A, to promote normal motor development of basic movement training
1.Head control training
2.Torso rotation training
3.Abdominal support training
4.Turn over training
5.Elbow support training
6.Hand support training
7.Knee hand position training
8.Sitting training
9.Kneeling position and single-leg kneeling training
10.Standing and standing balance training
11.Walking training
1.Head control training
Head control is the basis for the child to maintain the sitting position and to perform various movements.
Normal infant neural reflex development in 1 to 2 months, prone position of the vagus adjustment response and visual adjustment response is positive. At this time, the child can raise his head in the prone position and maintain it at 45°.
If the child is negative for both of these responses, he or she should be trained to readjust visually in the prone position.
Method: The therapist or the mother lies on her back with the child in a prone position, and the therapist uses both hands to control the child’s chest to induce a head-up movement.
The child can also be placed on the bed in a prone position and toys, bottles, and other objects can be used to induce head raising.
For children with severe impairment, a wedge-shaped pad can be placed under the chest and stimulation techniques can be applied on both sides of the spine.
When the child reaches 3 or 4 months of age, the head can be better controlled, otherwise the child should be trained in head control.
The therapist assists the child in sitting up from a supine position using the flexors of the neck and trunk. The therapist kneels, holds the child’s flexed lower extremities with both knees, and holds the child’s upper extremities with both hands to induce a sit-up movement with the head flexed forward and the chin approaching the sternum.
For children with coracobrachialis, the therapist’s fingers can be used to stimulate the pectoralis major and rectus abdominis muscles to induce a flexor pattern or to passively control the child in head flexion and scapular external booth to keep the flexor muscles in an easily contracted state.
This training is suitable for all types of tardive dyskinesia and for children who have difficulty switching between extensor and flexor patterns.
It is not suitable for children with spastic type, especially for children with spastic quadriplegia in which the flexors are dominant.
2.Trunk rotation training
Trunk rotation to improve the control ability of the external oblique muscles can be a preparatory training for turning over and sitting exercises.
The child is placed in a supine position, and the right lower limb is crossed over the left lower limb or both lower limbs are flexed in a knee-standing position. The therapist immobilizes the knee joint to prevent the pelvis from rotating to the right.
With the right hand, the child’s right upper extremity is gently pressed into an inward position. The left hand holds the child’s left upper extremity, and the child’s head is rotated to the right while the child is assisted to complete the flexion and rotation of the trunk to the right.
This training is an auxiliary active movement of trunk rotation starting from active or passive forward flexion of the head, which can effectively facilitate the trunk rotation adjustment response.
The main point of the training should be to rotate while the trunk is flexed forward. To prevent the wrong transformation into a passive movement of trunk lateral flexion.
3.Ventral support training
This training is to obtain head stability and lumbar back muscle control training, and is also one of the basic training for practicing the pre-sitting position.
Difficulties in the casual transformation of the whole body flexor mode to the extensor mode.
Motor dysfunction of the upper limbs.
Low scapular inversion function.
Children who cannot detach themselves from the influence of the tension labyrinth reflex are of special significance.
The training can be divided into two phases.
The first stage is.
The child is placed in the prone position and the therapist controls the pelvis with the hands to extend the hip joints and extend both upper limbs behind the back. The therapist supports the child’s upper arms or shoulders with his or her hands, causing the scapulae to be tucked in and the trunk to be extended posteriorly, while the child raises his or her head and extends it posteriorly as far as possible.
The therapist can stimulate the middle part of the scapulae and sacrospinous muscles bilaterally with the fingertips to induce abdominal support movements.
The second stage of training: The main point of training in this stage is to control the separation of the head and trunk.
That is, while the trunk is kept upturned, the head is trained in various positions such as neutral position, forward flexion, back extension and left-right rotation.
4.Turn over training
Training the child to turn over should start from suppressing the asymmetrical tension neck reflex and easing the trunk rotation adjustment response.
