From the international general trend, the rehabilitation training of cerebral palsy pays more attention to and emphasizes family training, which can be carried out from the following aspects.
I. Methods of training head control
1. Spastic type This type of child is often backward, so the trainer will place both hands on both sides of the child’s head, lengthen the neck upward, and use the forearm to press the child’s shoulder downward. Grasp the child’s forearm with his hand, lift his hand up and turn it outward, and pull it up to keep the child’s head elevated and in an upright position.
2.Slow-motion type In this type of child, the shoulder joint is often turned outward and the hands or one hand is twisted. The trainer should straighten the child’s arms and turn them inward and press them slightly downward, then slowly pull the child to sit up, which can promote the child’s head to stay elevated and forward.
3.Low muscle tone Because the muscle tone is too low, the child’s head cannot be controlled in the center position. The trainer should grasp the child’s shoulders with his or her thumbs in front of the chest and bring the shoulders forward to give the child greater stability and assist in lifting the head.
4. Other methods of stimulating the child’s head to lift.
a. Place the child in a prone position with both arms straight ahead and gently grasp the child at the midpoint of both shoulders or the center of both scapulae.
b. Apply pressure or stimulation to the caudal vertebrae of the child, and the head and spine will be lifted.
c. Place the child in a prone position and pull the hand outward.
d. Placing the child in a sitting position and pulling the hand outward may also promote head elevation.
e. Place a small pillow or a towel roll under his chest to make him lie on his back, tease him with sound, make him lift his head a little, and gradually increase his holding time.
Two, limb training methods
1.Upper limbs Common spastic children, head tilted to one side, shoulder joint turned inward and downward, elbow bending forearm turned inward and palm facing downward, wrist joint flexed, thumb held in the palm. The arm can be raised, straightened, turned outward, and the fist opened wide. If the elbow is very bent, it can be turned inward or outward while the arm is straightened. If the child’s fist is clenched, the wrist and fingers can be naturally straightened by using the arm straightened and turned outward. Using the hand, the child’s palm is placed flat and the wrist is flexed upward, so that the hand activity wrist, elbow and hand are straightened together.
Control of the arm in tachyphyseal cerebral palsy. The typical straightening pattern is common in children with tardive dyskinesia, with external rotation of the shoulder joint and contracture of both hands or one hand, while excessive contracture of the hip joint is common. The method is to turn the child’s hand inward and pull it slightly downward. When the child pulls forward, then slowly lift the hand upward, which can promote the child’s head to bend forward, arch the back, and improve the excessive hip flexion.
2, lower limbs lower limbs are stiff and clenched, the best way to move is to control the knee joint, when the legs turn outward, naturally and easily separate the legs clenched when the hip joint can be bent up, and rotate the hip joint can be relaxed. Both legs eagle claw-like hooked up, the activity will first turn the lower limbs outward, the foot dorsiflexion, and then straighten the toes.
Third, the training of turning over
Turn the child’s head to one side, fix his jaw firmly with your hand, press outward at the fifth sternal interval and push it to the opposite side of the chest, then the child’s body will induce a reflexive turning movement. The child’s pelvic bone rotation is used to drive the child’s turning movement; the arm-controlled turning method, and the head-controlled turning method.
Make the child lie on his or her back or side on a large towel, large bath towel, or hammock to tilt and turn. For children with tense limbs, first lift his hindquarters off the ground, hold his hands and feet rolled into a ball like a ball, roll from one side to the other, so that his body relaxes and can roll from side to side. Train him to roll over from the side-lying position, move his legs and twist his body. Hold his forearms at the same time and encourage him to turn his head and turn his forearms over.
IV. Sitting training
1.Spastic type First, separate the child’s legs, lean the upper body forward, and use your hands to press the lower limbs straight, and encourage the child to bend forward.
2, the hands and feet type will be bent together with the child’s feet, and catch the shoulders with their hands, turning inward, so that he can support himself with his hands on the sides.
3.Low muscle tone type The trainer holds the child and uses both hands to press down on the lumbar vertebrae of the child, and uses the thumbs on both sides of the spine to give fixed force, which can promote the straightening of the head and body. When the child learns to sit steadily, he can often be pushed back and forth, left and right, so that the child can learn to maintain balance in the dynamic.
4. When the child is unstable, you can ask him to sit with his legs crossed and make his body lean forward, and straighten his waist when sitting. Cross-legged sitting is good for those with spastic hip splits. For older children you can sit him on your lap with both knees straight. To straighten his back, hold his hips and press downward. The child can sit in a chair with a backrest at a height of 90° of hip, knee and ankle flexion, with both feet on the ground as standard. If the head and body cannot be controlled, a chair with armrests can be made to prevent the shoulders from pulling back and the legs from over-extending.
