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Introduction

The Gézengúz Foundation has been providing help for infants and children with perinatal and postnatal nervous system injuries since 1990. Its mission has not changed in the past 27 years, which is to prevent or treat children’s motoric, cognitive, or psychological problems on an individual basis, while cooperating with their families. The foundation offers them a transdisciplinary, complex, and unique therapy.

In its six centres spread around Hungary, the foundation provides diagnostic service and pediatric physiotherapy, along with pedagogical, psychological, and social help. By these medical, educational, and social activities, it aims to fill in essential gaps in the state-run early intervention system.

Helping more than 2,300 families every year, the foundation works with various methods, three of which are officially registered, unique inventions of the foundation. These innovations of the Gézengúz Foundation are namely the Huple® program, Neuro-hydrotherapy, and Combined Dynamic Sensory Integration Therapy (DSIT).

Neuro-hydrotherapy (NHT 1 and NHT 2)

This therapy was developed by Judit Schultheisz MD in 1986. She built on Myrtle McGraw’s and Igor Charkovsky’s ideas. She also studied Jean Ayres’ Sensory Integration Therapy [1] and Professor Ferenc Katona’s Neurotherapy [2, 3]. These therapies were used on the ground, and their main focus was on vestibular stimuli, which support the maturation of the central nervous system. Dr. Schultheisz improved these ideas and adapted them to a special aquatic environment. Hydrotherapy had been widely used in treating various motor deficiencies, but it did not exist in early childhood intervention.

Neuro-hydrotherapy, as an innovative therapeutic treatment, was adjusted at Gézengúz by adapting the land-based techniques to aquatic surroundings and by adding special grips to it [4, 5]. At present, it exists as a part of early childhood intervention in Hungary and even abroad.

Neuro-hydrotherapy has two parts namely NHT 1 and NHT 2. The therapy can be started even with newborn babies and can be applied until the age of 3–6 years, depending on the child’s developmental status. It may be continued with special or normal swimming courses. Used either individually or as a part of the modular system, the development can be objectively measured [6, 7]. Its efficiency can be tested, for example, by Water Orientation Test Alyn (WOTA1,2), Gross Motor Function Measure, and Bayley II scale [8]. The foundation organises certified post-gradual trainings for various primarily healthcare professionals, working in the area of early childhood intervention to make this method widespread, not only in Hungary but also internationally.

Neuro-hydrotherapy 1

Based on subcortical regulation, this therapy can be started soon after birth (depending on the adaptation period) and can be used during the first 4 or 5 months of a child’s life, that is, until the persistence of the McGraw reflex. The duration of the therapy also depends on the infant’s adaptation, status, and personal development. Working with elementary sensorimotor patterns, therapists take the advantage of the properties of the water and using special grips. The therapy takes place in a bathtub, where the baby can get auditory, visual, and tactile stimuli as well. Therapists adapt this technique individually to every infant and they teach the parents how to practice the therapy with their own kids in their homes every day. Therapists supervise the progress every week, by giving personal advice and providing control to achieve the best possible result [5].

Neuro-hydrotherapy 2

Based on cortical regulation, this therapy can start after the 16–20th weeks (depending on the maturation of the central nervous system) and it can be used in a swimming pool, individually or as a member of a group with the help of the parents. In addition to the development of postural control, the therapists analytically elaborate the final human-specific posture and movement patterns in functional playing situations. Having a multisensory focus, the therapy integrates gross-motor development with fine motor activities and cognitive tasks [4].

The areas of application of NHT 1 and 2 are numerous, as uncountable positive effects can be noticed, such as emotional, cognitive, and motoric development; breathing control; correct movement patterns; as well as improved social skills and family cohesion [9]. Therefore, NHT 1 and 2 can be employed by physiotherapists, psychotherapists, educators, special education teachers, and by many other different types of professionals in the fields of health care, pedagogy, and psychology.

It is worth mentioning that one of the most significant benefits of NHT 1 and 2 is their effect on the cohesion of the families. Bonds between the baby, the mother, and the father are strengthened during the therapy sessions. Without being exhaustive, the following benefits can be experienced during the therapy: improvement of non-verbal communication, very positive and effective quality time together, which increases mutual attachments, as well as the strengthening of the bond between the parents. It is especially worth mentioning that the father’s role in the family is particularly underlined during these lessons, which is a truly unique feature of this therapy method [9]. Several devices are used in the water to get the best results. One of the tools is Huple®, which is a specially formed multifunctional balancing equipment also invented by Dr. Schultheisz.

