Our study covers four clinical cases of preterm children (twin pregnancy) who have been treated only by Vojta therapy.
\nThis study aimed to investigate the improvement of the motor function and to maintain the normal physiologic aspects of the
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A preterm child is any child whose weight, at birth, is equal to or less than 2500 g, while, according to other opinions, it is the newborn with the gestational age under 37 weeks old. (6)<\/p>\n
Taking into consideration both the weight at birth and the gestational age, the preterm infants are (6):<\/p>\n
\u2014 true preterm: infants whose weight at birth is in agreement with their gestational age (less than 2500g, gestational age under 37 weeks);<\/p>\n
\u2014 dismature or with intrauterine growth restriction, having a weight at birth under 2500g which is not in agreement with the gestational age;<\/p>\n
\u2014 premature, having a weight at birth higher than 2500 g, but with the gestational age under 37 weeks old (infants whose mothers suff er from diabetes).<\/p>\n
According to their weight at birth, the premature infants may be divided into: (6)<\/p>\n
\u2014 I degree premature, with weight 2000-2500 g;<\/p>\n
\u2014 II degree premature with weight 1500-2000 g;<\/p>\n
\u2014 III degree premature with weight 1000-1500 g;<\/p>\n
\u2014 IV degree premature with weight under 1000 g.<\/p>\n
The premature newborn infant raises a series of problems in connection to its diffi culty in adapting to the extra uterine life secondary to the immaturity of diff erent organs. Th e premature babies have predominantly respiratory clinical manifestations but the lesion substrate is preponderantly cerebral.<\/p>\n
THE PREMATURE NEWBORN (3)<\/h2>\n
At birth, the premature infant’s state of health depends on numerous factors such as:<\/p>\n
\u2014 the gestational age at the moment of birth,<\/p>\n
\u2014 the weight at birth,<\/p>\n
\u2014 mother’s diseases or treatments she received during pregnancy which might have affected the foetus,<\/p>\n
\u2014 the newborn infant’s congenital deficiencies.<\/p>\n
DISORDERS OF THE NEWBORN INFANT (6)<\/h2>\n
Many newborn infants are energetic and surprise everybody with their spectacular rehabilitation. Still, they are vulnerable to infections and to diff erent complications connected to the incomplete development of certain organs. A continuous progress in the evolution of the infant might be possible for some days, followed by periods of relapse.<\/p>\n
Any infant born before the term (before 37 gestation weeks) may have an increased risk of developing ulterior medical complications:<\/p>\n
\u2014 the infants born at 32 weeks or more have the lest probable risk of developing complications;<\/p>\n
\u2014 any subtracted week increases the complication risk dramatically;<\/p>\n
\u2014 the newborn at 22 \u2013 26 weeks have a minimum development and a very high risk of mortality or of severe defi ciencies. It might be probable that parents should face diffi cult medical decisions in favour of life or death.<\/p>\n
SEVERE DEVELOPMENT RETARDATION AND IMPAIRMENT (1, 6)<\/h2>\n
The majority of premature infants do not suff er severe retardation in their development or have any impairment. Generally, the younger a newborn, with a higher degree of prematurity or disease, the higher the risk for him to have a delay in development or impairments. If the infant had III- IV degree of prematurity (i.e. was born before 26 gestation weeks), or it was very small (weighing less than 800g) he has a very high risk of developing severe problems. Among these problems, the most frequent are:<\/p>\n
\u2014 mental retardation 14<\/p>\n
\u2014 brain haemorrhage 8-12%<\/p>\n
\u2014 blindness 8%<\/p>\n
\u2014 deafness 3%.<\/p>\n
The newborn weighing 1500 \u2013 2500g might have diff erences of the intelligence quotient as compared to an infant born on term, but they are small. The newborn infants who weigh over 2500g have a very small risk to develop a delay in their development. Those children who display signs of development retardation are likely to improve their state in a welcoming family background and through attentive care.<\/p>\n
Early stimulation of the newborn \u2013 a necessity (2)<\/strong><\/p>\n The newborn infant who is kept in an incubator might be considered a child with risk concerning biological and psychological development; it must benefi t from an early intervention on the part of parents and kinesiotherapist. Lately, in the west of Europe, parents themselves are encouraged to take care of their infant for a few hours a day. Th e infant is laid on his mother’s or father’s chest, as soon as the state of the child allows it. Th us, the infant perceives normal, human tactile stimuli. Th e vestibular and proprioceptive systems benefi t from these stimulations, the child being likely to recognise his mother’s heartbeats (De Groot).<\/p>\n Numerous premature infants raise various problems for the young parents: posture regulation anomalies, anomalies of the wake \u2013 sleep rhythm, a lot of crying. Certainly, any intervention should be individualised, adapted to the specifi c needs of each child (Berard).<\/p>\n In the intrauterine period, the foetus moves in the amniotic liquid, its tactile system being precociously stimulated by contacts with the uterus walls. Towards the end of gestation, the surrounding space becomes smaller, the tactile perceptions are different and the proprioceptive stimuli are numerous. Th echild reacts to auditive stimuli like mother’s cardiac noises, mother’s voice, and bowels noises. Anyway, in the uterus, the stimulation system allows the foetus to benefi t from tactile-kinaesthetic experiences adapted to the maturity of its nervous system at that particular time (Gosselin).