Table 1.

Studies’ Characteristics for the Impact of DNS or Vojta on Respiratory Parameters

First Author (Year)	Study Design	Samples	Interventions	Comparison Group (Control)	Follow-up Time	Outcome Measure That Related to Respiratory System	Results
Giannantonio (2010)41	Quasi-experimental (1 group before and after clinical trial)	34 preterm newborns with average gestational age of 30.5 wk; birth weight: 1430 g. 2 interventional groups with these characteristics: Group 1: 21 neonate patients who had hyaline membrane disease, under treatment with nasal CPAP Group 2: 13 neonate patients undergoing oxygen treatment for pneumonia.	Phase 1 of Vojta method “reflex rolling.” Intervention was provided 3 times per day during the first week of life and thereafter.	Internal comparison (within group)	Not followed up (immediate effect)	PtcO2 SatO2 PtcCO2 RR	Hyaline membrane group changes: increase in PtcO2 values from 61.7 (12.9) to 73.1 (13.6) after stim and increase in SatO2 values, from 92.2 (3.9) to 94.0 (3.2). Pneumonia group changes: increase in PtcO2 values from 65.8 (12.9) to 73.6 (15.0) and increase in SatO2 values from 94.7 (3.0) to 97.5 (2.9). In both groups, PtcO2 and SatO2 were statistically different (P < .001), but no statistically significant difference was found for PtcCO2 or RR.
Kole (2014)42	Single-blinded randomized controlled trial	60 neonate patients undergoing O2 therapy for RDS and pneumonia with a range of gestational age between 30 and 37 wk. The demographic data for all the groups did not show any significant difference.	Group C: CPT + reflex rolling based on Vojta approach. 20 min/session at 0, 4, and 8 h, 3 sessions/d, 2 wk.	Group A: CPT: vibration on chest. Group B: LST + CPT: used both vibration and squeezing technique. 20 min/session at 0, 4, and 8 h, 3 sessions/d, 2 wk.	Not followed up	SpO2 PaO2 SaO2	Within-group significant improvements (P < .001) in SpO2, PaO2 and SaO2. Mean differences for reflex rolling group were: SPO2: 7.16, PaO2: 17.57, SO2: 8.18. No significant difference (P = .480, P = .258) in between-group patients. Chest x-rays showed re-expansion of the collapsed airways.
Son (2017)11	Quasi-experimental (1 group before and after clinical trial)	15 participants (7 female; mean age: 14.9 y) who had diagnoses of spastic diplegic CP and could follow instructions	DNS steps based on the Russell et al43 study consisted of respiratory training at the same time with therapist stimulation in chest zone in 90/90 supine position. 30 min/d, 3 sessions/wk, 4 wk.	Internal comparison (within group)	Not followed up	Ultrasound Diaphragm movement (mm)	Dual respiratory and descending diaphragm movement (9.30 ± 3.31 mm) increased (P < .01) remarkably after DNS exercises.
Ha (2018)12	Open-label randomized controlled trial	10 children with spastic CP; mean age: 4.8 y. General physiotherapy group (n = 5) and Vojta approach group (n = 5). Both groups showed no statistical difference in age, height, or body weight.	Reflex turning (1, 2) and reflex creeping based on Vojta approach. 30 min/session, 3 sessions/wk, 6 wk.	Trunk-strengthening exercise and gait training. 30 min/session, 3 sessions/wk, 6 wk.	Not followed up	Diaphragm movement during inspiration and expiration	Significant changes in diaphragm area in inspiration, unique to experimental group (P < .05, changes: 500.38 ± 884.50). Diaphragm area changing in expiration was not significant in both groups. A remarkable difference in changes of inspiration between the 2 groups (P < .05).
Mohammad-Rahimi (2020)16	Quasi-experimental (1 group before and after clinical trial)	26 sedentary male students with poor posture; mean age: 20.6 y; mean BMI: 22.1 kg/m2. Participants did not attend other courses or physical activities during treatment.	DNS diaphragmatic breathing exercise according to Kolar approach. 6 sessions/wk, including 3 sessions of supervised exercise and 3 sessions of home-based (unsupervised) exercise per week for 6 wk. Set 1: 30 s. Set 2: 90 s. Set 3: 180 s.	Internal comparison (within group)	Not followed up	FVC FEV1 FEV1/FVC MVV	Statistically significant differences between the mean spirometry parameters including MVV, FEV1, FVC, and FEV1/FVC ratio (P < .001). The changes (%) were: MVV: 26.2 FEV1: 16.4 FVC: 12.6 FEV1/FVC: 3.2
Yoon (2020)44	Open-label randomized controlled trial	31 patients with sub-acute hemiparetic stroke (17 men, 14 women); average age: 60.4 y. Average post-stroke onset was 7.22 wk.	DNS group (n = 16): standardized DNS intervention protocol based on Kolar approach. DNS focused on descending movement of diaphragm and co-activation with other core muscles. 30 min/d, 3 d/wk, 4 wk.	NDT group (n = 15): standardized NDT intervention protocol. NDT focused on selective movements of postural control such as the pelvic tilt. 30 min/d, 3 d/wk, 4 wk.	Not followed up	Paretic diaphragm movement (quiet and deep breathing). Non-paretic diaphragm movement (quiet and deep breathing). Asymmetrical ratio of diaphragm movement (quiet and deep breathing).	Both paretic and non-paretic diaphragm excursions were more significantly increased during DNS compared to NDT (P < .01). Diaphragm symmetrical ratio significantly decreased after DNS (P < .01). Effect size analysis for paretic and non-paretic sides of diaphragm movements: 0.27-0.46
Yoon (2020)45	Open-label randomized controlled trial	31 participants with hemiparetic stroke (17 men, 14 women); average age: 60.4 y. Average post-stroke duration was 7.2 wk.	DNS group (n = 16): DNS focused on descending movement of diaphragm and co-activation with other core muscles. 30 min/d, 3 d/wk, 4 wk.	NDT group (n = 15): NDT focused on selective movements of postural control such as the pelvic tilt. 30 min/d, 3 d/wk, 4 wk.	Not followed up	FVC FEV1 MEP MIP	FVC, FEV1, MIP, and MEP were statistically significantly different within each group (P < .01). Significantly more increase in FVC (P < .01), FEV1, MIP, and MEP in DNS group than in NDT group (P < .05). Respiratory function analysis showed improvement in DNS group (%) than in NDT group: FVC: 12, FEV1: 13, MIP: 9, MEP: 19.

CPAP, continuous positive airway pressure; CP, cerebral palsy; CPT, conventional chest physiotherapy; DNS, dynamic neuromuscular stabilization; FVC, forced vital capacity; FEV₁, forced expiratory volume in 1 second; LST, lung squeeze technique; MEP, maximum expiratory pressure; MIP, maximum inspiratory pressure; MVV, maximum voluntary ventilation; NDT, neurodevelopmental treatment; PaO₂, partial pressure of O₂; PtcO₂, transcutaneous oxygen tension; PtcCO₂, transcutaneous partial pressure of carbon dioxide; RDS, respiratory distress syndrome; RR, respiratory rate; SaO₂, arterial oxyhemoglobin saturation; SatO₂, oxygen saturation; SpO₂, oxygen saturation; stim, stimulation.