Automatic gait evoking in healthy adults through Vojta’s peripheric somatosensory stimulation: a double-blind randomized controlled trial

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Automatic gait evoking in healthy adults through Vojta’s peripheric somatosensory stimulation: a double-blind randomized controlled trial

• Luis Perales-López,
• Ismael Sanz-Esteban,
• Camen Jiménez-Antona,
• J. Ignacio Serrano,
• Ana San-Martín-Gómez,
• Xisca Vives-Gelabert &
• Roberto Cano-de-la-Cuerda 

Journal of NeuroEngineering and Rehabilitation volume 21, Article number: 174 (2024) Cite this article

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Abstract

Background

To study the effects of different interventions on automatic gait processing in contrast with voluntary gait processing in healthy subjects.

Methods

A double-blind randomised controlled trial was designed (120 able-body persons between 18 and 65 years old entered and completed the study), with pre-intervention and post-intervention assessments using the 6-Minute Walk Test (6MWT). The participants were randomly distributed into four groups. Prior to intervention, all participants performed voluntary gait on the ground (VoG) in a calibrated circuit following the 6MWT. The presence of automatic gait (AG) was explored post-intervention without a voluntary demand in the same circuit following the 6MWT. Each group received a different intervention for 30 min: Vojta stimulation, MOTOMED^® at no less than 60 revolutions/minute, treadmill walking at 3 km/h, and resting in a chair (control). The main assessment, conducted by a blinded rater, was the difference in distance covered (in meters) during the 6MWT between pre- and post-intervention. Surface electromyography (sEMG) average root mean square (RMS) signals in the right tibialis anterior, right soleus, right rectus femoris, and right biceps femoris were also considered outcome measures.

Results

The Vojta group was the only one that initiated AG after the intervention (476.4 m ± 57.1 in VoG versus 9.0 m ± 8.9 in AG, p < 0.001) with comparable kinematics and EMG parameters during voluntary gait, except for ankle dorsal flexion. Within the Vojta group, high variability in kinematics, sEMG activity, and distance covered was observed.

Conclusions

AG isolation is approachable through Vojta at only one session measurable with the 6MWT without any voluntary gait demand. No automatic gait effects were observed post-intervention in the other groups.

Trial registration

NCT04689841 (ClinicalTrials.gov).

Background

Studies on gait in able-bodied persons have served to identify common kinematic and kinetic patterns related to locomotion and to identify deviations from normality [1, 2]. In clinical practice, observational scales are the most common approach used to assess gait patterns, but instrumental systems provide more objective data on kinematic and kinetic parameters. Nevertheless, instrumental systems require custom instrumentation, they take a longer time, and their use in clinical practice is not always available [3].

Takakussaki described three levels of neural processing in gait: voluntary (VoG), emotional (EG) and automatic (AG) [4]. AG processing related to gait in humans has been shown to be localized in the mesencephalic locomotor region (MLR), in addition to other areas, such as the basal ganglia and cerebellum [5]. Therefore, although gait parameters may be influenced by the cortex depending on the goals or needs of the tasks, they do not seem to be indispensable for controlling posture and movement during walking [6]. In this context, the study of AG without an external trigger has been conducted in a very limited number of studies [4, 5].

Vojta reflex locomotion therapy (RLT) is considered a bottom-up rehabilitation approach [6], and it is based on the global activation of innate locomotion patterns evoked by sustained pressure stimulation on specific body points from a specific initial position [7]. Involuntary postural and motor responses may be activated by RLT [8], and their effects have been studied at several age ranges [9], and in different neurological disorders [10,11,12]. However, its neurophysiological justification for AG has not been demonstrated in able-bodied individuals.

In this context, most rehabilitation techniques seek to generate VoG in people with neurological disorders, considering the difficulties in differentiating between EG and AG neural processing. However, in situations of functional limitation, when there is a voluntary inability to initiate or execute movement, rehabilitation approaches that increase AG activation might be justified. In this sense, Malone et al. [13] reported that for gait rehabilitation, nonconscious training without verbal commands about the walking process provides greater benefits for learning to walk in an automatic manner. Consequently, studies justifying such hypotheses would be relevant and should be conducted in able-bodied persons to justify its potential use in people with neurological pathology at a later stage.

Therefore, the aim of this research was to study the effects of RTL, compared with those of different interventions and a control group, on AG in able-bodied persons. Our initial hypothesis was that, compared with other interventions, the AG pattern could be triggered with a single session of RTL because, with the RLT, the dissociation between the AG and the VoG and/or EG can be elicited by suppressing self-initiated gait commands.

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