Effect of Vojta Therapy on Stress and Emotional Well-Being in Parents of Children with Central Coordination Disorders

Introduction

Gross motor skill disorders, manifested primarily as abnormalities in muscle tone and the development of postural responses, can be diagnosed in the early stages of motor development, and according to Vojta’s diagnostic approach, early symptoms of central coordination disorders (CCDs) indicate abnormal development of these responses [1,2]. Neurodevelopmental disorders identified during the diagnostic process require early interventions to eliminate or alleviate the dysfunctions [3–6]. Improvement in social interactions and the quality of neurological reflexes, which precede the development of spontaneous motor skills and changes in postural responses, are the first effects of early intervention using the Vojta method [7].

The Vojta method is a neurophysiological approach used for the diagnosis and treatment of motor disorders in infants and children [8]. It is based on the concept of reflex locomotion, which assumes that specific movement patterns are innate and encoded in the central nervous system (CNS) and can be activated through targeted external stimuli [9]. At the neurophysiological level, stimulation through Vojta therapy [10] induces psychomotor changes [11]. Vojta therapy is a method that suppresses abnormal movements and supports the development of proper motor patterns by promoting postural control and eliminating compensatory, incorrectly acquired movements [10,12].

Parents play a fundamental role in the therapeutic process of their child’s treatment using the Vojta method. The responsibility for the consistency and effectiveness of therapy relies heavily on their level of engagement [13]. Parents of children with developmental disorders and disabilities experience elevated levels of stress and are at higher risk for mental health disorders than are parents of typically developing children [14–16]. Research shows that caregivers of children with various impairments report significantly higher levels of stress and depressive symptoms, as well as a lower quality of life, than do parents of children without such conditions [17]. According to Davis and Carter and Falk et al, parental stress results from the significant physical and psychological burden of daily caregiving duties and constant worry about the child’s future [18,19]. These experiences can destabilize the functioning of the entire family system and directly contribute to a reduced quality of life for all its members [20,21]. This is especially noticeable among parents of children undergoing rehabilitation using the Vojta method [10]. According to many reports, the Vojta therapy is effective, but it is still controversial, even among parents whose children are receiving the therapy [23–27]. It requires active parental involvement and can be associated with a high emotional burden, further intensifying the already stressful situation of having a child with illness [28]. High levels of stress and symptoms of depression among this group of parents beginning Vojta therapy have been confirmed in previously published pilot studies [22]. These studies highlighted the presence of emotional difficulties and their variation depending on participant sex and level of physical activity [22].

Physical activity is widely recognized as a key factor in the prevention and treatment of mental disorders, as well as in maintaining mental well-being [29,30]. Previous studies have confirmed that higher levels of physical activity are associated with a lower risk of depression and a reduced likelihood of developing anxiety disorders across all age groups [31,32]. Regular physical activity serves as a beneficial coping mechanism for negative emotions and reduces stress by inducing positive emotions, which in turn help regulate health behaviors and improve overall well-being [33,34]. Exercise alleviates the negative effects of stress by increasing antioxidant capacity and reducing inflammation, and it regulates the hypothalamic–pituitary–adrenal axis, lowers cortisol levels, and strengthens stress resilience [35,36].

Therefore, in this study, we aimed to assess changes in the emotional state of parents of children with CCDs undergoing rehabilitation using the Vojta method over a 2-month period, including levels of perceived stress, anxiety, depressive symptoms, and life satisfaction. Another objective was to identify key determinants of stress levels at baseline and after 2 months of therapy, with particular attention to the potential role of physical activity. To assess the parents’ emotional state, the most common and standardized tests were used: the Patient Health Questionnaire (PHQ-9) to assess depression, State-Trait Anxiety Inventory (STAI) to assess anxiety, and Satisfaction With Life Scale (SWLS) to assess life satisfaction [37–39]. The Perceived Stress Scale (PSS-10) was used to assess the level of stress [40].

The study emphasized the necessity of focusing not only on the child but also on the parent as co-therapist. This can be important in planning and conducting Vojta therapy and ensuring its effectiveness, as a decline in the psychophysical condition of the caregiver can negatively affect the quality of care given [41,42].