If the asymmetric tense neck reflex cannot be suppressed, the trunk rotation adjustment response cannot appear. The trunk rotation adjustment response is the basis for body rotation and turning movements.
The second stage of abdominal support training: head and trunk separation exercise training, if it can be better mastered, can suppress the effect of head position in space on the distribution of body muscle tension.
Trunk rotation training: can effectively ease the trunk rotation adjustment response.
Rollover training
Now take turning over to the right side from the supine position as an example: firstly, the head is rotated to the right side with force, the left upper limb is lifted up and inward beyond the midline of the body, the upper part of the trunk is rotated to the right side in accordance with the trend, and the whole body is lightly flexed to complete the side lying position. The head continues to rotate to the right, the whole body is lightly extended, and becomes prone in the body rotation. The right upper limb should be withdrawn at the final stage of completing the movement, and if there is difficulty in moving the right upper limb, it should be assisted only at this stage.
Turn over training
Turn over training
From the prone position, continue to rotate the head to the right side, and the right upper or lower limb supporting the ground can become a lateral position with the left side underneath. On this basis, gently remove the flexion pattern to become supine. A turning movement can be completed by the above training.
Generally, the child has no difficulty in completing the movement from prone to supine position, but when moving from supine to prone position, it is often difficult to change to flexor mode due to high tone of the extensor muscles.
Turning training
In clinical practice, it is often seen that the child turns over with the body cocked back and the lower limbs kicking backwards. This abnormal pattern is extremely detrimental to trunk control and sitting exercises and should be suppressed.
Turning training has high requirements for trunk and head control, and is important for future sitting maintenance, walking and various daily life movement training.
5.Elbow support training
This is the basic training of neck and shoulder control, and is also an important part of the training of upper and lower limbs in knee-hand position.
The child’s elbow joint is flexed at 90°, and the forearm is supported in a prone position. The elbow and shoulder are in a vertical line and the upper arm is perpendicular to the ground. While maintaining the above posture, the child raises the head and looks forward, and then practices head retention in various positions as well as neck flexion, extension, lateral flexion, rotation and other movements.
Children who have difficulty completing the exercises can be assisted with their upper arms, assist in raising the head or stimulate the oblique muscles with their fingertips.
You can also start practicing with wedge-shaped pads, pillows and other items on the chest.
6.Hand support training
When the elbow support is mastered, the elbow joint is extended into the hand support exercise.
The purpose and function of this exercise is the same as elbow support, which is to strengthen the control of neck, shoulder and upper limb muscles, improve the control of elbow joint, wrist joint and hand, and suppress the symmetrical tension neck reflex.
During the training, the child is placed in a prone position, with both fingers extended and abducted on the ground, the distance between the two hands is the same as the width of the shoulders, the elbow joints are extended, the shoulders, elbows and hands are on a vertical line, and the trunk above the abdomen must be lifted off the ground. At the beginning of the training, the therapist is usually required to assist in the control of the elbow joint or use an elbow orthosis.
On the basis of maintaining the above posture, the child should practice head movements in all directions to suppress the symmetrical tension neck reflex.
7.Knee-hand recumbency training
This training is a training program after the hand support movement is mastered, and its purpose and function are the same as hand support training.
The child’s hip and knee joints are flexed by 90°, and the weight is supported by the hands and knee joints, with the hands and knee joints directly below the shoulder and hip joints respectively, and the upper limbs and thighs are always kept perpendicular to the ground.
Some children often have low control of the upper and lower limbs or positive symmetrical tension neck reflex, increased tension of the extensor muscles of the upper limbs and increased tension of the flexor muscles of the lower limbs when raising the head, resulting in an acute angle between the hip and knee joints and a problem with the hips sitting back, which disrupts the knee-hand recumbent posture.
The stability of the knee-hand recumbent posture is the basis of crawling in children, and should be practiced repeatedly with the assistance of a therapist.
