17 Practical Part – VM2G – Therapy of Children and Adults

Basic Terms and Defining Building Blocks of VM2G

The therapy is targeted at:

1. Autonomic regulation of the posture of the body that always contains:

Punctum fixum

• The more there are, the more stable the position.
• The less there are, the more labile the position and the more prone to change; or alternatively the labile position enables the change.

Punctum mobile

• The less there are and the closer to the centre of gravity they are, the more stable the position.
• The more there are and the farther from the centre of gravity they are, the more labile the position.
• Puncta fixa and puncta mobila create spatial geometric objects that fundamentally aim to make the centre of gravity of the body stable or labile
• Initially, transitional phases from the stable position to the labile position and back to the stable position are performed only by the basic stereotypical movements
• The regulation of the transitional phases happens automatically and unconsciously. It is provided by the basic operating program of the motor skills.
• Subsequent motor learning happens partially unconsciously through gaining of the motor experience, and partially consciously through motor skills learning that enable development of the extension application programs

2. Autonomic regulation of joint centration

Happens completely unconsciously

It is an integral part of the following:

• Automatic regulation of the posture of the body
• Basic stereotypical movements
• All extension application programs of motor skills

3. Autonomic regulation of the muscle tone

4. Autonomic regulation of the basic stereotypical movements

The goals of therapy are:

• To attain the ability of the body to assume a position within the space that would ensure dynamic stability of the its centre of gravity with the potential of transition to a new position.
• Transition to the new position is highly efficient in terms of energy output. It utilises the kinetic energy of the centre of the gravity of the body and the centre of the gravity of the limbs. It is apparent that the performance of the transition is a highly-coordinated process of practically all muscles of the body.
• To perform an effortless motion that is perceived by an external observer as a harmonic and aesthetic movement – see the dance, ballet, gymnastics of figure skating

Disorders of autonomic regulation of the posture of the body subsequently lead to:

• Insufficient extension of the spine
• Impairment in creation of its physiological curvature
• Disorders of rotation in individual segments and the particular key points:

1. In craniocervical transitional zone
2. In cervicothoracic transitional zone
3. In the thoracolumbar transitional zone

Influences of the impaired autonomic regulation of joint centration

• The impairment develops through the deviation of the joint axes; it is manifested in the statics and the dynamics of the musculoskeletal apparatus.
• The disturbance happens because of external causes:

1. The disorder of the regulation of the basic motor programs (cerebral palsy, stroke, multiple sclerosis)
2. The disorders of regulation of the extension application programs (distortion of the form of motion, overload, immobilisation…)
3. The disorders from general degenerative causes (arthrosis, muscular slackness, osteoporosis…)
4. The disorders based on the traumatic changes (both HW and SW), diseases (neurodegenerative diseases), malnutrition…

• Normalisation of the autonomic regulation of joint centration is essential and necessary precondition of the correct function of the basic and extension motor skill

Case Study – Possibilities of Intensive Therapy in a Female Child Patient with Severe Central Coordination Disorder

Illustration of the Central Coordination Disorder, Hypotonic Type

Eliška was brought to our office by her grandma as an infant at the end of the girl’s ninth month. The girl didn’t show any interest in the world around her. She didn’t even show any signs of perception. She lay in supine position without any effort to move or a reaction to the stimuli. She was generally weak.

Grandma couldn’t conceal that she had only encountered hopeless prognoses about her granddaughter. She had to fight for the recommendation of rehabilitative care.

Description of the Problem
(Clinical Findings)

The history evidenced a very unhappy beginning of life of this small patient. Her mother was addicted to hard drugs and used them during the whole pregnancy. The new-born child quickly developed withdrawal symptoms. Her growth was generally poor, and she only put on a little weight. Because of the medical condition of her mother, Eliška has been entrusted to the care of her grandmother.