Huple®: A Medical Device and a Program

The purpose of its hemisphere-shaped balance swing (a registered medical device HU/CA01/73691/10) is to provide vestibular stimulation. HUPLE® is an international patent, which is suitable for giving isolated and complex vestibular stimulation and also for developing dynamic stability of the head–trunk–pelvis unit in various postures [10]. It can be employed not only in therapy, but also it is a useful diagnostic device as well (Figure 1).

Figure 1.
Figure 1.

Baby in the Huple®. Source: Gézengúz Foundation

Citation: Developments in Health Sciences 1, 1; 10.1556/2066.1.2018.05

A complex diagnostic and therapeutic program is built around this medical device, which is called the Huple® program. In the diagnostic process, the sensitivity of the vestibular system, muscle tone control, persistence of the primitive reflexes, and alternation of the arousal level can all be observed by Huple® [11]. The results can be easily interpreted not only by the therapists but also by the family members.

Within the therapy, the Huple® program can be started soon after birth. The stimulation can begin early in a stable supine position, when the posture of the trunk is similar to the one in the intrauterine period. This position prevents the abnormal reflexes and muscle tone by producing a relaxed posture. It helps the infants to adapt themselves to the different pulls of gravity. Later, Huple® can also improve verticalisation, by elaborating the pelvis–trunk–head stabilisation and the adequate usage of the extremities [10]. Having three main aims – cognitive development, treatment of the motoric functions, and emotional support – the Huple® program can be used individually or as part of a complex, modular treatment system (Figure 2).

Figure 2.
Figure 2.

Kids in the Huple®. Source: Gézengúz Foundation

Citation: Developments in Health Sciences 1, 1; 10.1556/2066.1.2018.05

To make the Huple® program more available in Hungary and even abroad, the foundation organises accredited practice-oriented courses called Special Balance Therapy in early childhood intervention [12]. Huple® can also be used in water very effectively, with the help of its waterproof material. The aquatic surroundings can ease or block the movements in the Huple®, allowing for more ways and kinds of movements than on the ground [11].

Combined DSIT

This method is also an invention of the Gézengúz Foundation, which was developed by improving the DSIT, also known as Ayres’ therapy [1]. Ayres’ Sensory Integration Therapy is based on the normalisation of the vestibular-proprioceptive and tactile systems [1]. She observed that these three systems not only organise the stimuli input but also responsible for essential emotional security and the formation of social relationships.

The innovation of Gézengúz was to use this method in water, by combining Ayres’ scientific aims with NHT 2 [4]. The therapy integrates Ayres’ ideas with Gézengúz’s analytic approach, including the corrective grips of the NHT 2. This therapy makes it possible for children with limited motion abilities to have the freedom of movement and mind. It effectively guides them towards self-regulation by giving them positive experiences. To achieve the desired results, the foundation’s therapists combine the land and aquatic trainings into 90-min-long lessons. During these lessons, children can develop their own immature or inadequately differentiated nervous system by playing and using a wide range of equipment [11].

These interesting tools, which are used on the ground, are hammocks, swings, rubber balls, rollers, cylinders, and other toys that challenge the sense of balance [12]; and spring-boards, various balls, roundels and rings, diving boards, shelves, and slides in the water. Huple® can be used in both environments (Figure 3).

Figure 3.
Figure 3.

Innovations of Gézengúz: Combined DSIT – (a) in land and (b) in the water. Source: Gézengúz Foundation

Citation: Developments in Health Sciences 1, 1; 10.1556/2066.1.2018.05

The primary factor that makes Combined DSIT effective is PLAY! [13]. By stirring the imagination, playing becomes the driving force of self-induced motion. The primary goal is that children have a good time playing in the therapeutic space. The focus is on the individual needs and on the children’s own active participation. The aquatic environment ensures a continuous but constantly changing sensory experience, with persistent tactile-proprioceptive and vestibular stimuli. The goal is to provide children with fine-conducted and controlled sensory stimuli throughout the games, many of which are invented during the session. Children get a certain degree of freedom of choosing what they would like to play and how long they would like to do it.

