Vojta therapy improves postural control in very early stroke rehabilitation: a randomised controlled pilot trial

Abstract

Background: It 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).

Methods: This 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]).

Results: Forty 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).

Conclusion: This 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 registration: ClinicalTrials.gov; Unique identifier: NCT03035968. Registered 30 January 2017 - Retrospectively registered; http://www.clinicaltrials.gov.

Keywords: Acute stroke; Physiotherapy; Postural control; Rehabilitation; Stroke recovery; Vojta therapy.

Conflict of interest statement

Competing interestsBM received a speaker honoraria from the International Vojta Society (IVS) The other authors declare that they have no competing interests.

© The Author(s) 2020.

Figures

Fig. 1

Consort diagram on trial flow. MRCS = medical research council scale for muscle strength; mRS = modified Rankin Scale

Fig. 2

Difference in Trunc control test (TCT) scores between baseline and day 9. The median improvement in the TCT within 9 days (primary outcome) was 25.5 points (=25.5%) (IQR 12.5–42.5) in the Vojta group and 0 (IQR 0–13) in the control group (p = 0.001). Data are presented as box-and-whisker plots, in which the top and bottom of the rectangles indicate the 75th and 25th percentiles, respectively; the horizontal lines within the rectangles indicate the 50th percentile (median); the lines above and below the rectangles indicate the minimum and maximum of all of the data, so far as this are no outlier. Outlier are data lying outside the box > 1,5 lenghts of the box (IQR) and are presented as a small circle

Fig. 3

Difference in Catherine Bergego Scale (CBS) scores between baseline and day 9. The median improvement in the CBS (Neglect test) within 9 days was 2 points (=33.3%) (IQR 1–2) in the Vojta group and 1 point (=16.6%) (IQR 0–2) in the control group (p = 0.054). Data are presented as box-and-whisker plots

Fig. 4

Difference in motor evaluation scale for upper extremity in stroke patients (MESUPES) scale scores between baseline and day 9. The median improvement in the MESUPES within 9 days was 4 points (=20%) (IQR 1.5–6) in the Vojta group and 2 points (=10%) (IQR 0–5) in the control group (p = 0.006). Data are presented as box-and-whisker plots

Fig. 5

Difference in National Institutes of Health Stroke Scale (NIHSS) scores between baseline and day 9. The median improvement in the NIHSS within 9 days was 4 points (=9.5%) (IQR2.5–5.5) in the Vojta group and 2 points (= 4.8%) (IQR 0–4) in the control group (p = 0.022). Data are presented as box-and-whisker plots