Rehabilitation Therapies

BackgroundGrade II hypoxic ischemic encephalopathy (GII-HIE) in newborns produces neurological sequelae in approximately 50% of patients. Neuro-rehabilitation offers rational therapeutic approaches in patients at risk of neurological damage; however, there is little information on comparison of different rehabilitation therapies.
Objective

Evaluate and compare results of Vojta therapy versus an early intervention program on the neurological and electrophysiological development of infants diagnosed with GII-HIE.

Methods

Controlled, randomized, simple blinded trial with term newborn patients diagnosed with GII-HIE, based on Sarnat-Sarnat criteria, aged 1-4 months. Thirty patients were recruited from the neonatology departments of two general hospitals in Mexico City. All patients underwent: Gesell Development Coefficient and evoked auditory, visual and somatosensorial potentials before therapy, and at 3 and 6 months of treatment. Therapy was applied by a therapist trained in the specific procedure for 30-40 minutes twice a week, for 6 months. The early intervention program includes proprioceptive and exteroceptive techniques that cover tactile stimulation (sucking, massage), vestibular stimulation, auditory stimulation (music, etc.), and visual stimulation (environment decoration, mobile elements).

Results

Twenty-seven patients finished the study, 13 girls and 14 boys, with an average age of 1.6 months; 12 had Vojta therapy and 15 early intervention. The Vojta therapy group had significantly higher scores in the Gesell test and its four neurological development areas (Mann-Whitney U, Gesell global, p=0.032; motor, p=0.04, language, p=0.01, adaptive, p= 0.01 and personal social, p= 0.02); in addition, there was also significant shortening (0.08 milliseconds) of the I-V interval in evoked auditory potential of the brain stem (p=0.05).Conclusions
Patients submitted to both therapies showed clinical and electrophysiological improvement, but the Vojta group had greater improvement in both the four areas of neurological development and in the I-V interval of evoked auditory potential.