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


The content of this document is based on V. Vojta's work.
This original document includes free translation of courses, various elements coming from a prolonged technical collaboration with V. Vojta and his team of Munich; it is also based on the practical experience, observations and personal notes of the author, H. Lagache, about the child development since 1982
Bibliography



Go to the documentation
























REFLEXOLOGY and C.P. SYNDROMES
by H. Lagache






The first trimester of life is the appropriate period for the diagnosis and the precocious therapy of disorder of the central nervous system (CNS) susceptible to resound negatively on the development of the coordination or to generate a cerebral palsy (CP).

The only reasonable conduct is : begin the appropriate therapy (global, neuro - proprioceptive physiotherapy) as soon as a totality of pathological elements is detected.

During the first trimester it is only possible, on the basis of an abnormal postural reactivity (module Selforma N° 2), to detect perturbations of the central coordination, under their various forms.

During the second trimester, by a child with a damaged CNS but a good mental development, appears the phase of dystonic spasms (or attacks) . That happens later at the mentally backward children; the importance and the duration of this phase vary according to the different motor pathological syndromes.

During the third trimester, specific signs appear and enable to differentiate the various orientations of the pathology. The majority of these signs have to be considered as the dynamic expression of the pathological motor development. That means that they are influenceable by an appropriate therapy. The fixing of the pathological coordination demands a certain time, indeed disorders of the postural reactivity, of uprighting mechanisms and phasic mobility have to perpetuate into a specific clinic syndrome. Therefore, from the third trimester, gaps in the development potential begin to determine the durable clinic situation.

If a CP syndrome is developing, it appears in its definitive configuration from the end of the third trimester and confirms during the trimester 4. During this period, a child that has been living 3 to 4 trimesters with important postural and reactive gaps has for a long time begun to use posturo-motor compensation patterns (or pathological patterns) that are the only available means of motor expression and motor relationship with the environment. That is why it is imperious to evaluate precociously the neurological situation to begin from the first trimester a global neurological physiotherapy.



REFLEXOLOGY


The clinic checkup of a baby suspected of abnormal neurological development includes the meticulous examination of the spontaneous motor function, the evaluation of the postural reactivity, and the research of a series of reflexes. The results obtained in these 3 rubrics have to be interrelated.

The reflexes are:

bone-tendon reflexes such as patellar reflex or muscular reflexes (percussion) described in the medical literature, that may be, according to each syndrome, normal, accentuated, reduced or negative.

primary reflexes are analysed according to the following parameters:
- stimulation mode,
- reflex answer,
- validity period,
- pathological persistence period, or period of pathological appearance,
- prognosis meaning.

other reflexes, appearing after the birth and that have to subsist, such as the cochleo-palpebral reflex and the optico-facial reflex.



REMARKS:

The primary reflexes have to be considered as reliable markers of the normal development; their premature absence is therefore considered as a nign of nervous dysfunction, in case of normalization they reappear. Similarly, their abnormal aspect at the neonatal stage is a pathological sign.

Their persistence after the normal period is a sign of pathology. However it is necessary to differentiate the normal period of validity, during which the reflex is first clearly positive then decreases gradually, and the period of pathological presence that does not begin generally immediately from the end of the period of validity; indeed there is often an intermediate period in the course of which the subsistence of the reflex has not still to be systematically considered as pathological, but indicates sometimes a simple delay in the development process.

Some reflexes never have to be positive. Their presence is always a sign of functional disorder of the CNS.

Do not only see in reflexes local answers, a lot reflexes radiate through the body.

The correlation of results obtained in the 3 rubrics ( spontaneous motor function, postural reactions, réflexology) enables:
- to define qualitatively and quantitatively the postural level of the child
- to specify the therapeutic indication
- to forecast the evolution to a type of syndrome.

The reflexological situation registrated during of a checkup is always susceptible to evolve, either spontaneously, or under the influence of a global proprioceptive therapy, as show many real examples.

E1: The attenuation, or the premature disappearance of the foot grasping reflex can induce the emergence of the Rossolimo reflex. This reflex disappears again if the grasping reflex gets its normal configuration. In this case, one can observe simultaneously modifications of some postural reactions (attenuation of the abnormal extension of the lower limb for example), or modifications of the spontaneous posture (diminution of the foot hyper-flexion, beginning of the flexion synergism in dorsal posture, etc...). The premature disappearance of the foot grasping reflex announces generally a spastique syndrome .

