Cerebral palsy, also known as cerebral palsy and cerebral palsy. Cerebral palsy is a syndrome caused by damage or injury to the immature brain before birth, at birth, or during the first month of life, with motor and postural disorders as the main manifestations, often accompanied by epilepsy, mental retardation, and speech disorders. It is basically synonymous with pediatric cerebral palsy. The lesions often damage the pyramidal tract and the extrapyramidal system. The disease is directly related to cerebral hypoxia, infection, trauma and hemorrhage, such as rubella, herpes zoster or toxoplasmosis in early pregnancy, severe infection in middle and late pregnancy, severe gestational hypertensive syndrome, pathological obstructed labor, etc. can cause neonatal cerebral palsy.
Etiology]
Causes include placental abnormalities, fetal malposition, intrauterine distress, prematurity, multiple births, asphyxia at birth, and neonatal hypoxic-ischemic encephalopathy, nuclear jaundice, infection, trauma, cerebral hemorrhage, and brain malformation.
1, hypoxic asphyxia: including fetal hypoxic asphyxia in the mother’s womb, neonatal hypoxic asphyxia during delivery, respiratory distress syndrome, peripheral circulatory failure, erythrocytosis.
2, brain injury: such as infant brain injury during delivery, neonatal cranial injury or brain infection, cerebrovascular accident .
3, premature birth and fetal dysplasia: intrauterine infection, intrauterine growth retardation, congenital malformations. The likelihood of cerebral palsy is greatly increased in newborns weighing less than 2,500 grams (about 40% of children with cerebral palsy weigh less than 2,500 grams)
4. Certain genetic diseases and neonatal nuclear jaundice.
5. Causes in pregnant women: including abdominal trauma, preterm abortion, prenatal hemorrhage, toxemia of pregnancy and placental causes (placenta abruptio, placenta praevia, placental necrosis or placental dysfunction), as well as certain chronic diseases in pregnant women (hypertension, hepatitis, diabetes, drug addiction, drug overdose, etc.).
[Clinical manifestations
The manifestations of cerebral palsy can be divided into several types.
1. Spastic children have stiffness of the limbs as the main manifestation.
The involuntary involuntary movements of the limbs and head appear, and the involuntary movements of the whole body increase when doing purposeful movements, such as “squeezing” of the face, difficulty in speaking and swallowing, often accompanied by drooling, etc.
Ataxia is characterized by muscle weakness of the limbs, inability to maintain body balance, unstable gait, and inability to complete fine movements such as pointing the nose with the fingers. Simple ataxia is less common. Ataxia can also be associated with tardive dyskinesia. The child is often unable to maintain a fixed posture, and when standing, has to make frequent adjustments in order to maintain the standing position. Walking is learned later than in normal children. When walking to obtain a more stable balance, the feet are widely spaced from side to side and the gait is wobbly and poorly oriented.
The following symptoms can help in the early diagnosis of cerebral palsy.
(1) The child often cries little, moves little, cries weakly and is excessively quiet shortly after birth. (1) Children often cry less, move less, cry less, and are excessively quiet shortly after birth, or cry more, are easily agitated, startled, or have recurrent flesh jumping.
(2) Feeding difficulties after birth, such as weak sucking, difficulty swallowing, and poor oral closure.
(3) Uncoordinated, asymmetrical movements and little random movement.
(4) Frequent abnormal muscle tone, abnormal posture and movement patterns.
(5) Motor development is delayed. For example, at 3 to 4 months of age, the child cannot hold his head in the prone position; at 4 months of age, he still cannot support weight with his forearms; his hands often make fists, and he cannot put his hands in his mouth to suck; at 6 to 7 months of age, he still cannot turn over and sit alone for a moment; when he stands on his toes or his legs are flexed, he cannot carry weight, or his two lower limbs are too straight or crossed.
Diagnosis
1.Inquire whether there is any history of upper motor neuron dysplasia or damage, such as premature birth, difficult birth, high fever, cerebral ischemia, cerebral hypoxia, cranial injury, brain infection, etc.
