POSMODEV Who are we Main markers of the postural development Questions, definitions Cerebral Palsy (C.P.)
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THE CENTRAL COORDINATION DISORDER


There is no cerebral palsy (CP) from the birth; CP is the consequent of a fixed neurological functional deficit, characterized by postural and motor anomalies, that concretize gradually during the development. The CP definitive aspect becomes clearly apparent at the end of the first year and confirms during the second year. During the first months of life, indices of this future pathological situation are therefore not yet evident and the aspect of the child is still frequently very different from what it will be some months later. Thus, for example, a severely spastic CP child, with hypertonic, sometimes almost rigid, trunk and limbs at the age of 3 - 4 years, has often been an hypotonic baby during his neonatal period.

An other important element is to consider: when a lesion of the central nervous system (CNS), that occurred before, during, or just after the birth, risks to induce functional aftereffects, it is during the first months of life that the CNS has the best chance to compensate the functional deficit by developing neuronal replacement circuits thanks to its great plasticity.

It is therefore necessary to screen for the future CP before it appears under its definitive form, to stimulate, by a very precocious appropriate therapy, the development of neurological compensation means.

The expression " central coordination disorder (C.C.D.)" has been introduced by V. Vojta to designate this transitory situation of the baby during the first year, at the time when the neurological function is already disturbed, when the presence of a CNS lesion could possibly already be verified, but when the evolution is still uncertain. It is then very important to decide immediately whether the risk of appearance of a CP is major and justifies a precocious therapy, or if spontaneous standardization chances dominate, and whether we can or not wait for this good evolution without therapy of the neuromotor development.

This decision has naturally not to be taken at random; it has to be based on the totality of medical elements. However the clinic long term experience has fully proved that the simple methodical observation of the child remains a reliable and fundamental element of the evaluation, usable from the birth, and that in case of doubt it is always preferable to preserve all the child chances by applying a precocious specific development stimulation program.

It is important to understand that the two actions (diagnosis search and stimulation) can run simultaneously and not successively, since the program of stimulation does not aim at correcting a particular pathological element (that is not yet totally defined), but at activating physiological mechanisms of the neuronal development that will allow to compensate partially or totally the negative influence of a possible CNS lesion.

The CCD is defined by:
analysis of the spontaneous motor function, samples of the main motor markers
analysis of the postural automatic reactions (PR), more about PR
presence of abnormal reflexes, more about reflexes

The CCD severity is determined according to the number of disturbed PR, and to the possible presence of abnormal reflexes. The CCD classification in 4 severity groups precises the evolution pronostic. Percentages of spontaneous normalization of the development presented in the next table have been established by V. Vojta from the long term follow up of several hundred risk babies.

C.C.D. classification
abnormal
PR
abnormal
reflexes
C.C.D. % spontaneous
normalization
therapy
1 to 3 no very light
(VL)
> 90% no
4 to 5 no light
(L)
75% no
6 to 7 no medium
(M)
45% yes
7
(+ tonus disturb.)
yes severe
(S)
10% yes


This table shows the necessity of a precocious therapy of the development in each case of MCCD and SCCD, owing to risks of ulterior confirmation of a CP. This therapeutic action can perfectly begin simultaneously with the pursuit of other medical investigations, without waiting for a definitive diagnosis that may sometimes take time. The development of postural and motor correct functions will be all the more probable since the treatment will precociously start . We can here speak about "prevention" of the pathology, even if it is not always possible to get an optimal result.

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MORE ABOUT P.R.


The P.R. test consists of changing rapidly the position of the child in space, and to observe the immediate reaction of some parts of the body. Each reaction transforms during the first year and passes by characteristic stages at determined ages . That allows to appreciate qualitatively and quantitatively the aptitude of the CNS to regulate automatically and instantaneously the posture and the movement. This automatic function is always gravely compromised among CP children.

The utilization of PR is precisely codified, and demands a theoretical and practical learning (formation in Germany: click here) (complete description of the P.R.: SELFORMA module N° 2); it is impossible to detail here the testing technique, but only to present the main usual reactions and tested corporal regions for each reaction (red corporal parts on the table).

table of the main postural reactions
reactions start position end position tested parts (red)
traction test
by upper limbs
supine position trunk incline: 45°
Landau R. prone suspension prone suspension
and lift
axillary suspension prone position lift to the
vertical position
Vojta R. prone position side incline
and lift
horizontal
Collis R.
supine position suspension 2 limbs
on the same side
Peiper and Isbert R. supine position suspension by
2 lower limbs
vertical
Collis R.
supine position suspension by
1 lower limb
and lift

Back to CCD text


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list of the main reflexes
for the C.C.D. classification

reflexes validity period
Babkin 0 - 4 weeks
rooting 0 - 3 months
sucking R. 0 - 3 months
doll eyes R. 0 - 4 weeks
acoustico-facial R. from 10 days, remains
optico-facial R. from 3 months, remains
automatic walking 0 - 4 weeks
support R. (upper limbs) always pathologic
support R. (lower limbs) 0 - 4 weeks
suprapubic R. 0 - 4 weeks
crossed extension R. 0 - 6 weeks
heel R. 0 - 4 weeks
hand root R. always pathologic
lift 0 - 4 months
Galant R. 0 - 4 months.
grasp R. (hand) up to prehension
grasp R. (foot)up to verticalisation

back to C.C.D. text





BIBLIOGRAPHY


- Die Zerebralen Bewegungsstörungen im Säuglingsalter: Vaclav Vojta - Ferdinand Enke Verlag Stuttgart
- Das Vojta Prinzip:Vaclav Vojta, Annegret Peters - Spinger Verlag Berlin, Heidelberg, New York, London, Paris, Tokyo, Hong Kong.
- Le concept Vojta: H Lagache - Kinésithérapie scientifique n° 366 - S.P.E.K. Paris, 1997

POSMODEV Who are we Main markers of the postural development Questions, definitions Cerebral Palsy (C.P.)
motor education : myth or reality..? the Vojta concept More about reflex locomotion Fitting for C.P. children Documentation and training