Cerebral palsy (CP), referred to as cerebral palsy or sequelae of cerebral palsy, is a non-progressive brain injury caused by various causes before birth to within one month after birth. The main manifestations are central motor deficits and postural abnormalities, which may be accompanied by mental retardation, epilepsy, visual, auditory, speech and feeding disorders. Western medicine believes that the disease is caused by the loss or lack of control of part or all of the spinal cord and nerves by the higher central nervous system, resulting in the weakening or loss of muscle inhibition by the brain. The disease is characterized by increased muscle tone, hyperreflexia, and dysmotility in the affected area, and may be accompanied by varying degrees of mental retardation. The risk factors for this disease include neonatal asphyxia, prematurity, low birth weight, abnormal delivery (including cesarean section, forceps delivery, suction delivery), infection during pregnancy, pathological jaundice, fetal preservation (small amount of vaginal bleeding in early pregnancy, treated with fetal preservation drugs), pregnancy abnormalities (anemia, hyperemesis, placenta praevia, amniotic fluid outflow, etc.), neonatal diseases, intracranial hemorrhage, twins, etc.
This disease belongs to the category of five delays, spasm evidence and impotence evidence in Chinese medicine, and is considered to be caused by congenital deficiency or brain damage during delivery. After birth, the body is weak, the liver, blood and kidney are not full of essence, the tendons and bones are not nourished and become impotent, resulting in paralysis. Damage to the brain at the time of delivery and insufficient medulla oblongata result in paralysis and dysarthria.
Diagnostic criteria
1.Diagnostic conditions
(1) Central paralysis that occurs during infancy.
②It may be accompanied by mental retardation, convulsions, behavioral abnormalities, perceptual disorders and other abnormalities.
③Excluding central paresis caused by progressive diseases and transient motor development delay in normal children.
2.Typing
According to the clinical characteristics, the classification was revised according to the 1956 American Cerebral Palsy Society.
(1) spastic type; (2) tardive type; (3) tonic type; (4) ataxic type; (5) tremor type; (6) hypotonia type; (7) mixed type (specify what type is mixed); (8) unclassifiable type.
According to the part of paralysis: ① monoplegia; ② paraplegia, ③ hemiplegia, ④ diplegia, ⑤ trigeminal paralysis; ⑥ quadriplegia; ⑦ dual hemiplegia.
Note: ①The clinical diagnosis should indicate the type, location of paralysis, and the presence of comorbidities. For those with obvious etiology, the cause should be indicated. If available, the tardive dyskinesia type can also be subdivided into tense and non-tensive types.
Identification criteria
1, liver and kidney yin deficiency: limb paralysis, tendon constriction, unfavorable flexion and extension, impatience and irritability, hyperactivity, twitching of limbs, low intelligence, growth retardation, red tongue, string or thin pulse.
2.Qi deficiency and blood stasis: restrained tendons and veins, flexion of upper limbs, straightening of lower limbs, painful flexion and extension or tingling of trunk and extremities, pale face, loose sweating, dark tongue, astringent and weak pulse.
3. Spleen deficiency and phlegm obstruction: unfavorable limb flexion and extension, inability to lift the hand, inability to stand on the foot, unfavorable language, mental retardation, incontinence of salivation, withered face, mental lethargy, lazy speech, muscle wasting, pale tongue, greasy coating, weak pulse.
Treatment principles and selection of acupuncture points
1. The basic treatment principle for this disease is to strengthen the brain and unblock the meridians. According to the specific situation of the child, it can be supplemented by tonifying the liver and kidney, benefiting the Qi and blood, and strengthening the spleen and resolving phlegm. In the treatment must be combined with exercise therapy, occupational therapy, language training and other rehabilitation treatment.
2. In the selection of acupuncture points, mainly based on the theory that the brain is the capital of the spirit, and the Governor’s vein enters the brain, the head acupuncture points, the Governor’s vein acupuncture points, and the interspinal acupuncture points are the main points, which can be combined with the selection of acupuncture points in the limbs by following the meridian, with the following principles.