E2: The Galant reflex can be prematurely absent during the first trimester on the suspicious side, at a child evolving to hemiparesis. Under the influence of the therapy, the Galant can become positive on both sides, before to disappear simultaneously on both sides when the child becomes able to align correctly its corporal axis ( postural level 3 - 4 month). In this case, the child has good odds to develop the grasping function of the concerned side even if the hemiparesis gets confirmed. The subsistence of the Galant reflex after the fourth month announces generally a dyskinetic syndrome (athetosis or ataxia).

E3: The presence of abnormal reflexes (added to the perturbation of all postural reactions) constitutes the difference between a medium central coordination disorder (spontaneous normalization odds: 45 %) and a severe CCD (spontaneous normalization odds: 10 %). Both situations justify a precocious therapy. In case of favorable evolution, we observe generally a parallel improvement of the reflexology and of the postural reactions.



EMERGENCE of the C.P. SYNDROMES
TRIMESTER 1


During the first trimester, the healthy child and the symptomatic risk-baby have common points .

1) The muscular configuration is the same.

2) The skeleton is anatomically identical, the possibly defective ossification of a disturbed region is not yet realized.

3) The afferent system and the quality of afferences, at the risk-baby, are not yet different from these of a healthy child. The medullar segmental function of the risk-baby, at least during first half of this trimester, does not yet influence in a pathological way the supra - segmental medullar level, as it will do later.

4) The degree of maturity of the medullar way, from a functional viewpoint, does not differ at the healthy child or the risk-baby. This identity, during the first trimester, can be the consequence of the preceding factors.

But at the end of the first trimester the muscular system and the other sources of proprioception of the risk-baby, activates differently the afferent system to medullar level and to the superior level. Efferent impulse (outputs) of the spinal and supra - spinal levels can therefore be disturbed.
a) directly because of the central lesion.
b) by anomaly of afferences.
c) through the appearance of the first muscular alterations in the locomotive system itself, under the influence of the abnormal coordination.

The pathological development is therefore a vicious circle, in which an active element induces an other one, after a certain action time of abnormal functions. Such a functional disorder confirms with the time and becomes an indissociable element of the organic lesion. That means that the corresponding perturbation of the movement is not only the consequence of the primary organic lesion (during the peri-native period ) but also of a totality of negative dynamic factors on which it is possible to act by an appropriate therapy, in order to influence positively the development process. In addition, the stimulation of the CNS by physiological ways contributes to reduce the process of secondary central degeneration linked to the afferent deficit , during this period of physiological selective stabilization.

The head control and uprighting during the first trimester.

Quantitatively, the spontaneous mobility of all children with a central coordination disorder is either normal, or reduced, compared to a healthy child. It is habitually the case of hypotonic children. Some of these hypotonic children have an almost apathetic behavior.
In case of hypertony, closely associated with a hyperreflexivity, or when the muscular hypertony looks like a rigidity corresponding almost to a decerebration syndrome, the spontaneous mobility is always insufficient. However, we can speak about C.P. in these cases of major encephalopathy.

The spontaneous mobility of a future C.P. hypertonic child is often quantitatively normal or even increased. However, in ventral posture, we may observe that movements obtained by provoking the reflex crawling are imperfect and showing a delay, as compared to the healthy child. All disturbed children (at this stage they are still ymptomatic risk-babies) have a delay of antigravitary uprighting at the end of the first trimester. The organization of the automatic uprighting mechanisms is clearly disturbed. During the Landau test, these children, at the age of six weeks, can not align symmetrically their neck. This incapacity to straighten symmetrically the neck is common to future cases of spsaticity, athetosis, ataxia, and mixed troubles .

The risk-baby characterizes increasingly by the perturbation of its coordination. This perturbation expresses with modifications of the muscular tension, anomalies of postural reactions and of spontaneous postures, especially the absence of axial alignment and symmetry. The spontaneous posture remains always unstable at the end of the first trimester (see Selforma modules N° 1 and 2).



