Abstract
BackgroundIt is still unclear, which physiotherapeutic approaches are most effective in stroke recovery. Vojta therapy is a type of physiotherapy that was originally developed for children and adolescents with cerebral palsy. Vojta therapy has been reported to improve automatic control of body posture. Because acute stroke patients are characterised by a disturbance in the ability to adapt to changes in body position, requiring automatic postural adjustment, we decided to investigate Vojta therapy in the early rehabilitation of stroke patients. Aim of the trial was to test the hypothesis that Vojta therapy - as a new physiotherapeutic approach in early stroke recovery - improves postural control and motor function in patients with acute ischaemic stroke (AIS) or intracerebral haemorrhage (ICH).MethodsThis prospective, randomised controlled trial included patients with imaging-confirmed AIS or ICH, severe hemiparesis and randomly assigned them to Vojta therapy or standard physiotherapy within 72 h after stroke onset. Main exclusion criterion was restricted ability to communicate. Primary endpoint was the improvement of postural control measured by the Trunk Control Test (TCT) on day 9 after admission. Secondary endpoint among others was improvement of arm function (measured with Motor Evaluation Scale for Upper Extremity in Stroke Patients [MESUPES]).ResultsForty patients (20 per group) were randomised into the trial. Median age was 75 (66–80) years, 50% were women. The median improvement in TCT within 9 days was 25.5 points (=25.5%) (interquartile range [IQR] 12.5–42.5) in the Vojta group and 0 (IQR 0–13) in the control group (p = 0.001). Patients treated with Vojta therapy achieved a greater improvement in the MESUPES than patients in the control group (20% vs 10%, p = 0.006).ConclusionThis first randomised controlled trial of Vojta therapy in acute stroke patients demonstrates improvement of postural control through Vojta therapy compared to standard physiotherapy. Although this trial has some methodical weaknesses, Vojta therapy might be a promising approach in early stroke rehabilitation and should be studied in larger trials.Trial registrationClinicalTrials.gov; Unique identifier: NCT03035968. Registered 30 January 2017 – Retrospectively registered; http://www.clinicaltrials.gov.
Highlights
Unilateral motor weakness is one of the most common deficits resulting from stroke and one of the main causes of disability [1, 2]
The basic principle of Vojta therapy is the regulation of posture [7], which is attained within the innate movement sequences of reflex-locomotion, is retrievable at all times and can be found in all forms of human locomotion representing the basis for human movement [5,6,7]
The possible observer bias due to unblinded primary outcome measure, the psychometric problems of the outcome measure (TCT ceiling effect) and the difference in baseline scores of the Trunk Control Test (TCT) are relevant methodical flaws and we can not estimate how much these factors influenced the results, the results have to be evaluated with caution. In this first pilot trial, treatment with Vojta therapy was beneficial in the early rehabilitation of acute stroke patients with a severe hemiparesis within 72 h after onset showing improved postural control, degree of neglect and motor function compared to standard physiotherapy, keeping the methodical weakness of the trial in mind
Summary
Unilateral motor weakness is one of the most common deficits resulting from stroke and one of the main causes of disability [1, 2]. The basic principle of Vojta therapy is the regulation of posture [7], which is attained within the innate movement sequences of reflex-locomotion, is retrievable at all times and can be found in all forms of human locomotion representing the basis for human movement [5,6,7] To activate these innate patterns of movement, the therapist applies pressure to defined zones. Vojta therapy is a standardised therapy with defined starting positions (prone, supine or side lying position) and specific initial angular positioning of the trunk and the extremities. It is still unclear, which physiotherapeutic approaches are most effective in stroke recovery. Aim of the trial was to test the hypothesis that Vojta therapy - as a new physiotherapeutic approach in early stroke recovery improves postural control and motor function in patients with acute ischaemic stroke (AIS) or intracerebral haemorrhage (ICH)
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