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“Back to sleep, tummy to play“
Frauke Mecher; private
Frauke Mecher works as a physical therapist in Braunschweig, Germany, is the director of the AG-Vojta (Vojta Workshop) as well the board spokesperson at the German Confederation for Physical Therapy (ZVK) and is going to give a lecture at the MEDICA on kinematic imbalances in babies. MEDICA.de first spoke with her about flattened heads, recommended sleeping positions and the Vojta therapy.
MEDICA.de: Kinematic imbalance is the third to fourth most common orthopedic problem during infancy. Mrs. Mecher, what types of symptoms definitely mark this disease?
Frauke Mecher: Clear symptoms are a flattened head on one side, facial asymmetry, convexity of the torso, pelvic obliquity as well as a curved spine. In addition it was noticed that children with symmetry disorder scream a lot and have sleep pattern disturbance. Oftentimes they are also so-called spitter babies with digestive problems.
MEDICA.de: How do symmetry disorders develop in babies?
Mecher: Kinematic imbalances can be caused by hereditary or a result of the fetal position causes. If a child has a lopsided face right after birth for example, it can be traced back to one-sided kicking and boxing against the abdominal wall. This could definitely create a lopsided body scheme. Admittedly so far it could not be proven as a clearly defined cause. After all, children born via Caesarian also have these symptoms. So the imbalance is not explicable just by the process of giving birth and a tight birth canal.
Unilateral flattened heads
emerge from monotonous
position; © Mecher
MEDICA.de: ITo what extent could there be causes related to the baby’s position?
Mecher: If infants are continuously positioned just on the same side, the head flattens very quickly. That’s why the head is then also always moving back to that same position, since the children are not able to control this yet. In addition, the children follow their heads with their entire bodies. If the head for instance only veers to the right, then they also lie more on their right side, use the right hand or right leg more.
MEDICA.de: Based on a multinational study to prevent sudden infant death syndrome, the American Academy of Pediatrics (AAP) published recommendations for the best sleeping position.
Mecher: Yes that’s correct. The AAP has recommended babies sleeping on their back to avoid sudden infant death. Between 1990 and 2005 these cases have then also decreased by about 68 percent. However, since 1992 one-sided head deformation has increased by 400 percent.
MEDICA.de: So what can you do to prevent this?
Mecher: At first you should observe the baby under prior consultation with the pediatrician. In addition it is important to inform parents early on and extensively on the right positions. The slogan to remember is: back to sleep, tummy to play. If the parents are around or if the child is awake, it always makes sense to put the baby on its stomach. Occasionally the lateral position is also OK. The main thing is to provide some variety. Then the risk of one-sided flattening is already minimised considerably.
Cranio ortheses should not be the
first way of treatment, according to
Frauke Mecher; © Mecher
MEDICA.de: And what do you do if even that is not working?
Mecher: Then you should start treating it, because even if the saying goes: “The child will outgrow it“– that’s unfortunately not the case here. That’s why I instruct parents in Vojta therapy, which they should perform at home three to four times daily. If no marked change can be detected or if there are additional findings, I recommend additional manual therapy and/or osteopathy and as the case may be craniosacral therapy. If all that doesn’t help, I advise obtaining so-called helm therapy services at the latest at the age of six or seven months.
MEDICA.de: What characterises Vojta therapy?
Mecher: The basic body positions of the human body, namely ventral position, dorsal position and lateral position are available for the therapeutic exercises. Via stimulation using appropriate pressure at very specific points of the body, natural motion sequences are being activated.
MEDICA.de: Where are those spots located?
Mecher: These areas are located at the trunk as well as the arms and legs. If they are appropriately stimulated, they are the key to the central nervous system (CNS) and its ability to control natural motion sequence programs.
These four-month-old babies show neither in the prone position nor in the supine position an age-appropriate posture: They cannot adjust their spine in the longitudinal axis, control their posture and do not adequately raise against gravity; © Mecher
MEDICA.de: So you try to take advantage of the neuroplasticity and plasticity of the CNS?
Mecher: That’s it exactly. The CNS is meant to memorize normal patterns activated by the therapy, so they can also be used in spontaneous motor function. This way abnormal posture and motion patterns are not turning into pathological ones and they cannot cortically lock. The Vojta therapy is a basic therapy on which other therapies such as logopedics and occupational therapy can build on.
The interview was conducted by Nadine Lormis and translated by Elena O'Meara.
MEDICA PHYSIO FORUM:
"The child will not outgrow it - Causes and possible consequences of kinematic imbalances in babies" (in German)
Contributor: Frauke Mecher
Date and time: Thursday, 17/11/2011; 12:00 to 12:30 Uhr and 15:00 to 15:30
Location and venue: Hall 4