Treatment of pediatric cerebral palsy Surgery and rehabilitation are inseparable

  For cerebral palsy treatment, surgery and rehabilitation are inseparably related, and functional training is in turn an important part of rehabilitation, which refers to the integrated and concerted application of medical, social, educational and vocational measures to the patient to train and retrain the child to restore his or her function to the highest possible level. Although cerebral palsy is a disability that cannot be completely cured, the growth, development, and social mobility of a person with cerebral palsy can be improved over a lifetime through relentless efforts and a reasonable surgical approach coupled with systematic rehabilitation.  The best time for surgical treatment is between the ages of 2.5 and 6 years old, but not all cerebral palsy is amenable to surgery; about more than half of people with cerebral palsy are amenable to surgery. The spastic type, hand-foot-movement type and mixed type can be treated with surgical interventions: functional selective spinal nerve root dissection (FSPR) is recommended for children with spastic cerebral palsy to reduce excessive muscle tone and relieve muscle spasm; for patients with hand-foot-movement cerebral palsy we can perform carotid artery epicraniectomy (CCA) to improve the patient’s speech, drooling and upper limb function. We can also perform CCA for patients with hand-footed cerebral palsy.  In general, the approach to cerebral palsy surgery is individualized according to the actual age of the child and the degree of dysfunction. For example, for the most common spastic type of cerebral palsy, we use FSPR to treat the patient by selectively cutting off some of the abnormal nerve fibers in the patient’s body in close consideration of the degree of spasticity of the limbs, and then the stiff limbs can be relaxed immediately.  In summary, for a significant proportion of children with cerebral palsy, surgical treatment is an essential part to effectively reduce spasticity, restore and improve muscle balance, correct contracture deformities of joints, and maximize the restoration of the body’s motor function. Lower limb surgery can also be beneficial to restore the normal negative gravity line; upper limb surgery can be beneficial to restore the function of the hand and remove obstacles for post-surgical rehabilitation, brace installation and other physical therapy.  Of course, we would like to emphasize again the importance of postoperative rehabilitation for cerebral palsy, such as motor function training, sensory function training, balance function training, coordination function training, hand function training, cognitive function training, and language function training. The most important thing is motor function training. This is because the human motor ability is the earliest development, is the basis for the development of other abilities.  In addition to motor training, language training should also be strengthened. Use brightly colored toys to attract the child’s attention and strive to imitate the trainer’s vocalization and pronunciation. Create a good speech environment and correct abnormal pronunciation in time. If the muscle tone of the limbs is obviously increased or the involuntary movements of the limbs prevent the child’s activities, consider using antispasmodic or tachycardia control drugs, such as Valium, Lioresal, Antan, Methadol, etc.  In addition, attention should be paid to the development of balance and automatic reaction ability in children with cerebral palsy during motor rehabilitation. Balance is a skill acquired later in life. The training can be done with the help of equipment to regulate the extension of the head, trunk and limbs, to induce a regulatory response, a protective extension response and to establish a special orientation function.  Last but not least, the principle of passive and then active rehabilitation should be adhered to in the postoperative rehabilitation of cerebral palsy. At the initial stage, children with cerebral palsy still have some spasticity in their limbs, and they are not able to move around too easily, and they are often not able to dominate the joints of their limbs on their own. At the same time, it should be noted that post-operative rehabilitation of cerebral palsy should be carried out regularly and quantitatively every day, and the principle of gradual progress must be followed.