Cerebral palsy has been the topic of many concerns in hand, and due to the increased incidence of cerebral palsy, more and more cerebral palsy problems have been triggered. Now I will ask the experts of China International Cerebral Palsy Treatment Center Network and Xu Lin Cerebral Palsy Network to give us an analysis on some common problems! The analysis is as follows.
1.What is pediatric cerebral palsy?
Cerebral palsy is a syndrome caused by non-progressive brain injury due to some causes before birth, at birth, or in early infancy, mainly manifesting as central movement disorders and postural abnormalities, which may be accompanied by intellectual backwardness and convulsive seizures, behavioral abnormalities, sensory disorders and other abnormalities. Although the clinical symptoms may change with age and brain maturation, the lesions of the central nervous system remain fixed.
2.What are the causes of pediatric cerebral palsy?
(l) Low weight infants (less than 2500g): including premature immature infants and full-term small-like infants.
(2) Congenital anomalies: including abnormal brain development caused by various reasons. 53% of cerebral palsy patients with tetraplegia are related to congenital anomalies; 35% of cerebral palsy patients with non-tetraplegia are due to congenital dysplasia.
(3) Cerebral ischemia and hypoxia: 20% of cerebral palsy patients are caused by asphyxia and birth injury, and the factors that lead to ischemia and hypoxia are
(1) Maternal factors: such as gestational hypertension syndrome, heart failure, hemorrhage, anemia, shock or drug addiction, drug overdose, etc;
②Placental factors: such as placenta abruptio, placenta praevia, placental necrosis or placental malfunction, etc;
③ cord blood flow blockage: such as cord prolapse, compression, knotting or winding, etc;
④Abnormal delivery process: such as breech delivery, stalled delivery, surgical delivery (forceps) or application of anesthetics, etc;
⑤ Neonatal factors: In addition to asphyxia, there are many abnormal cardiopulmonary diseases. Such as: congenital heart disease, respiratory distress syndrome, peripheral circulation failure, erythrocytosis.
(4) Nuclear jaundice: It is an important cause of cerebral palsy, but with the progress of domestic medicine, the proportion of cerebral palsy caused by nuclear jaundice has decreased.
3. What are the early abnormalities of pediatric cerebral palsy?
(1) Overstimulation: persistent crying and difficulty in sleeping. About 30% of children with cerebral palsy have severe “colic” like symptoms in the first 3 months of life.
(2) Feeding difficulties, uncoordinated sucking and swallowing, nursing difficulties, frequent spitting up, and persistent weight loss.
(3) Very “sensitive” or agitated, but this is not significant if the child (especially in low birth weight infants) is only hungry.
(4) Sensitivity to noise or changes in position, difficulty in extending the thighs, difficulty in breaking the fists during bathing, parents often report that “the child does not like bathing”, and when the feet touch the edge of the tub, the back becomes stiff and bowed. One of the above conditions may also occur in normal children, and cerebral palsy should not be diagnosed based on one or two of these conditions. If multiple conditions exist, and if they occur in children with high-risk factors, the possibility of cerebral palsy should be considered.
4. What are the clinical manifestations of pediatric cerebral palsy?
Cerebral palsy has a variety of clinical manifestations. The manifestations vary depending on the type and location of damage, and even in the same patient, the manifestations may be different at different ages.
(1) Motor development is backward: the head cannot be lifted at 100 days; the thumb is closed and the hand cannot be opened after 4 months; the hand cannot reach out to grasp things after 5 months; the patient cannot laugh, does not recognize people and has an abnormal appearance at 4-6 months; the patient cannot sit at 8 months; the patient cannot crawl at 10 months; and the patient cannot walk at 15 months. (2) Decrease in active activities (3) Abnormal reflexes: delayed disappearance of primary reflexes; weakened or non-appearance of protective reflexes. If the child is pushed in all directions while sitting, the child will not support himself with his hands. (4) Abnormal muscle tone and abnormal posture.
The lower extremities are internally rotated and straightened in the upright position, and the legs are crossed in a scissor-like manner.
From supine to sitting up, the head is tilted back, the lower limbs are extended, the feet are flexed, the trunk is extended back, and the tension of the extensor muscles is increased.
In the supine position, the tension of the extensor muscles is increased, the neck is extended backward, the lower limbs are extended or crossed, the hands are not held in front of the middle position, and the trunk is stretched in an anteverted manner.
