Cerebral palsy (CP), referred to as cerebral palsy, is a group of syndromes caused by non-progressive brain injury and developmental defects from pregnancy to birth and early postnatal brain development due to various causes, mainly manifesting as movement disorders and postural abnormalities. The incidence of cerebral palsy is 2 to 3 per 1,000, with spastic cerebral palsy accounting for 60 to 70% of the total incidence. With the development and maturity of neonatal science, the incidence of cerebral palsy is increasing year by year. With its long course and high disability rate, it has become one of the major diseases of intellectual and physical disabilities in children, which seriously affects the physical and mental health and quality of life of children and brings a heavy burden to families and society. At present, cerebral palsy is a worldwide medical problem that has not yet been overcome by the medical community at home and abroad, and there are no special drugs or special treatment methods. In our department, the clinical efficacy and nursing observation of children with spastic cerebral palsy were carried out by using Chinese herbal fumigation combined with acupoint therapy and effective nursing measures, and the efficacy was satisfactory, which is reported as follows.
I. Clinical data
1. General data
All 42 patients were hospitalized in our department from February 2005 to December 2005, 30 males and 12 females, the youngest being 7 months old and the oldest 3 years old. Among them, 11 cases were from July to December, 25 cases were from 1 year to 2 years old, and 6 cases were from 2 years to 3 years old, all of them were children with spastic cerebral palsy, and all of them had more obvious abnormal postures.
2. Diagnosis and inclusion criteria
The typing and diagnostic criteria were referred to the minutes of the National Symposium on Pediatric Cerebral Palsy in October 2004. ①Meet the diagnostic criteria of spastic cerebral palsy; ②Age between 7 months and 3 years old (including 7 months and 3 years old); ③No cardiopulmonary disorders, no skin breakage, no acute inflammation and infectious skin disease, etc.
3.Exclusion criteria
(1) Those who do not meet the diagnostic criteria of spastic cerebral palsy.
(2) Those who are 7 months or 3 weeks old.
(3) Except for patients with non-cerebral palsy (spastic type), such as viral encephalitis, tuberculous encephalitis and central palsy due to progressive diseases.
(4) Normal pediatric patients with transient developmental lag.
(5) Patients with epileptic seizures.
(6) Those with skin lesions and eczema and other skin diseases.
II. Treatment methods and efficacy evaluation
1.Chinese medicine fumigation
The child should be treated with herbal fumigation before point massage.
(1) Chinese medicine fumigation: The instrument is the Chinese medicine fumigation instrument produced by Guangzhou Jinjian Medical Equipment Co. The fumigation formula for pediatric cerebral palsy is composed of 12 grams of Wujia Pi, 12 grams of Danshen, 15 grams of Fangfeng, 15 grams of Ai Ye, 15 grams of Chuanniu Knee, 20 grams of Red Peony, 3 grams of Mulberry, 60 grams of Xanthopia, 60 grams of Turbinaria, 5 grams of Safflower, 5 grams of Gui Pi, 15 grams of Gui Zhi and 20 grams of Astragalus. Treatment method: Put the pediatric cerebral palsy fumigation formula into the automatic decoction machine first, then put the decoction and appropriate amount of water into the Chinese medicine evaporator of the fumigation treatment bed, let the child lie flat on the fumigation treatment bed, accompanied by parents or nurses, and carry out whole-body or local fumigation with the steam temperature of 37℃～41℃ for 20min each time, once a day. Continuous treatment for 20 days for a course of treatment.
(2) Chinese herbal bath: The Chinese herbal bath formula was developed by Prof. Liu Zhenhuan of our hospital for scleroplegia. Specific operation method: Decoct the above into 5000ml of herbal liquid, add it into an oval wooden bucket with a capacity of 50L, then warm the water to 40L, the water temperature is 38℃～40℃, put on a swimming collar for the child (to prevent the child’s head from being submerged in the water), then put the child into the medicinal bath bucket, and the nurse gives a full-body massage and point massage according to the child’s condition. Parents induce the child to play freely in the bath with toys for 20 min and then quickly take the child out of the bath and dry him/her to keep him/her warm. Once a day. Continuous treatment for 20 days for a course of treatment.