Neurological findings uniformly showed very severe brain damage and the development of central coordination disorder, of the hypotonic type. In the ninth month, there was persistence of new-born posture of the body without any basic righting or turning. Because of an inability to establish any contact with the child, who wouldn’t react to visual or acoustic stimuli, severe mental retardation was assumed.

The established prognosis was extremely poor due to the stigma experience during the intrauterine life. The development in future months only proved this prognosis. The attending paediatrician considered the initiation of the rehabilitative therapy of the patient as pointless. Only after the grandmother insisted, he sent the child into our care. It was commenced at the end of the ninth month of girl’s life.

The performed diagnostics proved there was the most severe degree of central coordination disorder of hypotonic type.

Expert Explanation of the Problem

In Eliška, typical development of the cerebral palsy could be presumed based on a clear cause. Undoubtedly proven factors of the brain damage by neurotoxic influence of the drugs explained the further unfavourable postpartum development. It headed toward the CP of severe hypotonic type, probably stagnating in the apedal form.

This type of neurological disorder is often combined with disorders of mental development. The observed manifestations indicated the development of very severe mental retardation.

Illustration of the Solution

The offered rehabilitative care in a form of VM2G offered hope to the patient’s grandmother that it would be possible to do at least something for her granddaughter. She began the therapy with enthusiasm and passion that could be rarely seen. She was convinced that her granddaughter’s future was in her hands. She exercised exactly in accordance with the recommendations. She followed the time and repetitions. She performed the exercises at home five times a day. Initially, it took twenty minutes, later thirty minutes and ended at forty minutes. The check-ups took place regularly every week.

Eliška’s first reactions to the exercises ­weren’t too obvious, but the muscle tone began to improve gradually. She slowly ceased to look like “a rag doll”.

After six months of very intensive therapy, initial efforts to turn on the belly appeared and the interest in the surroundings began to grow. She resembled “Sleeping Beauty” slowly awakening from a deep sleep. Every tiny progress was recorded by Eliška’s grandmother. She consulted the record and got sincere joy from it.

After the next two months, Eliška got on her knees and started to crawl on all fours. It took another two months, but Eliška began to stand up. At the time, she communicated pleasantly and was vividly interested in her surroundings. Walking appeared after more than ten months of very intensive exercise. Even after Eliška started to walk without aid, she still loved to hold the hand of her grandmother.

Kilbová Eliška – Poloha na břiše

Kilbová Eliška – Trakční test

Kilbová Eliška – Poloha na zádech

Kilbová Eliška – Landau

Kilbová Eliška – Vojtova boční metoda

Kilbová Eliška – Colis horizontál

Kilbová Eliška – Colis vertikal

Explanation of the Solution

Therapy of infants older than six months usually involves more complications than the treatment initiated before the third month. This patient began therapy at the end of the ninth month.

The initial reflex responses to stimulation were small. The maximum frequency of implemented stimulation was selected at five times a day. One exercise took thirty-five to forty minutes. The goal of this extremely intensive stimulation was to lead the patient from the persistent overall muscle hypotonia and, concurrently, to prevent the development of the pathological substitute motor skills.

We think that this intensive therapy prevented the development of the pathology in terms of spasticity and the development of pathological dyskinesia too.

Strong and long-lasting hypotonia prevented the use of tilted surfaces and lability support. During the first six months, the developmental progress was only small, but gradually the patient started to be more concerned about her surroundings. Only after six months of therapy, the motor development began to accelerate remarkably. Gradually, crawling on all fours joined the turning and righting.

In the end of the twentieth month of age, the patient started to walk. Although the gait was unaided, balanced and matured, the patient wasn’t willing to walk alone. She looked for a support and always held the hand of her grandmother. After another six months, this supposed separation anxiety ceased as the patient began to walk without aid.

The next check-up took place at eight years of age. She attended the second grade of elementary school and had full marks according to her grandmother. By second grade, she was playing the violin.

