Children with cerebral palsy often exhibit delayed or abnormal hand movements. The abnormal movement patterns are often a composite of several developmental levels, which are caused by the cognitive and psychosocial levels of the child encouraging him to attempt activities that exceed his motor abilities, and the sensory-motor stress resulting from the inability to complete the activity causes him to put his delayed movement developmental patterns superimposed on each other.
Training principles for fine motor function of the hand in children with cerebral palsy
1.Since there are many hand fine movements that are done in sitting position, therefore, when starting hand fine function training, we should first train the child to obtain good sitting balance and the ability to maintain good sitting posture, or provide the child with appropriate sitting chairs and tables to help him/her obtain good postural control during the training.
2. When engaging in unilateral hand activities, place the other hand in an appropriate position to help the child maintain correct posture and muscle tone.
3. Consider the size, texture, weight and shape of the manipulated object, because hand motor control begins with sensory input and different sensory exploration is beneficial to promote the development of hand function.
4. Encourage the use of two-handed activities.
5. The difficulty of the movement is set in the range that the child can accomplish through effort. Too much difficulty will produce a pressure on the child, and this pressure will induce or aggravate the joint response of spasticity, thus making the postural control and movement effort worse.
The importance of early hand training for children with cerebral palsy
1. The stage factor of hand use: visual contact with objects and their own hands, a hand contact with objects, grasping ability, placement ability, and manipulation of objects, each stage is the basis of another stage, so the earlier the training, the earlier the higher stage can be reached.
2. Avoid hindering the development of other functions: Hand function is closely connected to other functions, and early training can avoid hindering other functions.
Hand function training for children with cerebral palsy
The development of hand movement is from grip to reach, from clumsy to dexterous. Therefore, the training of hand movements must be carried out in the order of development. The basic principle of hand training is to focus on the hand with better function, and not to force the child to use the right hand to avoid increasing the difficulty of training.
1, picking up things training: many children always thumb inward, the remaining four fingers are “clenched. Fist, the shape. Because the fingers can not be extended, so it is difficult to grasp things, then the therapist can do the following training.
① Let the thumb radially abducted, the remaining four fingers will be easily extended.
② Hold the child’s palm in one hand, then dorsiflex the wrist joint and apply some pressure, and hold it for a few seconds. Once the child’s hand is extended, the therapist can place a small toy in the child’s hand and hold the toy with a little pressure. When the child learns to hold something, the therapist can choose something lighter and easier to grasp in the hand and encourage the child to take the initiative to get it.
2, put things down training: many children once grasping things, the tighter the grip, it is difficult to put down, the therapist can first let the child grasp things, and then do the following training.
① Lightly tap the tendon of the general extension of the fingers of the arm, and then lightly rub from the wrist to the direction of the fingers, along with the “hand open, hand open” language prompts.
The child’s hand is raised above the head and the elbow joint is extended and the wrist joint is palmarly flexed, using the “tendon effect” to promote hand extension. Once the child has learned to release his hand, the therapist should often use verbal cues to practice opening the hand. For example, let the child put something in his hand into the therapist’s hand.
3.Pick up and put down things: Based on the previous training, the therapist can arrange some continuous movements of picking up and putting down things for the child to practice. For example, the child can play a circle game or throw a sandbag.
Strengthening the awareness of hand use in children with cerebral palsy
1. Increase hand gaze (0-2 months of intellectual age, is no hand gaze).
① Encourage hands in the middle: For some children, lying on the side is the best way to put the shoulders and upper limbs forward in the midline position;
②Tactile stimulation method: Brush children’s hands with objects of different textures, such as brushes and towels from the palm to the fingers, or electric toothbrushes, electric massagers, ice packs or warm water packs to stimulate the hands;
③Visual stimulation method: shine a flashlight on the child’s hands; or colorful ribbons tied to his hands; or to print handprints, finger painting, fingers or manual cloth toys to attract his gaze;
④Taste stimulation method: smear some jam, peanut butter, honey and other things on the child’s hands to trigger the child to eat hands and gaze at the hands.
2.Use of sensory play and cause-and-effect relationship.
①Finger five senses play action;
②Put the ring on the hand;
③Guiding children to touch their own images in the mirror with their hands, or adding shaving cream on the mirror for him to paste with his hands will be better;
④ Use different sound-making toys or toys that move and have bright colors for him to fiddle with.
Note: ①The child should be placed in a corner of the room with a barrier to reduce environmental nuisance (environmental design);
Initially, the therapist can hold the child’s hand and cue “little hand”.
How to train finger control for children with cerebral palsy
1. Prepare the whole upper limb to have better control of sensory activities.
①Crawl on hands and knees in a good form;
②The therapist lifts the child’s feet and instructs him/her to walk with both hands; ③clap the hands or thighs.
2. Prepare the hands and fingers to have better control of sensory activities.
①Brush the arm, hand and each finger with oil, cloth or brush;
②Search for small objects in a container with beans or sand.
The function of the thumb is very important, as the thumb is required to perform all the functions of the hand, and loss of thumb function means loss of most of the functions of the hand.
The resting position of the thumb is mild abduction of the thumb, mild flexion of the metacarpophalangeal joint, and the finger belly approaching or touching the radial aspect of the proximal interphalangeal joint of the index finger. Extension of the thumb is the movement of the thumb away from the index finger and toward the radial side, with a range of motion of 700 to 800. Abduction of the thumb is the movement of the thumb from the resting position toward the palm in a vertical direction, with a range of motion of about 600. There are two types of thumb induction: ulnar induction. The thumb is inwardly retracted from the extended position, returns to the resting position and continues to be inwardly retracted, with the belly of the thumb touching the transverse palmar line of the ring finger. Metacarpal inversion. It is the movement from the outer booth back to the palm plane. The thumb to palm movement is a complex joint movement involving multiple joints and muscles. The palmar motion is accomplished by abduction, flexion and internal rotation of the carpometacarpal joint, abduction and rotation of the metacarpophalangeal joint, and mild flexion and rotation of the interphalangeal joint. The palmar surface of the distal phalanges of the thumb is in contact with the palmar surfaces of the distal phalanges of the other four fingers in correspondence.
