When it comes to head control training, no one is unfamiliar with it. The earliest gross motor ability that appears during the development of infants is head lifting. It is crucial for the rehabilitation therapist to assess and observe the head control ability of the child with cerebral palsy and to formulate the correct rehabilitation training plan, because the stable head control ability will affect the future skills of the child with cerebral palsy, such as walking, talking and writing.
Head control is the earliest movement completed in children’s motor development, and it takes about 3 months to complete from birth until the head is lifted and stabilized. Head control is also the basis for maintaining a sitting position and performing various movements.
I. Prone position head lift
Normal babies can lift their heads in the prone position at one month, and at two months, not only can they lift their heads, but they can lift their chests off the ground when they lift their heads. Then our rehabilitation therapist will start with prone head raising when assessing and training the child with cerebral palsy. If the child does not raise his or her head voluntarily, the trainer can use his or her fingers to tap the back of the child’s neck to induce him or her to raise his or her head, and the child will lie prone on a wedge-shaped pad or pillow, with the higher side of the pad under the chest. The child is placed prone on a wedge or pillow with the higher side under the chest. The child’s legs are straight and the hands are stretched forward. Place a toy in front of or above the child’s head and encourage the child to look up at the toy and reach out to grasp it.
1. Some children with cerebral palsy are affected by the tense vagal reflex and have their heads tilted back, shoulders rotated forward and raised, and the whole body in a hyperextended position. To correct this abnormal posture, do not put your hand behind the child’s pillow and lift the head upward. The correct method of operation is: the child to take the supine position, the operator with both hands to hold the child’s head on both sides, first make the child’s neck stretch, and then use both hands to gently lift the head upward, at the same time, the trainer with two forearms lightly press the child’s shoulders. Repeated training can correct the abnormal posture of the child’s head.
2.Training for children with hypotonia cerebral palsy: When in the upright position, the head cannot be kept in the right position. The method is: the trainer holds both shoulders of the child with both hands and presses the two thumbs in front of the child’s chest to make the shoulders rotate forward and stretch the scapular belt (shoulders forward), which can assist the child to lift the head and keep the head in the correct position.
3.Training for children with spasticity based on flexion: Such children tend to have forward head flexion, scapular band stretching, internal rotation of both shoulders, elbow and wrist flexion, and finger joint flexion. The method of correction is: the operator holds the child’s upper arms with both hands, makes the upper arms abducted, then lifts the child’s arms up and pulls them to the front of the body, while the child’s arms are externally rotated, so that the palms of the hands are upward, this technique can make the child raise his head, straight back and chest.
4.Training for children with tardive dyskinesia: Children often tilt their heads back, rotate their shoulders externally, and twist their hands or one hand, the way to correct this is to straighten the child’s arms and rotate them inward and press them slightly downward, and slowly pull them up to sit, which can encourage the child’s head to stay elevated and forward. 5.Other ways to stimulate the child’s head to lift up:? (1) Place the child in a prone position with both arms straight ahead and the operator gently grasping and pinching the midpoint of the child’s two shoulders or the center of the two scapulae. (2) Apply pressure or stimulation to the caudal spine of the child, and the child’s head and spine are lifted.? (3) Place the child in a prone position and pull his hands outward.? (4) Place the child in a sitting position and pull his hands outward, which can also lead to the elevation of his head?
Supine head raising training
The child’s lower limbs are flexed and the head and torso are positioned correctly.
The trainer holds the child’s elbow with both hands and slowly pulls the child up, stopping when the child’s head is slightly tilted back. To train the child to pick up his head supine, the therapist holds the child’s hands or shoulder tubes and slowly pulls him up to a semi-recumbent or seated position, and then invades the couple to put him back in his original position. If the child’s muscle tone is so low that the head hangs back, the therapist can first turn the child’s body sideways and then pull him from the side to a sitting position, sometimes holding him by the head and pillow. It is easier to practice lifting the child’s head when it is picked up high. The child can be made to lie on his back on a wedge-shaped board or with a pillow on his head or a brick to raise the head of the child’s bed. The child can also be made to lie on his back or prone on an inflatable ball (B; bath ball) to train the ability to hold his head up. If the child’s head and body are tilted back significantly, the therapist can first fully flex his head and collar, trunk, and limbs, and cross his arms in front of the zoo. Then the therapist supports his tendons and rocks his body repeatedly in the forward and backward direction, which can encourage the child to raise his head. In addition, when the child is lying on his back, the therapist squats at the foot of his bed and calls his name. The child’s head will be raised with a sound toy.