In the prone position, the flexor tone is increased, the head cannot be raised, the hips are raised, the shoulders are on the bed, and the extremities are flexed.
When the head is tilted to one side, the ipsilateral upper limb is straightened and the contralateral upper limb is flexed in an arrow-like manner.
5. How do parents of children with cerebral palsy treat their children with cerebral palsy?
(1) Face the problem, face the reality, and insist on scientific treatment;
(2) Have patience, love and confidence in rehabilitation for the child;
(3) Do not overprotect the child, do not pity, do not give up, do not intimidate, do not compare with other children, and encourage participation in games and activities.
6. Chinese medicine’s understanding of the etiology and pathogenesis of cerebral palsy
Cerebral palsy is not known as a disease in Chinese pediatrics. According to its clinical manifestations, it belongs to the category of five delays, five softnesses and five hardnesses. The five delays refer to the delay in standing, walking, hair, teeth, and speech; the five softnesses refer to the softness of the head and neck, mouth, hands, feet, and muscles; the five hardnesses refer to the hardness of the head and neck, mouth, hands, feet, and muscles. It is a difficult to treat disease in pediatrics.
(1) Etiology: The cause of this disease is mostly seen in congenital, acquired and traumatic three:
① congenital factors: the father’s essence deficiency, the mother’s blood deficiency, resulting in the fetus endowment deficiency, essence and blood deficiency, can not fill the marrow brain; or his mother was frightened during pregnancy or depression and sadness, disturbing the fetal energy, resulting in poor fetal development. ② acquired factors: the newborn child, elbow gas weakness, improper expansion, resulting in the birth of a major disease, damage to the brain marrow. ③ traumatic factors: various reasons caused by the birth of the brain uncovered injury.
(2) Pathogenesis: Insufficient endowment of thieves, poor fetal development, resulting in damage to the brain, involving the limbs and bones, the five senses and nine orifices through the meridians, and producing various symptoms of cerebral palsy.
7. Brand-new theory of treating palsy
The medical classics such as “Nei Jing” and “Jin Jian of Medicine”, “Jin Jian of Medicine” and “Jin Jian of Medicine. It is believed that this disease is mostly due to the parents’ weakness in qi and blood and congenital deficiency, resulting in the child being born with weak ribs, difficulty in walking, teeth not growing quickly, and inability to sit steadily, all due to the deficiency of xian qi. Combined with the theory of “brain is the sea of marrow” and the idea of “treating from the kidney” in Chinese medicine, we focus on the theory of tonicity and benefit to help its weakness, and caution in attacking and attacking. The brain power of children is not only due to congenital deficiencies, but also due to the lack of nurturing in later life. Insufficient congenital endowment, the kidney deficiency, the kidney is the main bone, the kidney does not moisten the bone loss of nourishment; the loss of nourishment, the spleen deficiency, the spleen is the main muscle, the spleen and kidney internal meat displacement. The spleen and kidney deficiency, the qi and blood deficiency, liver and blood is not moistened, the tendons are displaced nourishment, so the disease manifested in the body now defeated, the lesion of the internal organs in the spleen, liver, kidney. The heart and the brain are the main organs of the five wins and the six bowels, the gods are in the heart, the spirit is out of the brain, so the limbs can not move. Mental behavior abnormalities are related to the failure of heart and brain functions. The differences in the evolution of the pathology of the liver, spleen, kidney, heart, brain and other internal organs can produce many different symptoms. If the limbs are stiff, open but not relaxed, the liver blood is not moistened, and the tendons are not soft; if the limbs are atrophied, the spleen is weak and the flesh is not nourished; if the bones are haggard and the limbs are cut, they are straight and deformed, the kidney essence is not full and the bones are not nourished. The trembling of the limbs and uncoordinated movements are due to internal movement of liver wind and lack of wisdom and awareness; aphasia and delayed speech are due to confusion of the mind and spirit. The short course of the disease is mostly due to the deficiency of liver and spleen blood, while the long course of the disease is mostly due to the deficiency of liver and kidney yin essence, and all of them are related to the failure to fill the marrow sea. The kidney is the root of the disease. Therefore, the treatment should be based on benefiting the qi, tonifying the kidney, activating blood circulation, removing blood stasis, and quenching the wind and opening the ligaments.
8. What are the diagnostic criteria for cerebral palsy?
The diagnosis of cerebral palsy mainly relies on medical history and physical examination, EEG, CT and MRI.