V. Crawling training
When the child first starts to learn to crawl, the pelvis should be fixed by hand, and then the pelvis should be gently lifted upward, alternating between left and right, which helps the child to practice crawling. Choose a site that is easy to turn, make it supine, place the toys away from him and ask him to grasp them with one hand, if the lower limb on the same side cannot be flexed, to help carry out. Start by shaking the toy to tease, and then move to the opposite direction and ask him to catch. When he can crawl, move the toy forward and help him bend his knees, tell the child to stir and help his palms to crawl forward into.
The child gradually learned to crawl on his own, at first with his arms and legs stretched forward on the same side, gradually becoming alternate crawling with his left hand and right foot and right hand and left foot. Once the child’s hands and knees were stabilized, he began to practice balance. Lift up with hands – three-point balance method, or lift up with feet – three-point balance method, or lift up with right hand and left foot – two-point balance method.
Sixth, standing training
To stand up, you must learn to use the leg muscles, especially the hip and knee extensors, and the leg stomach muscles to exert force and place the weight of supporting the upper body weight between the two feet. When standing up, care must be taken to keep the child’s thighs on both sides apart and turned outward, and to use the hands to hold the knees so that the weight falls forward evenly to the ground. Then, support the child to stand up, or the child can stand up by holding something.
To stand up in squatting and sitting position, you can ask him to sit on a small stool, support the knees in front, pay attention to the correction of pointed feet and scissor legs, and ask him to practice standing, which can train standing balance, the randomness of lower limbs, and the correction of scissor step and pointed feet in spastic cerebral palsy.
Grasp the standing, or hold the platform to stand. The helper can hold the hip to help maintain balance and encourage not to be afraid. Then practice grasping standing with one hand or alternating hands to get toys, and slowly practice spreading the supporting hand when alternating.
VII. Walking training
There are many ways to train the child to walk, including controlling the hands; controlling the pelvis; using walkers, corrective shoes, crutches, parallel bars, etc.
To train the support response of each side of the pediatrician, you can gently support the knee from behind and make a large swing forward, backward, left and right to keep the body balanced. Stance balance exercises.
When taking a step, the weight is shifted to one foot first, so that the other foot takes a step. Be prepared to have one leg take the weight first and shift the weight forward while the other foot takes a step. Repeat the exercises when walking and also train to step to the side and back.
The child can be taught to ride a tricycle. You can also pedal a sewing machine, etc. to practice. When walking unsteadily, you can use balance bars to practice, or you can build two parallel bamboo poles, like the double bar in gymnastics, with the right height.
Be sure to develop good posture and ask the child to look at himself walking in front of a mirror to correct abnormal posture. If a child with spastic cerebral palsy has two knees colliding, tell him to practice on a board with a crack in the middle. For those who take big steps, ask him to practice walking a ladder that is put down and take one step accurately.
Eight, hand movement training
To open the hand, pull the thumb outward, the rest of the fingers will be straight, practice stimulating the grip response, you can stuff small toys into the child’s hand and press a little harder, the child’s hand will be easier to grasp the toy. Place something in a position that fits under the child’s hand and encourage the child to reach for it. Let the child drop the beads and play the violin to practice hand opening, and let the child put the loops on the shelf, which is a continuous movement training for grasping and placing. Use blocks that can be attached and detached to train the use of both hands. Propping up with both hands on the floor opens the fingers and relieves tension in the finger and hand flexors. Use the whole hand to grasp things. Use your fingers to hold things. Have the child practice picking up the cube and placing it in the jar. Hit the pile holder with this mallet. In addition, a variety of other comprehensive hand movement training can be used.
IX. Other training
Use different ways to make the child lie down and play with things, which can promote the head and upper body up. For example: let the child lying on the parent, practice upper body up, gradually climb up, with hands to touch the parent’s nose, mouth, ears, etc.. This will not only promote the child’s head and body control, but also practice the recognition of the five senses.
Let the child grasp the parent’s hand and pull it forward and backward to match the beat of the song, which will fiercely promote the child’s head control, train sitting balance and increase the child’s interest.
Let the child watch TV in a prone position, so that he can practice the head lifting movement more patiently.
A large sand ball can be used to train the child to establish various postures and turn movement into play.
For sitting training, a small chair of appropriate height can be set up for the child to play games, which can promote his head and body upward and allow him to sit for a longer period of time. For dynamic standing balance training, let the child stand on the balance board and sway from side to side to keep his balance. Let the child walk forward along the sides of the roller, which can train the child to move his weight to one foot alternately and help improve his balance.