Reminder,, the age of 3 months is characterized by the following components:
Alignment of the corporal axis and symmetry of the posture.
Stability of the dorsal and ventral postures for the free orientation of the head, thanks to the active construction of a triangular support polygon: in the ventral posture from the 2 elbows to the pubis, in the dorsal posture from the 2 scapulae to the sacrum.
Ventral posture: head lifted and maintained out of the support polygon (balance), with caudal transfer of the corporal G.C..
Dorsal posture: the four limbs are lifted simultaneously in space and can be maintained out of the support polygon (balance, flexion synergism of the lower limbs), with cranial transfer of the corporal G.C..
All these components appeared automatically and improved to satisfy an orientation need, activated by the sensorial functions. The automatic adjustment of the corporal postures and movements is absolutely not conscious, but it has always a finality, that is the motor answer to an appeal (here the orientation need). The child's body, through the motor function, is used like a tool or mean to create and improve the relational life in the environment.


TRIMESTER 2




The pre-spastic development

It appears sometimes after an initial phase of global hypotony during the trimester 1.

The spastic syndrome will only appear in all its characteristic aspects during the trimester 3. In the second trimester it only induces the poverty of the spontaneous motor function that begin to have a stereotyped character, instead of diversifyingand of becoming an adaptable expression means to each situation.

The postural stability can not be insured, the child tempts frequently to stabilize himself by using primary automatisms. Thus appears the coordination stereotypy.

The bone-tendon and muscular reflexes are accentuated. The primary extension reflexes are still often positive: heel reflex, suprapubian, crossed extension, positive support reaction.

The hand grasping reflex is strongly positive , but the foot grasping reflex may be reduced or negative.

The Galant reflex is attenuated, or may even be prematurely negative.

These reflexological anomalies cohabit with a clear insufficiency of spontaneous normal postural development patterns (see module Selforma N°1) generally compensated, in ventral posture, by hyper-extension of the vertevral axis to enable a (bad) form of optical orientation in the space, and by the appearance of stereotyped limb postures:
- upper limb: abduction of scapula, full flexion or extension of the elbow (difficulty to maintain an intermediate posture, flexion of the wrist, ulnal incline, hand closing.
- lower limb: often adduction, internal hip rotation, foot hyper-flexion. More rarely, batrachian posture.

In dorsal posture, the child can react violently to auditive and optical stimulations by losing all control of his posture and by extreme movements, this are the dystonic "attack" or "spasms" , characteristic of the trimester 2.

No spastic child is able, at the end of the trimester 2, to reveal a good hand-mouth-eye coordination.

All spastic syndromes have in common an insufficient coordination of the alignment and of the vertevral rotation but begin to differentiate, during the trimester 2, by the topography of the most disturbed.corporal segments

The spastic tetraparesis is a severe disorder of the axis and of the 4 limbs
The diparesis is also a disorder of the axis, but concerns especially the pelvic waist and lower limbs, and to a lesser extent upper limbs.
These syndromes are however rarely entirely symmetrical, what leads us to speak occasionally about triparesis when one upper limb seems to be less concerned.

A tetraparesis evolving favorably under precocious therapy can finally become a diparesis; conversely, a severe diparesis, not or badly treated, and deteriorating from the orthopaedic viewpoint, can practically become, in the course of years, as handicaping as a tetraparesis.

The hemiparesis is the disorder of a half-body, but always includes, during the trimester 2, a perturbation of the axis postural mechanisms mentioned for the other syndromes, with discreet functional repercussions on the "healthy" side.



The pre-athetosic development

It appears as well from an hypertonic context as from the hypotony.
When the pre-athetosic development occurs from an hypertonic context, bone-tendon reflexes are accentuated, this is not the case in an hypotonic context.

The incapacity to coordinate isometric muscular synergisms induces the appearance of the hyperkinesis. This amplifies (ineffective) movements aiming to stabilize the posture and contributes to destabilize it more.

During postural reactions one can begin to see discreet athetosic movements of extremities (wrists, fingers, feet), but during the trimester 2, disorders of the phasic motor function are not yet very flagrant comparatively to movements of the healthy baby, that have not yet reached the whole fineness and the precision that they will reach during the trimester 3.

The absence of head control in some postural reactions suc as the traction reaction, Landau, axillar suspension is clear. During the Vojta reaction , arms are in abduction and the lower limb of the high side is in hyperextension.

We find the same fundamental postural gaps as by a spastic child, with in addition a clear subsistence of the "Moro" reaction, occurring in case of postural imbalance . The muscular tonus is very fluctuating, with alternation of dystonic attacks in opisthotonos and of global hypotonic moments.