2.There are points in the meridian
Rest for 30min after the Chinese medicine fumigation. Specific methods: (1) Knock method: The child is placed in a supine position, the left hand fixes one lower limb, the middle finger and index finger of the right hand together, and knocks on each meridian point from top to bottom (below the waist) along the bladder meridian, spleen meridian, kidney meridian and gall bladder meridian, from light to heavy and then from heavy to light, for a total of three times; (2) Point method: The child is placed in a supine position, the left hand fixes one lower limb, the right hand holds an empty fist, the thumb is straightened and placed close to the middle knuckle of the index finger, with Press each meridian point in turn with as much force as the child can tolerate, pressing each meridian point three times. During the whole pointing process, Cheng Fu, Yin Men, Cheng Tendon, Cheng Shan, Kun Lun, Ji Men, Sea of Blood, Yin Ling Quan, San Yin Jiao, Yang Ling Quan, and Hang Zhong points are the main points.
3.Nursing
(1) Preparation before operation: Chinese medicine fumigation and washing should not be done within 30 minutes before and after eating, and the nurse should take the body temperature before doing treatment for the child, and suspend doing Chinese medicine fumigation and washing when the child’s body temperature is found to be 38.5℃ or above, and the skin is damaged, acute inflammation and infected skin. Appropriate background music can be played during treatment to enhance the therapeutic effect.
(2) Do a good job of psychological care for the child and parents: explain to the parents of the child before doing the treatment that herbal fumigation and point therapy are safe, comfortable and effective treatment methods to gain the trust of parents. And introduce them to communicate with other parents of children who have good results in herbal fumigation to enhance the confidence of treatment. The parents of the children are guided to accompany the children throughout the whole process, so that the children can maintain a good mood to cooperate with the treatment.
(3) Temperature adjustment: The nurse set the appropriate fumigation temperature for the child according to the child’s age and heat resistance, and the room temperature was 26℃-28℃. When the child is lying on the fumigation bed, the nurse must guard the child and ask and observe the child at any time.
(4) Observation and care during fumigation: pay attention to safety during fumigation to prevent falls and burns. In case of scalding, notify the doctor for symptomatic treatment. Pay attention to the indoor wind, the child will sweat a lot during the fumigation process, fumigation should be dried with a bath towel after the whole body, parents are advised to feed the child more warm water, pay attention to warmth, to prevent colds.
Observe the condition during the operation, such as facial color and breathing, if you find that the face is blue, you should immediately stop the operation.
(5) Prevention of cross-infection: Fumigation beds and medicine bath buckets are wiped with chlorine-containing disinfectant daily, and disposable sheets are used on fumigation beds and disposable spa bags are used on medicine bath buckets during treatment to prevent cross-infection. The treatment rooms for fumigation are each disinfected with ultraviolet light for 1 hour daily, and windows are opened and ventilated after treatment to prevent excessive humidity in the rooms.
(6) Dietary care: In order to improve the anti-disease ability of children, increase the immune function of the body, and achieve the ideal treatment effect, our department combined with health education to guide the eating habits and dietary arrangements of children, and together with the parents of children to develop nutritional recipes and implement effective nutritional interventions to ensure the smooth implementation of various treatments.
4.Effect evaluation
Before treatment and after 1 course of treatment, the modified Ashworth method was applied to assess the muscle tone.4 The score was 0 for muscle tone level 0, 1 for muscle tone level Ⅰ, 2 for muscle tone level Ⅰ+, 3 for muscle tone level Ⅱ, 4 for muscle tone level Ⅲ, and 5 for muscle tone level Ⅳ. Efficacy criteria: effective: normalization or reduction of muscle tone by more than 2 levels after treatment; effective: reduction of muscle tone by 1 level after treatment; ineffective: no improvement of muscle tone before and after treatment.
Joint mobility: effective: passive flexion angle increased by more than 20° or reached the normal range; effective: passive flexion angle increased by 10°～20°; ineffective: passive flexion angle was less than 10°.
