I. Definition.
Pediatric cerebral palsy, also known as cerebral palsy, is a non-progressive brain injury syndrome caused by various causes in children before birth to 1 month after birth. It manifests as central motor impairment and postural abnormalities, and may be accompanied by mental retardation, epilepsy, behavioral abnormalities, visual-auditory impairment, and speech impairment.
Because the etiology is before birth to 4 weeks after birth, it can show some symptoms in infancy, which can be observed by examining primitive reflexes, passive muscle tone, active muscle tone, and motor development, but because pediatric nerves are controlled by subcortical centers early and governed by reflexes, the symptoms are mostly atypical after brain injury at this time, and the muscle tone examination is affected by many factors, especially the child’s state at that time, so early Therefore, early diagnosis must be done carefully.
II. Characteristics of cerebral palsy: (elements of the definition of cerebral palsy)
1. occurring early in the child’s life, or before or during birth
2. cerebral palsy itself is a non-progressive disorder; cerebral palsy is an injury to brain tissue during growth and development, rather than occurring in the developed brain tissue; therefore, cerebral palsy itself is a non-progressive disorder.
3. The main disorders are motor disorders and postural abnormalities. The lesions are located in the brain and are caused by a variety of factors. Common pathological changes include different degrees of brain atrophy, ventricular dilatation, nerve cell reduction and degenerative changes. For these reasons, cerebral palsy is a central syndrome of motor dysfunction. Its main disorders are motor impairment and postural abnormalities.
III. Rehabilitation treatment
(I) Medical rehabilitation.
1.Exercise therapy
Movement therapy is a kind of physical therapy (PT), which mainly focuses on the rehabilitation of the child’s motor function. It can suppress abnormal posture and movement patterns, promote normal posture and movement development, and improve the ability of daily life activities.
(1) Principles of motor function training: (1) follow the rules of motor development from head to tail and from proximal to distal end; (2) suppress abnormal motor patterns while inducing normal patterns; (3) enable the child to maintain normal posture; (4) promote symmetrical posture and movement; (5) induce and strengthen the desired fixed motor patterns and gradually complete the coordinated movement from single to multiple movements (6) to relieve muscle tone before rehabilitation training.
(2) Key points of motor function training.
① Head control: to train the supine position to keep the head in a neutral position, the neck firmly upright, the prone position to lift and turn the head, and the sitting position to keep the head in an upright position.
② Support lifting training: trunk muscle control training, so that the body can lift, turn and gyrate, and gradually achieve elbow support, hand support, and sitting support.
③ Turning training: When children turn over, they have to lift their heads first, so turning over and head lifting are closely related.
④ Sitting training
⑤ Knee-hand stand and high crawl training: training the ability to lift the trunk by gradually moving the center of gravity upward.
⑥ Standing and standing training: If you can control the pelvis and hip joint to a certain degree, you can train in the standing position. You can start with human support to stand, to stand on your own, stand with alternate hands, establish standing balance, stand on one leg, and use assistive devices if necessary.
(7) Walking training: if you can’t stand, you can’t walk, so alternate movement training of both legs is carried out on the premise of standing on one leg.
⑧ Progressive and usability training of walking: The goal is to establish the ability to walk not only on flat ground, but also long distance and acceleration walking as well as having the ability to cross gates and walk uneven paths.
The main goals of treatment for spastic cerebral palsy are to reduce muscle tone, inhibit flexion patterns and internal rotation of the trunk, promote extension patterns and abduction and external rotation, promote symmetrical posture, and prevent contractures and deformities. The main goals of treatment for hand-foot tardive cerebral palsy are: to control the head to maintain intermediate position, to control the movement of the limbs toward the midline, to inhibit involuntary movements and postural fallibility, and to improve the ability to perform activities of daily living.
(3) Several commonly used movement therapies.
① Bobath therapy: also known as neurodevelopmental therapy. According to the theory of neurodevelopmental science, pediatric cerebral palsy is caused by brain injury that affects the normal development of the brain, causing backward or delayed motor development; as well as the release of abnormal postural reflexes and the emergence of abnormal postural movement patterns. bobath therapy adopts the treatment principles of inhibiting abnormal reflex activity, correcting abnormal posture, promoting the emergence and development of normal motor functions, and improving activity and mobility based on the above theory.
②Rood technique: adjusting limb muscle tone and inducing active movement by using snapping and light pressure.
③ Vojta therapy: Through stimulation of certain parts of the body to induce the production of generalized, coordinated reflexive movement, promote and improve the mobile motor function of the child and suppress abnormal movements. the movements induced by Vojta therapy are reflexive turning (R-U) (Figure 19) and reflexive abdominal crawling (R-K) (Figure 20). Through the repeated and regular occurrence of such mobile movements, normal reflex pathways and movement patterns are promoted and abnormal reflex pathways and movement patterns are inhibited for therapeutic purposes.
