An Assessment of Motor Skills in Infants at Risk of Abnormal Psychomotor Development Using the Vojta Method

An Assessment of Motor Skills in Infants at Risk of Abnormal Psychomotor Development Using the Vojta Method | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 2 June 2025 V1 Latest version Share on An Assessment of Motor Skills in Infants at Risk of Abnormal Psychomotor Development Using the Vojta Method Authors : Robert Podstawski 0000-0002-1492-252X [email protected] , Katarzyna Balewska-Juras , Krzysztof Borysławski , Atilla Szabo , and Jadwiga Snarska Authors Info & Affiliations https://doi.org/10.22541/au.174889644.41935738/v1 214 views 105 downloads Contents Abstract Introduction Ethical statement Procedures, Data Collection, and Equipment Statistical analysis Results 4. Discussion 5. Strengths and Limitations References Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Background: Some neonates are assessed for the risk of abnormal psychomotor development at birth and are referred for reflex locomotion therapy using the Vojta method. Aim: The aim of this study was to analyze the relationships between spontaneous motor activity (SMA), the quality of motor activity patterns (QMAP), central coordination disorders (CCD), vital signs at birth, involuntary reflexes, and postural asymmetry in infants. Methods: The study involved 90 girls and 107 boys in the age interval of 1-16 months (4.15±2.18). Their psychomotor development was assessed using the Vojta method. Age-appropriate involuntary reflexes were evaluated, and both parameters were correlated with perinatal risk factors. Results: Boys scored significantly higher than girls (difference of -0.7, p = 0.022) in the SMA test. In both sexes, SMA (p < 0.001 in both sexes) and QMAP scores improved significantly with age. In boys, higher CCD scores were associated with significantly lower SMA and QMAP scores (p = 0.017 and p < 0.001, respectively). Significantly higher CCD scores were noted in girls with the Moro reflex and postural asymmetry (p = 0.003 and p = 0.002, respectively). In boys, the Moro reflex was significantly correlated with the Vojta reaction (p = 0.012) and the Collis vertical suspension response (p <0.001). Conclusions: Vital signs at birth, including birth weight, the Apgar score, and type of delivery, can predict motor development disorders, but do not clearly discriminate infants that require neurodevelopmental therapy. An Assessment of Motor Skills in Infants at Risk of Abnormal Psychomotor Development Using the Vojta Method Robert Podstawski 1* , Katarzyna Balewska-Juras 1 and Krzysztof Borysławski 2 , Atilla Szabo 3† , Jadwiga Snarska 4† 1* Human Wellness Research Laboratory, Department of Physiotherapy, School of Public Health, University of Warmia and Mazury in Olsztyn, 10-957 Olsztyn, Poland. 2 Institute of Health, Angelus Silesius University of Applied Sciences in Wałbrzych, 58-300 Wałbrzych, Poland. 3 Faculty of Health and Sport Sciences, Széchenyi István University, 9026 Győr, Hungary. 4 Department of General Surgery, School of Public Health, University of Warmia and Mazury in Olsztyn, 10-957 Olsztyn, Poland*Corresponding author(s). E-mail(s): [email protected] authors: [email protected] ; [email protected] ; [email protected] ; [email protected] † These authors contributed equally to this work. Abstract Background: S ome neonates are assessed for the risk of abnormal psychomotor development at birth and are referred for reflex locomotion therapy using the Vojta method. Aim: The aim of this study was to analyze the relationships between spontaneous motor activity (SMA), the quality of motor activity patterns (QMAP), central coordination disorders (CCD), vital signs at birth, involuntary reflexes, and postural asymmetry in infants. Methods: The study involved 90 girls and 107 boys in the age interval of 1-16 months (4.15±2.18). Their psychomotor development was assessed using the Vojta method. Age-appropriate involuntary reflexes were evaluated, and both parameters were correlated with perinatal risk factors. Results: Boys scored significantly higher than girls (difference of -0.7, p = 0.022) in the SMA test. In both sexes, SMA (p < 0.001 in both sexes) and QMAP scores improved significantly with age. In boys, higher CCD scores were associated with significantly lower SMA and QMAP scores (p = 0.017 and p < 0.001, respectively). Significantly higher CCD scores were noted in girls with the Moro reflex and postural asymmetry (p = 0.003 and p = 0.002, respectively). In boys, the Moro reflex was significantly correlated with the Vojta reaction (p = 0.012) and the Collis vertical suspension response (p <0.001). Conclusions: Vital signs at birth, including birth weight, the Apgar score, and type of delivery, can predict motor development disorders, but do not clearly discriminate infants that require neurodevelopmental therapy. Keywords: physical therapy diagnosis, motor disorders, coordination of the central nervous system, postural reflexes, spontaneous motor activity Introduction In physical therapy practice, an accurate diagnosis is essential for the initiation of effective treatment in all age groups. Any deviations or delays in the psychomotor development of infants and young children should be immediately addressed to initiate early therapeutic interventions and prevent psychomotor disorders in later life (Brown et al., 2020). However, children younger than 12 months are very difficult to diagnose because their central nervous system is not yet fully developed (Izett et al., 2021; Joseph et al., 2023). In some cases, delayed myelination of nerve fibers can disrupt neural