CT and MRI can understand whether there is any abnormality in the cranial structure, which may be helpful to investigate the cause of cerebral palsy and judge the prognosis, but they cannot confirm or deny the diagnosis based on this, while EEG can understand whether there is a combination of epilepsy, which is a reference value for treatment. The diagnosis of cerebral palsy should meet the following conditions.
(1) the causative factor occurs during maternal pregnancy, perinatal period or neonatal period; (3) the central palsy disease appears in infancy; (3) except the central palsy caused by progressive diseases (metabolic disease, tumor, etc.); (4) except the normal pediatric transient motor development backwardness.
9. What are the principles of treatment for cerebral palsy?
(1) Early detection and early treatment of infants and young children at the developmental stage of motor system, early detection of motor abnormalities and early correction can easily achieve better results.
(2) Promote normal motor development, inhibit abnormal movement and posture according to the law of motor development of children, functional training, step by step to promote children to produce correct movement.
(3) Comprehensive treatment uses various effective means to provide comprehensive and diversified comprehensive treatment for the child. In addition to treatment for motor disorders, intervention is also needed for combined speech disorders, mental retardation, epilepsy, and behavioral abnormalities, and to develop the child’s ability to face daily life, interact in society and engage in a certain occupation in the future.
(4) Combination of home training and doctor’s guidance The rehabilitation of cerebral palsy is a long-term process, and short-term inpatient treatment cannot achieve good results.
(5) Most of the brain power is caused by the lack of endowment, poor fetal development, external evil attack, resulting in the brain marrow not being nourished, or being damaged, and through the meridians, the limbs and bones, the five senses and nine orifices are involved, resulting in various symptoms of cerebral palsy. Therefore, nourishing the liver and kidney, nourishing the brain cells and promoting the development of tissues is the key to treating this disease. Accordingly, the development of the series of palsy medicine is a scientific guarantee for the recovery of cerebral palsy patients.
10. Why is it better to treat pediatric cerebral palsy as early as possible?
(l) From the perspective of the developmental characteristics of the brain and nervous system, the earlier the detection, the greater the plasticity of the brain and nervous system, and the better the treatment effect. Research shows that: the newborn brain weighs 340 to 400g see him, 6 months after birth up to 800g; 3 years old before the development of the brain and nervous system up to 60%; 6 years old before the development of the brain and nervous system up to 90%.
(2) Early treatment can avoid the formation of bad posture, limb deformity and lifelong disability.
(3) The formation of personality and thinking ability is mainly in the preschool age, especially the earlier the education and psychological rehabilitation, the better, which is conducive to the overall growth of the affected children.
11. How can cerebral palsy patients conduct language training at home?
The family is the natural educational environment for children with cerebral palsy to learn. Parents spend the longest time with their children and have the closest contact with them, and they are also the earliest initiation teachers. Home education gives the whole family more opportunities to participate in the training process, not only for individualized one-on-one teaching, but also for individualized teaching without the constraints of time and space.
Especially in the critical preschool stage, if you can give a variety of basic training early, you can often achieve twice the result with half the effort. The following points should be noted in home teaching.
(1) Maintain correct posture When the child has good trunk control and feeding ability, you can start language training. Keep the child’s eyes at a high level to talk to him/her during the training. If you speak to the child from too high a position, the child’s whole body will be overextended, which is not conducive to pronunciation.
(2) Increase the amount of speech and activities Parents should not lose confidence because they cannot get an answer when talking to their children. It doesn’t matter if the child understands or not. The family will take every opportunity to talk to the child. Play games with the child to do breathing training, vocal training, fun, to arouse the child’s interest in training.
(3) Encourage the child to vocalize When the child vocalizes, talk to him/her immediately and say yes. Even if you can’t say a sentence, you should nod your head to show him, teach him repeatedly, and inspire him to express the words he wants to say. Praise or compliment the child, avoid excessive criticism and blame, and let the child
The child’s confidence in learning to speak should be built up. Take advantage of the child’s various requests and desires to encourage his or her enthusiasm for vocalization.
(4) Education should be persistent The correction and training of language is long and hard, parents should have great patience and perseverance, and education should be persistent, so that the child with cerebral palsy can gain a good language foundation.