This therapy can be the best solution for children who have had disappointments with other therapies or for those who have not gone through any therapy yet. Children with delayed or abnormal process of development, such as attention deficit disorder, attention deficit hyperactivity disorder, autism spectrum disorder, and sensory processing disorder, can benefit the most from this therapy between the age of 2 and 6 years. The therapy has numerous beneficial effects, including the advancement in motivation, attention, self-confidence, balance, coordination, muscle strength, and social skills [12]. Therefore, the result of this resilient therapy is sensory integration [13].

As a conclusion, we can say that the Gézengúz Foundation continues to develop something new to be able to help children more and more effectively. All these three inventions, such as the NHT 1 and 2, the Huple® program, and the Combined DSIT, serve the same purpose that is to facilitate neural integration; strengthen social and communication skills; support the family and the children’s well-being; acquire experiences on land and in the water; and advance the development of a positive personality [5].

Conflict of interest

The authors declare no conflict of interest.

References

  • 1.

    Ayres AJ . Sensory Integration and Learning Disorders. Los Angeles: Western Psychological Services; 1973.

  • 2.

    Katona F . Developmental clinical neurology and neurohabilitation in the secondary prevention of pre- and perinatal injuries of the brain. In: Vietze PM, Vaughan HG, eds. Early Identification of Infants with Developmental Disabilities. Philadelphia: Grune & Stratton; 1988. p. 12144.

    • Search Google Scholar
    • Export Citation
  • 3.

    Katona F . Clinical neurodevelopment diagnosis and treatment. In: Zelazo PR, Barr RG, eds. Challenges to Developmental Paradigms: Implications for Theory and Treatment. Hillsdale, NY: Lawrence Erlbaum Associates; 1989. p. 16787.

    • Search Google Scholar
    • Export Citation
  • 4.

    Schultheisz J . Neuro-Hydrotherapy in Early Childhood Intervention. Abstract Book of the Second European Conference on Evidence Based Aquatic Therapy, AQUA-LEUVEN 2015. p. 45.

  • 5.

    Schultheisz J , Kereskényi B . Neuro-hidroterápia. A kora gyermekkori – gyermekkori hidroterápia lehetséges útjai [Neuro-hydrotherapy. Hydrotherapy in early childhood and childhood intervention]. Gyermekgyógyászati Továbbképző Szemle. 2001;16(5):13.

    • Search Google Scholar
    • Export Citation
  • 6.

    Jobbágy Á , Schultheisz J , Horváth M , Bacsó P , Csuhaj P , Vraskó HR . Objective assessment of children with birth injuries. Paper presented at 14th Mediterranean Conference on Medical and Biological Engineering and Computing, MEDICON, 2016 March 31–April 2; Paphos, Cyprus. IFMBE Proceedings. 2016;57:5659.

    • Search Google Scholar
    • Export Citation
  • 7.

    Jobbágy Á , Schultheisz J , Horváth M , Réfy Vraskóné H . Development of an effective therapy and objective assessment for children with birth injuries. Int J Rehabil Res. 2016;39(4):35460.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Bayley N . BSID-II: Bayley Scales of Infant Development. 2nd ed. San Antonio: Hartcourt Brace & Company; 1993.

  • 9.

    Limbrick P . The Team Around the Child: Multi-agency Service Coordination for Children with Complex Needs and their Families. Manchester: Interconnections; 2001.

    • Search Google Scholar
    • Export Citation
  • 10.

    Kereskényi B . A fejkontroll fejlesztése neuro-hidroterápia segítségével [Improving head control with Neuro-hydrotherapy]. Fizioterápia. 2011;20(3):214.

    • Search Google Scholar
    • Export Citation
  • 11.

    Schultheisz J , Bancsó P . The Huple® program and hydrotherapy for premature babies. Paper presented at Grundtvig Meeting in Norway, Cooperation with Parent in Early Intervention, Early Childhood Intervention in Europe; 2008 September 3–4; Kristiansand, Norway.

    • Search Google Scholar
    • Export Citation
  • 12.

    Jantek B , Jobbágy Á , Szemán J , Schultheisz J , Bacsó P . Habilitation Aid for Children with Balance Disorders. Paper presented at World Congress on Medical Physics and Biomedical Engineering: Neuroengineering, Neural Systems, Rehabilitation and Prosthetics, 2009 September 7–12; Munich, Germany. IFMBE Proceedings. 2009;25(9):912.