and muscular coordination, and these symptoms can be misdiagnosed (Grotheer et al, 2022). For this reason, infants with prenatal or perinatal risk factors should receive specialized care immediately after birth and should be subjected to a full range of diagnostic tests. Early psychomotor development and disorders of the central nervous system (CNS) are diagnosed with the use of advanced imaging methods, including magnetic resonance imaging (MRI), transfontanellar ultrasound (TFUS), and encephalography (EEG) (de Vries et al., 2006; Shen et al., 2015). These imaging techniques enable early detection of developmental defects and neonatal encephalopathy, and facilitate quick initiation of therapeutic interventions (Bokiniec et al., 2014). In neonates, primitive reflexes, gross motor skills, positional preferences, and the quality of spontaneous movements and posture are also assessed by physical therapists (Pecuch et al., 2021; Malak et al., 2024). The most popular diagnostic methods include Vojta therapy (De-La-Barrera-Aranda et al., 2021, Strojek et al., 2022), the Bobath approach (neurodevelopmental treatment, NDT-Bobath) (Bobath & Bobath, 1967; Te Velde et al., 2022; Ungureanu et al., 2022), Prechtl’s method (Darsaklis et al., 2011, Apaydın et al., 2021), and the Munich Functional Developmental Diagnostics (MFDR) scale (Pazera et al., 2021; Pazera et al., 2023). Vojta therapy is a scientifically validated diagnostic tool with considerable prognostic value that relies on developmental kinesiology and reflex locomotion principles. The Vojta method can be used to diagnose and treat neurophysiological disorders from birth to the achievement of bipedal locomotion (Sánchez-González et al., 2024). This approach examines motor activity patterns, involuntary motor responses, and seven postural responses in young children. The quality of these responses and movement patterns is influenced by the development of the CNS. In Vojta therapy, special attention is placed on spontaneous motor activity (SMA), postural responses, the quantity and, above all, the quality of motor activity patterns (QMAP) (Vojta, 2009, Menéndez-Pardiñas et al., 2023). In this approach, other reflexes involved in postural control and SMA are also evaluated based on observations of the child’s primitive reflexes and automatic reactions, including the ability to support the head and control head movements, maintain an upright position and balance, and the ability to lean on the hands or elbows for support in a prone or sitting position. These developmental milestones follow a predictable sequence in successive stages of motor and neural development (Polczyk, 2018). The diagnosis provides information about non-retained disorders of the nervous system that can be effectively resolved through physical therapy involving neurophysiological methods (Jung et al., 2017). Abnormal psychomotor development of infants exposed to various risk factors during the prenatal period, delivery, and the postnatal period has been explored in numerous studies. Research has shown that perinatal risk factors can lead to neurological disorders and affect the results of neurophysiological tests conducted using the Vojta method (Polczyk, 2018, Menéndez-Pardiñas et al., 2023). However, the relationships between central coordination disorders (CCD) in infants diagnosed with the Vojta method and perinatal risk factors (gestation length, type of delivery, birth weight, Apgar score, and primitive reflexes) has never been examined in the literature. These links should be identified to facilitate early detection of psychomotor abnormalities in infants and to assist neonatologists and pediatricians in implementing therapeutic approaches that can significantly contribute to the healthy development of children. Therefore, the aim of this study was to identify the relationships between an assessment of the psychomotor skills of infants using the Vojta method based on the determination of SMA, QMAP, and CCD, and perinatal risk factors, involuntary reflexes, and postural asymmetry. 2. Materials and Methods Participants The study involved 197 infants at risk of abnormal psychomotor development who were patients of the Rehabilitation Clinic of the Center for Rehabilitation and Education in Szczytno and were referred for Vojta physiotherapy by a physician (a motor rehabilitation consultant) to confirm or rule out developmental disorders. The study group consisted of 107 boys aged 4.15±2.18 months and 90 girls aged 3.84±2.12 months (1-16 months). The inclusion criteria were: complications during pregnancy and delivery, preterm birth, low Apgar score in the first minutes after birth, low birth weight, postural asymmetry (at 7 weeks of age), abnormal muscle tone, delayed psychomotor development, and non-age-appropriate involuntary reflexes. During the study, all children were healthy and did not present with any symptoms of infection. Children with genetic disorders were excluded from the study. The examined infants were born between 24 and 42 weeks of pregnancy. On average, boys were born at 37.5±3.5 weeks and girls were born at 38.4 ±2.7 weeks. Birth weights were similar in both sexes at 3118.5±859.2 g in boys and 3078.4±783.2 g in girls on average. Neonates were evaluated on the 10-point Apgar test in the first minute after birth. The average score was 8.9±2.0 in boys and 9.3±1.4 in girls. The study population is characterized in Table 1. Table 1 Characteristics of the studied male and female infants. Mean SD Min Max Mean SD Min Max Gestation length [weeks] 37.5 3.5 24 42 38.4 2.7 26 42 -1.92 0.055 Birth weight [g] 3118.5 859.2 666 4900 3078.4 783.2 