Go test revisited: measurement of the component tasks. J Rehabil Res Dev 2000;37:109-13.

ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002;166:111-7. DOI: https://doi.org/10.1164/ajrccm.166.1.at1102

Bauer H, Appaji G, Mundt D. VOJTA neurophysiologic therapy. Indian J Pediatr 1992;59:37-51. DOI: https://doi.org/10.1007/BF02760897

Gorton GE 3rd, Abel MF, Oeffinger DJ, et al. A prospective cohort study of the effects of lower extremity orthopaedic surgery on outcome measures in ambulatory children with cerebral palsy. J pediatr Orthop 2009;29:903-9. DOI: https://doi.org/10.1097/BPO.0b013e3181c11c0c

Thamkunanon V. Improvement to ambulatory function with multilevel soft tissue surgery in children with spastic deplegic cerebral palsy. J Med Assoc Thai 2011;94 Suppl 3:S183-8.

Gajaseni P, Cheewakongkiat P, Surijamorn P, et al. Outcome of single event multilevel soft tissue release for spastic diplegic cerebral palsy. J Med Assoc Thai 2017;100:301-5.

Firth GB, Passmore E, Sangeux M, et al. Multilevel surgery for equinus gait in children with spastic diplegic cerebral palsy: medium-term follow-up with gait analysis. J Bone Joint Surg Am 2013;15;95:931-8. DOI: https://doi.org/10.2106/JBJS.K.01542

Saraph V, Zwick EB, Auner C, et al. Gait improvement surgery in diplegic children, how long do the improvements last ?. J Pediatr Orthop 2005;25:263-7. DOI: https://doi.org/10.1097/01.bpo.0000151053.16615.86

Gupta A, Srivastava A, Taly AB, et al. Single-stage multilevel soft-tissue surgery in the lower limbs with spastic cerebral palsy: Experience from a rehabilitation unit. Indian J Orthop 2008;42:448-53. DOI: https://doi.org/10.4103/0019-5413.43395

Ungureanu A, Rusu L, Rusu MR, et al. Balance rehabilitation approach by bobath and vojta methods in cerebral palsy: A pilot study. Children (Basel) 2022;9:1481:1-19. DOI: https://doi.org/10.3390/children9101481

Jung MW, Landenberger M, Jung T, et al. Vojta therapy and neurodevelopmental treatment in children with infantile postural asymmetry: a randomised controlled trial. J Phys Ther Sci 2017;29:301-6. DOI: https://doi.org/10.1589/jpts.29.301

Lim H, Kim T. Effects of vojta therapy on gait of children with spastic diplegia. J Phys Ther Sci 2013;25:1605-8. DOI: https://doi.org/10.1589/jpts.25.1605

Downloads

Published

2023-12-05

How to Cite

1.
Phongprapapan P, Boontawrach J, Adulkasem N, Eamsobhana P. Functional Outcome of Vojta Therapy as A Postoperative Protocol for Surgically Treated Patients with Cerebral Palsy. JseaOrtho [Internet]. 2023 Dec. 5 [cited 2024 Dec. 21];48(1):22-9. Available from: https://jseaortho.org/index.php/jsao/article/view/183

Issue

Section

Original Articles