View of the Possibilities of the Restitution of Motor and Mental Functions in Infants with Severe Neurological Findings and Very Severe History in Terms of VM2G

We repeatedly found that it’s important to initiate very intensive VM2G therapy in infant patients with severe signs of neurological impairment. If possible, the temporal and spatial summation of therapeutic stimulation should be combined. If we can’t permit a choice of intensification of spatial summation because of muscle hypotonia, it would be necessary to push the temporal summation to the maximum. For this conception of therapeutic strategy, it is essential to have a cooperative home therapist, who would invest all his time into the therapeutic goal.

Logic dictates that the early initiation of therapy plays a very important role. Three months of age or less would be the optimal time. Nevertheless, the sooner the better holds true.

Intensive and long-term brain stimulation is most probably the only possible way to ensure neurogenesis, which was previously impaired. Impairment of normal development of brain tissue is followed by other gradual deterioration spread over time. It is due to apoptosis in particular. Neurons that didn’t get the opportunity to interconnect with the neuronal networks are affected most. Because of inactivity or hypoactivity they succumb to pre-programmed death.

Preliminary utilisation of immature neurons participates in the overall deterioration of the neurological status. Due to insufficient differentiation, the neurons cannot fulfil the expected functional responses within the activity of neuronal networks and thus increase the overall chaos within the brain function.1

These impaired processes of maturation of the brain matrix constitute the fundaments of persistence of primitive new-born and infant reflexes. “Non-disconnection” of primitive reflexes results in an inability of onset of physiological developmental programs of righting and locomotion and gradual development of substitute pathological motor skills. Consequently, some form of cerebral palsy develops. Implementation of intensive VM2G stimulation permanently overwhelms the brain with activity because, after every stimulation exercise, the reflex activity continues in the brain centres for the following two hours. (Vojta, 1974).

Basic premise of reflex locmotion is:

An organ is developed by its function

VM2G is based on induction of a reflex that:

• Utilises ideal motor patterns, which are strictly individual
• Sets the degree of the load on muscles, joints and nerves exactly according to current bodily status, innate predispositions and biomechanical relations of the individual
• Absolutely excludes the probability of overload (muscular, neural, cardiopulmonary…).
• Prevents the reflex being “switched off” by any disease or trauma to the level of deep unconscious states.
• The program utilises permanent multifunctional feedback, so it enables the use of all available reserves of the musculoskeletal apparatus.

Reflex response or the “system” in the patient during the VM2G therapy is manifested in:

• Autonomic posture of the body and limbs against gravity without conscious effort.
• Gradual “deactivation” of the perceived body scheme to the level of a state before falling asleep.
• Realising the feeling of “losing the body”.
• Autonomic joint centration manifested in shaking, shivering and movement automatisms, particularly of the hands, feet, whole limbs and pelvis
• Gradual extension of the time of the patient’s tolerance of the stimulation without discomfort
• Increasing ability to tolerate the increase of load by multiple stimulation – balance discs, tilted and longitudinal position of the bed, tension of rubber straps, weights on the limbs
• Involvement of all muscles of the body in specific “mode” without fatigue during the performance of the therapy and afterwards
• There is no exhaustion within all stimulation zones; there is no tolerance of the stimulation
• The work of muscles reveals specific fatigue, usually localised due to muscle incoordination, which subsides immediately after cessation of the stimulation

VM2G – Implementation in Children

It is irreplaceable in diseases of musculoskeletal apparatus from birth to about 3 years of age

• Motor and coordination disorders, peripheral and central neural lesions, e.g. facial palsy
• Postpartum brachial plexus palsy, Scoliosis of the new-borns, postpartum valgus pronation of ankle joints, meningocele
• Orthopaedic developmental disorders of the chest, spine, valgus knee, varus knee

In older children

• Peripheral palsies of the muscles, postoperative conditions after surgery of the musculoskeletal apparatus
• Central palsies in children
• Developmental disorders of the musculoskeletal apparatus – scoliosis