    • Search Google Scholar
    • Export Citation
  • 13.

    Szvatkó A , ed. Billenések – Tanulmányok a dinamikus szenzoros integrációs terápia köréből [“Balance” – Studies on Dynamic Sensory Integration Therapy]. Budapest: Oriold és Társai Kft; 2016.

    • Search Google Scholar
    • Export Citation
  • 1.

    Ayres AJ . Sensory Integration and Learning Disorders. Los Angeles: Western Psychological Services; 1973.

  • 2.

    Katona F . Developmental clinical neurology and neurohabilitation in the secondary prevention of pre- and perinatal injuries of the brain. In: Vietze PM, Vaughan HG, eds. Early Identification of Infants with Developmental Disabilities. Philadelphia: Grune & Stratton; 1988. p. 12144.

    • Search Google Scholar
    • Export Citation
  • 3.

    Katona F . Clinical neurodevelopment diagnosis and treatment. In: Zelazo PR, Barr RG, eds. Challenges to Developmental Paradigms: Implications for Theory and Treatment. Hillsdale, NY: Lawrence Erlbaum Associates; 1989. p. 16787.

    • Search Google Scholar
    • Export Citation
  • 4.

    Schultheisz J . Neuro-Hydrotherapy in Early Childhood Intervention. Abstract Book of the Second European Conference on Evidence Based Aquatic Therapy, AQUA-LEUVEN 2015. p. 45.

  • 5.

    Schultheisz J , Kereskényi B . Neuro-hidroterápia. A kora gyermekkori – gyermekkori hidroterápia lehetséges útjai [Neuro-hydrotherapy. Hydrotherapy in early childhood and childhood intervention]. Gyermekgyógyászati Továbbképző Szemle. 2001;16(5):13.

    • Search Google Scholar
    • Export Citation
  • 6.

    Jobbágy Á , Schultheisz J , Horváth M , Bacsó P , Csuhaj P , Vraskó HR . Objective assessment of children with birth injuries. Paper presented at 14th Mediterranean Conference on Medical and Biological Engineering and Computing, MEDICON, 2016 March 31–April 2; Paphos, Cyprus. IFMBE Proceedings. 2016;57:5659.

    • Search Google Scholar
    • Export Citation
  • 7.

    Jobbágy Á , Schultheisz J , Horváth M , Réfy Vraskóné H . Development of an effective therapy and objective assessment for children with birth injuries. Int J Rehabil Res. 2016;39(4):35460.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Bayley N . BSID-II: Bayley Scales of Infant Development. 2nd ed. San Antonio: Hartcourt Brace & Company; 1993.

  • 9.

    Limbrick P . The Team Around the Child: Multi-agency Service Coordination for Children with Complex Needs and their Families. Manchester: Interconnections; 2001.

    • Search Google Scholar
    • Export Citation
  • 10.

    Kereskényi B . A fejkontroll fejlesztése neuro-hidroterápia segítségével [Improving head control with Neuro-hydrotherapy]. Fizioterápia. 2011;20(3):214.

    • Search Google Scholar
    • Export Citation
  • 11.

    Schultheisz J , Bancsó P . The Huple® program and hydrotherapy for premature babies. Paper presented at Grundtvig Meeting in Norway, Cooperation with Parent in Early Intervention, Early Childhood Intervention in Europe; 2008 September 3–4; Kristiansand, Norway.

    • Search Google Scholar
    • Export Citation
  • 12.

    Jantek B , Jobbágy Á , Szemán J , Schultheisz J , Bacsó P . Habilitation Aid for Children with Balance Disorders. Paper presented at World Congress on Medical Physics and Biomedical Engineering: Neuroengineering, Neural Systems, Rehabilitation and Prosthetics, 2009 September 7–12; Munich, Germany. IFMBE Proceedings. 2009;25(9):912.

    • Search Google Scholar
    • Export Citation
  • 13.

    Szvatkó A , ed. Billenések – Tanulmányok a dinamikus szenzoros integrációs terápia köréből [“Balance” – Studies on Dynamic Sensory Integration Therapy]. Budapest: Oriold és Társai Kft; 2016.

    • Search Google Scholar
    • Export Citation