<\/p>\n After birth, the premature infant is assisted in the incubator, eventually under intensive care and this means pain, intensive light and noise. Concerning pain, its perception has been found out using EKG modifi ed for a premature infant smaller than 30 weeks; thus, an accelerated heart rhythm, increased blood pressure, and palm sweating were signs infant pain (Escobark).<\/p>\n After the period of intensive care, it is necessary to encourage the parents’ relationship with their child, advising them in matters of child posture during feeding, of bathing and of placing it in a crib, on a soft mattress, possibly on a sheepskin, which is recommended for a better tactile integration. Sometimes it is advisable to place the infant in a hammock when hypotonia is present and prolonged or when in extension appears (De Groot).<\/p>\n Once the premature infant arrives at home, the parents need to be supported further with advice concerning the diet, positioning, stimulation, especially if the infant displays an exaggerated extension of the cervical area, retracted shoulders with hypertonia tendency.<\/p>\n During this period, the intervention of a kinesiotherapist specialised in the treatment of newborn infants is imperiously necessary. This person should be well trained, with and up to date knowledge in child neuro-motor development and the neurologic methods of rehabilitation.<\/p>\n Of course, ideally, the therapy sessions would take place at the child’s home (something that in our country is not stipulated by the law), but, anyway, the physical treatment is imperiously necessary. In our country, there is also an insuffi cient number of specially trained personnel in child kinetic therapy. Unfortunately, the medical universities off er neither serious practice in this fi eld, nor a theoretical basis. Nevertheless, the responsibility is huge since an abusive or wrong intervention might have disastrous consequences on the ulterior development of the child.<\/p>\n The early diagnosis (Prof. Dr. V\u00e1clav Vojta) has 3 components (11,12):<\/strong><\/p>\n A. Analysis of spontaneous motor function (postural ontogenesis) (11, 12)<\/strong><\/p>\n \u2014 we mean the infant’s postural ontogenesis which depends on:<\/p>\n \u2014 each individual’s development,<\/p>\n \u2014 genetic determination,<\/p>\n \u2014 has a specific sequence,<\/p>\n \u2014 is obtained without a special training,<\/p>\n \u2014 is obtained automatically.<\/p>\n B. Automatic postural reactivity\u00a0<\/strong>(posture reactions) (1, 12)<\/p>\n 1. Traction Response\u00a0<\/strong><\/p>\n \u2014\u00a0execution:\u00a0<\/strong>The infant is in dorsal decubitus; the therapist takes him by the wrist (above the backhand) and draws him slowly until the trunk reaches a 45\u00b0 position.<\/p>\n \u2014\u00a0assessment of:<\/strong>\u00a0Position of head and inferior limbs (at hip and knee level).<\/p>\n \u2014\u00a0normal reactions: – In newborn infants (n.i.)<\/strong>\u00a0the head lags behind (falls back), the inferior limbs (IL) are flexed and abducted, heels inert on the ground;<\/p>\n \u2014\u00a0After 3 months,<\/strong>\u00a0the head is in line with the spine, IL adjust in active fl exion; 3rd trimester head in anterior fl exion, IL fl exed, plantar grasping reflex;<\/p>\n \u2014 since\u00a03rd trimester<\/strong>\u00a0on IL start to extend, in slight abduction and exterior rotation, feet in pronation and dorsal fl exion (Figure 1 \u2013 Traction response in a premature newborn, chronologic age \u2013 3 months; corrected age \u2013 2 months)<\/strong><\/p>\n <\/p>\n Fig. 1.<\/strong>\u00a0Traction response in a premature newborn<\/p>\n \u2014 chronologic age \u2013 3 months<\/p>\n \u2014 corrected age \u2013 2 months<\/p>\n 2. Landau Reaction<\/strong><\/p>\n \u2014\u00a0execution:\u00a0<\/strong>The infant is held prone under the stomach upon the fl attened hand of the examiner, strictly in the horizontal plane.<\/p>\n \u2014\u00a0assessment of:<\/strong>\u00a0Position of head, trunk and limbs<\/p>\n \u2014\u00a0normal reactions:<\/strong>\u00a0In the first 6 weeks attempts to raise the head, the trunk hangs on the palm, IL hang inertly.<\/p>\n \u2014\u00a0At 3 months<\/strong>, the head is in line with the spine, IL in semifl exion;<\/p>\n \u2014\u00a0At 6 months<\/strong>, the thoracic lumbar and lombo sacral extension increases, the back is straight, the tights are at 90\u00b0 with respect to the abdomen, the shins at 90\u00b0 with respect to the tights, superior limbs (SL) begin to extend.<\/p>\n \u2014\u00a03rd & 4th trimesters\u00a0<\/strong>head in line with the spine, SL oriented as for the parachute refl ex, tights at 90\u00b0, knees extended, IL have a tendency to support the body when placed on a fi rm surface, SM with the elbow in semifl exion. (fig. 2.<\/strong>\u00a0Landau Reaction in a premature newborn \u2013 chronologic age \u2013 3 months; corrected age \u2013 2 months).<\/p>\n <\/p>\n Fig. 2.\u00a0<\/strong>Landau Reaction in a premature newborn<\/p>\n \u2014 chronologic age \u2013 3 months<\/p>\n \u2014 corrected age \u2013 2 months<\/p>\n 3. Axillary (Vertical) Suspension Reaction<\/strong><\/p>\n \u2014\u00a0execution:<\/strong>\u00a0The infant is held at trunk level, with his back to the examiner.<\/p>\n \u2014\u00a0assessment of:<\/strong>\u00a0Position of IL<\/p>\n \u2014\u00a0normal reactions: In n.i.