VM2G – Implementation in Adults

In neurology and neurosurgery:

• Neurodegenerative diseases (multiple sclerosis, myopathies, Parkinson disease)
• Conditions after neurosurgical interventions (on spine, brain)
• Physiotherapy of conditions after stroke
• Physiotherapy of conditions after injuries of spine and peripheral nerves
• Functional disorders of the spine, functional myoskeletal disorders in general

Sports medicine:

• Conditions after sport injuries (ruptures of tendons and muscles…)
• Conditions after inflammations of myoskeletal system
• Conditions after overload of the musculoskeletal apparatus

Traumatology, surgery:

• Conditions after injuries of the musculoskeletal apparatus (following the acute phase)
• Combustions (following the acute phase)
• Multiple trauma (following the acute phase)

Orthopaedics:

• Developmental defects (spinal scoliosis, chest deformities, developmental disorders of bearing joints…)
• Degenerative joint diseases (arthritic changes of the joint cartilages, disorders of bearing joints…)
• Conditions after joint replacement surgeries
• Final treatment of traumatic conditions
• Conditions after orthopaedic surgical interventions

Anaesthesiology and resuscitation – coma:

• Intensive physiotherapy in patients after long-term unconsciousness

Video – Th erapy of adults

Case Study – Implementation of VM2G in a Patient with Chronic Progressive Pain of the Lumbar Spine

Illustration of the Problems with Chronic Spinal Pain

The patient, who sought help from our outpatient department, suffered from lower back pain. In the previous six months, the pain deteriorated so badly that the patient was unable to work. He was employed as a plumber, and his job required pronounced physical stress. MRI examination demonstrated herniations of intervertebral discs of three lumbar vertebrae. Previous rehabilitative and pharmacological therapy wasn’t successful and the patient had been sent to the department of neurosurgery. The suggested surgical solution didn’t seem suitable for him due to his physically demanding profession.

Video – Therapy of adults

Description of the Problem (Clinical Findings)

Medical history and repeated X-ray and MRI findings proved the presence of herniations of intervertebral discs of varying severity at three levels of the lumbar region. These herniations pressed on the neural roots. The pain itself was typically distributed along the course of sciatic nerve bilaterally. The patient had significantly impaired statics and dynamics of the lumbar spine, which didn’t develop when bending forward. Pain restricted the extent of the movements of the spine within all directions. The patient had a moderate degree of obesity that worsened the mobility of the body within the abdomen in particular. Obesity as an accompanying phenomenon worsened the possibilities of the restitution of movement. The patient was repeatedly reminded during expert consultations with the specialists that it would be necessary to reduce the weight to normalise the motion. The pain spread from the lumbar region to both legs down to the level of knees. Besides the permanent pain lasting for several months, paraesthesia in the dermatome innervated by the sciatic nerve appeared. A severe problem was indicated by intermittent motor loss, particularly after a longer walk – the tip of the right foot would not elevate sufficiently and the patient stumbled.

Expert Explanation of the Problem

Pain caused by functional and morphological insufficiencies of the spine is among the classic lifestyle diseases. The incidence increases together with the inability to work, leading even to disability. There are several factors contributing to these difficulties. Generally, they could be summarised under the term non-physiological “use” of musculoskeletal apparatus.

Obesity increases the risk of development of the functional spinal disorders, particularly in combination with a unilateral loading. When the pain becomes chronic, the reduction of weight is difficult to address. Restriction of caloric intake alone is not sufficient, unless it is accompanied by physical activity. Chronic spinal pain makes the implementation of sufficient physical activity impossible. Concurrently, obesity is the factor that participates in the back pain.