2. Check for spastic paralysis, muscle movement disorder, muscle tone enhancement, hyperreflexia, muscle atrophy, joint deformity, ataxia and mental retardation.
[Auxiliary examination].
Children diagnosed with cerebral palsy based on clinical manifestations must also undergo the following auxiliary examinations.
①Intelligence test.
②Electroencephalogram examination.
(iii) Brainstem auditory evoked potential measurement.
④Imaging and other examinations to confirm the diagnosis.
Treatment
There is no special treatment, except for seizures, which are controlled with drugs, and the rest of the symptoms are mostly symptomatic. Early education and training of intelligence and psychology should be implemented.
Comprehensive treatment, including intellectual and language training, physiotherapy, physical therapy, acupuncture, massage, braces and plaster orthopedics, is appropriate.
2.Orthopedic surgery is only applicable to spastic type, intelligence is still acceptable, the age is above 5 years old, non-surgical treatment is ineffective. The purpose of surgery is to reduce spasticity, improve muscle balance, correct deformity, and stabilize joints. Surgical methods can be divided into 4 categories.
①Posterior root neurectomy.
② neurectomy: severance of the nerve branches innervating the spastic muscles.
(iii) tendon surgery.
④Bone and joint surgery.
Chinese medicine treatment
1.Cupping therapy for cerebral palsy
Take shoulder well, quchi, kidney yu, ring jump, Chengshan, alternating sides, once every other day, 3-5 minutes each time. 10 times is a course of treatment, rest 3-5 days in the middle of the course.
2.Treatment of cerebral palsy
Specialized prescriptions for specific diseases
1. Cerebral palsy spirit is suitable for children with various types of cerebral palsy. It is composed of Radix et Rhizoma Ginseng, Radix Salviae Miltiorrhiza, Radix Astragali, Radix Paeoniae Alba, Radix et Rhizoma Hauppo, Radix Angelicae Sinensis, Fructus Lycii, Cortex Eucommiae, Pig Spinal Cord, Rabbit Brain Marrow, Rhizoma Ligustici Chuanxiong, Panax Ginseng Powder and Sheep Tibiae. Adults and children ≥12 years old take 1 packet (10g) each time with warm water, 3 times a day; children ≥3 years old but <12 years old take half a packet each time, 3 times a day; those <3 years old take 1/3 packet each time, 3 times a day. Other drugs were also added with the evidence. A total of 46 children with cerebral palsy were treated, with 6 cases cured, 15 cases with significant effect, 23 cases with improvement and 2 cases with no effect. (Lei Zhengrong. Clinical observation and application of cerebral palsy spirit. (Chinese Traditional Chinese Medicine Emergency, 1997<1>: 18)
2. Treatment of five tardive formula Deer horn, Radix Codonopsis pilosulae, Niubizi, 6g each, Fructus Lycii, Radix Rehmanniae, Poria, Radix Angelicae Sinensis, Radix Paeoniae Alba, Rhizoma Yam, Semen Cuscutae, 10g each, decoction in water, 1 dose daily.
3. Xing late san Dried raw groundnut, sour date (wine soaked and fried), spicy cinnamon, white poria, wind, angelica, Chuanxiong, cow knee and other parts of the powder, each serving 4.5g, to porridge mix drink, the next into the good wine a few drops and then mix, take before eating, 2 times a day.
4. Tonic day, benefit qi, nourish yin and tranquilize the mind: 30g each of Gum Kappa, fried jujube seeds and maidenhair, 20g each of Antler Gum, Fructus Lycii, Cornu Cervi Pantotrichum, Radix Angelicae Sinensis, Fructus Schisandrae, Acorus Calamus, Poria Cocos, Atractylodes Macrocephalae, etc. Roast the above herbs lightly and grind finely.
Turning exercise for children with cerebral palsy
Turning and head lifting are closely related. Normal children should lift their heads first when they start to turn over. In the supine position, the lower limbs of the child are lifted upwards and later twisted in the direction of turning over. In this way, the lower body is in a lateral position and the upper body is raised, resulting in a twisting movement between the upper and lower body. The upper body is turned into a lateral position with the pelvis, and the upper body is supported by the hand on the lower side of the body, and the head is pushed in the vertical direction.