660 4450 0.34 0.734 Apgar score* [points] 8.9 2.0 1 10 9.3 1.43 2 10 -1.70 0.091 Age [months] 4.2 2.2 1 16 3.8 2.1 1 11 0.99 0.324 Notes: *- in the first minute after birth Ethical statement The research was performed in compliance with the guidelines and policies of the Health Science Council and the Declaration of Helsinki. The study was approved by the Ethics Committee of the Medical University of Poznań (179/2012). Each child’s parent received detailed information about the purpose of the study, potential threats, as well as the course of the study and the relevant procedures. All parents gave voluntary informed consent to participate in the study. Procedures, Data Collection, and Equipment The psychomotor development of the studied infants, including potential disorders, were assessed. Before the tests, information about the progression of pregnancy, maternal diseases, gestation length, type of delivery (spontaneous or with surgical intervention), the child’s birth weight, Apgar score, and adaptation for life in the first days after birth was collected from the parents. Spontaneous motor activity was evaluated in supine and prone positions based on the number of presented skills, and QMAP was assessed in the supine position, during rolling, sitting, toddling, standing up, and walking. Special attention was paid to postural asymmetry. Any deviations in the position of body parts relative to the midline axis were evaluated in supine and prone positions. Postural asymmetry was diagnosed based on the flexion of the head towards the shoulder girdle (always the same shoulder), asymmetry of the shoulder and pelvic girdles, and clear preference for turning the head and the body to the same side. The same criteria were applied to diagnose postural asymmetry in sitting and standing positions. In the next stage, primitive reflexes were assessed based on the child’s age and CNS development. The test involved an evaluation of spinal and tonic reflexes, the ability to support the head and control head movements, maintain an upright position and balance, and lean on the hands or elbows for support in a prone or sitting position. The child’s behavior and responses to each test were registered. Assessment involving the Vojta Method The rate of motor development was assessed using the seven postural responses proposed by Vojta for neuromotor screening (1973). In healthy children, these responses correspond to normal stages of ontogenic development of postural and locomotive skills in the first year of life (Strojek et al., 2022). These skills evolve with age and follow a predictable sequence in successive stages of psychomotor development (Vojta, 1973). Atypical responses that deviate from the pattern described by Vojta are referred to as CCD. The severity of CCD is evaluated on a four-point scale based on the number of abnormal postural responses: 1. Mildest – 1-3 abnormal postural responses, 2. Mild – 4-5 abnormal postural responses, 3. Moderate – 6-7 abnormal postural responses, 4. Severe – 7 abnormal postural responses (Vojta 1985; Vojta at al., 1989). The infants’ involuntary responses (automatic reactions) to changes in body position were evaluated during the test, and all children received a CCD score based on the above rating scale. The quality of support and extension postures, changes in muscle tone, position of the spine and ball-and-socket joints, and phases of motion were assessed in the postural response test. The assessments were conducted by a certified Vojta therapist in the presence of the parents. Each test was conducted under identical, optimal conditions at constant temperature and in a quiet room. The vast majority of the examined infants participated in neurodevelopmental therapy after the study. The children were evaluated for the achievement of age-specific developmental milestones (the age of pre-term infants was adjusted accordingly) and for the presence of normal or abnormal postural responses. The motor skills and CCD scores of male and female participants were compared separately. The presence of significant relationships between vital signs at birth, SMA, QMAP, severity of CCD, involuntary reflexes, and postural asymmetry was determined. Statistical analysis The significance of differences between means was determined by Student’s t-test for independent variables. The relationships between quantitative traits were analyzed by calculating Pearson correlation coefficients (r). The relationships between nominal (category) features were analyzed by the chi-square test. The gamma (γ) coefficient numerically equivalent to Pearson’s r was also calculated. The results were processed statistically in Statistica PL v. 13.0 at a significance level of p<.05. Results Boys received significantly higher scores than girls (difference of -0.7, p = 0.022) only in the assessment of SMA. No significant differences in CCD and QMAP scores were observed between the sexes (p = 0.151 and p = 0.321, respectively) (Table 2). Table 2. Scores received by male and female infants in CCD, SMA, and QMAP tests Mean SD Min - Max Mean SD Min - Max CCD 4.61 2.17 0-7 5.06 2.18 0-7 -1.44 0.151 SMA 3.42 2.02 0-11 2.74 2.07 0-9 2.31 0.022 QMAP 1.68 2.01 0-8 1.39 2.05 0-8 0.99 0.321 Notes: CCD – central coordination disorders, SMA – spontaneous motor activity, QMAP – quality of motor activity patterns. In both sexes, SMA (p < 0.001 in both sexes) and QMAP (p < 0.001 in both sexes) scores improved significantly with age. In girls, higher birth weight and higher Apgar scores were associated with significantly higher (p < 0.05) SMA and QMAP scores (Table 3). In both sexes, gestation length