Herniations of the intervertebral discs, if located at multiple levels of the lumbar spine, press down on the root nerves and the spinal cord. Besides pain, restrictions to the sensitive nerves appear. This causes paraesthesia and occurrence of areas of decreased sensitivity at various locations on the legs. Compression of the motor component of the peripheral nerve constitutes a very serious problem, which is represented by loss of motor functions, mainly in the feet. This motor loss may impair the stereotypical gait and lead to stumbling caused by foot drop. Paresis of the perineal nerves is the final consequence. The effort to solve the change of impaired muscle coordination, the so-called lower crossed syndrome (refer to Janda, 1984) 1 by classical strengthening of the weak muscles and stretching of the shortened muscles doesn’t have a positive effect in the long run. The effort to build a sufficient corset muscle by conscious action of the patient is limited by pain and obesity in the region of the abdominal wall. The patient comprehends the uncomfortable situation repeatedly explained by medical professionals, but he is not able to deal with it due to chronic back pain.

Illustration of the Solution

The patient decided to undergo intensive VM2G physiotherapy. His wife became his home therapist. Thanks to the high level of motivation of the patient and his wife, it was possible to increase the therapy quickly. For home therapy, the patient bought a folding medical lounge, labilising disc, a set of stimulation balls, antiskid mat, mat under the disc and a set of weights on limbs.

Home exercises were performed twice a day for twenty minutes. Regular check-ups at the office attended by the patient and his wife were scheduled monthly. After each visit, it was possible to increase the load. It had been achieved by gradual increase in transversal and longitudinal tilt of the medical lounge, labilisation of supporting points and by increasing the load of weights on the hands and feet. Gradually, all limbs would be fitted with 2.5 kg weights. Implementation of the stimulation under these conditions was physically demanding, but only for the wife of the patient. The patient himself was in a relaxed state and the reflex itself, induced by stimulation, elevated the limbs with weights against gravity. The overall therapy took one year, although significant improvement was achieved after six months. Nevertheless, the stimulation and its intensification continued.

During the year, the patient has slightly reduced his weight. Now, he is fit to work, including carrying heavy loads, which is necessary for his job.

Explanation of the Solution

For patients suffering from chronic spinal problems, in which it is aetiologically apparent that the cause lies in both excessive strain and weight, it is very problematic to find a way of correction through classic therapeutic physical exercises. In cases where the functional disorder has shifted into gradual morphological change manifested in degeneration of intervertebral discs, moreover, with restrictions of root nerves and the spinal cord, the above-mentioned approach is usually hopeless. It can bring short-term relief from pain, but in most cases, it cannot start the process of recurring regeneration. The regeneration in patients with disc herniations is very difficult and it can’t be restricted to strengthening or stretching of specific muscle groups. These targeted active exercises can have the opposite effect because it’s the regulation of the essential “power unit” of the body that’s been impaired.

Muscle chains that provide basic kinetic functions between the pelvis girdle on one side and the ribcage with shoulder girdles on the other are significantly inhibited in their functions in lumbar spine disorders. Their function is to perform the principal locomotion of the human body with the help of coordinated activity of muscle chains. These are sinusoid movements of the pelvis in relation to the chest secured by the coordinated interplay of flection and extension, lateral flection and outer and inner rotation.

In terms of biomechanics, the lumbar spine works as a three-dimensional cardan joint made of five levels. The bearing of these joints, the intervertebral discs, are able to carry a great load, but only provided that the force vectors of the load are in accordance with biomechanical parameters. These parameters need to be physiological.

First, the chronic overload leads to functional impairments and, subsequently, to structural disorders of the very construction of the discs. Clinical experience shows that the only meaningful intervention should involve the system of regulation, particularly, when the patient is obese.

VM2G allows gradual normalisation of the central regulating mechanisms responsible for the physiological coordination of the muscular chains. They are supposed to perform correct, centred and coordinated movements of the pelvis in relation to the chest. Gradual normalisation of this motion could return the deviated force vectors back to the physiological norm. Subsequently, the gradual slow reparative process can take place in the skeleton, specifically in the intervertebral discs, but most probably in the vertebral bodies as well.

