Exercises are designed for parents who went through education of the vojta method from professional physiotherapist and they want to relearn the technique in order to avoid mistakes during the exercise. We will present how to activate movement patterns with activation position and activation trigger points.
- A) Activation position
- Activating position is given exactly by the position, which is necessary to hold through the whole time of the activation.
- B) triggering zone
- Triggering zone is a place on the human body, which during irritation in specific direction evokes the same reaction.
Main triggering zones - laying on the extremities (on the bony protrusions)
Secondary triggering zones - laying on the shoulder and pelvic girdles
The exercising person keeps these zones under pressure in a described direction during the time of reaction:
- Children up to 8 months max. 5 minutes.
- Children older 8 months max. 15 minutes.
For a correct irritation of the CNS (central nervous system) and enhancement of the exercises, it is necessary to perform the activation several times a day (4 - 5x).
Exercise is performed in two basic positions:
Global coordination models are performed in two varying patterns:
- Reflexive crawling (RP)
- Reflexive turning (RO)
Its main goal is:
- Activation of the mechanisms needed for s support, grip, straight posture and walking
- Activation of the breathing and abdominal muscles, muscles of the pelvic floor, sphincters of the urinary bladder and rectum
- Activation of the swallowing functions and chewing muscles
- Activation of the extraocular muscles
- Position on the abdomen
- The head is slightly turned on one side by 30 degrees and resting against the forehead
- Upper extremities (child is looking at its own hand) is in the shoulder joint in a flexion, 120 - 135 degrees, in abduction, the elbow is in flexion (the elbow is in the level of the nose), supporting arm is resting against the mat.
- The second upper extremity is placed alongside the body in a neutral position.
- The leg is in the hip joint flexed up to 30 - 40 degrees, abducted to 30 degrees, and slightly bending in the knee joint to 40 degrees.
- The second leg is resting freely (by adults). Children keep the leg slightly abducted, flexed, with outer rotation in the hip joint, slight flexion in the knee joint.
Trigger points are:
- A) Zones of the arm and direction of the stimulating pressure:
- Inner elbow (medial epicondyle) - direction of the pressure in going towards the shoulder joint.
- Inner (medial) edge of the shoulder blade - interface between the lower and middle third - direction of the pressure is going towards the elbow.
- B) Zones of the second arm
- Acromion - direction of the pressure is going towards thewards the 4th thoracic vertebra.
- Radial styloid process - direction of the pressure is going towards the elbow.
- C) Zones of the leg
- Inner part of the knee joint (medial condyle of the femur) - direction of the pressure is going towards the hip joint.
- Anterior superior iliac spine - directon of the pressure is going towards the hip joint.
- D) Zones of the second leg
- Calcaneal tuberosity - the direction of the pressure is going towards the knee.
- Interface of the gluteus minimus and gluteus maximus muscles - direction of the pressure is going towards the knee joint.
Exercising is starting with the arms.
During the pressure on the trigger zone, was noted above, it leads to the clenched muscle groups, especially in the muscles of the shoulder girdle. The child has in this phase a tendency to stand up by using elbows joints, bring the abdomen asymmetrically towards one arm forward and up. The elbow becomes a supporting point of the whole movement pattern. This movement is resisted by physiotherapist due to the needed isometric contraction. The hand develops the grasping motion.
Pressing the trigger zones on the leg, leads to its activation. Supporting point is in this case a knee joint. Pelvic girdle is pulled towards the hip joint as well as being lifted up from the mat.
The second arm is during the movement forwards in the reflexive crawling. The movement of the arm is recognized as a flexion phase. The movement of the arm is connected to the activity of the axial organ as well as to the supportive function of the arm itself.
The opposite leg takes over the supportive function.
The model of reflexive turning is based on the position lying on the back, and turning to the side and all the way to the stomach. The goal of this movement is moving on all fours.
- I. Position A - 1. Reflexive phase: turning from asymmetric position on the back to a symmetrical position on the back
- Default position for this movement a position lying on the back.
- According to the position of the head we categorize the extremities, similarly as by reflexive crawling.
- Upper and lower extremities are freely resting on the mat.
- For reflexive turning we use trigger zones in the center of the thorax, more precisely in the area of the mamilar line, between 5th and 9th rib - ideally between 6th and 7th. The pressure is directed upwards, inside and back, towards the scapula. It forces the body, more specifically trunk and spine into a central position. The pelvis is being tilted into neutral position. The first phase is finished by activity, which changes the asymmetric position on the back to a symmetric position on the back, due to changed center of the gravity.
- If we don’t reach the symmetric position on the back, the further reflexive rotation will be pathological.
- II. Position B - reflexive turning - 2. phase
- Default position for this phase is position on the side.
- The head is extended from the body.
- There is a 90 degree angle between the exercising person and mat, support is secured by resting against the humeral bone and hip bone.
- The upper leg is in flexion against the thorax.
- The second leg is placed on the side (laterally) of the thorax.
- Legs are in flexion in the knee joint, and hip joint is in adduction.
- In the second phase of the reflexive turning, we use activation zones as a reflexive crawling - most commonly on the edge of the scapula and anterior superior iliac spine.
Resistance can lead to a specific zone where it results in isometric contraction. Resistance is applied against transfer of the center of the gravity, the burdening remains on the shoulder and hip joint, therefore there is no need to rest the arm against the knee. There is however massive contraction involved on the supporting extremity (rotation of the forearm) and stretching the arm out with flexion in the wrist (extension - bending of the wrist outwardly) as a preparation for future walking on all fours.
Reactions, which we expect during the 1. phase of the reflexive turning:
- Straightening the spine
- Lifting up legs from the mat
- Holding the legs in this position against the gravitation without resting
- Preparing the arms for future supportive function
- Movement of the eyes to the side
- Deeper breathing
- Coordinated activation of the abdominal muscles
Reactions, which we expect during the 2. phase of the reflexive turning:
- Upper and lower extremities on the lower side are stretching, the opposite extremities are bending - the supportive function of the shoulders is getting stronger, and supportive function of the leg is going through pelvis, thigh and knee
- Straightening of the spine during the turning process
- Holding the head in a position on the side, against the gravity
Author: FYZIOklinika physiotherapy Ltd., Prague, Czech Republic