The reflexology shows a significant difference compared with the pre-spastic development: both grasping reflexes are positive, hands but also at feet. Furthermore the Galant reflex is always strongly positive.

Les enfants engagés dans un développement pré-athétosique sont souvent très craintifs et montrent une réaction de panique lors des changements rapides de position corporelle dans l'espace (lift reaction par exemple).

The differentiated look orientation (without mhead ovement ) is disturbed particularly upwards.

In summary, in the course of the trimester 2, the athetosic child develops a kind of holokinetic movements (as the arm abduction ), with bone-tendon accentuated or normal reflexes, severe postural gaps confering on him a quasi-neonatal level comparatively to the optimal postural ontogenese.



The cerebellar syndrome

During the second trimester, the cerebellar syndrome is masked by a major global hypotony .
Bone-tendon reflexes are generally normal. One observes general apathy or weakness (astheny of Luciani); children have feeding troubles and are frequently vomiting.
The dorsal posture is still unstable, movements of upper limbs are irregular, but without real hypermetry. The dystonic spasms can appear briefly. The Moro reaction remains positive.
There are often disorders of the oculomotor coordination without real nystagmus. 50% of these children have an alternating convergent strabismus.
The mental delay is frequent in the cerebellar congenital syndrome. It explains the important development delay of the spontaneous motor function, and of antigravitary mechanisms that play an important part in this function. None of these children have a correct head control spontaneously in the ventral posture, during the trimester 2, they do not roll from the dorsal to the prone posture. A small proportion of these children, not so mental delayed, begins some grasping movements at the end of the second trimester.

The cerebellar syndrome can be differentiated from other hypotonic syndromes as the congenital muscular hypoplasy of Krabbe, or the spinal infantile amyotrophy (S.I. A), Werdnig-Hoffmann, Kugelberg-Welander), because in these syndromes the reflex es are absent or attenuated, the muscular weakness concerns especially the limbs roots, and the mental development is normal. During the second trimester, these children are therefore able to orient to a resonant source or an other interesting pole; the dorsal posture is relatively stable, the hand - mouth - eye coordination appears, the Moro reaction is negative.

The cerebellar syndrome is not easily differentiated from the "atonic diplegia of Forster (1909) that includes accentuated reflexes, a positive Moro reaction, and that evolves, in 25% of cases, to a West syndrome ("flexion spasms").



Mixed hypertonic syndrome

During the second trimester, that is severe clinic situation, combining a spastic tetraparesis with athetosic jerks, a severe mental delay, a neonatal reflexology.
All the postural reactions show severe alterations concerning all limbs.
from the age of 3 - 4 month one observes microcephaly and various central malformations may exist: lyssencephaly, porencephaly, pachygyry, microgyry, lobar sclerosis,...).

The vital prognosis is sometimes somber, the oligophreny limits severely the environment appeal and the motor expression. Need to move appears generally only at the age of 4 - 5 years.

These children are particularly threatened of major orthopaedic degradation compromising severely the ulterior life quality, but a regular therapy is a way to preserve a more bearable orthopaedic situation, nevertheless without generating a real motor appeal strongly compromised by the oligophreny.

Comparative table of spastic and dyskinetic (ataxia or athetosis) development during the trimester 2.


spastic
development
dyskinetic
development
spontaneous
motor func.
reduced
dystonic
attacks
muscular
tonus
non significant
non significant
clonus
absent
absent
extension reflexes
(see table of réflexes)
all ++
possible crossed refl.
(hypertonic context)
Galant refl.
attenuated or nul
accentuated ++
posit. support. react.
lower limbs
positive ++
positive, with
automatic stepping
Lift reaction
+, abnormal pattern
+, abnormal pattern
hand grasp. refl.
++++
attenuated
foot grasp. refl.
attenuated or nul
++++
ocular coordination
conv. altern.
strabismus
vertical look diffic.
compens. opisthotonos


Reminder,: the main postural markers of the second trimester are:
homolateral coordinated grasping (about 4 months).
grasping on, then beyond, the median corporal axis (4,5 months).
support on one elbow (4,5 months).
hands / feet meeting (6 months).
support on both open hands (6 months).
supine / prone rolling (6 months).
lateral, more and more caudal transfer of the corporal gravity center.