In our patient’s case, we placed therapeutic weights on the limbs while facilitating the centring of their force vectors. Clinical experience gained over the previous 10 years has proved that it’s prudent to not finish the therapeutic process in the phase when the pain has subsided. Particularly for patients who proved to have severe morphological changes and who experienced a large occupational or sporting strain on the locomotive apparatus, it is extremely important to proceed with the therapy for much longer. It’s necessary to build sufficient resistance to upcoming physical stress. The experience showed that such an approach is extraordinarily effective and lets the patient tolerate physical stress without risk of recurrence.

View of the Solution of the Problems in Terms of VM2G in a Patient with Chronic Progressive Lumbar Spine Pain

Repeated experiences with patients who suffer from spinal problems have shown that the approach primarily focussed on the normalisation of the regulation of muscle coordination, represents the correct solution. It is effective in acute and chronic pain. The VM2G therapy also has beneficial effects not only in patients with problems caused by functional disorders, but also in patients with clearly demonstrated morphological changes of the spine.

Limitations associated with back pain such as obesity, reduced fitness in the elderly or psychiatric patients and other concurrent diseases don’t represent an obstacle for VM2G therapy. The program of reflex locomotion is capable of solving many restrictions through intrinsic regulation and finding the optimal way to recurrent involvement of muscle coordination.

Therapeutic interventions themselves are successful and usually bring relief from pain very quickly. Sensitive regulation of the stimulation load allows the optimal initial therapeutic condition for “starting” the reflex to be set up. For patients in acute pain, the VM2G can be conducted under lighter conditions to minimise muscle strain and prevent painful irritation as well as to enable the reflex process itself. This leads to involvement of the coordinated activity of muscle chains and subsequently also to waning of painful neural irritation. The attenuation of pain persists even after the stimulation itself.

The gradual increase in intensity through stimulation with tilting of the medical lounge, labilisation of the supporting surfaces and adding weights to all limbs proved to be very useful. Weights on the limbs stimulate force muscle loops responsible for the transition of the forces between the pelvic girdle and the chest.

Thanks to labile supporting surfaces, the regulating system is being forced into intensive centration, particularly in the lumbar spine itself. In our opinion, a sufficient length of the therapy is extremely important, particularly in patients with chronic problems. It’s the only way to ensure not only the cessation of the acute and chronic pains, but also to allow the reparative process in degenerated intervertebral discs to run its course and to ensure smooth locomotion and endurance of the musculoskeletal apparatus against strain.

Results of the VM2G therapy occur at several levels:

• Normalising the autonomic posture of the body at all levels from toes to posture of the head
• Normalising the setting of angles, axes and physiological extents in all joints of the body (influence of autonomic centration)
• Normalising the muscle tone and muscular coordination
• Normalising the autonomic regulation of righting reflexes
• Normalising the autonomic regulation of balancing reflexes
• Normalising the autonomic regulation of joint centration during physical activity without risk of recurrent decentrations, subluxations or blockages
• Normalising the basic stereotypical movements (gait, grip, respiration, swallowing…)
• Normalising the configuration of the body

1. Posture of the arches of the feet, posture of calcanei and toes
2. Axes of the lower limbs, particularly the posture of the knees and hip joints
3. Posture of the pelvis in all axes
4. Posture of the axes of the spine in sagittal and frontal planes
5. Configuration of the ribcage
6. Posture of the shoulder girdles, particularly of the scapulae
7. Axes of the upper limbs, particularly of the hand
8. Posture of the head
9. Posture of mandiblePosition of the eyes and coordination of ocular movements

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The therapy has a demonstrable positive influence on superior neural functions, including the cognitive functions.

