Common intervention methods for children with cerebral palsy
1.Vojta method, also known as induction therapy, induces two kinds of movement movements, reflex crawl and reflex roll, by giving compression stimulation to specific parts of the body to induce normal reflex pathways and movements, thus inhibiting abnormal reflexes and movements. Including
①Reflexive crawl (R-K): By stimulating the medial humeral ankle, medial femoral ankle, lower third of the medial scapula and other evoked bands, head gyration, thumb abduction, foot dorsiflexion, pelvic elevation, double lower limb reciprocal movement, elbow and hand support and other movements are induced. It is suitable for children with unstable head raising, thumb inversion, stiff lower limbs, and poor pelvic separation movement of the pointed foot.
Reflex turning (R-U): By stimulating the thoracic evoked zone, it induces typical turning movements, breaks the tense labyrinth reflex, promotes body axis rotation, keeps the body in the midline position, supports the upper trunk with the upper limbs, produces hip elevation, lower limb flexion, abduction and other movements. It is suitable for children who have difficulty in raising their heads, do not turn over and have crossed lower limbs and pointed feet.
Advantages: simple method, easy to master, painless, non-invasive, wide range of treatment, from newborns to older children can be applied; do not need expensive equipment, only a warm, well-lit place, a treatment table, economical and practical; can carry out early treatment, family-type treatment. The treatment effect is obvious and well received by parents and medical staff.
Problems.
(1) It is not suitable for children with weak constitution and poor respiratory function.
(2) At the beginning, the children cry intensely, causing serious mental burden to the parents and even refusing to accept the treatment, which affects the recovery of the children.
(3) In a theoretical sense, Vojta method training needs to be based on early diagnosis in order to induce a normal posture before the abnormal posture appears or is completely fixed to inhibit and prevent the appearance of abnormal posture and movement. Therefore, the Vojta method is more suitable for the training of children with early and ultra-early diagnosis. With the exception of individual children, it should not be done later than 2 to 3 years of age at the latest.
(4) For children with greater strength or severe muscle tension, stronger training and treatment personnel are required.
2, Bobath method, also known as neurodevelopmental therapy, according to the sequence of neurodevelopment of children, the use of inhibition, facilitation, snap hand technique, inhibition of abnormal posture and movement, to promote the normal motor sensory and motor patterns. Methods include:
① vertical head training, there are holding the ball method, Bobath ball training method, triangle pad method, etc.
②Turn over training, there are whole body stretching mode, hand mouth foot coordination, trunk gyration, one arm support, etc.
③Sitting training, with position change, sitting balance, etc.
④Crawling training, with hand support, four crawl position pelvic separation training, upright and balance response promotion, lower limb interactive movement promotion, etc. Standing training, with support, pelvic control, postural transition, etc. Walking training, there are cross gait inhibition, stride training, Bobath method to inhibit abnormal posture, static and dynamic balance training, etc.
Advantages: scientific, effective, painless, non-invasive, and does not require expensive equipment and devices, economical and practical, easy to grasp; wide range of treatment, should be used in any age, any type, any degree, any abnormal pattern of training children with CP. It is also suitable for speech function, occupational therapy, and training of daily life skills, such as chewing, swallowing, breathing, and excretion. It can be used for both children and adults, and can be treated in the hospital or at home.
Problems: Bobath method training in the game, requiring a relaxed environment, the trainer and the child to establish a good interpersonal relationship, try to guide the child’s active movement, in order to play the best training effect.
3, Ueda method Ueda method is also known as the opposite neural excitation inhibition method, the basic principle is based on Myklebust’s opposite neural excitation network doctrine. By releasing the spasm at the end of the limbs to reduce the over tension of the limbs and trunk, thus breaking the abnormal posture, it can reduce muscle tone, relieve muscle spasm, and prevent joint contracture and deformation. Commonly used methods:
①Upper limb method, including flexion phase, flexion and extension alternating movement, and then to flexion phase three stages.
②Lower extremity method, including extension phase, extension and flexion alternating movement, and then to extension phase. This is applicable.
Advantages: It is effective for children with high muscle tone and severe spasticity; the method is simple and suitable for application in the family and community.
Problems: painful, takes a long time, must reach 18min each time.