Material and Methods

ETHICS STATEMENT:

The participants were informed of the study’s rules and objectives, after which they gave voluntary (written) consent to participate. Approval for the study was obtained by the Senate Commission for the Ethics of Scientific Research at the Wrocław University of Health and Sport Sciences (reference no. 21/2023). The study was conducted in accordance with the Declaration of Helsinki.

STUDY DESIGN:

This prospective observational study was conducted in centers providing Vojta therapy for children (the Diagnostic and Rehabilitation Center of the “Promyk Słońca” Foundation and the “Creator” Non-Public Health Care Institution) in Wrocław, from November 2023 to January 2025. The research was planned based on a pilot study published in the International Journal of Environmental Research and Public Health in 2022 [22].

PARTICIPANTS:

The study group included parents of children with CCD who were qualified for rehabilitation using the Vojta method. Based on the pilot studies, the following inclusion criteria were established: parents of children aged 0 to 1 year; willingness to start their child’s therapy with the Vojta method; use of the Vojta method with the child and parents for the first time; therapy duration of a minimum of 2 months; no previously diagnosed serious mental illnesses or pharmacologically treated mental illnesses (eg, psychosis, bipolar disorder, depressive disorder); and writing consent to participate in the study [22]. Participants were recruited consecutively during scheduled visits to centers providing Vojta therapy. Data collection was conducted in person using paper-based questionnaires completed on site, with the researcher available to provide explanations if needed.

A total of 103 parents (mean age 32.7±4.8 years; 61 women and 42 men) who met the inclusion criteria were recruited for the study. At the final assessment, conducted 2 months after the child’s therapy (T2), 51 participants (mean age 32.4±4.3 years) were evaluated. The characteristics of the study group are shown in Table 1.

METHODS:

The authors’ questionnaire was used to collect sociodemographic data and information about parents’ physical activity. Additionally, Polish adaptations of the PSS-10, PHQ-9, STAI, and SWLS were used.

PERCEIVED STRESS SCALE (PSS-10): The PSS-10 is used to assess the subjective perception of stress in the context of stressful situations. The PSS-10 questionnaire consists of 10 questions concerning subjective feelings related to daily problems and personal events, and the behaviors and coping strategies triggered by them over the past month. This scale is a simple and reliable tool that can be useful in clinical practice and in scientific research. The higher the score (max. 40 points), the higher the level of perceived stress. Raw scores were converted into sten scores, where 1 to 4 stens (0–13 points) indicate a low level of stress, 5 to 6 stens (14–19 points) indicate a moderate level of stress, and 7 to 10 stens (20–40 points) indicate a high level of stress. The Cronbach’s alpha is 0.86 [43].

PATIENT HEALTH QUESTIONNAIRE (PHQ-9): The PHQ-9 is used to assess the severity of depressive symptoms. The scale consists of 9 questions about the presence of depressive symptoms. Respondents can score a maximum of 27 points. Scores of 5, 10, 15, and 20 points represent cutoff points for mild, moderate, moderately severe, and severe depression, respectively. The PHQ-9 is currently one of the best tools for assessing the risk of depression in individuals aged 18 to 60 years. The Cronbach’s alpha is 0.88 [44].

STATE-TRAIT ANXIETY INVENTORY (STAI): The STAI is used to assess anxiety as a state (STAI X-1) and anxiety as a trait (STAI X-2). The scale consists of 40 responses. Respondents can score a maximum of 80 points (40 for each scale). The higher the score, the higher the level of anxiety. The high level of anxiety as a state is above 44 points, and for anxiety as a trait is above 46 points. The STAI is widely used in scientific research and clinical practice. The Polish version demonstrates psychometric properties comparable to that of the original version. The Cronbach’s alpha is 0.89 for STAI X-1 and 0.83 for STAI X-2 [45].

SATISFACTION WITH LIFE SCALE (SWLS): The SWLS assesses subjective life satisfaction through the use of 5 statements. Respondents rate the extent to which each statement reflects their experience of life so far, and the total score provides a general indicator of life satisfaction. The scale is intended for use with adults who are either healthy of ill. The maximum total score is 35 points, with higher scores indicating higher satisfaction with life. Results of 5 to 17 points indicate low satisfaction; 18 to 23 points, average satisfaction; and 24 to 35 points, high satisfaction. The Cronbach’s alpha is 0.81 [46].

