Cerebral palsy is a syndrome caused by non-progressive brain damage before birth, at birth, or in early infancy. Although the clinical symptoms may change with age and brain maturation, the lesions of the central nervous system remain constant. Ma Xiaolei, Department of Rehabilitation Medicine, Henan Provincial People’s Hospital
Causes of cerebral palsy.
(l) Low weight infants (less than 2500g): including premature immature infants, full-term small-like infants. (2) Congenital anomalies: including abnormal brain development caused by various reasons. 53% of cerebral palsy patients with tetraplegia are related to congenital anomalies; 35% of cerebral palsy patients with non-tetraplegia are due to congenital dysplasia. (3) Cerebral ischemia and hypoxia: 20% of cerebral palsy patients are caused by asphyxia and birth injury, and the factors leading to ischemia and hypoxia are: ① Maternal factors: such as gestational hypertension syndrome, heart failure, hemorrhage, anemia, shock or drug addiction, drug overdose, etc.; ② Placental factors: such as placental abruption, placenta praevia, placental necrosis or placental malfunction, etc.; ③ Umbilical cord blood flow blockage: such as cord prolapse, compression ④ Abnormal delivery process: such as breech delivery, stalled delivery, surgical delivery (forceps) or application of anesthetics; ⑤ Neonatal factors: in addition to asphyxia, there are many abnormal cardiopulmonary diseases. Such as: congenital heart disease, respiratory distress syndrome, peripheral circulation failure, erythrocytosis. (4) Nuclear jaundice: It is an important cause of cerebral palsy, but with the progress of domestic medicine, the proportion of cerebral palsy caused by nuclear jaundice has decreased.
Clinical classification of pediatric cerebral palsy Because of the various causes of cerebral palsy and the different clinical manifestations, there are five clinical types. 1. Spastic cerebral palsy: It is the most typical and common type. The main manifestation is spastic paraplegia or quadriplegia with both lower limbs. The child has difficulty walking and standing, and walks with a scissor gait on the toes. There is a marked increase in muscle tone, hyperactive tendon reflexes, and pathological dermal projections. It is often accompanied by speech and intelligence impairment. 2. Dystonic cerebral palsy: Most often seen in young children, the main manifestation is a marked decrease in muscle tone. They are unable to stand or walk, cannot lift their head and neck, and have obvious movement disorders and excessive joint movements, but tendon reflexes are active and pathological reflexes may appear. It is often accompanied by aphasia and mental retardation. 3. Hand-foot tardive cerebral palsy: Most of the cases are caused by nuclear jaundice and neonatal asphyxia, resulting in damage to the basal nucleus. The child exhibits choreiform or tachycardia-like movements of the face, tongue, lips and trunk limbs. It is accompanied by dyskinesia and increased muscle tone. The main clinical manifestations are hypotonia, ataxia, intentional tremor, dysarthria and motor retardation. 5. Mixed type: Combining some characteristics of the above-mentioned types. According to clinical characteristics: (1) spastic type; (2) tardive type; (3) tonic type; (4) ataxic type; (5) tremor type; (6) hypotonia type (also called flaccid type); (7) mixed type (must specify what type is mixed); (8) cannot be divided into types. By site of paralysis: (1) monoplegia; (2) paraplegia; (3) hemiplegia; (4) bilateral paresis; (5) trigeminal paresis; (6) quadriplegia; (7) dual hemiplegia
The latter schedule…
l
Normal development table (1)
l 4 months: Sitting straight against an object with the neck erect and adjusting the position of the head. l 7 months: Remaining seated for one minute with the body tilted no more than 45 degrees.
l 10 months: rolls over to sides; stands up against objects; crawls (1.8 m in one minute scuffing). l 12 months: crawls 1.8 m in 15 seconds in knee-hand position; stands up against objects and stands in place. l 12 months: crawls 1.8 m in 15 seconds in knee-hand position; stands up against objects and stands in place.
l 15 months: can stop on own after 6 steps and then start walking again. 18 months: runs without falling within 15 m; can sit in a chair with armrests; can go up and down stairs using either method. 21 months: can go down stairs with one-handed support; goes up stairs with two-handed or one-handed support.
Normal Development Chart (2)
l 24 months: runs continuously for 15 meters without falling; supports going down stairs with both hands or one hand. l 30 months: jumps on both feet simultaneously. l 36 months: alternates legs going up and down 6 flights of stairs without assistance; jumps and balances from a l5-cm high platform. l 42 months: stands on one leg for 2 seconds. l 48 months: jumps forward 30 cm with assistance for 1.8 meters; jumps forward more than 24 cm in place and maintains balance. l 54 months: jumps forward 4 cm on one leg and maintains balance. l 55 months: jumps forward 4 cm on one leg and maintains balance. l 56 months: jumps forward 4 cm on one leg and maintains balance. l 57 months: jumps forward 4 cm on one leg and maintains balance. months: bounces forward 4 times on one leg 60 months: bounces forward 3 m on alternate legs; stands on one leg for 8 seconds; walks on a line 2.5 cm wide in a straight line
l 72 months: jumping from a 30cm platform first on the toes and then the feet follow the ground to maintain balance; alternating single-leg stand with both lower limbs with eyes closed
Second, the training points of each type (3)
1. Spastic type
The principles of treatment for patients are to reduce muscle tone and improve contraction of antagonist muscles; maintain expanded joint mobility; use RIP to suppress abnormal reflex posture and let patients learn to move actively; improve balance; encourage patients to carry out spontaneous activities to induce random and dissociative movements.
2. Hand and foot tardive type
Use RIP to suppress abnormal muscle tension and asymmetrical posture; improve simultaneous muscle contraction through compression, weight-bearing, resistance, etc.; provide continuous postural control in intermediate position; provide appropriate stimulation and sensory reinforcement education to improve balance.
3. Ataxia
Improving muscle tone and simultaneous muscle contraction, continuous postural control; repeated sensory education and re-education and distance determination training; improving balance ability.
4. Mixed type
Use RIP to control spasticity and suppress asymmetrical posture; pay attention to posture control in intermediate position and induce active motor ability to improve balance ability; in addition, pay attention to joint mobility training.
Treatment methods of cerebral palsy in our department.
1 tui na, 2 exercise therapy, 3 occupational therapy, 4 physical therapy, 5 speech therapy, 5 acupuncture, 6 acupoint injection and other comprehensive treatment is safe and effective.