④Guided education: Guided education is the application of the conceptual system of education to rehabilitate the abnormal function of the dysfunctional person by means of education. It is not purely physical therapy, but a situation in which the dysfunctional person learns various functional movements by inducing and achieving predetermined goals through certain means. This functional learning is done through the interaction of the dysfunctional person’s own internal factors and the external environment to actively and relatively independently complete functional movements, achieving the purpose of learning, mastering, and actively completing functional movements. The rehabilitation referred to in guided education not only promotes the improvement of function, but also leads to the change of personality and character, i.e., the improvement of intelligence, cognitive function, and interpersonal skills, which in turn promotes the improvement of function.
2. Occupational therapy
Occupational therapy OT refers to the planned and targeted selection of assignments from the child’s daily life, learning, labor and cognitive activities to train the child in order to recover and learn various fine coordination movements, difficulties in daily life and social interaction, and to achieve a certain degree of independence and adaptability. The most important part of the occupational therapy is the training of activities of daily living. The purpose of the occupational therapy is to make the children with cerebral palsy gradually understand what they are capable of as they grow up and learn and develop the ability to deal with their own problems. It mainly includes feeding function; toileting function; dressing and undressing function; grooming function, etc.
Eating function training should include different levels of difficulty in eating.
(1) Eating with hands or spoons: mainly training the active stretching of upper limbs, eye-hand coordination, grasping and square opening, hand-mouth coordination, biting, lip closing, swallowing and chewing, and other actions and assignments completion.
(2) Eating with chopsticks: The focus is on training finger coordination and flexibility, forearm rotation forward, and rotation backward.
Toilet function should include.
(1) Squatting on the potty with the handrail: training the child’s standing balance, head control, body symmetry, grasping and releasing, hip mobility, knee flexion and extension, ankle dorsiflexion, postural changes from standing to squatting, and weight transfer.
(2) Sitting on the potty: seated balance, head control, body symmetry, elbow extension, sustained grip, trunk extension, hip flexion, ankle dorsiflexion, lower extremity abduction.
(3) Rising from sitting on the potty: position change, lower extremity weight bearing.
(4) bowel and urine control.
Dressing and undressing functions include.
(1) dressing and undressing: balance in sitting position, hands coordination
(2) Putting on and taking off pants: position change.
(3) putting on and taking off socks: sitting balance.
(4) Putting on and taking off shoes: learning the concept of left and right.
Grooming should include: hand washing, face washing, tooth brushing and hair combing.
3.Speech correction: The main speech disorders are dysarthria and delayed speech development.
Dysarthria: including the stimulation and promotion of basic speech motor functions, improving breathing, increasing facial activities, such as crying and laughing.
Delayed speech development: According to the specific situation of the child, the corresponding training plan is formulated, and different methods such as promoting articulation, using speech symbols, etc. are adopted to make the child understand the concept and meaning of language and improve his speech communication ability.
4.Cultural and physical therapy: Through games and imitation and other forms to fully mobilize the active participation of the affected children, improve their coordination, flexibility, endurance and other motor skills, improve their language and behavioral skills such as interaction with others, solidarity and cooperation.
5.Other therapies: low-frequency pulse electrotherapy, hydrotherapy, medicine, acupuncture, surgery, etc.
6.Application of assistive devices and orthopedic devices: The purpose is to ① maintain the functional position of the limbs; ② strengthen the weight-bearing capacity of the limbs; ③ prevent and correct deformities; ④ promote the development of motor functions, thus improving the ability to take care of oneself in life activities.
(II) Psychological rehabilitation
The psychological development of children includes the development of cognition, attention, memory, thinking, imagination, will, emotion, and personality. These developments are related to biological factors, environmental factors, and parenting factors. The presence of brain injury in children causes not only physical movement disorders, but also emotional and personality problems and disorders. The corresponding psychological support is given at different periods to promote the development of more potential of the affected children.
(iii) Educational rehabilitation
Fifty percent of children with cerebral palsy are combined with mental retardation. At the same time, motor disorders, psychological abnormalities and social factors have a negative impact on their intelligence. Therefore, education for cerebral palsy is also advocated to be carried out early. Systematic, planned, and evaluated education allows children with cerebral palsy the opportunity to receive education, develop basic skills and the ability to learn and live, and develop better social adaptation skills.
The children’s learning should be individualized, diversified, with varied scenarios and appropriate content.
(IV) Social service
Social services are to assist children with cerebral palsy to solve the problems they may encounter when they return to society, such as material, policy and spiritual support and assistance that society can provide; certain employment opportunities, etc.
IV. Prevention and early intervention.
In recent years, with the continuous progress of medical technology, the survival rate of preterm infants, low weight infants, and children with moderate to severe encephalopathy is getting higher and higher, and the probability of these high-risk infants eventually being diagnosed with cerebral palsy is much higher than that of ordinary infants and toddlers, and it is more difficult to diagnose cerebral palsy at an early stage for small monthly age such as 0-3 months. However, when the child has abnormal reflexes, abnormal movement patterns, abnormal posture, and backward movement, the best time for rehabilitation is lost. Therefore, we should follow up and actively treat the infant when he or she has a history of high risk, abnormal muscle tone, backward development, and abnormal reaction to the external environment.