• Normalising the palmar and plantar stereognosis
• Normalising the disorders of fine motor skills, writing, painting, playing musical instruments
• Normalising the reading, vocal presentation, singing
• Normalising the manifestations of hyperactivity in children with ADHD
• Normalising physical coordination disorders

VM2G can slow and delay pathological progression of manifestations of senile frailty, including the following:

• Tiredness during common daily activities
• Decreased mobility and restriction of physical activities
• Psychomotor slowing
• Deterioration of the physical condition
• Loss of muscular mass and power
• Instability with subsequent falls
• Uncoordinated motion
• Change in autonomic posture of the body, senile kyphosis of the spine and flexed posture of the limbs

Case Study, The Implementation of VM2G in Elderly Patients

Illustration of the Locomotion Problems in the Elderly

An eighty-four-year-old patient, who came to our office four years ago, had undergone total replacement of the right hip joint. At that time, it had been two years since the operation. The surgery was complicated because of inflammation. The joint had to be removed and repeatedly replaced once the inflammation was treated. This had shortened the limb and remarkably weakened the gluteal muscles. When walking, the patient experienced pain in the hip and the lumbar spine particularly. Due to the shortened limb, she had to use a walking stick.

Previous repeated rehabilitative and spa therapy focussed on active strengthening of the gluteal muscles and passive improvement of motion range in the hip joint hadn’t achieved significant success.

Description of the Problem
(Clinical Findings)

The medical history revealed other chronic diseases, particularly a treated tumour. A complication caused by an inflammation occurred during the hip joint replacement, resulting in the shortening of the limb by almost five centimetres, and significant hypotrophic to atrophic changes of the gluteal musculature. The atrophy of the muscles responsible for lateral stabilisation of the pelvis particularly complicated normal gait mechanism. Other skeletal muscles were in a very good condition. Bone density wasn’t remarkably osteoporotic. Basic stereotypical gait was impaired by incipient pain and the muscle hypothrophy on the whole right side of the pelvis. Gluteal muscles didn’t enable posterior and lateral extension of the lower limb. The gait of the patient was noticeably swaying to the right side. The patient regarded her walking as exhausting, painful and limiting in many activities. She looked for a way to regain her former good shape.

Expert Explanation of the Problem

If a challenging surgical intervention, which causes devastating consequences to large muscle groups, wasn’t followed by adequately sufficient and focused rehabilitation, gradual hypotrophy or atrophy of the involved muscles would appear. This process may spread to adjacent muscles that haven’t been operated on, and the resulting state is far severer, particularly in terms of morphology and function.

The purpose-built links within muscular chains become impaired, which further impairs the regulation of muscle coordination. As result of insufficient and late rehabilitation, the formerly peripheral disorder influences central regulatory mechanisms.

The muscles have been devastated and subsequently become atrophic because of the insufficient stimulation. Consequently, these processes lead to their partial alienation in the CNS. The process of alienation that generally works as a protective mechanism during the phase of posttraumatic reaction should be disconnected again in the reparative phase to let the muscles return to their normal function again.

If the muscles weren’t sufficiently stimulated, the phase of alienation would be prolonged and would have an ominous influence on future muscle function. That’s why it’s important to involve the muscle stimulation as soon as possible. Its omission in elderly patients has more serious consequences than in younger patients as it could become the source of deteriorated locomotion. Subsequently, the impairment of physical condition leads to senile frailty and an increase in the risk of falls with all the harmful consequences.

Illustration of the Solution

The patient tolerated the VM2G therapeutic stimulation very well. Since the patient lives in Great Britain, we agreed on two check-up visits at an outpatient office and consultations via Skype.

Her home therapist was well trained and the course of therapy ran smoothly. Gradual intensification of stimulation was very slow.

Special training clothes with integrated vibrating stimulation balls proved to be a useful aid. Inducing the reflex stimulation was quite simple with its help. The therapeutic dress was also beneficial for the patient in terms of tolerating the therapy.