\u00a0<\/strong>there is a slight flexion of IL<\/p>\n \u2014\u00a01st trimester\u00a0<\/strong>\u2013 active IL fl exion of<\/p>\n \u2014\u00a03rd trimester<\/strong>\u00a0\u2013 starts IL extension<\/p>\n \u2014\u00a04th trimester<\/strong>\u00a0\u2013 IL extension- positive support reaction\u00a0(Figure 3 \u2013 Axillary (Vertical) Suspension Reaction in a premature newborn, chronologic age \u2013 3 months; corrected age \u2013 2 months)<\/strong><\/p>\n Fig. 3.\u00a0<\/strong>Axillary (Vertical) Suspension Reaction in a premature newborn<\/p>\n \u2014 chronologic age \u2013 3 months<\/p>\n \u2014 corrected age \u2013 2 months<\/p>\n 4. Vojta Rolling Over (Turning) Reflex<\/strong><\/p>\n \u2014\u00a0execution:\u00a0<\/strong>The infant is held at thoracic level, his back to the examiner, then he is suddenly oriented in a horizontal position to the right side, is kept on a flat surface in ventral decubitus for 2-3 seconds, then he is lifted and positioned on the left side.<\/p>\n \u2014\u00a0assessment of:<\/strong>\u00a0Position SL situated cranially; position of IL situated cranially; position of the trunk<\/p>\n \u2014\u00a0normal reactions: In n.i.<\/strong>\u00a0Moro refl ex takes place, IL in triple fl exion.<\/p>\n \u2014\u00a0After 4 months<\/strong>, More refl ex disappears<\/p>\n \u2014\u00a0in the 2nd trimester<\/strong>, there is an active fl exion of the IL<\/p>\n \u2014\u00a03rd & 4th trimesters<\/strong>\u00a0cranial IL is abducted, cranial SL is extended.\u00a0(Figure 4 \u2013 Vojta Rolling Over (Turning) Refl ex in a premature newborn, chronologic age \u2013 3 months; corrected age \u2013 2 months)<\/strong><\/p>\n Fig. 4.<\/strong>\u00a0Vojta Lateral Rolling Over (Turning) Reflex<\/p>\n \u2014 chronologic age \u2013 3 months<\/p>\n \u2014 corrected age \u2013 2 months<\/p>\n 5. Collis Horizontal Reaction<\/strong><\/p>\n \u2014\u00a0execution:\u00a0<\/strong>The infant is placed on a fl at surface in lateral decubitus, his back to the examiner who takes the infant’s cranial arm and tight, while the other arm, hand and inferior limb are free<\/p>\n \u2014\u00a0assessment of:\u00a0<\/strong>Position of free arm, hand inferior limb<\/p>\n \u2014\u00a0normal reactions: – In n.i.<\/strong>\u00a0SL adjusts as in Moro refl ex, with the hand opened; initially, IL extends, then it flexes.<\/p>\n \u2014\u00a0Until the end of 1st trimester<\/strong>, it is the typical fl exion phase.<\/p>\n \u2014\u00a0Since 4th month<\/strong>, the hand is in pronated position.<\/p>\n \u2014\u00a0At 6 months<\/strong>, the hand tends to fi nd support on the fl at surface, IL in fl exed.<\/p>\n \u2014\u00a0Since 9th month on<\/strong>\u00a0\u2013 Plantar support on the fl at surface Fig. 5.\u00a0<\/strong>Collis Horizontal Reaction in a premature newborn<\/p>\n \u2014 chronologic age \u2013 3 months<\/p>\n \u2014 corrected age \u2013 2 months<\/p>\n 6. Collis Vertical Reaction<\/strong><\/p>\n \u2014 execution: Th e infant is in dorsal decubitus. The examiner takes one of the infant’s tights and suspends him in a vertical position.<\/p>\n \u2014 assessment of: Position of free IL<\/p>\n \u2014 normal reactions: 0-6 months: after a short extension, IL comes to a triple flexion.<\/p>\n \u2014 Starting with the 7th month, the knee will extend more and more while the tight will remain at 90\u00b0 with respect to the abdomen. (Figure 6 \u2013 Collis Vertical Reaction in a premature newborn, chronologic age \u2013 3 months; corrected age \u2013 2 months).<\/p>\n Fig. 6.\u00a0<\/strong>Collis Vertical Reaction in a premature newborn<\/p>\n \u2014 chronologic age \u2013 3 months<\/p>\n \u2014 corrected age \u2013 2 months<\/p>\n 7. Peiper-Ispert Reaction<\/strong><\/p>\n \u2014\u00a0execution:\u00a0<\/strong>The examiner fastens her hands around the infant’s upper tights. The child is then lifted quickly but smoothly until the head lies vertically down.<\/p>\n \u2014\u00a0assessment of:<\/strong>\u00a0Position of shoulders, arms and hands<\/p>\n \u2014\u00a0normal reactions: – In n.i., for a short period<\/strong>, there is a tendency to extend the neck and the Moro refl ex.<\/p>\n \u2014\u00a06 weeks – 3 months<\/strong>, abduction of SL and extension of cervical spine and dorsal sup.<\/p>\n \u2014\u00a03 \u2013 7 months<\/strong>, the whole spine extends, SL take the position of the parachute (startle) refl ex<\/p>\n \u2014\u00a04th trimester<\/strong>\u00a0\u2013 the reaction is no longer convincing, because the child grasps the examiner with his hands\u00a0(Figure 7 \u2013 Peiper-Ispert Reaction in a premature newborn, chronologic age \u2013 3 months; corrected age \u2013 2 months).<\/strong><\/p>\n Fig. 7.<\/strong>\u00a0Peiper-Ispert Reaction in a premature newborn<\/p>\n \u2014 chronologic age \u2013 3 months<\/p>\n \u2014 corrected age \u2013 2 months<\/p>\n 1 \u2013 3 abnormal posture reactions =\u00a0Slight central coordination disorder (CCD) \u2013 control after 6 weeks<\/strong><\/p>\n 4 \u2013 5 abnormal posture reactions =\u00a0Slight central coordination disorder (CCD) \u2013 control after 4 weeks, then the therapy starts\u00a0<\/strong><\/p>\n 6 \u2013 7 abnormal posture reactions =\u00a0Medium central coordination disorder (CCD) \u2013 immediate therapy<\/strong><\/p>\n 7 abnormal posture reactions with severe disorders of muscle tone =\u00a0Severe central coordination disorder (severe CCD) \u2013 immediate therapy\u00a0<\/strong><\/p>\n The central coordination disorder (CCD) describes a momentary state if the coordinating capacity.<\/strong><\/p>\n <\/p>\n C. The dynamics of primitive reflexes (11, 12)<\/strong><\/p>\n One may speak of cerebral palsy only\u00a0after 7 months<\/strong>\u00a0on,<\/p>\n \u2014 If 6 of the posture reactions are abnormal, there is no longer CCD, but a diagnostic may be established since we enter the sphere of\u00a0neurologic pathology<\/strong>.