To reduce the effect of the physiotherapist’s personality and her or his ability to explain the therapy, all parents surveyed had a scheduled appointment with the same person, who was a certified therapist in the Vojta method with many years of work experience [22]. The assessments were conducted at baseline (T1) and after 2 months of Vojta therapy (T2).

STATISTICAL ANALYSIS:

Due to the ordinal nature of most variables and the non-normal distribution of quantitative variables, descriptive statistics are presented using the median and interquartile range (IQR=Q3-Q1). For nominal variables, frequencies and percentages were calculated. The significance of differences between measurements 1 (T1) and 2 (T2) was tested using the Wilcoxon signed-rank test. The Mann-Whitney U test was used to assess the significance of differences between 2 groups. Ordinal variables were analyzed using the chi-square test. The influence of the examined factors on stress levels assessed with the PSS-10 in T1 and T2 was identified using multivariate regression models.

All analyses were conducted using Statistica 14.1 and PQStat 1.8.4 software. The significance level was set at P<0.05. For multiple comparisons, the Bonferroni correction was applied by dividing the significance level by the number of comparisons: P=0.05/2=0.025.

Results

QUANTITATIVE ANALYSIS OF PSYCHOLOGICAL VARIABLES:

The quantitative analysis of the study results showed that participants exhibited a moderate level of stress, average level of anxiety, mild depressive symptoms, and high level of life satisfaction. There was a significant decrease in the severity of depressive symptoms after 2 months of the child’s therapy (Table 2).

QUALITATIVE ANALYSIS OF STRESS AND DEPRESSION:

The qualitative analysis, however, showed that at T1 (in the groups n=103 and n=51), nearly 70% of participants reported experiencing moderate or high levels of stress. Additionally, more than 60% of participants presented symptoms of depression (Table 3). Only 29.4% of participants with an initially high level of stress showed a reduction to a low or moderate level at T2. A high level of stress persisted over time in more than 70% of participants (Table 4). It is also noteworthy that approximately 23% of participants with a low initial level of stress exhibited an increase to a moderate or high level at T2 (Table 4). Among participants who presented with depressive symptoms at the first measurement, 40% showed a reduction in symptom severity to normative levels (ie, absence of depressive symptoms). Nevertheless, more than 60% of participants reported low mood and depressive symptoms at T2 (Table 5).

EMOTIONAL STATE AND LIFE SATISFACTION BY PHYSICAL ACTIVITY:

Participants’ emotional state and life satisfaction were also assessed concerning their physical activity. In the group of participants who reported physical activity at T1 (in the groups n=103 and n=51), significantly lower levels of stress and higher life satisfaction were observed. No significant differences were found in the severity of anxiety or depressive symptoms. At T2, the physically active group also exhibited lower stress levels and less severe depressive symptoms, compared with the inactive group. However, no statistically significant changes in the measured parameters between T1 and T2 were observed in either the physically active or physically inactive parent groups (Table 6).

SEX DIFFERENCES:

The comparison of measured parameters between mothers and fathers showed that women had significantly higher levels of stress (P=0.0071) and trait anxiety (P=0.0002) than did men. No statistically significant differences between T1 and T2 were observed in either group.

MULTIVARIATE REGRESSION MODELS FOR STRESS LEVEL AT T1:

To identify variables affecting the level of perceived stress (PSS-10), multivariate regression models were developed. The analysis showed that sex, physical activity, trait anxiety, and life satisfaction were significant factors influencing stress levels at T1. Higher stress levels were observed among women than among men, and among physically inactive individuals than among those who were physically active. According to the presented model, a 1-point increase in trait anxiety (STAI X-2) was associated with a 0.32-point increase in the stress score, while a 1-point increase in life satisfaction was associated with a 0.4-point decrease in the PSS-10 score (Table 7).

We also examined whether frequency of physical activity affected stress levels at T1. In the developed regression model, physical activity was treated as a dummy variable, with no physical activity (0) set as the reference category. The analysis showed that only physical activity performed 3 times a week significantly reduced stress levels, compared with no activity. The other components of the model remained unchanged, confirming the significant impact of sex, trait anxiety, and life satisfaction on PSS-10 levels (Table 8).