was not significantly correlated with SMA and QMAP scores. Table 3 Relationships between SMA and QMAP scores and vital signs at birth in male and female infants. r p r p SMA Gestation length [weeks] -0.06 ns 0.12 ns Birth weight [g] -0.04 ns 0.24 0.023 Apgar score [points] -0.12 ns 0.22 0.048 Age [months] 0.71 <0.001 0.76 <0.001 QMAP Gestation length [weeks] 0.07 ns 0.14 ns Birth weight [g] 0.06 ns 0.27 0.011 Apgar score [points] -0.02 ns 0.24 0.025 Age [months] 0.64 <0.001 0.75 <0.001 Notes: ns- not significant In the study population, CCD scores were not significantly correlated with vital signs at birth or the infant’s age on the day of the assessment (Table 4). Table 4 Relationships between CCD scores and vital signs at birth in male and female infants. r p r p CCD Gestation length [weeks] 0.09 ns -0.05 ns Birth weight [g] 0.04 ns -0.11 ns Apgar score [points] 0.01 ns -0.14 ns Age [months] -0.09 ns 0.17 ns The relationships between CCD, SMA, and QMAP scores are presented in Table 3. Significant correlations were found only in male subjects. In boys, a significant inverse correlation was noted between the CCD score and SMA and QMAP scores (p = 0.017 and p < 0.001, respectively). Table 5 Relationships between the CCD score and SMA and QMAP scores in male and female infants. r p r p CCD SMA -0.23 0.017 -0.05 ns QMAP -0.36 <0.001 -0.11 ns Potential relationships between the number of abnormal postural responses (CCD score) and the type of delivery (spontaneous or with surgical intervention), involuntary motor reflexes, and postural asymmetry were determined in a detailed analysis (Table 6). Girls with the Moro reflex and postural asymmetry received significantly higher CCD scores (p = 0.003 and p = 0.002, respectively). The number of abnormal postural responses (CCD score) was also significantly higher in boys with the palmar grasp reflex and postural asymmetry (p = 0.049 and p<0.001, respectively). In the group of male and female infants born by cesarean section, CCD scores were significantly higher in girls (p = 0.018). Table 6 Relationships between CCD scores, involuntary motor reflexes, postural asymmetry, and type of delivery in male and female infants. N Mean SD min-max N Mean SD min-max t p Sex 107 4.61 2.17 90 5.06 2.18 1.44 ns Type of delivery Spontaneous 20 4.90 1.71 2-7 16 5.07 2.32 0-7 0.24 ns C-section 36 4.14 2.37 0-7 26 5.54 2.04 0-7 2.43 0.018 t (p) Ns ns Palmar grasp reflex Absent 41 4.17 2.17 0-7 30 4.33 2.23 0-7 0.31 ns Present 52 4.81 2.11 0-7 46 5.34 2.16 07 1.25 ns t (p) Ns 1.99 (0.049) Moro reflex Absent 44 4.30 2.18 0-7 28 5.14 2.12 0-7 1.62 ns Present 19 6.00 1.45 3-7 18 5.17 2.41 0-7 1.29 ns t (p) 3.11 (0.003) ns Postural asymmetry Absent 16 3.13 2.22 0-7 13 3.15 2.48 0-7 0.03 ns Present 88 4.87 2.06 0-7 73 5.45 1.95 0-7 1.78 ns t (p) 3.12 (0.002) 3.75 (<0.001) The results of the analysis examining the relationships between the Moro reflex and seven postural responses (CCD score) are presented in Table 7. In boys, the presence of the Moro reflex was significantly correlated only with the Vojta reaction (p = 0.012) and the Collis vertical suspension response (p <0.001). In male infants, the relationship between the Moro reflex and the Landau reaction was on the borderline of statistical significance (p=0.053). In girls, postural responses (CCD score) were not significantly correlated with the Moro reflex (p>0.05). Only the correlation between the Moro reflex and the pull-to-sit (traction) reflex was on the borderline of statistical significance (p=0.056) (Table 7). Table 7 Relationships between the Moro reflex and seven postural responses in the CCD test. Present (n=19) Absent (n=44) Present (n=18) Absent (n=28) Pull-to-sit test χ 2 =1.28, γ =0.42, p=0.258 χ 2 =3.65, γ =0.58, p=0.056 * 0 Fo fo-fe 2 -1.62 10 1.62 7 2.70 4 -2.70 1 Fo fo-fe 17 1.62 34 -1.62 11 -2.70 24 2.70 Landau reaction χ 2 =3.74, γ =0.63, p=0.053 * χ 2 =0.01, γ =0.04, p=0.917 0 Fo fo-fe 2 -3.13 15 3.13 3 -0.13 5 0.13 1 Fo fo-fe 17 3.13 29 -3.13 15 0.13 23 -0.13 Auxiliary suspension test χ 2 =0.75, γ =0.27, p=0.385 χ 2 =1.96, γ =0.47, p=0.161 0 Fo fo-fe 4 -1.43 14 1.43 3 -2.09 10 2.09 1 Fo fo-fe 15 1.43 30 -1.43 15 2.09 18 -2.09 Vojta reaction χ 2 =6.37, γ =0.73, p=0.012 χ 2 =0.01, γ =0.02, p=0.953 0 Fo fo-fe 2 -4.33 19 4.33 5 -0.09 8 0.09 1 Fo fo-fe 17 4.33 25 -4.33 13 0.09 20 -0.09 Collis horizontal suspension test χ 2 =2.81, γ =0.44, p=0.094 χ 2 =0.12, γ =0.11, p=0.732 0 Fo fo-fe 6 -3.05 24 3.05 6 0.52 8 -0.52 1 Fo fo-fe 13 3.05 20 -3.05 12 -0.52 20 0.52 Peiper-Isbert suspension test χ 2 =3.18, γ =0.60, p=0.074 χ 2 =0.23, γ =0.17, p=0.632 0 Fo fo-fe 2 -2.83 14 2.83 4 -0.70 8 0.70 1 Fo fo-fe 17 2.83 30 -2.83 14 0.70 20 -0.70 Collis vertical suspension test χ 2 =12.43, γ =0.90, p<0.001 χ 2 =0.10, γ =0.10, p=0.754 0 Fo fo-fe 1 -6.24 23 6.24 5 -0.48 9 0.48 1 Fo fo-fe 18 6.24 21 -6.24 13 0.48 19 -0.48 Notes: * Borderline significant; fo - frequency observed; fe - frequency expected. The results of the analysis examining the relationship between the palmar grasp reflex and postural responses in the CCD test are presented in Table 8. In girls, the palmar grasp reflex was significantly correlated only with the pull-to-sit reflex and the Landau reaction (p = 0.006 and p = 0.035, respectively). In both sexes, the palmar grasp reflex was not significantly correlated with the results of the remaining motor tests (Table 8). Table 8 Relationships between the palmar grasp reflex and seven postural responses in the CCD test. Present (n=52) Absent (n=41) Present (n=46) Absent (n=30) Pull-to-sit test χ 2 =2.63, γ =0.38, p=0.105 χ 2 =7.57, γ =0.61, p=0.006 0 fo fo-fe 9 -3.30 13 3.30 8 -5.32 