I. One month after surgery
The initial training intensity is not easy to be too high, and the parents should be well informed. The focus can be on improving the strength of the quadriceps and low back, and balance training such as sitting balance, four-point kneeling position and kneeling with both knees straight can be added according to the specific patient’s condition. Note: Do not carry out walking training at this stage.
Second, 1 to 3 months after surgery
This stage is the strengthening period of strength, according to the patient’s specific situation, gradually increase the intensity of training, this stage is the key period of the rehabilitation effect, because the patient has just experienced surgery, the physique is relatively weak, three months training must be able to improve, you can add some homework such as (squatting and standing, etc.) let the patient’s family cooperate to complete, to communicate with the patient’s family is not enough only by our PT 40 minutes, usually We also need parents to cooperate with the completion of some training, pay attention to account for the training intensity, so as to help improve the training effect.
Key lower limb muscles and their role
Hip extension active muscles: gluteus maximus and biceps femoris.
Hip abduction active muscle: gluteus medius.
Hip adduction active muscles: adductor group, pubococcygeus muscle, etc.
External rotation active muscles of hip joint: internal closed muscle, external closed muscle, gluteus maximus, femoral square muscle, pear muscle.
Hip internal rotation active muscles: gluteus minimus, vastus lateralis tensor fasciae.
Knee flexion active muscles: biceps femoris, semitendinosus, semimembranosus.
Knee extension active muscle: quadriceps.
Ankle plantarflexion active muscles: gastrocnemius, hallux valgus.
Ankle dorsiflexion combined with internal rotation active muscle: tibialis anterior
Active muscle of internal rotation of the foot: posterior tibialis
Active muscle of foot valgus: peroneus longus and shortus
3. 3 to 6 months after surgery
This stage is the period of incremental strength, if the strength has improved, you can enter into the training of standing balance and other correction of abnormal posture, etc. The training program can be arranged differently according to the progress of different children, for example, children with mild symptoms can enter into the initial gait training.
The following conditions need to be met in the early stages of gait:
1.Leg strength up to level 4
2.Standing balance can reach three levels
3.Can complete squatting independently
4, can control the weight shift
Knee tension training
Causes.
1.Bone changes in the knee joint itself, resulting in abnormal knee joint position
2. Poor knee joint control under weight bearing, joint relaxation, weak quadriceps and guojiao muscles
3. Knee hyperextension can be caused by high muscle tone.
IV. 6 to 9 months after surgery
During this period, balance and coordination training can be strengthened according to the patient’s condition
Basic principles of coordination training
1. From easy to difficult, step by step, from simple to complex movements.
2, repetitive training: each action needs to be repeated in order to achieve the effect of strengthening.
3, targeted training: targeted training for specific coordination obstacles, so more purposeful.
4, comprehensive training: in addition to coordination, but also to improve muscle strength and balance training.
Coordination training methods.
1.Step in place, gradually increase the speed
2, in situ high legged running, the upper limbs can alternate arm swing, and then gradually increase the speed
3.Other, such as jumping rope shuttlecock, etc.
V. Post-operative period from 9 to 12 months
This stage may be the platform period of rehabilitation training, the platform period is not much effect and progress, but lies in the persistence, the same effect will be achieved, so this stage and the patient’s communication is particularly important, so that the patient’s family can understand the rehabilitation, while some relatively light patients can enter a higher physical and corrective posture training.
Sixth, one to two years after surgery
In general, most of the patients can choose home rehabilitation training according to the situation after entering gait training, and patients with heavy conditions should continue to insist on training, so we must communicate more with patients’ families and let them know the situation of their children.