Balance Rehabilitation Approach by Bobath and Vojta Methods in Cerebral Palsy: A Pilot Study

Abstract

In cerebral palsy (CP) the basis for rehabilitation comes from neuroplasticity. One of the leading therapeutic approaches used in the management of CP is the NDT Bobath therapy and Vojta therapy consists in trying to program the ideal movement patterns for the age. The aim of our research was to analyze, from a functional point of view, the evolution of the biomechanical parameters characterizing the balance, in children with CP. The group of 12 subjects average age of 7 ± 3.28 years. The subject’s evaluation included a functional clinical evaluation by Berg pediatric scale and a biomechanical evaluation performed using the “Stabilometry footboard PoData 2.00” for evaluation the body weight distribution on the foot level. The rehabilitation program was developed based on two methods, NDT Bobath and Vojta. A 90-min physiotherapy session starts with a Vojta therapy activation, for 20 min. Between the two therapies there is a 10-min break, then the session continues with NDT Bobath exercises within the 3 physical exercises proposed for 60 min. 5 days per week, 6 months. The analysis of the data collected before and after the application of the rehabilitation program, regarding the using the Berg scale indicates a progress of 32.35%, (p = 0.0001 < 0.05) and the effect size is large. The evolution of the data that indicate the distribution of body weight at the level of the two lower limbs, at the two moments pre/post, evaluation. For left side a progress of 8.39%, (p = 0.027 < 0.05) but a small effect size of 0.86. For right side a progress of 10.36% (p = 0.027 < 0.05) and also a small effect size of 0.86. Analyzing the results, we find that there is a left-right rebalancing in most patients. The favorable results that were obtained by drawing up a physiotherapy program composed of the combination of the two Vojta and NDT Bobath methods are proof of the fact that both methods are based on the creation of a stimulating peripheral pressure, which, if maintained, generates an extended stereotyped motor response. A pattern of symmetrical muscle contraction is thus created and thus balance and postural control can be achieved. The left-right rebalancing, proven by the percentage distribution analysis of the weight at the lower segmental level, demonstrated that the body alignment approach through the Vojta method on the one hand and the inhibitory facilitating postures/exercises promoted by the NDT Bobath method, allows obtaining a symmetry.

Keywords: balance; cerebral palsy; rehabilitation; therapy activation.

Figure 1

Patient preparation and positioning.

Figure 2

Plantogram picture (left spastic hemiparesis patient).

Figure 3

Reflex crawling.

Figure 4

“First position”.

Figure 5

The exercise “Quadruped imbalances”.

Figure 6

Imbalances from the “kneeling” position.

Figure 7

“The Servant Knight” position.

Figure 8

The evolution of the Berg scale score for subjects P1–P6.

Figure 9

The evolution of the Berg scale score for subjects P7–P12.

Figure 10

Evolution of GMFCS score patient P1–P6.

Figure 11

Evolution of GMFCS score patient P7–P12.

Figure 12

Percentage distribution of the weight on the left leg, from the total weight at the first and second evaluation of the subjects of the experimental group (N = 12).

Figure 13

Percentage distribution of the weight on the right leg, from the total weight at the first and second evaluation of the subjects of the experimental group (N = 12).