When the child can better maintain the knee-hand recumbent position, the therapist assists in completing the rotation of the head in all directions, suppressing the symmetrical tension neck reflex and asymmetrical tension neck reflex, and easing the balance response.
The child should not enter the crawling training if he/she cannot master the above positions correctly.
8.Sitting training
Sitting balance response appears in normal children about 10-12 months after birth and is maintained for life, which is the basic condition for children to maintain sitting position. The child should be trained to sit and at the same time to be easy.
Maintaining a stable sitting position is the basis for the child’s upper limb movement, standing and walking. After the child acquires the ability to roll over, hand support and knee-hand recumbency, the long sitting position and chair sitting position are completed with the assistance of the therapist.
When the child can do it independently, induce the adjustment reaction of the child’s head and trunk as well as the protective extension reaction of the upper limbs.
9.Kneeling position and single-leg kneeling training
The kneeling position is necessary for the child to stand and walk, especially the single-legged kneeling position is more important.
Take the left knee weight training as an example: when the kneeling position is not sufficient, the right hip joint will be internalized and the knee joint will be tilted beyond the midline to the left. At the same time, the left hip joint is internally rotated and flexed, and the kneeling position cannot be maintained.
At this time, the therapist places one hand on the right side of the child’s greater trochanter and pushes and presses it to the left side, while the other hand fixes the right knee to the outside (external hip booth), so that the child can experience the sensation of movement to maintain a single-leg kneeling position.
Children with spastic and lower limb spastic hand-foot-movement cerebral palsy have more difficulty mastering these movements and must be trained repeatedly.
Children with hand-foot-movement cerebral palsy without spasticity are easy to master and can be trained without special training.
10.Standing and standing balance training
Standing is the foundation of walking. No matter what type of cerebral palsy, standing is the most important training program and requires the most time.
As parents and children look forward to the improvement of standing and walking ability, they often neglect the developmental procedures and the necessary basic skills training. Inappropriate training, such as blind grasping and standing or barely walking with assistive devices, can be extremely harmful to a child with the potential to walk independently.
Standing is based on good balance in the seated position and in the single-legged kneeling position.
The child is positioned in the standing frame with the legs apart to inhibit hip inversion and internal rotation and ankle plantarflexion and inversion. The elbow flexion is inhibited by placing his or her hands on the table of the standing frame. The therapist adjusts the child’s posture through head, trunk, shoulder, and pelvis control.
When the child can maintain correct posture, the upper limbs are removed from the table or some games are designed to release the upper limbs from the table, and then the angle of lower limb abduction is gradually reduced to increase the difficulty of standing.
For children with flexor spasm pattern, in order to prevent excessive reliance on the standing frame, the child’s back can be leaned against the wall and the therapist can fix the child’s foot with his foot to make him land on the full foot.
Depending on the child’s problem, the standing posture can be adjusted by fixing the knee joint with the lower leg to extend the hip and knee (to prevent knee hyperextension), or by fixing the shoulders with both hands to extend the trunk and tuck the scapulae in.
On the premise that the correct posture can be maintained, the child is released from the assistance of the apparatus and the therapist assists the pelvis, upper thighs, knees and upper calves in descending order according to the child’s balance ability until he/she can maintain independent standing. On the basis of this, the standing balance training will be carried out.
11.Walking training
The basic conditions such as normal standing balance response, alternate and coordinated movement of bilateral lower limbs and weight support of one lower limb are necessary for independent walking.
A careful evaluation must be done before walking training for children with cerebral palsy, and the results should be used to determine the possible level of walking, such as independent walking, walking on crutches, or living in a wheelchair for the rest of the child’s life.
The developmental characteristics of the child should be taken into account before making the determination, and every effort should be made to achieve independent walking. Training programs should be rigorously designed to bring the child as close to a normal gait as possible.
With the exception of a few children with severe cerebral palsy, most children can achieve independent walking through comprehensive rehabilitation.