How to train a child with cerebral palsy to turn over
Because children with cerebral palsy, especially those with severe disease, do not have good head control function, and because of the influence of asymmetrical tension neck reflex, the trunk does not rotate when they want to turn over, so they need to be trained to turn over.
(1) To address the reasons why children with cerebral palsy cannot turn over, first of all, head control training and symmetrical posture maintenance training should be carried out. The training of head control is as mentioned before, and symmetrical posture maintenance is to keep the head in a neutral position, and the free posture of both upper limbs can be specifically referred to the correct holding and lying posture. These two types of training are the basis for turning over.
(2) there are many ways to turn over training, here are a few.
① teasing turning method: first let the child lie on his side, ask him to turn to supine, and then ask him to turn to the side. Later, tease with vocal toys to make him chase and then supine. The same method then tease to the opposite side, and give praise when finished, as in Figure 4.59.
② upper limb help turn over method: let the child lie prone, first make the child’s face turn to the direction to turn over, make the rear head side arm lift to the head, flex the lower limbs, while pulling and pushing the pelvis, make it turn over in the supine direction, or use toys to tease the child to turn over from the prone position to the supine position. Pay attention to let the child do it by himself as much as possible, and give support if necessary. Note that both sides should be turned evenly.
③Lower limb help turning method: let the child lie on his back, bend the unilateral hip and knee to drive the pelvis, fully tilt the femur to make the body twist and turn, and slowly reduce the assistance to make the child complete the action by himself. The child is placed in the supine position, holding both knees, and the leg of the flexed side is twisted to the side, turning the pelvis into a semi-lateral position. In turn, return to the supine position, then flex the opposite leg and drive the pelvis to the opposite side as shown in Figure 4.60, Figure
④ Hand-foot action separation turning method: let the child lie on his back, then slowly pull up, so that the head is lifted, but do not pull suddenly. You can also tease with sound or toys to make it tilt slowly to the left front or right front to achieve the overall body rotation. Next, then train the separation of hands and feet, that is, fix the shoulders in the supine position to twist the lower part of the waist, or fix the lower limbs to twist the shoulders, and keep training until the child can control the trunk.
⑤ Bath towel to help turn over method: lay a large bath towel on the platform, let the child straight supine, then lift one end of the bath towel and roll it in the side direction to make it prone. You can also make the child twist the upper body, reach for the toy, gradually twist the waist a little bit to achieve a complete turn. Then use the toy to tease to the other side and do the turning action continuously.
Prevention
1, first of all, before the child is born.
(1) pregnant women should actively conduct early prenatal checkups, good perinatal health care to prevent congenital diseases in the fetus.
(2) should abstain from bad habits, such as smoking, drinking alcohol, not abusing narcotics, sedatives and other drugs.
(3) Prevent viral infections such as influenza and rubella, and do not come into contact with cats, dogs, etc.
(4) Avoid contact with harmful and toxic substances such as radiation and frequent ultrasound examinations.
2.Fetal birth, i.e. during delivery. Fetal asphyxia and intracranial hemorrhage caused by delivery is an important cause of pediatric cerebral palsy. Preterm delivery and obstructed labor should be prevented. Medical personnel should carefully and meticulously handle all aspects of delivery and do all the treatments for difficult fetuses.
3.The fetus should be given better care and reasonable feeding within one month after birth, and intracranial infection and traumatic brain injury should be prevented.
4.Pregnant women with the following conditions should have prenatal checkups as early as possible.
(1) Older pregnant women (over 35 years old) or men over 50 years old.
(2) Marriage between close relatives.
(3) History of unexplained miscarriage, premature birth, stillbirth and neonatal death.
(4) Pregnant women with mental retardation or both close relatives with a history of epilepsy, cerebral palsy and other genetic diseases. If fetal abnormalities are detected in early pregnancy, the pregnancy should be terminated as soon as possible.