<\/p>\n \u2014 starting with\u00a0the 2nd trimester<\/strong>, if the extension reaction + calcaneal reflex + tonic reflexes (Suprapubian, Crossed Extension) persist =\u00a0spasticity<\/strong>,<\/p>\n \u2014 if Plantar Grasp, Galant’s Refl ex, Stepping Refl ex, Asymmetrical tonic neck refl ex (ATNR), persist =\u00a0diskinezia (Table 1).<\/strong><\/p>\n Birth information \u2013 Date of birth \u2013 27.07.2009<\/p>\n \u2014 Pregnancy period \u2013 30 weeks<\/p>\n \u2014 Labour interval \u2013 10 hours (fi rstly born)<\/p>\n \u2014 Weight at birth \u2013 1600g<\/p>\n \u2014 Type of birth \u2013 natural<\/p>\n \u2014 APGAR score \u2013 3, then 5<\/p>\n \u2014 Observations \u2013 1 month in incubator<\/p>\n A. Neurologic examination at the age of 3 months old \u2013 chronologic age, Corrected age \u2013 2 weeks\u00a0<\/strong><\/p>\n \u2014 FA = 4\/3<\/p>\n \u2014 head bent to the right side<\/p>\n \u2014 PC \u2013 35,5 cm.<\/p>\n \u2014 redressing reaction is absent<\/p>\n \u2014 Bone-Tendon Reflexes are lively with some clonuses on Achilles’ Refl ex<\/p>\n \u2014 Posture reactions with a neonatal aspect,<\/p>\n \u2014 ATNR,<\/p>\n \u2014 Moro,<\/p>\n \u2014 Grasping ++,<\/p>\n \u2014 Sub-axillary suspension reaction is absent,<\/p>\n \u2014 the infant remains slightly crouched without an anti-gravitation reaction,<\/p>\n \u2014 Grenier reaction absent,<\/p>\n \u2014 the infant keeps his fists clenched, the thumb is palmar adducted,<\/p>\n \u2014 when oriented in lateral decubitus, infant displays the extension of the cervical spine<\/p>\n \u2014 in lateral suspension he does not abduct the tights,<\/p>\n \u2014 at traction, the head is blatant,<\/p>\n \u2014 the stepping reflex is absent, astasia<\/p>\n \u2014 Galant reaction is only incipient.<\/p>\n The infant starts Vojta therapy \u2013 4 sessions a day.<\/p>\n B. Neurologic examination at the age of 4 1\/2 months old \u2013 chronologic age, Corrected age \u2013 2 months<\/strong><\/p>\n \u2014 PC \u2013 38,5 cm.<\/p>\n \u2014 FA = 3\/3<\/p>\n \u2014 Bone-Tendon Refl exes are lively<\/p>\n \u2014 redressing reaction is absent,<\/p>\n \u2014 at traction, the head is no longer blatant, but lags behind,<\/p>\n \u2014 in ventral decubitus, the head is in Gesell I-II zone,<\/p>\n \u2014 does not keep the doll’s posture,<\/p>\n \u2014 Moro + (slightly asymmetrical, the right IL remains half fl exed at moment 1),<\/p>\n \u2014 Grasping + palmar and plantar<\/p>\n \u2014 Sub-axillary suspension reaction is possible, astasia<\/p>\n \u2014 opens the fists better,<\/p>\n \u2014 follows moving objects,<\/p>\n \u2014 smiles.<\/p>\n The infant continues Vojta therapy \u2013 4 sessions a day.<\/p>\n Table 1.<\/strong>\u00a0Th e dynamics of primitive refl exes<\/p>\n C. Neurologic examination at the age of 7 months old \u2013 chronologic age<\/strong><\/p>\n Corrected age \u2013 4 1\/2 months\u00a0<\/strong><\/p>\n \u2014 PC \u2013 40 cm.<\/p>\n \u2014 FA = 2\/3<\/p>\n \u2014 Bone-Tendon Refl exes lively<\/p>\n \u2014 redressing reaction is absent,<\/p>\n \u2014 at traction, the head is in line with the trunk’s axis,<\/p>\n \u2014 in ventral decubitus, the head is in Gesell II-III zone,<\/p>\n \u2014 doll’s posture is present, with fi ngers still half flexed,<\/p>\n \u2014 only rarely throws himself in opisthotonus,<\/p>\n \u2014 Vojta reaction \u2013 starts to abduct the tight,<\/p>\n \u2014 Collis horizontal reaction \u2013 corresponding to 1st trimester<\/p>\n \u2014 in all manipulations, there is a slight contracture in fl exion of the left SL (in Moro Refl ex, he extends only the right SL),<\/p>\n \u2014 keeps himself up in sub-axillary suspension,<\/p>\n \u2014 in crouched position, supports his weight,<\/p>\n \u2014 no anti-gravitation reaction,<\/p>\n \u2014 stretches hands for toys, catches and transfers them,<\/p>\n \u2014 fixes with the sight<\/p>\n \u2014 follows moving objects,<\/p>\n \u2014 smiles socially,<\/p>\n \u2014 motor age \u2013 4 months.<\/p>\n The infant continues Vojta therapy \u2013 4 sessions a day.<\/p>\n Fig. 8.<\/strong>\u00a0Vojta simulation in a premature child<\/p>\n \u2014 Phase II reflex roll over \u2013 chronologic age \u2013 7 months<\/p>\n Corrected age – 4 \u00bd months<\/strong><\/p>\n Fig. 9.<\/strong>\u00a0Vojta simulation in a premature child<\/p>\n \u2014 Phase I reflex roll over \u2013 chronologic age \u2013 7 months,\u00a0Corrected age – 4 \u00bd months<\/strong><\/p>\n Fig. 10.<\/strong>\u00a0Analysis of a premature child<\/p>\n \u2014 After therapy \u2013 dorsal decubitus position<\/p>\n \u2014 chronologic age \u2013 7 months,\u00a0Corrected age \u2013 4 \u00bd months<\/strong><\/p>\n <\/p>\n D. Neurologic examination at the age of 9 months old \u2013 chronologic age\u00a0<\/strong><\/p>\n Corrected age \u2013 6 1\/2 months<\/p>\n \u2014 PC \u2013 43 cm.<\/p>\n \u2014 FA = 2\/3<\/p>\n \u2014 Head control \u2013 Gesell III<\/p>\n \u2014 in doll’s posture does not extend the elbows, yet,<\/p>\n \u2014 he is propping on palm roots,<\/p>\n \u2014 in Vojta reaction \u2013abducts the tight,<\/p>\n \u2014 Collis horizontal reaction \u2013 corresponding to the respective age,<\/p>\n \u2014 in sub-axillary suspension \u2013 physiologic astasia,<\/p>\n \u2014 in crouched position, still no anti-gravitation reaction,<\/p>\n \u2014 slight tricipital hypertonia, a little more pronounced on the right side,<\/p>\n \u2014 reaches for toys, catches them,<\/p>\n \u2014 psychic development: very good,<\/p>\n \u2014 if positioned, sits down in imperfect balance,<\/p>\n \u2014 rolls over,<\/p>\n \u2014 brings feet to his mouth,<\/p>\n \u2014 sketches the parachute,<\/p>\n \u2014 begins to articulate monosyllables,<\/p>\n \u2014 motor age \u2013 7 months.