(1) Finger pinching training: The best way to train is to use colored playdough and insert the child’s five fingers into the playdough, and when his hand is withdrawn the finger pinching action will naturally occur, or use small beans to teach the child to pinch people in a plate, or even put a few raisin grains in the plate and let him pinch them up and put them in his mouth. If necessary, the therapist can consider using an elastic bandage to restrain the child, except for the thumb and index finger, and use only the thumb and index finger to pinch small objects, and repeat the training.
(2) fingertip pinching training: the best way to train the child is to allow the child to pinch up toothpicks or nails in order to put them on the pre-prepared plastic foam board with patterns, or use small colored plastic blocks for puzzle games.
Training the child to grasp objects with the caudal three fingers
1. Test whether the child still has the grip reflex before training
Grasp reflex: when the palm is stimulated or lightly pressed, the fingers will be flexed inward to grip objects.
2. The object used should be long and small. For example, a small 1.5 cm diameter stick or the trainer’s finger.
3.If the child can grasp with the palm of the hand or grasp with the first three fingers, it means that the child has gone beyond the stage of grasping with the last three fingers, so this project can not be trained.
4, with the tail three fingers grasp is not a functional grasp, so we will not deliberately do training, training grasp, should start from the palm grasp.
For children with visual problems training palmar grip
For some children with visual problems, the following methods can be used.
① Use brightly colored objects or objects with strong contrasting colors;
②Touch the back of the child’s fingers to indicate the location of the object;
③ Use toys with sounds to indicate the location of objects;
④Place toys in different positions and make sounds to train children’s ability to reach for different positions, thus preparing children to learn some higher level of small muscle activities. Objects of different textures, such as smooth, rough, and bumpy objects.
Palmar grip practice for children with physical control problems
The following methods can be used for some children who have problems with physical control.
1.Low tension type: To support the child’s wrist so that it can operate in a normal position.
2. High tension type: To prevent him from having excessive flexion of the wrist when grasping. Sui condition.
3.For some children with hand spasms, they should avoid using some elastic toys such as sponges, etc.
Training the use of the first three fingers to grasp objects
1, the use of objects to be suitable for children to grasp the first three fingers.
For example, a block with a side length of 1 cm or a small wooden stick with a diameter of 2.75 px. The position of the object should be close to the thumb, or the object should be placed in front of the child in the middle line, and then the trainer should hold the child’s wrist and let the child grasp it with the first three fingers.
2, some control methods can be used to strengthen the child’s ability to grasp with the first three fingers.
For example, the trainer can hold the child’s pinky finger and ring finger in his or her hand and only let the child manipulate the first three fingers; or an elastic bandage can be applied to the pinky finger and ring finger, but please consult an occupational therapist when using this method to see if it is appropriate for the child.
3, for some older children, can be used to press the vocal dolls, etc. to train children’s ability to thumb, show finger and middle finger relative to each other. (Note that children with hand spasms should not do this activity).
4.Use the sound board to put the thumb, finger and middle finger on the child, and tap the two to make a sound to attract the child’s interest.
5.Use clay glue or therapeutic glue, pinch some small objects, such as small balls, small animals. Stick them on another ball of clay glue and induce children to take them with the first three fingers.
When playing with water, wet a small sponge block and teach children to hold it with the first three fingers and pinch out the water.
Teach children to hold the paper with their first three fingers and tear it apart. A small section of the paper can be torn in advance to make it easier to tear.
Give the child food such as finger cakes, shrimp sticks, chips, etc. and encourage him to use his first three fingers to grasp them. Place blocks with 1 cm sides in a bucket or box and encourage the child to remove the blocks from the bucket or box. Due to the limitations of the container, the child needs to use the first three fingers to grasp the object before it can be easily removed.
Ability to grip objects
1.The ability to grip objects can be subdivided into.
①Grip awareness (when to grip objects);
② Persistence of grip (how long to grip before letting go);
③Grip strength (how much force is needed);
④Grip method (which part of the palm and fingers are used for grip);
⑤ Strain of grip (grip objects of different sizes, shapes and textures).
2. Suggestions.
①Use basic needs for motivation, such as holding a spoon to eat, holding objects to avoid falling, holding objects to sit, stand or turn position;
②When giving objects, pay attention to sensory stimulation, such as touching the texture and shape before holding them tightly;
③Place larger or modified-shaped objects in the palm of the child’s hand to make it easier to hold them firmly;
④In the game, encourage children to grasp.
3.Examples.
①Play with toys that have gripping hands such as rattles, drums, etc;
②Give toys that can make sounds, but be careful when using them on children with spasticity, as they are more likely to aggravate the spasticity.
4.Remarks.
①Position of the object. The therapist should move the object to the child’s middle finger and raise the object so that the child can raise the wrist to the correct position to grasp it;
②The therapist holds the child’s hand or ties the hand with a glove to squeeze the object;
③When the child grasps with the fingers, the therapist can gently press the object toward the palm to strengthen the child’s grip.
Comprehensive hand movement training
The ultimate goal of hand movement training is to be able to do comprehensive, continuous, functional movements to achieve the purpose of doing things with the hands. The use of a variety of colorful games such as assembled toys, origami, fabric applique, and piano playing can promote the training of continuous hand movements.