① According to the theory that the Directing Vessel enters the brain, the acupoints of the Directing Vessel such as Baihui, Renzhong, Fengfu, Mute Gate, Shenting and Shangxing are used to unblock the Directing Vessel, awaken the brain and open the orifices, and regulate the spirit and guide the qi. The points on the back of the bladder meridian, such as Baihui, Renzhong, Fengfu, Shenting, and Shangxing, are often used to unblock the Governor’s Vessel, awaken the brain, open the mind, and regulate the energy. Acupoints on the back of the bladder meridian such as Kidney Yu, Liver Yu, Spleen Yu, Tendon Shrinkage and Dazhi and Lumbar Yangguan of the Directing Vessel can be used.
②Head acupuncture is often used for this disease, such as paralysis and numbness of the lower extremities in the top middle line; paralysis of the upper and lower extremities, trunk paralysis, motor aphasia, and salivation in the top front temporal oblique line; balance disorders in the occipital parietal line; sensory disorders of the limbs and trunk in the top post-temporal oblique line; paralysis and numbness of the lower extremities in the top parietal line 1; paralysis and numbness of the shoulders, arms, and hands in the top parietal line 2; motor aphasia in the front temporal line, etc.
③ Symptomatic selection of points: the symptoms of this disease are more complex. Damage to the developing central nervous system may lead to feeding difficulties and speech disorders. Due to early brain damage, the innervation of oropharyngeal movements and the learning of feeding skills are affected, resulting in abnormal feeding skills of different nature and degree. Almost all patients with xerostomatous, dyscalculia and spastic tetraplegia have oropharyngeal movements and feeding disorders, therefore, acupuncture points such as Lianquan or Jinjingyuju, Cheek Chee, and Dicang are often used to open the tongue, facilitate the pharyngeal orifices, and unblock the orofacial meridians. For neck, waist and back tenderness, the acupuncture points are used for pinching the spine, Tianzhu, Body pillar, Zhizhong, Life-gate, Lumbar Yangguan, Lumbar Yu, Spleen Yu and Kidney Yu; for delayed speech, the acupuncture points are used for Lower Lianquan, Tongli, Neiguan and Tongue Three Needles; for salivation, the acupuncture points are used for Di Cang, Chee Che and Cheng Jue.
Acupuncture prescription
Recommended prescription 1
Treatment: Tonifying the liver and kidney, opening the orifice and benefiting the congestion.
Main acupoints: Liver Yu (⊥) Kidney Yu (⊥) Guan Yuan (⊥) Tai Xi (⊥) (tonifying the liver and kidneys, benefiting the Yuan and consolidating the essence)
Baihui (⊥) Sishencong (⊥) Dazhi (⊥) Hangzhong (⊥) (benefits the marrow and strengthens the brain)
Lianquan(⊥) Fengchi(⊥) (opens the orifice and invigorates blood)
Foot San Li(⊥) San Yin Jiao(⊥) (strengthens the spleen and stomach, helps the hind heaven)
Neiguan(⊥) Hegu(⊥) Taichong(⊥) Tianquan(⊥) (Promoting meridians and activating blood circulation, harmonizing Qi and blood)
Yanglingquan (relaxes the tendons and opens the ligaments) (⊥)
Operation: For younger children, use the fast-acupuncture method, and release the needles after obtaining qi. For older children, the needles can be left in for 20-30 minutes if appropriate. The Lianquan point requires needle sensation to be transmitted in the direction of the throat and tongue root; the Fengchi point requires deep stabbing in the direction of the tongue root, and needle sensation is transmitted in the direction of the tongue root. The remaining points are operated routinely.
Recommended prescription 2
Treatment: Strengthening the brain and educating the mind, and clearing the meridians.