12. What are the massage and tui-na methods for cerebral palsy?
Tui-na and massage therapy is one of the important therapies for treating pediatric cerebral palsy, which is the main content of meridian adjustment and one of the main rehabilitation treatment methods for pediatric cerebral palsy in Chinese medicine. The skillfulness of massage and tui na will directly affect the effectiveness of the treatment and is the key to the failure of the treatment. Unlike adults, children have delicate skin and small extremities, and they do not cooperate, so only by mastering the manipulation skillfully can we receive satisfactory results. In addition to skilled techniques focus on practicing even force, steady and solid, durable and powerful, so that it reaches light and not floating, heavy and not stagnant, just in the soft, soft in just, just and soft degree, but also must pay attention to the appropriate gesture, otherwise it will also affect the application of surgery. There are many pediatric massage and massage techniques, some of which are the same as adults, but the posture is different, especially for children with cerebral palsy, which does not include orthopedic movements. For example, in pediatric massage, the thumb or index and middle finger are used to push and wipe in one direction or to push in the opposite direction at the same time; in adult massage, the thumb is used to push the end of the thumb, and the end of the thumb is used for flexion and extension activities, gradually moving forward. The two pushing method regardless of the action gestures and feel are different. Commonly used massage and massage techniques for children: push, transport, knead, massage pinch, rub, rub, pinch, squeeze, shake, shake, orthopedic and more than a dozen. These techniques can be applied to children under 5 years of age, the younger the child, the more effective, and can be used in conjunction with orthopedic techniques for children over 5 years of age.
How to prevent the occurrence of cerebral palsy?
Cerebral palsy is a common disabling disease that seriously affects the future life of children. If early prevention can be achieved, it is of great significance to reduce the burden on families and society and improve the quality of the population.
How can prevention be carried out?
First, before birth, that is, from the mother’s pregnancy to delivery. The development of the fetal nervous system is better than other systems, and the fetus depends on the mother for survival, so the health and nutrition of the pregnant woman is closely related to the growth and development of the fetus, which requires active prenatal checkups, fetal forecasting, eugenics education, and perinatal health care to prevent congenital diseases in the fetus. Pregnant women should quit bad habits, such as smoking, drinking alcohol; do not abuse drugs such as anesthetics and sedatives; avoid influenza, rubella and other viral infections and contact with cats and dogs; avoid radiation and other harmful and toxic substances.
Avoid exposure to harmful and toxic substances such as radioactive rays and frequent ultrasound examinations, and it is better not to watch TV and operate computers. In addition, pregnant women with the following conditions should do prenatal checkups as soon 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 have a history of epilepsy, cerebral palsy or other genetic diseases. If fetal abnormalities are detected early in pregnancy, the pregnancy should be terminated as soon as possible.
The second is at birth, i.e. during delivery. Fetal asphyxia and intracranial hemorrhage caused by intrapartum factors are an important cause of pediatric cerebral palsy. Therefore, we should prevent premature birth and obstructed labor, improve the medical skills and ethics of medical personnel, handle all aspects of delivery carefully, and do a good job in handling obstructed fetuses, which is an extremely important part of preventing the occurrence of pediatric cerebral palsy.
Once again, we should strengthen the care of the fetus within one month after birth, feed the fetus reasonably, and prevent intracranial infection and traumatic brain injury.
14. Will pediatric cerebral palsy heal on its own without treatment?
Some people think that the movement disorder of pediatric cerebral palsy is non-progressive, and the child will naturally get better when he/she grows up. Even if the movement of pediatric cerebral palsy is non-progressive, it is naturally very difficult to recover without treatment. From our treatment survey in the past few years, among the 17 cases of children who came for systematic treatment in 1994, all 17 cases were unable to take care of themselves, and among the 6 cases of pediatric cerebral palsy in 1996, 4 cases were female and 2 cases were male, the oldest was 16 years old and the youngest was 6 years old, all of them were unable to take care of themselves without systematic rehabilitation.
From March 1997 to March 1999, we investigated 215 cases of pediatric cerebral palsy who had been treated systematically for 2 to 5 sessions (2 months is 1 session), and of the 137 cases followed up, 31 cases were enrolled in school or in the infant group, 60 cases had obvious improvement in motor disorders and continued treatment, and the remaining 46 cases were reported to have different degrees of improvement. In addition, there are still a pair of twin girls aged 8 months (the younger one has less motor impairment than the older one), who both suffered from pediatric cerebral palsy and came to our hospital, and only the older one came to our hospital 40 days later due to the parents’ divorce. In contrast, the twin-born little girl could only move around in bed on her back, and the movement disorder of the limbs and trunk was progressively aggravated.
Therefore, it is important to detect and treat pediatric cerebral palsy early and not to hope for a self-cure without treatment.