5.Statistical method
All data were established and statistically analyzed using SSPS11.5 (t-test), and P0.05 indicated statistical significance.
III. Results
After the treatment course, analysis of the treatment results showed that: the muscle tone scores of both lower limbs before and after treatment were statistically significant (P < 0.01), and the total effective rate reached 83.3%; the comparison of the degrees of the adductor angle, N-fossa angle and dorsiflexion angle of the foot before and after treatment were statistically significant (P < 0.05), and their effective rates were 83.3%, 81.0% and 73.8%, respectively. This indicates that the combination of Chinese medicine fumigation and meridian point method can significantly reduce the muscle tone of both lower limbs and improve the mobility of the six joints of both lower limbs in children with cerebral palsy.
IV. Discussion
Hyper-extension reflex is a typical clinical characteristic of children with spastic cerebral palsy. Due to the hyper-extension reflex contraction of the muscles, the limitation of movement and the narrowing of joint range of motion occur, which affects the normal sitting, standing and coordination activities of the child and makes the clinical treatment very difficult. Our department applies acupuncture, massage, acupuncture points, hydrotherapy, herbal fumigation, physiotherapy, functional exercise and medication to treat children with spastic cerebral palsy, and through long-term clinical observation, the efficacy has been confirmed.
The mechanism of Chinese medicine fumigation has a long history, which is to make use of the skin’s characteristics of absorption, permeation and excretion, and the medicine vapor and Chinese medicine bath produced by the decoction of Chinese herbs is directly applied to the surface of the limbs. On the other hand, the warming effect produced by the fumigation and bath can promote blood circulation and lymphatic circulation, make the metabolism flourish and improve the functions of the whole body, and make the muscle tension decrease, relieve the muscle spasm, maintain and expand the joint mobility and correct the contracture, so as to improve the motor ability and expand the joint mobility. In spastic cerebral palsy, Chinese medicine identifies that most of the cases are due to liver and kidney deficiency, blood deficiency and wind multiplication, so the main treatment method is to tonify the liver and kidney, invigorate blood and nourish blood, dispel wind and open the ligaments. In the formula of fumigation for pediatric cerebral palsy, Wujia Pi, Chuanniu Knee, have the function of tonifying the liver and kidney; Dan Shen, Angelicae, and Red Peony have the effect of invigorating the blood and nourishing the blood; Fang Feng, Mulberry Branch, Xanthopia, Turbinate, Wujia Pi, Papaya, and Qiang Wu have the effect of dispelling the wind and opening the channels. Considering that the child sweats more in the bath, Huang Qi is added to benefit the Qi and strengthen the surface, and mugwort leaves warm the meridians and disperse cold. The combination of all the medicines can dispel the evil without hurting the positive, and achieve the purpose of both ventilation and tonicity.
Point therapy is one of the traditional therapies in China, and it was recorded in Cao Shiheng’s “Secret Essentials of Health Protection” in the Ming Dynasty. Point therapy is a method of preventing and treating diseases by using different techniques such as pointing, pressing, tapping, pinching, knocking and pounding on the patient’s body surface points and specific stimulation lines to restore the body’s function to normal. Modern medicine believes that the effect of acupuncture point therapy is mainly to stimulate the nerve receptors or nerves in the area where the acupuncture point is located, and conduct to the central nerve to adjust the function of the nervous system, improve blood circulation and metabolism, and promote the recovery and regeneration of tissue cells in the diseased area through the regulation of the central nerve. Through pointing, pressing and clasping techniques on the kidney meridian, bile meridian and other meridian points, we can adjust yin and yang, regulate qi and blood, open the meridians and cultivate vital energy, and adjust the body’s function by stimulating the biological effect of meridian points, so that the body’s yin and yang can reach balance and the disease can be eliminated by itself.
Our department applies Chinese medicine fumigation combined with acupuncture points and effective nursing measures to treat children with spastic cerebral palsy. Through clinical observation, we found that this therapy can reduce the muscle tone of children, improve joint mobility and reduce abnormal posture, thus achieving better treatment effect, shortening the hospitalization time of children and reducing the burden of society and children’s families.