TRIMESTER 3


The trimester 3 is the period where syndromes of CP really concretize, at this stage the functional prognosis may become more precise, but has also to take into account, in parallel with the clinic examination, other simultaneous factors:
possibility or not to begin a regular therapy,
kind of therapy,
quality and regularity of parental collaboration ,
daily life conditions,
presence of comitiality, or other pathological elements, etc...

This plurality of factors intervening in the evolution of the child implies a great prudence, nevertheless without forbiding the estimable and constructive dialogue between the health professionals and the family who needs to appreciate the evolution, in order to envisage the near future, to preserve a realistic confidence in the therapeutic action, and to persevere in this collaboration.

The spastic development

1) Spastic Hemiparesis :
The postural asymmetry is flagrant, the spasticity confirms on muscular main groups.
- Upper limb: pectoral group, elbow flexors, pronators, finger flexors. The negligence of the disturbed limb becomes flagrant as the child is committed in new functions based on the activation of opposite limb .
- Lower limb, some postural reactions as the axillar suspension may show a surprising result: an abnormal reaction in moderated extension of the "healthy" lower limb. This observation is probably linked to the fine coordination deficit of the vertevral axis. It is then interesting to realize the " pendulum test " (see Selforma module N° 2: annex reactions) that shows a fixation in extension of the disturbed lower limb while the "healthy" lower limb remains supple. This test avoids a confusion with a diparesis.

Roll ing from supine to prone posture is always realized by passing the healthy side over. autonomous sitting up is impossible. The quadrupedic locomotion , with its cyclic alternation of supporting diagonal, is the great est gap of the hemiparetic development at the end of the trimester 3, if the child does not benefit from an appropriated global therapy. This gap in the daily exploitation of the crossed pattern will condition inescapably the asymmetry of the erected posture and the weight transfer will then always appear exclusively onto the healthy side, while the disturbed lower limb will play the role of a lateral o"bracer"on which the weight will never be truly hoisted, what will correspond later to a severe gap in the supportig phase on the disturbed side during the vertical locomotion.

The foot grasping reflex is still present on the healthy side; it is prematurely lessened or negative on the disturbed side, as in the other spastic syndromes.

Convulsive crises are frequent at hemiparetic children (more of 30% of cases during the trimester 3).

The language development is linked to the mental development, it is not therefore necessarily compromised in case of lesion of the genotypic dominant hemisphere. Nevertheless, a majority of children that present a disturbance of the dominant hemisphere have a more or less marked mental delay. One considers that when both parents are right-handed or both left-handed, their child has the same dominance: a child whose both parents are right-handed and who presents a right hemiparesis is therefore disturbed on his dominant side and vice-versa.

2) Spastic diparesis

With the hemiparesis, the diparesis is the most frequent form of C.P.. At the end of the trimester 3 no child can spontaneously get into long sitting. Placed in long sitting, these children have to stabilize with cyphosis.

The stabilization of the pelvic waist is always unsufficient, the stereotype in adduction - extension and internal rotation of lower limbs is frequent in horizontal posture, but can change into a pseudo-external rotation of hips in the long sitting posture by moderately spastic children. In fact, that is a semi-flexion of lower limbs, with impossibility to stabilize hips in a medium rotation posture that makes both thigh fall laterally, while the pelvis is attracted backwards by ischio-crurals muscles and adductors, inducing thus the compensatory cyphosis.

The average postural level does not exceed generally the end of the first trimester, the dorsal posture is still unstable. Postural activities necessitating a differentiated rotation of the vertevral axis are not present. The spontaneous lower limb motor function is poor: alternated movements of flexion - extension as during the neonatal pedaling. The simultaneous abduction of both arms is often the manifestation of a dystonic spasm. Attempts of grasp function in dorsal posture generate frequently a stiff adduction of lower limbs, with possible crossing. The lateral posture is unstable with the result that the sudden return in dorsal posture can happen under a falling form and induce then a partial Moro reaction.

The suprapubian extension reflex is often positive, as well as the heel reflex. The foot grasping reflex is prematurely negative, one can then observe occasionally the appearance of a Rossolimo reflex, that will disappear if the reflex foot grasping reflex appears again thanks to the therapeutic context.

