A survey of applications in the rehabilitation of children with cerebral palsy?

  Cerebral palsy is one of the most common neurologically disabling disorders of childhood, and it places a tremendous economic and psychological burden on the child, family, and society. To date, there is no evidence to suggest that children with cerebral palsy can fully recover [1]. However, cerebral palsy does not affect life expectancy, and children with cerebral palsy eventually grow up to be adults [2-4]. Therefore, how to rehabilitate children with cerebral palsy so that they can grow up healthy and happy is a great challenge for rehabilitation workers and parents of children with cerebral palsy. In order to understand the current situation of cerebral palsy rehabilitation treatment and the application of games in the treatment, we conducted this survey.  1. Survey methods and results From April 2004 to May 2007, we surveyed the participants of four rehabilitation training courses for children with cerebral palsy about whether rehabilitation treatment for children with cerebral palsy should include games by using convenient sampling method (conveniencesampling), interviews and questionnaires. A total of 142 participants from Jilin, Hebei, Henan, and Guangxi were surveyed. These included: medical staff (115), parents (9), officers of the Disabled Persons’ Federation (5), and community rehabilitation workers (13).  The survey results showed that the respondents lacked understanding of the role of play. When asked in the questionnaire whether children with cerebral palsy should play, 41.5% (59/142) of the respondents thought that children with cerebral palsy should take time for treatment and should not spend time on playing. The respondents felt helpless about the parents’ demands (51.7%, 76/133). When asked, “Do you play with children with cerebral palsy?”, the rehabilitation staff indicated that they were willing to play with children with cerebral palsy, but were met with resistance from parents. The survey respondents were confused about the method of play. 75.4% (107/142) of the respondents thought that there was no way to play with children with cerebral palsy, and expressed confusion about this.  2. Discussion 2.1 Play and children’s brain development The human brain is plastic and fallible, and studies of brain imaging techniques have revealed that the functional brain module is a dynamic and changing assembly [5]. The completion of the same higher brain function includes cortical and subcortical structures, as well as multiple sensory and motor components, in addition to the involvement of the dominant hemisphere. In this process, all nerve cells cannot be connected without synapses, and the connections between synapses cannot be stimulated and consolidated by early experiences. As a result, brain science researchers have suggested that early experiences of children’s play play play an important role in determining the breadth and quality of brain circuits and children’s intelligence [6]. Neuroscientists have found through brain imaging techniques that the cognitive development of the early brain is well disguised in seemingly useless play [7-8].  Studies on children’s emotional development have found that play promotes emotional and brain development [8]. Children’s play accompanied by smiling, laughing, dancing, and other excited and pleasant expressions, and when children scream with glee, enhances bioelectrical signals in the human brain and the circuits that connect the brain to stability. In addition, excessive or persistent trauma can cause excessive physiological responses in the hypothalamus. The more frequent the emotional stimulation, the easier the neural circuits are established. Therefore, play is known as a “regulatory decoder” of children’s emotional experience [10]. Therefore, children play freely at their own will and pace, although they focus on the process of play rather than the outcome, but in the process of play, all sensory information through hands and brain is integrated in the cerebral cortex into higher-level cognitive activities, which affects personality development. In other words, the development of personality is based on the improvement of senses, perception and cognition. By attracting the child’s attention through play, the brain selectively receives and processes information and inhibits the images of other sounds and objects around them, so that emotions are not disturbed and remain stable for a long time, while bilateral awareness, attention and hand-eye coordination are improved.  