Prague school of Rehabilitation

Prague school of Rehabilitation Dynamic Neuromuscular Stabilization

A group of neurologists and other specialists in Prague was since the early 1950s researching and developing new approaches to musculoskeletal rehabilitation of patients with motor disorders and back pain, including infants with cerebral palsy or polio patients. In the 1960s, they became known as the Prague School of Rehabilitation and Manual Medicine. Their groundbreaking discoveries revealed the substantial relationship between the nervous system and manual medicine, and elevated manual medicine to science. Over the years, members of the group pioneered several new methods for motoric disorders treatments. They believed that there are natural motoric patterns in the brain that can be stimulated by manual manipulation. They also emphasized the need for education, training and proactive participation of a patient. (Karel Lewit: The first treatment is to teach the patient to avoid what harms him. The patient must always leave your office with homework. 1)

The Prague School promoted a synergy of clinical approach and radiology for better diagnostics, and manual therapy with an emphasis on patient’s motor functionality restoration. Their credo was that the functional pathology of the motor system is the key to musculoskeletal rehabilitation, not the structural pathology (inflammation or herniated disc). Muscle strength is not as important as coordinated movement. (Vladimír Janda: Muscle strength is not as important as coordinated movement.)

They worried that the technical progress in medicine led to increased dependence on medical technology in diagnostics as more objective, and thus to decline in use of the clinical manual approach. (Vladimír Janda: Every body tells a story. Let the body speak to you.)1)

The founding fathers and “stars” of the Prague School of Rehabilitation were neurologists and physical therapists Vladimír Janda – who first noted the upper and lower cross motor syndrome and developed sensorimotor stimulation exercises, known as the Janda Approach; Karel Lewit – who defined the reflex therapy; and Václav Vojta – who developed Vojta Method based on reflex locomotion. Their colleagues and collaborators such as the radiology expert Jan Jirout and the electromyography specialist František Véle 2) also significantly contributed to the Prague School’s excellent professional reputation.

The new rehabilitation techniques and methods introduced by the Prague School are still recognized, adopted and further developed by rehabilitation practitioners around the world treating a variety of motoric disorders and back pains. In the Czech Republic, Pavel Kolář built on the work of his mentors and developed his method Dynamic Neuromuscular Stabilization (DNS). One of many talented students of Václav Vojta, Jarmila Čápová developed her method
Basal Postural Programs  (BPP).

Prague School Founding Fathers: Karel Lewit, Vladimír Janda, and Václav Vojta
Prague School Legacy in the Czech Republic: Pavel Kolář and Jarmila Čápová

1. www.dns-cz.com/prazska-skola

2. Procházka, Miroslav, MD.; Sbohem pane profesore (vzpomínka na neurologa Karla Lewita). Roš chodeš, Věstník židovských náboženských obcí v českých zemích a na Slovensku. 11 2014, roč. 76, čís. 5775, s. 13. ISSN 68 121074 68. https://cs.wikipedia.org/wiki/Ro%C5%A1_chode%C5%A1

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

image

Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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