65% of diparetic children have a normal mental development, and can therefore show at the end of the trimester 3 an appeal to the vertical posture helped by the adult. This practice, if it is repeated, contributed strongly to the fixing of the pathological pattern of the pelvic waist and lower limbs, with increasing spasticity and contractures. During this period, the cdiparetic hild is not even able to realize a form of physiological quadrupedic locomotion.

The gap of axial and trunk coordination induces the frequent subsistence of a primary breathing type with, as corollary, the Harrisson's thoracic deformation.


3) Spastic tetraparesis:

The clinic aspect of the spastic tetraparesis does not change a lot as compared to the preceding trimester. The average postural level remains quasi - neonatal.

Initially hypertonic children have positive hand grasping and foot grasping reflexes while these reflexes can be lessened at initially hypotonics children.

In all cases the bone-tendon and muscular reflexes are accentuated, the extension reflexes and the Galant reflex often positive, but the spontaneous posture can differ according to whether the child was beforehand hypertonic or hypotonic: the initially hypotonic child has generally a batrachian posture of limbs, while the initially hypertonic child is in stiff hyperextension, with lower limbs adduction.

Naturally, the global posture is never truly symmetrical neither reciprocal.

35% to 40% of tetraparetic children have an alternating convergent strabismus.

The third trimester is, by the spastic child and particularly the tetraparetic child , the critical stage from which the deformative process concretizes without an adequate therapy, while it is still possible to favor the evolution to a diparesis by some children, that means to develop a manual function and to improve partially the antigravitary automatisms. The end of the third trimester also marks the diminution of the central malleability because of the furtherance of the neuronal selective stabilization. The quality of life through the ulterior years is therefore closely linked to the precocity of a therapeutic adapted action. The trimester 3 is the ultimate starting point of this therapeutic action. If it is not possible begin before this moment, the re-education will lose a large proportion of its effectiveness...


4) Athetosis

During the trimester 3, the athetosic development characterizes by a very dystonic motor function on the basis of the same fundamental postural gaps as in the other syndromes. No child can realize a coordinated rolling from the supine to the prone posture. The head is then always used as a supporting point (opisthotonos).

The dystonic spasms are more visible when the athetosis develops from an hypertonic context.

Among a series of 76 athetosic children, 28 presented a neonatal hypertony. Other presented an hypotonic situation. The trunk hypotony is especially flagrant in the Landau reaction, but it may also alternate with an opisthotonos.

The trunk instability is particularly clear; the trunk seems to be "snaking" between the hands of the examiner in several testing situations. The trunk curves according to the orientation of the head. The Galant reflex is always strongly positive.

The hand grasping reflex can disappear during the trimester 3 because of the hyperextension of fingers. This disappearance is "premature" when it does not correspond to the simultaneous emergence of a grasp function or support function. However the stimulation by a cold object can provoke the grasping reflex again.

The foot grasping reflex is strongly positive and may last several years (4 - 5 years).

Bone-tendon, and muscular reflexes, other primary reflexes are normalizing in the trimester 3.

In dorsal posture a beginning of grasp function may start but not in a coordinated way, with flexion of the wrist in ulnal incline, exaggerated extension of the metacarpo-phalanxial joints. Associated foot grasping movements are minimal, or accompanied by lower limbs extension.

From a therapeutic or functional viewpoint, it is useless to divide the athetosic development in several specific syndromes, since the postural gaps to see are not specific.

The intensity of dystonic spasms (or attack) observable by the athetosic child varies according to the stimulation situation. Joy, fear, desire to reach an object, may provoke them and make them radiate through the whole body.

Besides this irradiation phenomenon, the athetosic development characterizes also by the lack of isometric muscular contraction, or the incapacity to regulate in time the isometric contraction. This gap materializes through the great difficulty to stabilize durably the posture and the appearance of anarchic movementsof which direction can not be controlled. As soon as the strong muscular contraction stops, the child becomes hypotonic again.

The upwards look orientation is frequently difficult, all attempt generates the opisthotonos. The chewing and swallowing disorders are frequent, tongue movements are not coordinated, dribbling is abundant.

25% to 40% of athetosic children present an auditive disorder from central origin.

5) The hypotonic syndrome:

Hypotony may be a transitory state before one of the CP syndromes previously described or it may also correspond to other families of pathologies such as some myopathies, infantile spinal amyotrophies (I.S.A.), or a congenital analgesy, etc... The reflexology is one of the elements contributing to the differential diagnosis.