<\/p>\n The infant continues Vojta therapy \u2013 4 sessions a day.<\/p>\n Fig. 11.\u00a0<\/strong>Vojta simulation in a premature child<\/p>\n \u2014 chronologic age \u2013 9 months<\/p>\n \u2014\u00a0Corrected age – 6 \u00bd months<\/strong><\/p>\n Fig. 12.\u00a0<\/strong>Vojta simulation in a premature child<\/p>\n Phase III reflex roll over \u2013 chronologic age \u2013 9 months, Corrected age – 6 \u00bd months<\/p>\n Fig. 13.<\/strong>\u00a0Vojta simulation in a premature child<\/p>\n \u2014 First position \u2013 chronologic age \u2013 9 months<\/p>\n \u2014 Corrected age \u2013 6 \u00bd months<\/strong><\/p>\n Birth information \u2013 Date of birth \u2013 27.07.2009<\/p>\n \u2014 Pregnancy period \u2013 30 weeks<\/p>\n \u2014 Labour interval \u2013 10 hours ( secondly born)<\/p>\n \u2014 Weight at birth \u2013 900 g<\/p>\n \u2014 Aspect \u2013 Cranian<\/p>\n \u2014 Type of birth \u2013 natural<\/p>\n \u2014 APGAR score \u2013 1, then 3<\/p>\n \u2014 Observations \u2013 1 month in incubator<\/p>\n A. Neurologic examination at the age of 3 months old \u2013 chronologic age, Corrected age \u2013 2 weeks\u00a0<\/strong><\/p>\n \u2014 PC =35,5 cm.<\/p>\n \u2014 FA = 4\/3<\/p>\n \u2014 deshicence of stright muscles of the abdomen,<\/p>\n \u2014 lively child, follows objects with the eyes, fixes, sketches smile,<\/p>\n \u2014 head-neck bent to the left side,<\/p>\n \u2014 left dorso-lombar scoliotic curvature,<\/p>\n \u2014 axial hypotonia,<\/p>\n \u2014 Galant reaction is slightly sketched,<\/p>\n \u2014 redressing reaction is absent<\/p>\n \u2014 stepping reflex absent,<\/p>\n \u2014 ATNR,<\/p>\n \u2014 Grasping +,<\/p>\n \u2014 Grenier reaction absent,<\/p>\n \u2014 at traction, the head is in lags behind,<\/p>\n \u2014 in lateral suspension, does not abduct the tight,<\/p>\n \u2014 in ventral decubitus, head in Gesell zone I,<\/p>\n \u2014 in sub-axillary suspension does not keep up,<\/p>\n \u2014 posture reactions with a neonatal aspect,<\/p>\n \u2014 spontaneous motility within loose normal limits.<\/p>\n The infant starts Vojta therapy \u2013 4 sessions a day.<\/p>\n B. Neurologic examination at the age of 4 1\/2 months old \u2013 chronologic age, Corrected age \u2013 2 months\u00a0<\/strong><\/p>\n \u2014 PC \u2013 37,7 cm.<\/p>\n \u2014 FA = 2\/3<\/p>\n \u2014 Moro + (sometimes the right SL is lazier),<\/p>\n \u2014 ATNR did not disappear,<\/p>\n Grasping + palmar and plantar,<\/p>\n \u2014 fists are generally closed, but open spontaneously,<\/p>\n \u2014 Grenier reaction absent,<\/p>\n \u2014 in Collis horizontal reaction \u2013 SL adducted and fl exed,<\/p>\n \u2014 in ventral decubitus, the head is in Gesell I zone, if the SL are by the sides of the trunk, he has diffi culty in taking out the right one,<\/p>\n \u2014 keeps himself up in subaxillar suspension, IL does not prop on the fl at plane- astasia,<\/p>\n \u2014 the extension of the cervical-dorsal spinal cord is slightly exaggerated,<\/p>\n \u2014 follows moving objects, smiles.<\/p>\n The infant continues Vojta therapy \u2013 4 sessions a day.<\/p>\n C. Neurologic examination at the age of 7 months old \u2013 chronologic age, Corrected age \u2013 4 1\/2 months\u00a0<\/strong><\/p>\n \u2014 PC \u2013 40 cm.<\/p>\n \u2014 FA = 2\/3<\/p>\n \u2014 Bone-Tendon Reflexes lively<\/p>\n \u2014 reminiscences of Moro,<\/p>\n \u2014 palmar and plantar grasping,<\/p>\n \u2014 an accentuated paravertebral extensor tonus is still maintained with slight hypertonia of the limbs \u2013 fl exion model<\/p>\n \u2014 redressing reaction is absent,<\/p>\n \u2014 at traction, the head is along the trunk’s axis,<\/p>\n \u2014 in ventral decubitus, the head is in Gesell II-III zone, with prop on the forearms, fi sts closed,<\/p>\n \u2014 in ventral decubitus, with SL by the sides of the trunk, manages to draw the SL forward,<\/p>\n \u2014 Collis horizontal reaction \u2013 does not take hands to the table\/fl at surface,<\/p>\n \u2014 Peiper reaction corresponding to 1st trimester,<\/p>\n \u2014 in crouched position, supports his weight,<\/p>\n \u2014 no anti-gravitation reaction,<\/p>\n \u2014 right SL has more imperfect reactions,<\/p>\n \u2014 reaches after toys, catches and transfers them,<\/p>\n \u2014 there is visible motor progress,<\/p>\n \u2014 motor age \u20133- 4 months.<\/p>\n The infant continues Vojta therapy \u2013 4 sessions a day.<\/p>\n Fig. 14.\u00a0<\/strong>Vojta simulation in a premature child<\/p>\n Phase III refl ex roll over – chronologic age – 7 months, corrected age – 4 \u00bd months<\/p>\n Fig. 15.<\/strong>\u00a0Vojta simulation in a premature child<\/p>\n \u2014 The abyss – chronologic age – 7 months<\/p>\n \u2014 Corrected age – 4 \u00bd months<\/p>\n Fig. 16.<\/strong>\u00a0Analysis of a premature child<\/p>\n After therapy- dorsal decubitus position<\/p>\n \u2014 chronologic age – 7 months<\/p>\n \u2014 corrected age – 4 \u00bd months<\/p>\n D. Neurologic examination at the age of 9 months old \u2013 chronologic age, Corrected age \u2013 6 1\/2 months<\/strong><\/p>\n \u2014 PC \u2013 43 cm.