MULTIVARIATE REGRESSION MODELS FOR STRESS LEVEL AT T2:

Similarly, the regression models developed for the results obtained at T2 did not show a significant effect of participant sex on PSS-10 level, but they confirmed, just as in T1, a significant influence of physical activity, trait anxiety, and life satisfaction level. The model that included exercise frequency also confirmed a significant effect of engaging in physical activity 3 times a week on stress levels at T2.

Discussion

The study aimed to assess the emotional state of 103 parents of children with CCDs rehabilitated using the Vojta method over 2 months and to identify factors determining parents’ stress levels at the beginning and after 2 months of therapy. The results of the present study confirmed previous findings reported by numerous authors, indicating that parents of children with developmental disorders experience higher levels of parental stress, depressive symptoms, and general psychological burden than do parents of typically developing children [47–49].

In the preliminary assessment conducted before therapy, almost 70% of the participants reported moderate or high stress levels, and 60% exhibited symptoms of depression. After 2 months, a higher proportion of participants reported improved mood, with fewer individuals experiencing high stress (decreasing from 17 at T1 to 12 at T2) and depressive symptoms (from 31 to 19). However, the percentage of participants with high stress levels and depressive symptoms remained elevated at approximately 70%. This highlights the highly stressful nature of having a child with developmental impairments and the resulting need for therapeutic intervention. Moreover, approximately 23% of participants who initially reported low stress levels experienced an increase to moderate or high levels. This rise in stress among some parents during the rehabilitation process can stem from multifactorial causes. Numerous publications have demonstrated that effective collaboration between families and specialists contributes to improved functioning in children [50–52]. On the other hand, the literature also highlights notable limitations in therapy programs involving strong parental engagement. Many therapeutic protocols require intensive exercise regimens lasting several hours to achieve effectiveness [53]. Concurrently, findings by McConnell et al suggest that adherence to therapeutic recommendations by parents is limited, often due to the need to forgo professional activity, rest, and family life to fully commit to the therapy process [54]. The authors further confirmed a significant association between the extent of sacrifices made by parents to implement therapy and the overall well-being of the family [54,55]. Parents engaged in therapeutic programs face considerable pressure to adhere to recommendations, and the level of commitment required can negatively impact family relationships [56]. These potentially adverse consequences of parental involvement in therapy delivery can contribute to increased perceived stress. Nevertheless, after 2 months of Vojta therapy, some parents in this study exhibited positive changes in their psychological functioning (a significant reduction in the severity of depressive symptoms and stress to low or moderate levels), despite the ongoing demands of caregiving and therapeutic responsibilities. The levels of stress observed in parents before and after 2 months of therapy are likely a consequence of complex and overlapping factors. Researchers have identified several such factors, including the child’s developmental deficits, increased caregiving demands, limited access to appropriate social support, experiences of social isolation, unfavorable socioeconomic conditions, and chronic emotional tension associated with uncertainty about the child’s future [57,58]. Findings from pilot and main studies highlight the positive effect of physical activity on the emotional state of participating parents [22]. Before the onset of therapy, significantly lower levels of stress and higher levels of life satisfaction were observed among participants reporting regular physical activity. At the final measurement, physically active individuals continued to report lower stress levels and fewer depressive symptoms than did those who were inactive. This phenomenon is supported by existing scientific evidence indicating that physical activity plays a significant role in the prevention of depression [31], reduction of anxiety symptoms [59,60], and lowering of stress levels [61]. Practices such as physical exercise, yoga, meditation, tai chi, and qi gong have demonstrated therapeutic potential in alleviating symptoms of depression and anxiety [62]. Regular physical activity contributes to a decreased risk of developing depression, alleviates its symptoms, supports treatment and recovery processes, lowers the risk of relapse, and reduces the psychological burden experienced by caregivers of individuals affected by the disorder [63–69]. These conclusions were further supported by regression analyses, which identified parental physical activity as a significant factor influencing stress levels both before and after therapy. Additionally, the frequency of physical activity was shown to be a significant predictor. Only regular physical activity performed at least 3 days per week was associated with reduced stress levels in the study group. These results agree with World Health Organization guidelines indicating that mental health benefits are maximized when physical activity is undertaken 3 to 5 times per week; when exercise frequency was either lower or higher, its effectiveness decreased. In a large-scale study involving 1 to 2 million individuals in the United States, Chekroud et al similarly found that exercising 3 to 5 times per week yielded the most favorable mental health outcomes [70]. Excessive physical activity – exceeding 5 sessions per week – can interfere with muscle recovery, strain the immune system, and increase the risk of psychological problems and sleep disturbances. Conversely, exercising less than twice per week yielded only limited benefits [71]. These findings underscore the importance of physical activity not only as a preventive measure but also as a component supporting the mental health of parents of children with CCD undergoing Vojta therapy. Other significant predictors identified in the regression analysis included participant sex, trait anxiety, and life satisfaction. Women reported higher stress levels than did men, which can be attributed to the fact that the demanding and intensive care of children with disabilities often reinforces traditional gender roles, with caregiving responsibilities typically falling on mothers [72]. These findings are consistent with those of other studies showing higher stress levels and a greater prevalence of mood disorders are significantly more common among mothers than fathers [73,74], likely reflecting their greater involvement in daily caregiving, educational tasks, and developmental support. Similar patterns were reported by Dąbrowska and Pisula, who found significant differences between mothers and fathers in terms of experienced burden and parental stress [75]. In the present study, another important predictor of stress levels was trait anxiety (STAI X-2). At T1 and T2, increases in trait anxiety were associated with elevated stress levels. These findings are consistent with those of previous studies indicating that trait anxiety is a significant risk factor for heightened perceived stress [76]. A similar trend was observed for life satisfaction, which, as a key indicator of psychological well-being, is strongly linked to stress perception and can effectively buffer its negative effects. These results are in line with the findings of other researchers who emphasize the protective role of life satisfaction in mental health [77].