2.2 Incorporating play into the rehabilitation of children with cerebral palsy Cerebral palsy is a serious and disabling disorder that results in lifelong disability, mainly due to motor impairment. It can occur before birth, at birth, and during infancy. The prevalence of cerebral palsy is between 1 and 5 per 1,000; in the last 20 years, with the improvement of perinatal medicine and neonatal emergency, the neonatal mortality rate has decreased, but the incidence of cerebral palsy has not decreased. Currently, there are about 310,000 children with cerebral palsy under 6 years of age nationwide and the number is increasing by 46,000 per year [12]. The current general trend in the treatment of cerebral palsy can be divided into three categories [13-15]: specialized sensory input stimulation, developmental promotion and establishment of neural bypasses to control muscle coordination and movement, integration and reorganization of brain function, which are more established and include: neurodevelopmental therapy, sensory stimulation or strong stimulation, guided education, motor learning, etc., and the use of assistive devices and medical treatments, such as These methods include: neurodevelopmental therapy, sensory stimulation or strong stimulation, guided education, motor learning, etc., as well as the use of assistive devices and medical treatments, such as orthopedic surgery and drugs to inhibit muscle spasm. Cell growth factors to repair damaged early neurological conduction. Replacement of damaged or dead brain cells, such as stem cell transplantation, is still in the experimental stage. To date, there is no evidence that any one type of approach is better for the rehabilitation of children with cerebral palsy. Rehabilitation should not only be about physical improvement, but more importantly about developing survival skills and adapting to society to the greatest extent possible.  2.2.1 Clarify the purpose of rehabilitation treatment for cerebral palsy: Since the impact of cerebral palsy on children is lifelong, it is very important to provide stretching and standing training for children with cerebral palsy, but it is only part of the rehabilitation treatment for children with cerebral palsy. The focus should not only be on improving symptoms but also on stimulating the motor and promoting overall development [16]. While it is understandable that parents seek a cure for their children, it was found in the survey that some professionals also have a vague understanding of the purpose of rehabilitation for cerebral palsy, and as therapists should convey the right message to parents and understand that children with cerebral palsy need more play to promote development, learning, and fun. These will influence the behavior of the child as an adult. In the practice of rehabilitation for children with cerebral palsy, we emphasize play as “an important form of holistic development for children with cerebral palsy”, which means not only taking advantage of the child’s preference for play activities to engage the child’s immediate interest in the form of play activities and make the child more active in therapeutic activities, but more importantly, the child must and can only achieve his or her physical development through play. More importantly, it is through play that children must and can only achieve their physical development and psychological growth [17]. Fundamentally, play is a fundamental way to best integrate rehabilitation with the child’s life. Play is a legitimate right of children, and children with cerebral palsy should also have this right. Because a life of play is a real life for children [16]. If the unique value of childhood life for children with cerebral palsy ceases to exist, the result will ultimately be to overwhelm the real potential for development of children with cerebral palsy and to limit the development of certain important functions.  2.2.2 Enhancing play training for children with cerebral palsy: While play occurs naturally for normal children, children with cerebral palsy need opportunities to be created, actively encouraged, and assisted in their play. Given that most people are confused about how to play with children with cerebral palsy, training of relevant personnel should be strengthened. As the interviewees noted, children with cerebral palsy have varying degrees of motor, perceptual, and cognitive impairment due to their own limitations. Often they do not have the opportunity to engage in exploratory play, so they do not understand their surroundings; they cannot play with regular toys, which is not only physically impossible, but parents and rehabilitation staff may prevent them from doing certain games for safety reasons, which further limits their development. In the long run, children with cerebral palsy become more and more unfamiliar with their environment, and their desire to explore it becomes less and less curious. Play for children with cerebral palsy requires special design and extra help to give them the opportunity to receive stimulation from all sources. Therefore, it is recommended that “play” be a necessary part of training related to the rehabilitation of children with cerebral palsy so that the trainees have sufficient knowledge and skills to play with children with cerebral palsy.  3. Summary Play is the best integration of the natural and social nature of children’s lives; children with cerebral palsy, like other children, need to play to promote their development. However, the survey found that play is not included in the rehabilitation process of children with cerebral palsy in most cases. Play can maximize the potential of children with cerebral palsy to develop a healthy personality and prepare them for adult life. Therefore, it is recommended that training on how to play with children with cerebral palsy be increased, that the role of play be better understood by those involved, and that play be incorporated into the rehabilitation of children with cerebral palsy.