<\/p>\n \u2014 FA = 2\/3<\/p>\n \u2014 head control in ventral decubitus \u2013 Gesell III-IV<\/p>\n \u2014 extends the elbows in doll’s posture,<\/p>\n \u2014 rolls over,<\/p>\n \u2014 if positioned, sits down in good balance,<\/p>\n \u2014 tries to crawl,<\/p>\n \u2014 sketches the parachute,<\/p>\n \u2014 redressing reaction+,<\/p>\n \u2014 Vojta, Collis Horizontal, Peiper reactions – corresponding to the corrected age,<\/p>\n \u2014 in sub-axillary suspension \u2013 rests on the entire sole,<\/p>\n \u2014 in crouched position, supports his weight,<\/p>\n \u2014 no anti-gravitation reaction,<\/p>\n \u2014 reaches for toys, catches and transfers them,<\/p>\n \u2014 catches his feet and brings them to mouth,<\/p>\n \u2014 lively baby, smiles all the time,<\/p>\n \u2014 motor age \u2013 7 months.<\/p>\n The infant continues Vojta therapy \u2013 4 sessions a day.<\/p>\n Fig. 17.<\/strong>\u00a0Vojta simulation in a premature child<\/p>\n \u2014 Phase I reflex roll over \u2013 chronologic age – 9 months<\/p>\n \u2014 corrected age – 6 \u00bd months<\/p>\n Fig. 18.<\/strong>\u00a0Vojta simulation in a premature child<\/p>\n \u2014 Phase I refl ex roll over \u2013 chronologic age \u2013 9 months<\/p>\n \u2014 corrected age – 6 \u00bd months<\/p>\n Fig. 19.<\/strong>\u00a0Vojta simulation in a premature child<\/p>\n \u2014 Refl ex crawling \u2013 chronologic age \u2013 9 months<\/p>\n \u2014 corrected age \u2013 6 \u00bd months<\/p>\n Birth information<\/strong><\/p>\n \u2014 Date of birth \u2013 15.11.2009 (fi rstly born)<\/p>\n \u2014 Pregnancy period \u2013 29 weeks and 4 days<\/p>\n \u2014 Weight at birth \u2013 1650g<\/p>\n \u2014 Aspect \u2013 Cranian<\/p>\n \u2014 Type of birth \u2013 Caesarean<\/p>\n \u2014 APGAR score\u2013 4 at 1 minute<\/p>\n \u2014 6 at 5 minutes<\/p>\n \u2014 6 at 10 minutes<\/p>\n At release from hospital<\/p>\n \u2014 PC = 29,5 cm<\/p>\n \u2014 PT = 25 cm<\/p>\n \u2014 T = 43cm<\/p>\n \u2014 Weight = 1850g<\/p>\n \u2014 PC = 32 cm<\/p>\n \u2014 PT = 27 cm<\/p>\n \u2014 T = 46 cm<\/p>\n Diagnosis<\/strong>\u00a0at release from hospital \u2013 Severe perinatal asphyxia<\/p>\n \u2014 group and RH incompatibility<\/p>\n \u2014 haemorrhagic syndrome of the newborn infant,<\/p>\n \u2014 intraventricular haemorrhage<\/p>\n \u2014 nosocomial infection with Klebsiella<\/p>\n A. Neurologic examination at the age of 4 months old \u2013 chronologic age, Corrected age \u2013 2 months<\/strong><\/p>\n Diagnosis \u2013 Slight central coordination disorder (twin pregnancy, prematurity)<\/strong><\/p>\n \u2014 lively child, follows objects with the eyes, smiles,<\/p>\n \u2014 optico-facial + acoustic-facial refl ex +<\/p>\n \u2014 Bone-Tendon Reflexes are lively<\/p>\n \u2014 Babinsky +<\/p>\n \u2014 Moro+<\/p>\n \u2014 Galant absent<\/p>\n \u2014 ATNR +<\/p>\n \u2014 Landau \u2013 extension persists after the fl exion of the head<\/p>\n \u2014 Grasping+<\/p>\n \u2014 redressing reaction is absent<\/p>\n \u2014 automated digitigrade stepping+ (a characteristic of premature babies),<\/p>\n \u2014 posture reactions corresponding to 1st month,<\/p>\n \u2014 in horizontal suspension, does not abduct the tight,<\/p>\n \u2014 keeps up in sub-axillary suspension,<\/p>\n \u2014 in crouched position, supports his weight,<\/p>\n \u2014 has positive support reaction,<\/p>\n \u2014 Grenier reaction absent,<\/p>\n \u2014 at traction, the head lags behind,<\/p>\n \u2014 in ventral decubitus, head raises by cervical paravertebral hypertonia,<\/p>\n \u2014 maintains position of ventral decubitus with SL generally “in chandelier” position, fi sts are closed, the thumbs are palmar adducted,<\/p>\n \u2014 slight hypertonia at the level of adductor muscles of the tight and of the triceps surae, predominantly left \u2013 at rapid dorsal fl exion of the leg, the fl exion angle decreases signifi – cantly.<\/p>\n The infant starts Vojta therapy \u2013 4 sessions a day.<\/p>\n B. Neurologic examination at the age of 4 1\/2 months old \u2013 chronologic age<\/strong><\/p>\n \u2014 Corrected age \u2013 2 months<\/p>\n \u2014 PC \u2013 40,3 cm.<\/p>\n \u2014 Bone-Tendon Reflexes- lively especially the calcaneal refl ex,<\/p>\n \u2014 compared o the previous examination one may remark:<\/p>\n \u2014 persistence of Moro reaction,<\/p>\n \u2014 Grasping +<\/p>\n \u2014 redressing reaction absent,<\/p>\n \u2014 at traction, the head is along the trunk axis,<\/p>\n \u2014 in ventral decubitus, the head is in Gesell II zone, with SL in “doll’s posture”, fi sts closed,<\/p>\n \u2014 no longer keeps SL “in chandelier” position,<\/p>\n \u2014 spontaneous motility is expressed better,<\/p>\n \u2014 Collis horizontal reaction \u2013 absent,<\/p>\n \u2014 slight tension at the level of the triceps surae (at rapid dorsal fl exion of the legs) is maintained,<\/p>\n \u2014 follows with the eyes, being attentive to mother,<\/p>\n \u2014 motor progress \u2013 Vojta Th erapy, 4 times a day,<\/p>\n \u2014 motor age \u2013 4 \u00bd months.<\/p>\n The infant continues Vojta therapy \u2013 4 sessions a day.<\/p>\n Fig. 20.<\/strong>\u00a0Analysis of a premature child \u2013 Before therapy<\/p>\n \u2014 ventral decubitus position \u2013 chronologic age \u2013 5 \u00bd months<\/p>\n \u2014 corrected age\u2013 3 \u00bd months<\/p>\n Fig. 21.\u00a0<\/strong>Vojta simulation in a premature child<\/p>\n \u2014 First phase of refl ex rolling – chronologic age \u2013 5 \u00bd months<\/p>\n \u2014 corrected age \u2013 3 \u00bd months<\/p>\n Fig. 22.