Cerebral palsy (CP), or cerebral palsy for short, is a movement disorder and postural abnormality caused by non-progressive brain damage or developmental defects from before birth to one month after birth. About 60% to 70% of these children have spasticity. These children have difficulty in maintaining their posture for flexible movements due to hyperactive detrusor reflexes, and are also prone to joint contractures and deformations, making it difficult for them to walk for life. The “suppressing the strong and supporting the weak” massage method is based on the traditional pulling and pushing of the spastic muscles, and the strong stimulation of the antagonistic muscles to improve muscle strength and relieve spasticity. The pointed foot is a common symptom of spastic cerebral palsy, so we took this as the observation point and conducted a clinical comparison observation, which is reported as follows.
1. Subjects and methods
1.1 General information
Basic information of children in both groups: all cases were from children hospitalized in the Pediatric Rehabilitation Center of the Hospital Pediatric Hospital from 2009.4-2010.4. There were 80 cases in the treatment group, including 55 males and 25 females, aged 6 months to 6 years, with a mean age of 18.65±15.62 months, with 151 pointed feet; 40 cases in the control group, including 27 males and 13 females, with 74 pointed feet, aged 6 months to 6 years, with a mean age of 17.55±12.89 months; the gender, age, pre-treatment CSI values and ankle mobility values of the two groups were Comparison by independent sample t-test, P > 0.05, it can be considered that the two groups of children are from the same sample and are comparable.
1.2 Case selection
1.2.1 Inclusion criteria
(1) Meeting the diagnostic conditions of spastic cerebral palsy as discussed and adopted by the National Pediatric Cerebral Palsy Rehabilitation Symposium in 2004.
(2) accompanied by unilateral or bilateral acromegaly.
(3) Age between 6 months and 5 years.
(4) No combination of epilepsy, severe mental retardation and behavioral abnormalities.
(5) Informed consent and ability to accept the prescribed treatment regimen and requirements (duration, frequency, etc.).
(6) No antitussive treatment such as surgery, botulinum toxin type A injection, or oral baclofen within 1 year prior to treatment.
1.2.2 Exclusion case criteria
(1) Exclusion of acromegaly due to peripheral nerve or muscle lesions.
(2) Excluding children with serious primary diseases such as cardiac, hepatic, renal and hematopoietic system.
(3) Those who are taking antitussive and antiepileptic drugs or receiving botulinum toxin injections at the same time during treatment
(4) Those who do not cooperate with the treatment as required and have incomplete information, which affects the determination of efficacy.
1.2.3 Grouping and assessment methods
According to the random number table, 120 children were randomly divided into treatment group and control group with the ratio of 2:1. The treatment group adopted the method of suppressing strong and supporting pushing and the control group adopted the method of traditional pushing and pulling. A single-blind method was used. Persons outside the subject group were designated as observers to assess the children.
1.2 Treatment method
1.2.1 Treatment group
The “suppressing the strong and supporting the weak” method of massage was used, and the operation steps were as follows.
(1) First, push and knead the spastic muscle groups such as the foot solar bladder meridian (Guizhong to Kunlun) and the calf triceps and posterior tibial muscles with lighter techniques, followed by point kneading of Guizhong, Chengshan, Kunlun and Yongquan points, and holding and kneading the Achilles tendon 50 times. Finally, the ankle joint is shaken and the knee is pressed for the whole foot (the child is in supine position, the physician presses the knee downward with one hand to straighten the lower limb, holds the sole of the foot with the other hand and tries to keep the foot in maximum dorsiflexion).
(2) Then push and knead the foot Yangming Stomach meridian (calvaria to Xiexi) and the tibialis anterior, k-long extensor and metatarsal long extensor muscles with a heavier technique. Then the acupuncture points are pressed on the foot Sanli, upper Juxu, lower Juxu and Xiexi. Finally, the dorsiflexors of the ankle joint are pulled (the child is placed in a supine position, the physician presses down on the knee with one hand to straighten the lower limb, holds the tip of the foot with the other hand, and tries to keep the foot in maximum plantar flexion).
The above treatment was done twice a day for 10-15 minutes each time, 6 days a week, and the course of treatment was three months (12 weeks).
1.2.2 Control group
Only the spastic calf triceps and posterior tibial muscles were subjected to meridional pushing and pressing, acupoint point pressing and posture correction, with the same techniques and treatment time as above.
1.3 Observation of therapeutic effect
The clinical spasticity index [4] and the dorsiflexion angle [5] were evaluated before and after treatment, and the CSI assessment included Achilles reflex, triceps muscle tone and ankle clonus.
1.4 Efficacy assessment criteria [6]:
(1) Normalized: walking posture was basically normal or CSI score of 7 or less, and dorsiflexion angle of the foot was 60-75°.
(2) Significant effect: reduction of CSI score ≥ 4 points and reduction of dorsiflexion angle of the foot > 10°.
(3) Effective: reduction of CSI score ≥ 1 point or reduction of dorsiflexion angle of the foot by 5 to 9°.
(4) Invalid: no reduction in CSI score or no change in the dorsiflexion angle of the foot.
1.5 Collation and analysis of data
The data were statistically processed with SPSS13.0 statistical software, and the count data were analyzed by the joint table data analysis independent sample rate 2 test, and the measurement data were analyzed by t-test and other statistical methods.
2, Results
There were significant changes in CSI and dorsiflexion angle of the foot in both groups of children before and after treatment.