Main acupoints: Baihui(│) Shenting(│) Brain Household(│)
Motor zone(│) Foot movement sensory zone(│) Balance zone(│)
Matching points: for mental retardation, Sishencong(│); for speech disorders, Yu(│), Quchi(│), Jiquan(│), Waiguan(│), and Hand Sanli(│); for lower limb paralysis, Huanjiao(│), Yanglingquan(│), Foot Sanli(│), Sanyinjiao(│), and Xiexi(│); for weakness of the neck and waist, Duoyuan and Hua Tuo Pinch Points(│).
Operation: stab straight from the Shenting point along the skin toward Baihui, and from Baihui toward the brain household. The head acupuncture point is entered rapidly, and the needle is retained for 4 h each time. During the retention period, the needle is twisted rapidly (200 rpm ) 3 times, once every other day. The rest of the acupuncture points are flat tonic and flat diarrhea; children <3 years old and infirm children are not kept in needles, children >3 years old are kept in needles for 30 min and needled twice a week.
Recommended prescription 3
Treatment: Awakening the brain and opening the orifices, activating blood circulation, promoting essence and filling the marrow.
Main points: Neiguan (⊥), Shuigou (⊥) (awakening the brain and opening the orifices)
Sanyinjiao(T) (nourishes liver and kidney)
Jiuquan(⊥) Shizhe(⊥) Hegu(⊥) Guizhong(⊥) (Drainage of meridians)
Fengchi(⊥) Mute Gate(⊥) (Drain cerebral channels, invigorate blood circulation)
Baihui (T) Sishencong (T) (Benefiting the essence and filling in the marrow, stimulating the brain)
2/5 below the parieto-temporal anterior oblique line (│) Anterior temporal line (│) (Facilitates speech, stops salivation)
Di Cang (⊥) Cheek Cheeks (⊥) (tonifies the mouth and cheek meridians, stops salivation)
Lianquan (⊥) (opens the tongue, facilitates speech)
Operation: first, double Neiguan, straight stab 0.5 inch, twist and turn diarrhea, twist frequency 120/, apply 5; then stab Shuigou, upward oblique stab 0.inch, that is, out of the needle; then stab Sanyinjiao, along the posterior edge of the tibia and the skin at an angle of 45 degrees, into the needle 1 inch, using the lifting and inserting method of tonic, so that the child has a flexion of the knee performance can be, Jiquan point along the meridian at 2 inches below Jiquan straight stab 0.5 inch, lifting and inserting diarrhea, so that the child’s upper limbs flexion The acupuncture point was taken at 120 degrees of elbow flexion, and the acupuncture point was directly pricked at 0.5 inch, with the lifting and inserting diarrhea method, so that the child’s elbow was flexed to the degree.
Evaluation criteria for therapeutic effect
1.Application of Geyser method to determine the development quotient (DQ) of gross motor and fine motor
(1) Motor function assessment: including 10 major items of 28 movements, namely head raising (prone, supine, upright position); turning (prone to supine, supine to prone), sitting (sitting with support, leaning, sitting alone), crawling (crawling, crawling on hands and knees, crawling on hands and knees), kneeling (kneeling on both knees, kneeling on one knee), standing (standing with support, leaning, standing alone), walking (walking with support, walking alone), climbing stairs (holding, grasping the railing or going up and down alone). Coordinated movements (hand, hand, foot and mouth, hand, foot and between hand and eye), 10 points for each item, total score 100 points.
(2) Efficacy assessment criteria
(1) Significant effect: motor function assessment improved by 20 points, while DQ improved by 15.
②Effective: motor function assessment improved by l0 points, while DQ improved by 10 points.
(③Ineffective: the motor function evaluation improved by less than 10 points and DQ improved by less than 10.
2.Application of the mental development scale for children aged 0-6 years developed by the Capital Institute of Pediatrics for the detection of intellectual development, referred to as the Children’s Heart Scale
The scale was divided into 5 functional areas, namely gross motor, fine motor, adaptive ability, language and social behavior.