The presented study has some limitations. First, the study had a high attrition rate observed between the initial and follow-up assessments, with only 51 out of the original 103 participants completing the study. These parents did not attend the subsequent scheduled therapy sessions for their children, and we are unaware of the specific reasons for the discontinuation of Vojta therapy among these individuals. It can be hypothesized that not all parents were able to cope with the demanding role of a parent-therapist required by the Vojta method. The need for consistent application, with possible distress for the child during sessions, may have led some parents to discontinue this method in favor of alternative therapeutic approaches. Furthermore, the study did not consider the severity of the disorders present in the children. However, medical records showed that the condition of children who continued the 2-month therapy improved, compared with the initial assessment. Another limitation of the study was the method used to assess physical activity, which was based on original, self-constructed questions included in the survey. An attempt was made – both in the pilot study and in the main research chase – to use a standardized tool, namely the International Physical Activity Questionnaire (IPAQ). Unfortunately, due to the overall number of survey items and the extensive set of questionnaires assessing parents’ emotional well-being, the IPAQ, positioned at the end of the study, proved to be too lengthy and time-consuming. This significantly discouraged participants from completing it. Therefore, the decision to use a simplified measurement approach, based on the use of original survey questions, stemmed from practical considerations and, most importantly, from the need to ensure comprehension and convenience for the surveyed parents, particularly in situations requiring them to simultaneously attend to a distressed or crying child. The selected standardized questionnaires had a screening nature, without a medical diagnosis. The PSS-10 scale measures the subjective perception of stress, meaning it does not account for the number or objective intensity of stressors and relies solely on the respondent’s self-assessment.

We believe that, despite the challenging and sensitive nature of the subject matter, conducting this study was justified and highlights the need for further research in this area.

Conclusions

The results of the present study confirm that parents of children with CCD who are rehabilitated based on the Vojta method experience significantly elevated levels of stress and depressive symptoms. A significant reduction in the severity of depressive symptoms was observed after 2 months of therapy.

In our study, regular physical activity (3 times per week) was associated with significantly lower stress levels and fewer depressive symptoms in parents, both before and after 2 months of Vojta therapy. This suggests that regular physical activity can serve as a protective factor for the mental health of parents whose children are rehabilitated using the Vojta method.

Predictors of parental stress levels, both before Vojta therapy and after 2 months of its application, included sex, physical activity 3 times a week, level of anxiety as a trait, and life satisfaction.

The results indicate that the emotional state of parents of children with CCD is dynamic and can depend on multiple interacting factors. This highlights the need to provide parents with appropriate support and to promote physical activity as a preventive and therapeutic measure. Such actions can contribute to the reduction of psychological burden and the enhancement of parental mental well-being.

Data Availability Statement

The data presented in this study are available on request from the corresponding author (Kinga Strojek).