\u00a0<\/strong>Analysis of a premature child \u2013 After therapy<\/p>\n \u2014 ventral decubitus position – chronologic age – 5 \u00bd months<\/p>\n \u2014 corrected age – 3 \u00bd months<\/p>\n Birth information<\/strong><\/p>\n \u2014 Date of birth \u2013 15.11.2009 (secondly born)<\/p>\n \u2014 Pregnancy period \u2013 29 weeks and 4 days<\/p>\n \u2014 Weight at birth \u2013 1650g<\/p>\n \u2014 Aspect \u2013 Cranian<\/p>\n \u2014 Type of birth \u2013 Caesarean<\/p>\n \u2014 APGAR score \u2013 6 at 1 minute<\/p>\n \u2014 7 at 5 minutes<\/p>\n \u2014 PC = 30 cm<\/p>\n \u2014 PT = 25 cm<\/p>\n \u2014 T = 44cm<\/p>\n At release from hospital\u00a0<\/strong>\u2013 Weight = 2080g<\/p>\n \u2014 PC = 34 cm<\/p>\n \u2014 PT = 28 cm<\/p>\n \u2014 T = 47 cm<\/p>\n \u2014 haemorrhagic syndrome of the newborn infant,<\/p>\n \u2014 cerebral haemorrhage<\/p>\n \u2014 pulmonary haemorrhage<\/p>\n \u2014 hydrocephalus<\/p>\n A. Neurologic examination at the age of 3 \u00bd months old \u2013 chronologic age, Corrected age \u2013 1 \u00bd months<\/strong><\/p>\n \u2014 Int. hydrocephaly<\/p>\n \u2014 PC = 39,5cm<\/p>\n \u2014 FA = 3\/2<\/p>\n \u2014 Bone-Tendon Refl exes are lively and symmetrical,<\/p>\n \u2014 redressing reaction absent,<\/p>\n \u2014 Moro+<\/p>\n \u2014 Galant ++<\/p>\n \u2014 without stepping refl ex,<\/p>\n \u2014 in lateral suspension, slight axial hypotonia without tight abduction,<\/p>\n \u2014 sub-axillary vertical suspension for 10 seconds,<\/p>\n \u2014 at traction, the head lags behind,<\/p>\n \u2014 in ventral decubitus, the head is in Gesell I-II zone,<\/p>\n \u2014 slight tendency to hyperextension of cervical spine,<\/p>\n \u2014 Grasping+<\/p>\n \u2014 in crouched position, supports his weight,<\/p>\n \u2014 without anti-gravitational reaction,<\/p>\n \u2014 Grenier reaction absent bilaterally,<\/p>\n \u2014 posture reactions (Vojta, Collis, Peiper) corresponding to 1st month,<\/p>\n \u2014 generally maintains fi sts closed, the thumb being palmar adducted,<\/p>\n \u2014 the infant is lively, following moving objects with the eyes,<\/p>\n \u2014 oculo-palpebral reflex and cochleo-palpebral reflex are absent.<\/p>\n The infant starts Vojta therapy \u2013 4 sessions a day.<\/p>\n B. Neurologic examination at the age of 5 1\/2 months old \u2013 chronologic age, Corrected age \u2013 2 months<\/strong><\/p>\n \u2014 PC \u2013 41,5 cm.<\/p>\n \u2014 FA = 2\/1<\/p>\n \u2014 Bone-Tendon Reflexes- lively ,<\/p>\n \u2014 redressing reaction absent,<\/p>\n \u2014 Moro+<\/p>\n \u2014 Galant +<\/p>\n \u2014 Collis horizontal reaction \u2013 absence of hand support on the fl at surface,<\/p>\n \u2014 in Vojta reaction \u2013 does not abduct the tight,<\/p>\n \u2014 in traction reflex, the head is in the trunk’s axis,<\/p>\n \u2014 in ventral decubitus, the head is in Gesell II zone, with SL in “doll’s posture”, fi sts closed,<\/p>\n \u2014 a slight paravertebral cervical hypertonia is maintained,<\/p>\n \u2014 Grasping +<\/p>\n \u2014 maintains himself in sub-axillary suspension,<\/p>\n \u2014 in crouched position does not have anti-gravitational reaction,<\/p>\n \u2014 Grenier reaction absent,<\/p>\n \u2014 Peiper Reaction corresponding to 1st trimester,<\/p>\n \u2014 reaches for toys and grasps them<\/p>\n \u2014 the thumb is no longer palmar adducted,<\/p>\n \u2014 very lively infant, follows moving objects, smiles easily to the people around him,<\/p>\n \u2014 motor age \u2013 3 \u00bd months.<\/p>\n The infant continues Vojta therapy \u2013 4 sessions a day.<\/p>\n Fig. 23.\u00a0<\/strong>Analysis of a premature child \u2013 Before therapy<\/p>\n \u2014 ventral decubitus position – chronologic age \u2013 5 \u00bd months<\/p>\n \u2014 corrected age – 3 \u00bd months<\/p>\n Fig. 24.<\/strong>\u00a0Vojta simulation in a premature child<\/p>\n \u2014 First phase of refl ex rolling – chronologic age – 5 \u00bd months, corrected age – 3 \u00bd months<\/p>\n Fig. 25.<\/strong>\u00a0Vojta simulation in a premature child \u2013 Reflex crawling<\/p>\n \u2014 ventral decubitus position – chronologic age – 5 \u00bd months<\/p>\n \u2014 corrected age – 3 \u00bd months<\/p>\n Fig. 26.\u00a0<\/strong>Analysis of a premature child \u2013 After therapy<\/p>\n \u2014 ventral decubitus position – chronologic age \u2013 5 \u00bd months<\/p>\n \u2014 corrected age – 3 \u00bd months<\/p>\n Using Vojta Therapy we can infl uence the motor pathologic models in a premature child (we may recall the ideal partial models). Early initiation of the Vojta Therapy leads to the substantial rehabilitation of the neuro-psycho-motor deficit.<\/p>\n In the premature child, Vojta Therapy will be instituted taking into consideration the child’s health condition, age and tolerance in being touched. In order to obtain the desired eff ects, the Vojta Th erapy sessions (4 sessions a day) are performed in comfortably heated environments, while the therapist communicates with the little patient permanently.<\/p>\n The family, in their role as co-therapist, will be instructed so as to be able to continue Vojda Th erapy at home, too.<\/p>\n <\/p>\n 1. Berard C. et al. 2008. La paralysie c\u00e9r\u00e9brale de l’enfant. Sauramps Med., p. 25-29.<\/p>\n 2. De Groot L. 1993. L’intervention pr\u00e9coce et la stimulation du d\u00e9veloppement chez l’enfant pr\u00e9matur\u00e9. Motr. C\u00e9rebr. Tome 14 ; 1: 10-16.<\/p>\n 3. Dhondt J.L. Prematurit\u00e9 et depistage n\u00e9onatal, Arch. Pediatr., 15 s1, 2008, pg. 7-11.<\/p>\n 4. Escoban G. J., Cormick M. C., Zupancic J. A., Coleman- Phox K., Armstrog M. A., Greene J. D., Eichenwald E. C., Richardson D. K., 2006. Unstudied infants: outcomes of moderately premature infants in the neonatal intensive care unit. Archives of Diseases in childhood Fetal et Neonatal Edition, 91: F 238-44.<\/p>\n 5. Gosselin J., Amiel Tison C. 2007. \u00c9valuation neurologique de la naissance \u00e0 6 ans. Ed. II de CHU Sainte-Justine, Masson. p. 28-30.<\/p>\n 6. Lupea I. Tratat de Neonatologie. Cluj Napoca : Editura Medical\u0103 Universitar\u0103 “Iuliu Ha\u0163ieganu”, 2000: 74,75,179- 185.<\/p>\n 7. Marlow, N. et al (2005). Neurologic and developmental disability after preterm birth. The New England Journal of Medicine, 352 (9) 9 \u2013 19.<\/p>\n 8. Marshall H. Klaus, Avroy A. Fanaroff . Care of the high-risk neonate; Saunders-Elselvier; 2001. p. 107, 468-469.<\/p>\n 9. Morrison J. Twin gestation and premature birth, J. Perinatol, 2005, 25: 1-3.<\/p>\n 10. Polin Richard A., Spitzer Alan R. Twin pregnancies and multiple births in: Fetal and neonatal secrets. Mosby-Elselvier; 2007. p. 31-32.<\/p>\n 11. Vojta V. 2000 – Die zerebralen Bewegungsst\u00f6rungen im S\u00e4uglingsalter. Fr\u00fchdiagnose und Fr\u00fchtherapie. Hippocrates Verlag GmbH. Stuttgart.<\/p>\n 12. Vojta V., Peter A. 2001. Das Vojta Prinzip. Muskelspiele in Refl exfortbewegung und motorishe Ontogenese. Ed. Springer.<\/p>\n![\"\"](\"http:\/\/snpcar.ro\/wp-content\/uploads\/2018\/09\/11.01.jpg\")