4. Conductive Education System Conductive Education (CE) was founded by Hungarian neurologist, psychologist and educator Professor Pet¨o in the 1940s. Originally designed for children with cerebral palsy, it was gradually expanded to include children with multiple disabilities as well as adults. The aim is to stimulate and develop the personality and active participation of children with central nervous system impairments through active learning, so that they can develop physically, verbally, intellectually, and master the skills of daily life in parallel, develop their potential to compensate for their dysfunctions, and adapt to society and their environment as independently as possible. The main features of the system of guided education are The main features of the guided education system:
(1) Emphasis is placed on active activities rather than passive or supplementary activities; active learning leads to a greater sense of progress and achievement, which is a sign of normal character development;
②According to the age of the child, the degree of dysfunction and the goal to be achieved, the educational unit is a group, and through the group work process, the child’s motivation is stimulated, and the ability to imitate and compete with each other is induced, so that the child can take the initiative to challenge difficulties, achieve interaction between individuals and others and promote the normal development of personality;
(3) The facilitator is the central figure in the system, who integrates the roles of teacher and therapist and is responsible for the education and development of the child. He or she conducts activity analysis according to the degree of impairment and characteristics of each child, and uses rhythmic intentional training methods to guide the child to use his or her motor potential and transfer movement to action, thus acquiring skills for independent daily living;
(4) Rhythmic intentional approach: Unlike special education for blind, deaf, and mute children, guided education for children with cerebral palsy makes full use of the child’s sensory organs to express his/her inner intentions through the use of rhythmic language, so that sound symbols prepare the mind for external behavior, linking speech and movement and facilitating motor learning;
Special training devices: In order to improve the motor impairment, to complete each procedure steadily, to induce children’s spontaneous participation, and to gain a sense of accomplishment and self-confidence, Professor Pet¨o designed special devices for Conductive Education, such as wooden beds, ladder-backed chairs and obstacle ladders.
Advantages: It is suitable for the rehabilitation of motor dysfunctions caused by various reasons, as well as for the rehabilitation of co-occurring mental retardation, language disorders, behavioral abnormalities, etc. It not only promotes the improvement of the dysfunction itself, but also the change of personality and character, i.e., the improvement of intelligence, cognition, interpersonal skills, etc.
Problems: It is a kind of group therapy, with high requirements for the guide and large space required. It is not suitable for people within 2 years old and those with severe mental retardation, who cannot understand others’ questions and cannot communicate with others in a simple way.
5, “compulsory use” motor therapy (CI) CI is advocated by a group of scholars at Alabama University in Birmingham, USA, and is the product of basic behavioral neuroscience research on primates. CI therapy is supported by controlled, randomized evidence that it is effective in restoring upper extremity movement, does not involve drugs, has no adverse effects, and is safe and non-hazardous, and is valued by the rehabilitation community. With the use of focused, repetitive exercises introduced to the affected limb, neuroimaging and transcranial magnetic stimulation (TMS), CI therapy is now widely used in neurological rehabilitation, such as chronic and subacute CVD, chronic traumatic brain injury paralysis. Incomplete spinal cord and hip fracture, etc. can achieve better results
6.The concept of occupational therapy (occupational therapy, OT) is a method of treatment and training through purposeful and selected occupational activities according to the disability of each child, which can promote the recovery, improvement and empowerment of those who have physical, mental and developmental dysfunctions or disabilities resulting in different degrees of loss of self-care, learning and working abilities. For people with physical, mental, or developmental dysfunction or disability resulting in varying degrees of loss of self-care, learning, and working ability, it has the effect of promoting recovery, improvement, and enhancement.
Occupational therapy mainly focuses on the mastery of upper limb functions and daily life movements and the improvement of intelligence, promoting motor development; promoting the development of upper limb functions; improving perceptual and cognitive functions; the independence of daily life movements; and promoting emotional and social development.
7, physical therapy (physical therapy, PT) mechanism of action: external physical and chemical factors to stimulate the body, through the nerve, body fluid regulation mechanism, to achieve anti-inflammatory, analgesic, antibacterial, sedative, hypnotic, desensitization, anti-cancer, neuromuscular excitement, enhance immunity and other effects.
Advantages: quick effect, no pain, less side effects, long lasting effect.