14 5.32 1 fo fo-fe 43 3.30 28 -3.30 38 5.32 16 -5.32 Landau reaction χ 2 =2.71, γ =0.37, p=0.010 χ 2 =4.42, γ =0.56, p=0.035 0 fo fo-fe 11 -3.54 15 3.54 5 -3.47 9 3.47 1 fo fo-fe 41 3.54 26 -3.54 41 3.47 21 -3.47 Auxiliary suspension test χ 2 =0.93, γ =0.22, p=0.335 χ 2 =1.09, γ =0.28, p=0.296 0 fo fo-fe 13 -2.10 14 2.10 9 -1.89 9 1.89 1 fo fo-fe 39 2.10 27 -2.10 37 1.89 21 -1.89 Vojta reaction χ 2 =2.37, γ =0.32, p=0.124 χ 2 =2.69, γ =0.38, p=0.101 0 fo fo-fe 16 -3.57 19 3.57 13 -3.34 14 3.34 1 fo fo-fe 36 3.57 22 -3.57 33 3.34 16 -3.34 Collis horizontal suspension test χ 2 =0.05, γ =0.05, p=0.829 χ 2 =0.13, γ =0.09, p=0.715 0 fo fo-fe 28 -0.52 23 0.52 15 -0.74 11 0.74 1 fo fo-fe 24 0.52 18 -0.52 31 0.74 19 -0.74 Peiper-Isbert suspension test χ 2 =1.14, γ =0.24, p=0.286 χ 2 =0.96, γ =0.24, p=0.326 0 fo fo-fe 18 2.34 10 -2.34 12 -1.92 11 1.92 1 fo fo-fe 34 -2.34 31 2.34 34 1.92 19 -1.92 Collis vertical suspension test χ 2 =2.73, γ =0.34, p=0.099 χ 2 =0.74, γ =0.21, p=0.390 0 fo fo-fe 19 -3.92 22 3.92 14 -1.74 12 1.74 1 fo fo-fe 33 3.92 19 -3.92 32 1.74 18 -1.74 Notes: fo - frequency observed, fe - frequency expected. 4. Discussion In the first year of life, SMA serves as a window into the development and functional state of the CNS. Neurodevelopmental disorders should be diagnosed with the use of standardized tools based on the results of thorough observations to identify potential correlations between a child’s spontaneous behavior and motor reflexes. In the present study, an attempt was also made to analyze the relationships between vital signs at birth, the infants’ motor skills, QMAP, and CCD. In physical therapy practice, the identified correlations could facilitate diagnosis and shorten the time from diagnosis to treatment. The study revealed significant correlations only for some vital signs at birth; in no case, they were observed simultaneously in both sexes. These findings suggest that the identified relationships may point to the risk of neurodevelopmental disorders; however, they cannot serve as definitive predictors of such abnormalities. The analyzed relationships indicate that vital signs at birth, including birth weight and the Apgar score, as well as the infant’s age during the examination can be associated with developmental abnormalities in girls, but do not play a key role because they proceed differently in both sexes. In turn, SMA and QMAP are related with CCD in male infants. This observation suggests that newborns that have not achieved motor development milestones or whose motor skills deviate from the norm should be diagnosed for CNS disorders and referred for neurodevelopmental therapy as soon as possible. In the current study, the risk of CCD was not correlated with gestation length, birth weight, or the Apgar score. The above could be attributed to the fact that these associations were explored across the entire study population that was not divided into subgroups characterized by short (up to 37 weeks) and normal gestation length (40 weeks), low birth weight (up to 2500 g) and macrosomia (birth weight higher than 4000 g), or low Apgar score (≤4 points). Therefore, further and more detailed research is needed to explore potential differences between these subgroups. Lipińska et al. (2021) examined potential correlations between progression of pregnancy and hyperactivity in children and adolescents aged 7-17 years. They found that the risk of neurodevelopmental disorders was higher in children who received an Apgar score of 0-4 points at 1 minute and 5 minutes after birth. In turn, Kubisa (2021) evaluated the psychomotor development of preterm infants and did not report significant correlations (p>0.05) between the Apgar score at 1, 3, 5, and 10 minutes after birth and the psychomotor development of infants in the first year of life. The present study revealed a significant correlation between the Apgar score (p < 0.05) and the psychomotor abilities (SMA and QMAP) of girls, but not boys. These observations suggest that the Apgar score is not always a reliable predictor of normal or abnormal psychomotor development; therefore, the decision to refer infants for motor skills therapy should not be based solely on this parameter. In a cohort study examining infants aged up to 5 months, Kwong et al. (2018) attempted to identify diagnostic tools for evaluating SMA and capturing the activity repertoire of newborns who were later diagnosed with cerebral palsy. The cited authors conducted a thorough analysis of the literature to identify studies investigating the SMA of infants using Prechtl’s General Movements Assessment. They concluded that the SMA and motor skills of infants are strong predictors of neurodevelopmental disorders and cerebral palsy. The cited authors also attempted to demonstrate that motor skills and QMAP are associated with CNS disorders in newborns. They found that male infants’ scores in SMA and QMAP tests deteriorated significantly with a rise in the number of abnormal postural responses in the CCD test. Emma et al. (2014) conducted a cohort study of 232 mothers and their term newborns (50.4% boys) who were assessed at three time points in the first postnatal year. An analysis of the relationship between gestation length and the child’s cognitive and motor development revealed that a longer pregnancy, even in children that were born at full term, promotes mental and motor development and that preterm infants show persisting impairments in cognitive function, school achievement, and brain development. In turn, Zachwieja (2021) investigated the psychomotor development of 283 preterm children and found that the risk of pediatric