The gait and stability in standing gradually improved. The overall status didn’t diminish, physical and mental freshness and the working performance remained in good condition. Two years ago, the patient had a break in training for three months because of a change in home therapists. She described her overall condition as beginning to deteriorate. Renewed commencement of the exercise has brought her back to her former condition. Now, the patient has decided to continue the VM2G therapy permanently.

Explanation of the Solution

Implementation of active rehabilitative exercises in elderly patients is complicated. The restriction results from the reduced overall physical condition, often accompanied by several internal diseases and weakening of the cardiovascular system in particular. Among the elderly, physical activity and effort to perform individual exercises is often made more difficult by scant motivation. Therapeutic physical exercises may be accompanied by subsequent general fatigue and aches of muscles and joints. That is why the systematic rehabilitation is problematic in this group of patients.

Experience with rehabilitation shows that classic active movement therapy is not tolerated well among the elderly, and only with great effort. Elderly patients usually come with several polyvalent difficulties, most often muscular pain and rigidity, overall fatigue and hypomobility.

The View of the Therapy of Locomotive Problems in Elderly and the Solution in Terms of VM2G

The available technique of stimulation of the locomotive apparatus with VM2G, during which the patients are in a relaxed state and predominantly for the elderly in the supine position, is usually received very well. VM2G respects the actual mental status and physical exhaustion. Gradual and sensitively increased intensity of the stimulation is well tolerated by the elderly, as it doesn’t induce any negative reactions in terms of fatigue or pain. After stimulation, the patients usually feel relaxed. If they had pain before the stimulation, it would usually diminish or even cease afterwards. This could be explained by improvement in the autonomic regulation of the posture of the body and the normalising of the stereotypical gait and breathing thanks to VM2G therapy, which are usually impaired in the elderly. This naturally influences several other bodily functions – improvement of venous return from the lower limbs, resolution of the swellings of the lower limbs, facilitation of the activity of the right side of the heart, general improvement in action of the cardiopulmonary system, oxygenation and thus brain function, improvement in the function of the digestive apparatus etc.

In terms of VM2G physiotherapy, there is no contraindication in exhaustion of the patients with chronic pain or in patients in subacute state. These conditions are often accompanied by a depressive mood. Patients with psychiatric disorders are difficult to persuade into active physical activity. Our experience shows that the available form of VM2G therapy is well accepted under these circumstances and the patients perceive improvement in their mental state after therapy. It seems that the Vojta method of the 2nd generation could positively involve the treatment of the elderly in a significant way.

VM2G can have the following impact on the lives of seniors:

• Tiredness during common daily activities
• Decreased mobility and restriction of physical activities
• Impairment of basic stereotypical movements (gait, grip, breathing, swallowing)
• Psychomotor slowing
• Deterioration of physical condition
• Loss of muscular mass and power
• Decreasing tolerance of physical exertion
• Instability with subsequent falls
• Uncoordinated motion
• Change in autonomic posture of the body
• Sensory and especially sensorimotor deficits
• Chronic pain

VM2G – Basic Prerequisites for Performing the Therapy

Basic knowledge of developmental kinesiology

• Physiological
• Pathological

Basic knowledge of positions of reflexive stimulation

• Reflexive turning 1
• Reflexive turning 2
• Reflexive belly-crawling
• Reflexive crawling on all fours

Other knowledge

• Movement interplay enabling the transition from one position of the body to another
• Basic knowledge of the righting mechanisms
• Knowledge of the system of stimulation zones and their utilisation
• Combinations of stimulation zones (spatial summation)
• Induced by vectors of movement of the limbs and the torso

Broadening and superstructural possibilities of VM2G

• System of inhibition of the induced movement

1. Counter-movement with rubber straps
2. Restraints

• Stimulation by balance technique, Aktiva disc, inflatable balls…

1. Stimulation by changing the position of the body by tilting the medical lounge, in longitudinal and transversal axis
2. Stimulation by shifting the centre of gravity of the limbs with the weight
3. Auxiliary techniques, support of limbs, antalgic positions