The mental development assessment was divided into 5 levels, with Developmental Quotient (DQ) ≥130 being excellent, 115-129 being intelligent, 85-114 being normal, 70-84 being low, and ≤69 being low. The test tool is a special test kit, which is administered by a formally trained medical professional.
Analysis of the efficacy
1.Factors affecting the efficacy of acupuncture
If the brain injury is mild and there is no abnormal change in CT examination or only mild abnormality, children with cerebral palsy can get better recovery with timely acupuncture treatment and functional training. If the brain injury is severe, CT examination can be seen diffuse brain atrophy and multiple brain softening foci, etc., then acupuncture has some effect on improving symptoms; if the brain injury is very serious, CT shows that the brain penetration malformation and other developmental abnormalities, acupuncture is less effective. However, the severity of cranial imaging abnormalities and the severity of clinical CP sometimes do not coincide, some children with severe clinical manifestations, while CT examinations are often normal, so the severity and prognosis of CP cannot be judged by imaging examinations alone, and should be closely combined with clinical.
In general, the younger the child, the better the acupuncture effect, the lighter the disease, the fewer complications, the better the acupuncture effect. As the age of the patient increases, if the patient does not receive timely and regular rehabilitation treatment, the complications such as tendon contracture, joint deformation and muscle atrophy will become more and more serious, and the effectiveness of acupuncture will become worse. Foreign reports have shown that if diagnosed and treated before the age of 6 months, the results are better. It has been proven that 0 to 2 years old is the period with the most rapid brain development and strongest compensatory capacity, especially in the neonatal period, the brain is still in the growth and development stage, brain injury is also in the primary stage, abnormal postures and movements are not yet fixed, external stimulation and reinforcement and rich environment has a relatively strong role in shaping or pruning brain development, inhibiting abnormal postures and movement patterns, assisting in producing normal responses, and through Repeated stimulation and training lead to the gradual development of normal motor patterns. After 2 years of age, the abnormal posture tends to become fixed, which makes treatment very difficult. Therefore, early detection and treatment of children with cerebral palsy is essential to ensure that their potential abilities are maximized. The best time for acupuncture and various rehabilitation treatments is usually before the age of 2.
③Types of lesions: Cerebral palsy is clinically divided into spastic type, tardive type, hypotonia type and ataxia type, and acupuncture is relatively more effective for hypotonia type than other types. In terms of limb paralysis, acupuncture is more effective for hemiplegia than for diplegia and tetraplegia.
④Coinciding with other treatments: acupuncture is effective in treating this disease, but it must be combined with the necessary functional exercises, which are very important to provide acupuncture efficacy. For example, exercise therapy is recognized as the main means of rehabilitation treatment for this disease. Exercise therapy includes head control function training, upper and lower limb function training, turning training, sitting training, crawling training, straight kneeling training, standing and walking training, trunk adjustment and balance training, etc.; occupational therapy includes feeding, dressing and undressing, continence and hand skill training, etc. In addition, speech and language training should be provided. Studies have shown that intensive training for children with cerebral palsy can increase muscle strength, improve movement and reduce disability, because only a certain amount of correct movement can suppress peripheral abnormalities and replace wrong patterns with correct patterns in the center, which is conducive to stimulating the compensatory potential of brain cells.
2.The link and mechanism of acupuncture treatment
Modern research shows that the more immature the brain is, the stronger the plasticity of the brain, that is, the stronger the variability and compensatory potential. The modern neurorehabilitation theory of neuroplasticity suggests that the recovery of neurological function is generally divided into two cases: the damaged nerve does not die and can be restored directly; after the death of the damaged nerve, the regeneration of axons of central nervous cells, the germination of dendrites and the mechanism of synaptic threshold change can reorganize a network system of functional cell groups in the central nervous system and achieve functional reorganization, which is manifested by the reconstruction of cortical functions or by This is the compensatory potential of brain cells. Therefore, the theory of neuroplasticity has important theoretical significance for the treatment of pediatric cerebral palsy with acupuncture. According to the principle of neurodevelopment, the brain develops fastest in the first 2-3 years after birth, and there is evidence that if benign stimulation is given during this period, it can promote the development of brain structures and functional compensation. Therefore, the links and mechanisms of acupuncture treatment for this disease include.