cerebral palsy increases with shorter gestational length. The cited studies indicate that the length of pregnancy affects the development and potential abnormalities of the CNS in newborns. This observation was not corroborated by the present study, where no significant correlations between neurodevelopmental disorders and gestation length were found in male or female infants. In this study, an attempt was also made to analyze the relationships between the Moro reflex, the palmar grasp reflex, and seven postural responses. Age-appropriate involuntary responses were evaluated in each of the seven tested postures. The assessment revealed a significant correlation between both involuntary responses and the postural reaction. In girls, the grasp reflex was significantly correlated with abnormal pull-to-sit and the Landau reaction. Prolonged retention of the grasp reflex is usually associated with abnormally high muscle tone in the upper limbs, which could explain the postural responses noted in the study. In male infants, the Moro reflex was correlated with the Vojta reaction and the Collis vertical suspension response. In addition, girls and boys diagnosed with postural asymmetry were also characterized by higher CCD scores. The above suggests that postural asymmetry is significantly correlated with CCD and could be a predictor of abnormal psychomotor development in later life. Surowińska et al. (2023) examined 107 newborns at 3 months, with follow-up checks at 9 and 16 months, and found that qualitative assessments were better predictors of developmental milestones than any of the reflexes, excluding walking which is strongly predicted by the Babkin reflex. Chinello et al. (2018) observed that the persistence of primitive reflexes, including the sucking reflex and palmar and plantar grasp reflexes, can be promising early indicators of autism spectrum disorders in children. The clinical significance of palmar and plantar grasp reflexes was also demonstrated by Futagi et al. (2012). The cited researchers concluded that these reflexes are sensitive and clinically significant predictors of abnormal neural development, particularly in children with spastic cerebral palsy. Neurodevelopmental assessments of neonates should be conducted as early as possible, especially in children at risk of developmental abnormalities. The risk factors that predispose infants to neurodevelopmental disorders include obstructed labor, maternal hygiene and lifestyle, maternal medical history, and maternal physical activity (Luoto et al., 2013; Bagherzadeh et al., 2021), which were not considered in the current study. These assessments can be conducted using numerous diagnostic tools that were discussed in the study. These tools should be carefully selected based on the examiner’s skills and experience as well as the child’s age, to ensure that neonates’ psychomotor development is evaluated objectively and that the results of the assessment can be reliably used to choose the optimal treatment. 5. Strengths and Limitations The strength of the study lies in the fact that it analyzed the correlations between multiple variables, including perinatal factors. The main limitation was that the study population was not divided into subgroups based on specific risk factors, such as preterm birth, low birth weight, and low Apgar score. 6. Conclusion Vital signs at birth, including birth weight, the Apgar score, and type of delivery, can be reliable predictors of motor development disorders, but do not clearly discriminate infants that require neurodevelopmental therapy. The grasp reflex, the Moro reflex, and postural asymmetry are significantly correlated with CCD and could be indicative of potential abnormalities in the psychomotor development of infants. Special attention should be paid to prolonged retention of motor reflexes to diagnose neonates at risk of abnormal psychomotor development and to initiate the appropriate treatment as early as possible. 7. Supporting information 66 Author Contributions: Conceptualization: Robert Podstawski, Katarzyna Balewska; Data curation: Katarzyna Balewska; Formal analysis: Krzysztof Borysławski; Funding acquisition: Robert Podstawski; Investigation: Katarzyna Balewska, Robert Podstawski, Jadwiga Snarska; Methodology: Katarzyna Balewska, Robert Podstawski; Validation: Krzysztof Borysławski; Project administration: Robert Podstawski; Software: Krzysztof Borysławski; Supervision: Robert Podstawski; Writing - original draft: Robert Podstawski, Katarzyna Balewska, Krzysztof Borysławski, Atilla Szabo, Jadwiga Snarska; Writing – review & editing: Robert Podstawski, Katarzyna Balewska, Krzysztof Borysławski, Atilla Szabo; Visualization: Robert Podstawski; Resources: Robert Podstawski. All authors have read and agreed to the published version of the manuscript. This research received no external funding. Institutional Review Board Statement The study was conducted upon the prior consent of the Ethics Committee of the Medical University of Poznań, Poland (179/2012). Informed Consent Statement The study involved volunteer children whose parents provided written informed consent. Data Availability Statement The access to Excel data generated during this study has been restricted by the Ethics Committee of the UWM in Olsztyn to protect the participants’ privacy. Researchers who meet the criteria for access to confidential data can submit a data request by email to [email protected] . Acknowledgments The authors would like to express their gratitude to the parents whose children participated in the study. Conflicts of Interest The authors declare no conflicts of interest. References 