Commonly used methods are introduced.
(1) Electrical stimulation therapy refers to the application of low-frequency pulsed current below 1000Hz, and the application of medium-frequency pulsed current between 1001-100000Hz to treat diseases, including induction electrotherapy, electrical excitation therapy, inter-motion electrotherapy, super-stimulation electrotherapy, transcutaneous electrical stimulation neurotherapy, spasm antagonistic muscle electrical stimulation, interference electrotherapy, audio electrotherapy and modulated medium-frequency electrotherapy etc. The main clinical applications are neuromuscular electrical stimulation (NMES), functional electrical stimulation (FES), and transcutaneous electrical nerve stimulation (TENS).
(2) Biofeedback therapy (BFT) is a treatment or training method that uses electronic instruments to transform changes in bodily functions (such as electromyography, skin temperature, heart rate, blood pressure, etc.) that people are not normally aware of into signals that can be felt, such as visual or auditory forms, and then allows patients to learn to control their own involuntary functions based on these signals.
(3) Light therapy refers to the application of daylight or artificial light source cure method. Modern artificial light sources used for healing include visible light, infrared, ultraviolet and laser.
(4) hydrotherapy refers to the use of water temperature, hydrostatic pressure, buoyancy and the chemical composition of the water, in different ways to act on the human body to treat disease. Commonly used hydrotherapy methods include whirlpool baths, bubble baths, Hubbard baths, walking baths, etc.
(5) Horseback riding therapy is to improve the balance and coordination of movement of the child through horseback riding, and to improve self-confidence and self-reliance, so as to achieve the purpose of curing the disease. This method is currently developing rapidly in the United Kingdom, the United States, the Netherlands and Japan.
8, Sensory integrative therapy (Sensory integrative therapy) sensory integration disorder is a multifactorial contribution, early infant development of various sensory information input is one of the main factors. In scientific infant care, at present, we have paid more attention to visual, auditory, tactile and proprioceptive information stimulation, but the input of vestibular information is not enough, so the input of vestibular information should be strengthened in infant care. The vestibular system consists of two vestibular receptors in the inner ear, the brainstem, the cerebellum, and the vestibular nucleus, and is also closely related to the brain. The two vestibular receptors in the inner ear are gravity receptors and motor receptors. When the position of the head changes, the small calcium carbonate crystals in the gravity receptors leave their original position, and the fluid in the three pairs of semicircular canals in the motor receptors flows and transmits information to the cerebellum and brain.
If there is sufficient vestibular information input about the various position changes of the head during infancy, the brain’s integrative function will be strong and the child will have good balance and other functions. Vestibular perception is not only related to balance, but is also involved in the improvement of many functions of the body. For example, in children with poor vestibular function, the eye and neck muscles are also impaired, the eyes cannot gaze well and move with objects, and hand-eye coordination is poor. It has also been reported that electrophysiological tests show that syndromes characterized by impairments in reading, writing, and spelling inversions are primarily dysfunctions or lesions of the cerebellar-vestibular system. Studies have also shown that vestibulo-cerebellar function also affects emotional and cognitive refinement, and that vestibulo-cerebellar deficits are a factor in emotional instability, poor attention, learning disabilities, language deficits, and autism.
A number of studies have confirmed that vestibular information input not only enhances balance, but also promotes multiple aspects of infant development. It has been observed with infants held in a swivel chair that after four weeks of swivel chair stimulation four times a week, the group was better developed than the two control responses and movements without sitting and sitting without swiveling, especially in sitting, crawling, standing and walking. It has also been shown that preterm infants who received additional vestibular stimulation gained weight faster, were less likely to cry, and slept better. The various exercises assisted by the large inflatable ball can input vestibular information about various body positions and movements, including head-down position, as well as tactile, proprioceptive, visual and auditory information, which is an ideal way to improve infants’ vestibular function, sensory integration and motor function. In infancy, no other sensory integration program can safely input vestibular information in the head-down position, which makes large ball movements even more valuable.
9.Chinese medicine rehabilitation therapy
Commonly used methods include acupuncture therapy, massage therapy, herbal therapy, warmth therapy, acupoint injection therapy, buried wire therapy, hanging wire ligation therapy, etc.