Psychological care of cerebral palsy
(1) Establish a good nurse-patient relationship with the child and set a special person for nursing care. Only with mutual trust and respect can the child reflect his or her psychological problems in a true and detailed manner, actively cooperate with the treatment and improve the treatment effect.
(2) Nursing staff can use conversation, questions and answers, and specific and effective scales or questionnaires to conduct psychological tests on children and their relatives to understand the psychological and behavioral problems of children and their relatives, and take corresponding nursing measures according to the psychological problems of children.
(3) Nurses should make frequent visits to the ward, communicate with the child, encourage the child to interact with others, ignore the misunderstanding and discrimination against cerebral palsy patients in the society, eliminate the fear, exercise social skills, and educate the child that he or she can still feed himself or herself through exercise and grow up to be a person with a disability.
(4) Instruct parents to help the child overcome the dependency mentality, not to do everything for the child, but to let the child do as much as possible on his or her own, to cultivate his or her sense of independence, so that he or she can take care of himself or herself, and to reduce the parents’ burden.
(5) Communicate with the child patiently, carefully, softly, slowly, use simple and clear language, listen patiently and adequately, and try to answer the questions raised by the child.
(6) Comfort and encourage the child more, and criticize less. When the child makes some progress, the nurse should give praise and encouragement in time.
(7) Assist parents to properly educate and guide the child, try to overcome psychological barriers, so that the child’s body and mind will develop in a healthy direction.
(8) Instruct parents to communicate with their children more often and tell them that the rehabilitation of children with cerebral palsy is a long-term or even lifelong process, and the training of the training staff alone is far from enough. The effect of half the effort is twice as great.
Turning exercise for pediatric cerebral palsy
Children with cerebral palsy, especially those with severe palsy, do not have good head control function, and the asymmetrical tension neck reflex affects them, so they need to be trained to turn over when they want to turn over.
(1) To address the reasons why children with cerebral palsy cannot turn over, first of all, head control training and symmetrical posture maintenance training should be carried out. The training of head control is as mentioned before, and symmetrical posture maintenance is to keep the head in a neutral position, and the free posture of both upper limbs can be specifically referred to the correct holding and lying posture. These two types of training are the basis for turning over.
(2) there are many ways to turn over training, here are a few.
① teasing turning method: first let the child lie on his side, ask him to turn to supine, and then ask him to turn to the side. Later, tease with vocal toys to make him chase and then supine. The same method then tease to the opposite side, and give praise when finished, as in Figure 4.59.
② upper limb help turn over method: let the child lie prone, first make the child’s face turn to the direction to turn over, make the rear head side arm lift to the head, flex the lower limbs, while pulling and pushing the pelvis, make it turn over in the supine direction, or use toys to tease the child to turn over from the prone position to the supine position. Pay attention to let the child do it by himself as much as possible, and give support if necessary. Note that both sides should be turned evenly.
③Lower limb help turning method: let the child lie on his back, bend the unilateral hip and knee to drive the pelvis, fully tilt the femur to make the body twist and turn, and slowly reduce the assistance to make the child complete the action by himself. The child is placed in the supine position, holding both knees, and the leg of the flexed side is twisted to the side, turning the pelvis into a semi-lateral position. In turn, return to the supine position, then flex the opposite leg and drive the pelvis to the opposite side as shown in Figure 4.60, Figure
④ Hand-foot action separation turning method: let the child lie on his back, then slowly pull up, so that the head is lifted, but do not pull suddenly. You can also tease with sound or toys to make it tilt slowly to the left front or right front to achieve the overall body rotation. Next, then train the separation of hands and feet, that is, fix the shoulders in the supine position to twist the lower part of the waist, or fix the lower limbs to twist the shoulders, and keep training until the child can control the trunk.
⑤ Bath towel to help turn over method: lay a large bath towel on the platform, let the child straight supine, then lift one end of the bath towel and roll it in the side direction to make it prone. You can also make the child twist the upper body, reach for the toy, gradually twist the waist a little bit to achieve a complete turn. Then use the toy to tease to the other side and do the turning action continuously.