1. Apaydın U, Erol E, Gücüyener K, Yıldız A, Elbasan B. Yıldız R, Acar S-S. Gücüyener K, Elbasan B. (2021). The use of neuroimaging, Prechtl’s general movement assessment and the Hammersmith infant neurological examination in determining the prognosis in 2-year-old infants with hypoxic ischemic encephalopathy who were treated with hypothermia. Early Human Development 163: 105487. Crossref Google Scholar 2. Bagherzadeh R, Gharibi T, Safavi B, Mohammadi SZ, Karami F, Keshavarz S. (2021). Pregnancy; an opportunity to return to a healthy lifestyle: a qualitative study. BMC Pregnancy Childbirth 21(1): 751. Crossref Google Scholar 3. Bobath, K.; Bobath, B. (1967). The Neuro-Developmental Treatment of Cerebral Palsy. Phys. Ther. 1967, 47, 1039–1043. Google Scholar 4. Bokiniec R, Bekesińska-Figatowska B, Rudzińska I, Borszewska-Kornacka MK. (2014). Sonographic and MRI findings in neonates following selective cerebral hypothermia. Ginekol Pol 85: 933-938. Google Scholar 5. Brown KA, Parikh S, Patel DR. (2020). Understanding basic concepts of developmental diagnosis in children. Transl Pediatr 9(Suppl 1):S9-S22. Crossref Google Scholar 6. Chinello A., Di Gangi V., Valenza E. (2018). Persistent primary reflexes affect motor acts: Potential implications for autism spectrum disorder. Elsevier, Research in Developmental Disabilities 83: 287-295. Google Scholar 7. Darsaklis V, Snider LM, Majnemer A, Mazer B. (2011). Predictive validity of Prechtl’s Method on the Qualitative Assessment of General Movements: a systematic review of the evidence. Dev Med Child Neurol 53(10): 896-906. Crossref Google Scholar 8. De Vries LS, Verboon-Maciolek MA, Cowan FM, Groenendaal F. (2006). The role of cranial ultrasound and magnetic resonance imaging in the diagnosis of infections of the central nervous system. Early Hum Dev 82(12): 819-25. Crossref Google Scholar 9. De-La-Barrera-Aranda E, Gonzalez-Gerez JJ, Saavedra-Hernandez M, Fernandez-Bueno L, Rodriguez-Blanco C, Bernal-Utrera C. (2021). Vojta Therapy in Neuromotor Development of Pediatrics Patients with Periventricular Leukomalacia: Case Series. Medicina (Kaunas) 57(11): 1149. Crossref Google Scholar 10. Espel EV, Glynn LM, Sandman CA, Davis EP. (2014). Longer gestation among children born full term influences cognitive and motor development. PLoS One. 9(11): e113758. Crossref Google Scholar 11. Futagi Y, Toribe Y, Suzuki Y. (2012). The grasp reflex and moro reflex in infants: hierarchy of primitive reflex responses. Int J Pediatr 191562. Crossref Google Scholar 12. Grotheer M, Rosenke M, Wu H, Kular H, Querdasi FR, Natu VS, Yeatman JD, Grill-Spector K. (2022). White matter myelination during early infancy is linked to spatial gradients and myelin content at birth. Nat Commun 22;13(1): 997. Crossref Google Scholar 13. Izett E, Rooney R, Prescott SL, De Palma M, McDevitt M. (2021). Prevention of Mental Health Difficulties for Children Aged 0-3 Years: A Review. Front Psychol 29(11): 500361. Crossref Google Scholar 14. Joseph HM, Lorenzo NE, Fisher N, Novick DR, Gibson C, Rothenberger SD, Foust JE, Chronis-Tuscano A. (2023). Research Review: A systematic review and meta-analysis of infant and toddler temperament as predictors of childhood attention-deficit/hyperactivity disorder. J Child Psychol Psychiatry 64(5): 715-735. Crossref Google Scholar 15. Jung MW, Landenberger M, Jung T, Lindenthal T, Philippi H. (2017). Vojta therapy and neurodevelopmental treatmentin children with infantile postural asymmetry: a randomised controlled trial. Phys. Ther. Sci 29: 301–306. Crossref Google Scholar 16. Kubisa A. (2021). Ocena rozwoju psychoruchowego u dzieci po zastosowaniu selektywnego chłodzenia mózgu. Polich Paltform of Medical Research skRepository of Wroclaw Medical University of the Piasts of Silesia. Crossref Google Scholar 17. Lipińska E., Słopień A., Pytlińska N., Słopień R., Wolańczy T., Bryńska A. (2021). The role of factors associated with the course of pregnancy and childbirth in attention deficit hyperactivity disorder (ADHD). Psychiatr. Pol. 2021; 55(3): 659–673. Google Scholar 18. Luoto R, Mottola MF, Hilakivi-Clarke L. (2013). Pregnancy and lifestyle: short- and long-term effects on mother’s and her children’s health. J Pregnancy 2013: 537526. Crossref Google Scholar 19. Malak R, Torzyńska P, Żółkiewska J, Matecka M, Samborski W. (2024). Assessment of motor development in children with postural asymmetry and the application of neurodevelopmental-based improvement methods. Rheumatol. Forum 10(2): 194–206. Crossref Google Scholar 20. Menéndez-Pardiñas M, Alonso-Bidegaín M, Santonja-Medina F, Sánchez-González JL, Sanz-Mengibar JM. (2023). Effects of Vojta Therapy on the Motor Function of Children with Neuromotor Disorders: Study Protocol for a Randomized Controlled Trial. J Clin Med 12(23):7373. Crossref Google Scholar 21. Pazera G, Młodawska M, Kukulska K, Młodawski J. (2023). The Assessment of Psychomotor Development in Full-Term Children at 12 Months of Age with Munich Functional Development Diagnostics Depending on the Feeding Method: A Cross-Sectional Study. Pediatric Reports 15(2):381-389. Google Scholar 22. Pazera G, Młodawska M, Młodawski J, Klimowska K. (2021). Principal Component Analysis of Munich Functional Developmental Diagnosis. Pediatr Rep 13(2): 227-233. Crossref Google Scholar 23. Pecuch A, Gieysztor E, Wolańska E, Telenga M, Paprocka-Borowicz M. (2021). Primitive Reflex Activity in Relation to Motor Skills in Healthy Preschool Children. Brain Sci 23;11(8): 967. Crossref Google Scholar 24. Polczyk AE (2018) Early Use of Vojta Therapy in Children with Postural Asymmetry, at Risk of Hip Dysplasia. Pediatr Ther 8: 