①Promoting the compensatory function of brain cells: acupuncture, as a physical stimulus, inevitably triggers a response from the central nervous system. This positive stimulation promotes the electrical activity of the brain and the secretion of neurotransmitters, activates the compensatory function of the brain cells involved, improves brainstem function, and allows peripheral information to reach the cerebral cortex smoothly, effectively regulating cortical function. Some studies have observed that acupuncture can improve cerebral artery blood flow velocity and cerebral topography, thus improving blood supply to brain tissue, improving central nerve cell function, enhancing intelligence, improving motor function and cognitive ability of affected children, and promoting rehabilitation.
②Regulation of muscle tone and muscle strength: Acupuncture increases muscle strength and coordinates tension through the neuromuscular reflex, improving the motor balance and coordination of the limbs and reducing disability. By stimulating the nervous system, acupuncture facilitates the nerve conduction pathway through a large number of times, which accelerates the repair and development of brain cells, inhibits abnormal postural reflexes and abnormal movement patterns, promotes the development of normal movement, and helps muscle strength recovery.
③Improve circulation: acupuncture has a good effect of promoting blood circulation through the neuro-vascular reflex pathway, increasing the blood circulation of brain and limbs, especially in children with spastic cerebral palsy, the blood and oxygen supply to the muscles occurs due to long-term spasm, nutritional metabolism disorders, degeneration of muscle cells, demyelination of motor and sensory nerves in the limbs, etc. These disorders are the main peripheral factors affecting the muscle strength recovery of children with cerebral palsy. These disorders are the main peripheral factors affecting the recovery of muscle strength of children with cerebral palsy. Acupuncture can reduce muscle spasm, improve vascular compression and promote blood circulation. This improves the nutrient metabolism of limb muscles and nerves, and plays a good role in muscle strength recovery. It has been reported that there is still a considerable range of reversible damage zone around the necrotic area of cerebral tissue in cerebral palsy, where the brain tissue is pale, edematous, intravascular small thrombosis or thinning of the official cavity, insufficient blood supply leads to loss of function of brain nerve cells, but necrosis has not yet occurred – that is, the critical nerve cells, head acupuncture therapy is to stimulate the corresponding motor projection area of the cerebral cortex through acupuncture, improve the local blood supply, increase the nutrition of brain cells, The head acupuncture therapy is to improve the local blood supply, increase the nutrition of brain cells, and restore the function of the critical cells.
Prognosis
The rehabilitation of cerebral palsy is a long-term slow and complex process, therefore, to establish the view of long-term treatment, parents must be persistent and persistent, the minimum continuous treatment time should not be less than 3 months, and the daily life and rehabilitation training should be combined to maximize the quality of rehabilitation. The prognosis of cerebral palsy mainly depends on the degree of brain injury and the timing of treatment. The younger the age, the less severe the symptoms, the shorter the duration of the disease, and the more timely the correct treatment, the better the prognosis. In general there is a big difference in prognosis between treatment before 2 years of age and treatment after. The older the child is, the more and more severe the symptoms become and the less chance of recovery. Therefore, early detection, early diagnosis, and early treatment of cerebral palsy are necessary, and CP combined with epilepsy may further aggravate the child’s motor and cognitive impairment. The prognosis is not good; and CT shows that the developmental abnormalities such as brain penetration malformation can also remind the parents of the child to avoid ineffective treatment. Of course, there are some children with morphological changes that are inconsistent with clinical manifestations, therefore, the prognosis should be judged in conjunction with clinical aspects.
The treatment of CP is a long-term comprehensive process, and in order to maximize the quality of life of children with CP, early detection and management of comorbidities such as epilepsy, hearing impairment, visual impairment and mental retardation, and comprehensive rehabilitation are important for the prognosis. The prognosis is very important.