<\/p>\n![\"\"](\"http:\/\/snpcar.ro\/wp-content\/uploads\/2018\/09\/11.02.jpg\")
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<\/p>\n![\"\"](\"http:\/\/snpcar.ro\/articole\/2010\/3\/11.04.jpg\")
<\/p>\n
\n(Figure 5 \u2013 Collis Horizontal Reaction in a premature newborn, chronologic age \u2013 3 months; corrected age \u2013 2 months)<\/strong><\/p>\n![\"\"](\"http:\/\/snpcar.ro\/articole\/2010\/3\/11.05.jpg\")
<\/p>\n![\"\"](\"http:\/\/snpcar.ro\/articole\/2010\/3\/11.06.jpg\")
<\/p>\n![\"\"](\"http:\/\/snpcar.ro\/articole\/2010\/3\/11.07.jpg\")
<\/p>\nASSESSMENT OF POSTURE REACTIONS (11, 12)<\/h2>\n
CASE STUDY<\/h2>\n
CASE 1 \u2013 I.D.<\/h2>\n
DIAGNOSIS – Central coordination disorder (twin pregnancy, prematurity)<\/h2>\n
\n\n
\n Reflexes,<\/strong>
\nautomated reactions<\/strong><\/td>\nWaiting time<\/strong>
\nNeonatal intensit<\/strong>y\u00a0<\/strong><\/td>\nPathology<\/strong><\/td>\n<\/tr>\n \n Babkin<\/td>\n 0 \u2013 4 s\u0103pt.<\/td>\n Persistent after 6 weeks<\/td>\n<\/tr>\n \n Rooting<\/td>\n 0 \u2013 3 luni<\/td>\n Persistent after 6 months<\/td>\n<\/tr>\n \n R. de supt<\/td>\n 0 \u2013 3 luni<\/td>\n Persistent after 6 months<\/td>\n<\/tr>\n \n R. optico-facial<\/td>\n After 3 months \u2013 persists all life long<\/td>\n If it is missing after 4th month<\/td>\n<\/tr>\n \n R. acustico-facial<\/td>\n Since day 10 \u2013 persists all life long<\/td>\n If it is missing after 4th month<\/td>\n<\/tr>\n \n Glabela<\/td>\n Since birth \u2013 persists all life long<\/td>\n Missing at birth<\/td>\n<\/tr>\n \n \u201cDoll\u2019s Eyes\u201d Reflex<\/td>\n 0 \u2013 4 s\u0103pt.<\/td>\n After 6 weeks<\/td>\n<\/tr>\n \n Palmar Grasp Reflex<\/td>\n Until the development of the grasp and support function<\/td>\n Absent in the diskinetic development\u2013 asymmetry
\nIf propping on the hand does not appear \u2013 2nd trimester
\n+++ in 3rd trimester = spasticity<\/td>\n<\/tr>\n\n Plantar Grasp Reflex<\/td>\n Until the development of the
\nsupport function<\/td>\nAbsent at birth
\nIf absence persists after 2nd &3rd = diskinezia<\/td>\n<\/tr>\n\n Palm Root Reaction<\/td>\n –<\/td>\n Since birth<\/td>\n<\/tr>\n \n Automated walking
\n(Stepping Reflex)<\/td>\n0 \u2013 4 s\u0103pt.<\/td>\n After 3 months<\/td>\n<\/tr>\n \n Reaction of arms extension
\n(Arm Recoil)<\/td>\n–<\/td>\n Since birth<\/td>\n<\/tr>\n \n Reaction of extension of IL
\n(Positive support reaction)<\/td>\n0 \u2013 4 s\u0103pt.<\/td>\n After 3 months<\/td>\n<\/tr>\n \n Calcaneal Reflex
\n(Achilles or ankle-jerk reflex)<\/td>\n0 \u2013 4 s\u0103pt.<\/td>\n After 3 months<\/td>\n<\/tr>\n \n Suprapubian Reflex<\/td>\n 0 \u2013 4 s\u0103pt.<\/td>\n after 3 – 5 months<\/td>\n<\/tr>\n \n Crossed Extension Reflex<\/td>\n 0 \u2013 6 s\u0103pt.<\/td>\n after 3 – 5 months<\/td>\n<\/tr>\n \n Lift Reaction<\/td>\n 0 \u2013 4 luni<\/td>\n +++ in 2nd trimester<\/td>\n<\/tr>\n \n Galant\u2019s Reflex<\/td>\n 0 \u2013 4 s\u0103pt.<\/td>\n After 3 months \u2013 possible diskinezia
\nAbsent at birth<\/td>\n<\/tr>\n\n R. Moro<\/td>\n 3 \u2013 4 luni<\/td>\n After 4 months
\nAbsent at birth<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n![\"\"](\"http:\/\/snpcar.ro\/articole\/2010\/3\/11.08.jpg\")
<\/p>\n![\"\"](\"http:\/\/snpcar.ro\/articole\/2010\/3\/11.09.jpg\")
<\/p>\n![\"\"](\"http:\/\/snpcar.ro\/articole\/2010\/3\/11.10.jpg\")
<\/p>\n![\"\"](\"http:\/\/snpcar.ro\/articole\/2010\/3\/11.11.jpg\")
<\/p>\n![\"\"](\"http:\/\/snpcar.ro\/articole\/2010\/3\/11.12.jpg\")
<\/p>\n![\"\"](\"http:\/\/snpcar.ro\/articole\/2010\/3\/11.13.jpg\")
<\/p>\nCASE 2 – I.R.<\/h2>\n
DIAGNOSIS \u2013 Central coordination disorder (twin pregnancy, prematurity)<\/h2>\n
![\"\"](\"http:\/\/snpcar.ro\/articole\/2010\/3\/11.14.jpg\")
<\/p>\n![\"\"](\"http:\/\/snpcar.ro\/articole\/2010\/3\/11.15.jpg\")
<\/p>\n![\"\"](\"http:\/\/snpcar.ro\/articole\/2010\/3\/11.16.jpg\")
<\/p>\n![\"\"](\"http:\/\/snpcar.ro\/articole\/2010\/3\/11.17.jpg\")
<\/p>\n![\"\"](\"http:\/\/snpcar.ro\/articole\/2010\/3\/11.18.jpg\")
<\/p>\n![\"\"](\"http:\/\/snpcar.ro\/articole\/2010\/3\/11.19.jpg\")
<\/p>\nCASE 3 – M. M.<\/h2>\n
![\"\"](\"http:\/\/snpcar.ro\/articole\/2010\/3\/11.20.jpg\")
<\/p>\n![\"\"](\"http:\/\/snpcar.ro\/articole\/2010\/3\/11.21.jpg\")
<\/p>\n![\"\"](\"http:\/\/snpcar.ro\/articole\/2010\/3\/11.22.jpg\")
<\/p>\nCASE 4- M.M.<\/h2>\n
DIAGNOSIS at release from hospital \u2013 Severe asphyxia at birth<\/h2>\n
DIAGNOSIS \u2013 Central coordination disorder (twin pregnancy, prematurity)<\/h2>\n
![\"\"](\"http:\/\/snpcar.ro\/articole\/2010\/3\/11.23.jpg\")
<\/p>\n![\"\"](\"http:\/\/snpcar.ro\/articole\/2010\/3\/11.24.jpg\")
<\/p>\n![\"\"](\"http:\/\/snpcar.ro\/articole\/2010\/3\/11.25.jpg\")
<\/p>\n![\"\"](\"http:\/\/snpcar.ro\/articole\/2010\/3\/11.26.jpg\")
<\/p>\nCONCLUSIONS<\/h2>\n
BIBLIOGRAFIE \/ BIBLIOGRAPHY<\/h2>\n