339. Crossref Google Scholar 25. Sánchez-González JL, Sanz-Esteban I, Menéndez-Pardiñas M, Navarro-López V, Sanz-Mengíbar JM. (2024). Critical review of the evidence for Vojta Therapy: a systematic review and meta-analysis. Front Neurol 15: 1391448. Crossref Google Scholar 26. Shen W, Pan JH, Chen WD. (2015). Comparison of transcranial ultrasound and cranial MRI in evaluations of brain injuries from neonatal asphyxia. Int J Clin Exp Med 15;8(10): 18319-26. Google Scholar 27. Strojek K, Wójtowicz D, Kowalska J. (2022). Assessment of the Emotional State of Parents of Children Starting the Vojta Therapy in the Context of the Physical Activity-A Pilot Study. Int J Environ Res Public Health 19(17): 10691. Crossref Google Scholar 28. Surowińska J., Sobieska M., Gajewska E. (2023). Qualitative assessment in the third month of life allows for a better prognosis of the achievement of motor milestones versus assessment of pathological reflexes- prospective studies on Polish children. Front Public Health 11:1253137. Crossref Google Scholar 29. Te Velde A, Morgan C, Finch-Edmondson M, McNamara L, McNamara M, Paton MCB, Stanton E, Webb A, Badawi N, Novak I. (2022). Neurodevelopmental Therapy for Cerebral Palsy: A Meta-analysis. Pediatrics 149(6): e2021055061. Crossref Google Scholar 30. Ungureanu A, Rusu L, Rusu MR, Marin MI. (2022). Balance Rehabilitation Approach by Bobath and Vojta Methods in Cerebral Palsy: A Pilot Study. Children (Basel) 28;9(10):1481. Crossref Google Scholar 31. Vojta V. (1973). Frühbehandlung der CP-Risikokonder Analyse der Endresultate. Mschr. Kinderhelik 121:271-273. Google Scholar 32. Vojta V. (1985). Lokomotorische Prognose der CP-Kinder bei Behandlung mit Refleks-Lokomoti-onssystemen. Vortag, Jahreskongres der Zentralverbandes der Krankengymnastik, Mainz, Mai 1985. Google Scholar 33. Vojta V. (1989). The postural activity and reactivity and its stages of ontogenical maturation. In: Bottos M. Neurological lesions in infancy. Padova: Liviana, 45-52. Google Scholar 34. Vojta V. (2009). Die Entdeckung der idealen motorik. München: Pflaum Verlag, 2009. Google Scholar 35. Zachwieja J. (2022). Psychomotor development of children born prematurely. Medical university of Silesia in Katowice, 2021 (PhD thesis) Google Scholar Information & Authors Information Version history V1 Version 1 02 June 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords coordination of the central nervous system motor disorders physical therapy diagnosis postural reflexes spontaneous motor activity Authors Affiliations Robert Podstawski 0000-0002-1492-252X [email protected] University of Warmia and Mazury in Olsztyn View all articles by this author Katarzyna Balewska-Juras University of Warmia and Mazury in Olsztyn View all articles by this author Krzysztof Borysławski Angelus Silesius University of Applied Sciences in Wałbrzych View all articles by this author Atilla Szabo Széchenyi István University View all articles by this author Jadwiga Snarska University of Warmia and Mazury in Olsztyn View all articles by this author Metrics & Citations Metrics Article Usage 214 views 105 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Robert Podstawski, Katarzyna Balewska-Juras, Krzysztof Borysławski, et al. An Assessment of Motor Skills in Infants at Risk of Abnormal Psychomotor Development Using the Vojta Method. Authorea . 02 June 2025. DOI: https://doi.org/10.22541/au.174889644.41935738/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . Format Please select one from the list RIS (ProCite, Reference Manager) EndNote BibTex Medlars RefWorks Direct import Tips for downloading citations document.getElementById('citMgrHelpLink').addEventListener('click', function() { popupHelp(this.href); return false; }); $(".js__slcInclude").on("change", function(e){ if ($(this).val() == 'refworks') $('#direct').prop("checked", false); $('#direct').prop("disabled", ($(this).val() == 'refworks')); }); Cited by Artur Polczyk, Ewelina Wolańska, Anna Zimny, Agnieszka Zubkiewicz-Kucharska, Mateusz Biela, Agnieszka Pawelak, Robert Śmigiel, Neurodevelopmental Disorder with Psychomotor Delay, Hearing Loss, and Spasticity Caused by Compound Heterozygous SPATA5L1 Variants—Expanding Phenotype, Journal of Clinical Medicine, 14 , 23, (8442), (2025). https://doi.org/10.3390/jcm14238442 Crossref Loading... View Options View options PDF View PDF Figures Tables Media Share Share Share article link Copy Link Copied! Copying failed. Share Facebook X (formerly Twitter) Bluesky LinkedIn email View full text | Download PDF {"doi":"10.22541/au.174889644.41935738/v1","type":"Article"} Now Reading: Share Figures Tables Close figure viewer Back to article Figure title goes here Change zoom level Go to figure location within the article Download figure Toggle share panel Toggle share panel Share Toggle information panel Toggle information panel Go to previous graphic Go to next graphic Go to previous table Go to next table All figures All tables View all material View all material xrefBack.goTo xrefBack.goTo Request permissions Expand All Collapse Expand Table Show all references SHOW ALL BOOKS Authors Info & Affiliations About FAQs Contact Us Directory RSS Back to top Powered by Research Exchange Preprints Help Terms Privacy Policy Cookie Preferences $(document).ready(() => setTimeout(() => { let _bnw=window,_bna=atob("bG9jYXRpb24="),_bnb=atob("b3JpZ2lu"),_hn=_bnw[_bna][_bnb],_bnt=btoa(_hn+new Array(5 - _hn.length % 4).join(" ")); $.get("/resource/lodash?t="+_bnt); },4000)); (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'9feb26798956aa64',t:'MTc3OTI3ODEwNA=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();