Reminder,: the main postural markers of the trimester 3 are:
stability in lateral posture (7 months).
lateral support on one elbow (8 months).
seal crawling (8 months).
oblique sitting (9 months).
support on both open hands (6 months).
autonomous passing to sitting posture (9 months).
crossed quadrupedic locomotion (9 months).


Conclusion

The precocious evaluation of the central coordination disorder enables the precocious therapy, in the aim to normalize the neurological situation each time as possible, or to reduce the functional impact of a future CP.

The reflexology enables to specify the prognosis, it contributes to the differential diagnosis, and to the quantification of the evolution.














Professor Vaclàv Vojta: neurologist, born in 1917 in Mokrosuky, Czech Republic ; 1956 dep. of chlid neurology univ. hospital, Prague; 1968 emigration in west Germany, 1975 leader of the child rehabilitaion dep. , Kinderzentrum, München. Dead in September 2000, München. fly leaf / documentation start




German 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.
French bibliography:
- Le concept Vojta: H Lagache - Kinésithérapie scientifique n° 366 - S.P.E.K. Paris, 1997
- Le mythe du clou: H Lagache - Kinésithérapie scientifique n° 395 - S.P.E.K. Paris, 1999
- PMDforma, module N° 1, H. Lagache: Développement postural et moteur, repères qualitatifs et chronologiques.
- PMDforma, module N° 2, H. Lagache: Evaluation de la réactivité posturale automatique.
- PMDforma, module N° 3, H. Lagache: Vie journalière et développement moteur, suggestions d'environnement.
- PMDforma, module N° 4, H. Lagache: Synergies musculaires du développement locomoteur humain.
- PMDforma, module N° 5, H. Lagache: Bases de la thérapie Vojta.
- PMDforma, module N° 6, H. Lagache: Rélexologie et syndrômes d'I.M.C.
- PMDforma, module N° 7, H. Lagache:Scoliose, traitement Vojta.
- PMDforma, module N° 8, H. Lagache: 35 techniques proprioceptives.
English bibliography:
- PMDforma, module N° 1, H. Lagache: postural and motor development, qualitative and chronological markers.
- PMDforma, module N° 2, H. Lagache: Checkup of the automatic postural reactivity
- PMDforma, module N° 3, H. Lagache: Daily life and motor development, environment proposals.
- PMDforma, module N° 4, H. Lagache: Muscular synergisms of the human locomotor development.
- PMDforma, module N° 5, H. Lagache: Basis of the Vojta Therapy
- PMDforma, module N° 7, H. Lagache: Scoliosis, treatment according to Vojta.
- PMDforma, module N° 8, H. Lagache: 35 proprioceptive techniques.
- The Vojta concept, H. Lagache, Physiotherapie, Fachzeitschrift des öPV (3/2000), Verlagspostamt 1060, Wien.

fly leaf / documentation start









Rossolimo reflex: activated by the percussion of the last phalanxes of toes (plantar face), the answer is a brief movement of toe claw (flexion of the phal. 1 and extens. of the phal. 2 and 3). The presence of this reflex is always a pejorative neurological sign. back to diparesis back to réfl. remarks

Moro reaction: reaction in 2 parts: simultaneous rapid extension-abduction (spread) of both upper limbs, with open hands, and of the lower limb, followed by a slower return to the trunk. This reaction can be activated from different ways; it reveals the postural insecurity of the newborn during the holokinetic stage; it has therefore to disappear gradually in the course the first trimester as the child acquires a better automatic control of his posture. The second part of the Moro reaction disappears first (limbs return to the body), then the first part (abduction) some weeks later. pre-athetosis cerebellar synd. spast. diparesis

selective stabilization:
The plasticity (see this word) of the central nervous system is very important during the first months of life. Potentially available neurological itineraries for the transmission of impulse are, in this period, overabundant. A selection is gradually done , with degeneration of the few solicited connections, while the most used connections get their maturity, and take on the responsibility of various functions: that is the selective stabilization. This process offers a functional compensation appropriateness in case of neurological lesion; it decreases at the end of the first year, and that corresponds to a diminution of the central malleability. Every lesion of the central nervous system has therefore to be detected very precociously and followed by a neurological appropriate rehabilitation (proprioceptive and glogal) to preserve the best chances of satisfying functional evolution.
back to trim. 1

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