Third, sitting head control training
The child’s legs are separated and he sits on the trainer’s lap.
The trainer faces the child and sits with his legs bent. Through games with the child, the child practices head lifting, head lowering and head turning. When the child cannot sit with his or her head upright and stable, the therapist can give appropriate head support. The smaller the area of head support provided, the better. Children who can move both 31. He can be supported on the table or elbows outstretched to grasp the object or stick in front of him to assist in head control training. You can also use sound-making toys around the child’s body to attract the child to turn his head and lift his head. Some children with tardive dyskinesia can sit steadily in their seats by themselves. If the child’s head and body are tilted back and the arms are abducted and stretched back, the child can be allowed to straighten both arms in front of the feet and hold hands with each other.
Head control rehabilitation training for children with cerebral palsy can enhance the child’s ability to self-control his or her head and prepare him or her to improve function and complete activities of daily living. During training, the child should take the initiative to perform the head lifting action, and the trainer should give appropriate assistance, or use toys or objects of interest to induce head lifting. Head raising training should be done alternately in the prone, supine and sitting positions.
However, poor head control can be caused by muscle weakness or muscle strength imbalance in the neck in addition to impaired motor development in the brain. Therefore, in addition to head raising training, neck muscle control training and strength training should be performed during training.
Neck movement training: Place the child on his back with his head turned to the side, and the parents tease him while placing a colored toy 10-20 cm in front of his eyes for him to see and move in order to make him catch up with his eyes, or use a bell to tease him. When the child’s head is turned from the side to the middle position, try to keep the neutral position for 2, 5, 10 seconds, so as to extend the time little by little, and give affirmation and praise when the child completes the action. Note that the time of turning to both sides should be the same.
Head control training: Head vertical and face in neutral position is very important for the development of respiration, feeding function, vision, hearing, etc., and should be completed early. The child is passively seated with the back against the parent’s chest and abdomen, and the parent controls the two hands in front of the chest with one hand and the head in a neutral position with the other hand to keep the head vertical and the face neutral. This method is more suitable for children with tardive dyskinesia.
When the child is able to complete the vertical neutral head position, he or she is placed in a sitting position; the shoulders and upper trunk are kept in a normal position, while the head is inverted to the front and back, in order to keep the child’s head in a vertical position during the movement. Start with a small range initially and gradually expand the range according to the child’s ability. When a response occurs, continuous reinforcement is needed to consolidate and perfect the response. When the response in the anterior and posterior directions can be completed, it is then induced from the lateral side.
Neck muscle strength training: The following methods can be used for neck muscle strength training.
(1) pull up the head upright training: the child can be picked up on the parents, the parents back against the pad half lying down, legs flexed. The child reclined on the parents’ lap, head on the parents’ knee, parents with both hands will pull up the child’s hands to keep both elbows straight, so that the head, trunk lift up to sit up, prompting the lifting of the head upright, exercise the neck; can also tell him to tilt the head again against the knee, repeatedly pull up, training about 10 times.
(2) Prone position training: The therapist or mother lies on the bed, the child is in prone position on his body, the therapist uses both hands to control the child’s chest to induce him to do the head lifting action, or the child can be placed on the bed in prone position, using toys, bottles and other objects to induce the head lifting action. 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. The child’s arms must be straight when they are stretched out in front of the wedge pad, and the upper arms or shoulders can be supported by hand, and when his head is raised, the hand can be used to press the waist and gradually extend his support time.
(3) Supine training: The therapist assists the child in using the flexors of the neck and trunk to complete the movement of sitting up from the supine position. The therapist kneels, holds the child’s flexed lower limbs with both knees, and holds the child’s upper limbs with both hands to induce the child to sit up with the head bent forward and the chin close to 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 muscle groups 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 those with spastic quadriplegia in which the flexors are predominant.