Methods of early intervention: At present, comprehensive rehabilitation interventions are used at home and abroad, mainly including pharmacological interventions, early educational interventions, motor development interventions, physiotherapy interventions, TCM massage interventions, musical early interventions, hydrotherapy, etc.
I. Pharmacological intervention
Because children with cerebral palsy have structural abnormalities such as cerebral cortical dysplasia, limited cerebral softening and myelin dysplasia on cranial CT and MRI examination, which account for about 56% to 80%, and also have cerebral local blood perfusion deficiency, intracranial hemodynamics of high resistance and low flow rate, which manifests as cerebral microcirculation disorder. Therefore, it is necessary to carefully use some drugs that can improve this pathophysiological state and can help the recovery of brain structural abnormalities. Improving intracranial blood supply disorders, promoting brain cell metabolism, promoting regeneration and repair of nerve cells, and alleviating and preventing neurological sequelae. The main choice of drugs is to nourish brain cells and improve brain metabolism; Chinese medicine treatment mainly uses drugs with the effects of soothing the tendons and opening the ligaments, awakening the brain, strengthening the spleen and benefiting the kidneys; Chinese medicinal preparations can also be used to conduct a medicinal bath to regulate muscle tone, promote muscle strength improvement and relieve muscle spasm.
Commonly used drugs are the following categories.
1, improve cerebral microcirculation drugs: scopolamine injection, usage and dose: 0.03-0.06mg/Kg-d, diluted to 50-100ml with 5% or 10% glucose injection, slowly intravenous drip, once a day, 20 days as a course of treatment. It is best to administer the drug under the monitoring of microcirculation microscope in multiple sites, and gradually increase the dosage according to the degree of microcirculation disorder and tolerance of the child.
2.Nutritional brain cells, improve brain metabolism drugs: most of the drugs in this category contain essential amino acids and low molecular peptides, which can promote the recovery of brain cell function. According to the child’s condition, gangliosides can also be used for intravenous infusion.
3, to promote the growth of nerve cells and repair drugs: the current clinical use of nerve growth factor. Nerve growth factor, usage and dose: 1000-2000u/d, intramuscular injection or acupoint injection, once a day, 30 days as a course of treatment.
4, according to the child’s condition can also be used to promote brain development of DHA preparations, such as Shanghai Fudan University developed Jin Aocong capsule.
5.Adjustment of muscle tension drugs: mainly Antan, Lioresin, Shule Valium and other muscle tension relaxation drugs.
6, combined with epilepsy to give anti-epileptic drugs: mainly luminal, sodium valproate, dutai and other drugs.
Early education intervention
The main focus is on the development of physical, motor, perceptual, language, attention, memory, thinking, mood and emotion of infants and young children at different ages, and individualized education and training for children in different stages.
Concept: Early education generally refers to the stage of 0-6 years old, according to the characteristics of the child’s physiological and psychological development and the developmental characteristics of the sensitive period, and targeted guidance and training, to lay a good foundation for the cultivation of multiple intelligences and healthy personality of the child, called early education.
Purpose: Early education can promote the comprehensive and balanced development of children with cerebral palsy. On the one hand, it is about the development of survival ability, from not being able to move actively, learning to lift the head, roll over, sit, crawl, stand and walk, originally not being able to move the hands, originally the ability of the hands is getting stronger and stronger, about the development of survival ability, basic activity ability. On the other hand, it is about the development of learning ability, the child has the ability to learn as soon as he or she is born. The third aspect is about the learning of creative ability.
Methods: The early intervention methods that are more applied in China are Dai’s method, Bao’s method and Zhan’s method.
Dai’s method: The early education concept of “sensory education” is proposed by Prof. Dai Shufeng of Peking University First Hospital on the basis of studying the theoretical system of “treatment of children’s sensory integration disorder” by Dr. Els of the University of Southern California and the relevant research results of the Sixth Affiliated Hospital of Peking University. The core concept of early education is “sensory education”. Sensory education includes the training of senses such as touch, vision, hearing, smell and taste. She believes that since young children always recognize things around them through touch, tactile practice is the main aspect of all kinds of sensory training.
Bao’s method: It is the research result of the national “Eighth Five-Year Plan” research project “Early Education and Early Intervention for Asphyxiated and Premature Infants”, which is in charge of Professor Bao Xiulan, a famous pediatrician, and is based on the developmental rules of infants and toddlers from 0 to 3 years old in terms of physique, movement, perception, language, attention, memory, thinking, emotion and emotion. The early intervention is based on the physical, motor, perceptual, language, attention, memory, thinking, emotional and emotional development of infants and toddlers. The intervention includes four aspects: motor development, cognitive ability, language development and communication ability. From 2 months after birth, infants are given rich stimulation in visual, auditory, tactile, taste, smell and motor senses. Within 1 year of age, perception and movement training are the main focus. ③In addition to systematic and comprehensive training, therapeutic interventions such as acupuncture and nerve nutrition are given to those who are significantly behind in development.
Zhan’s method: After years of dedicated research and practice, Dr. Zhan Li of Xiangya Second Hospital proposed a new method to develop the intellectual potential of newborns and infants – CCSOS (synchronized sensory combination stimulation) neonatal infant swimming water therapy and CCSOS (Chinese character – sensory combination stimulation) infant intelligence development reading and literacy method. CCSOS is the abbreviation of Chinese charactor and sense organs stimulations, which means Chinese character-synchronous sensory combination stimulation. It is a set of intelligent development methods with complete theoretical support, Chinese characteristics, operability and good results based on the latest results of international research on neonatal and infant developmental psychology, brain science, neuromolecular biology and pediatric health care in recent years, combined with the basic properties of Chinese characters.
III. Motor Development Therapy Intervention
It is based on gross motor and motor function training, using mechanical and physical stimulation to target various motor disorders and abnormal postures left behind by cerebral palsy. The aim is to improve function, inhibit abnormal postural reflexes, and induce normal motor development. Motor development interventions can effectively promote the recovery of motor function and lead to the overall development of the child’s physical and mental health.
1.Doman-Delecato therapy in Philadelphia, USA: Founded in the United States in the 1970s by Doman, a physical therapist, and Delecato, an educational psychologist, the therapy focuses on comprehensive rehabilitation and intensive training of the six channels of vision, hearing, touch, superficial touch, balance, and temperature to promote the overall development of the child.
2.Vojta Induction Therapy: Created and applied by Dr. Vojta, there are two basic techniques of reflexive turning and reflexive belly crawling, which are effective in promoting normal motor reflexes and correcting abnormal posture of children.
3.Bobath method: This method was co-founded by British scholars Karel Bobath and Berta Bobath. It is mainly based on the law of children’s neurological development, using techniques to suppress abnormal postural movements and promote normal postural reflexes and motor development to treat cerebral palsy.
Inhibition of abnormal postural movements consists of three main areas. Inhibition of abnormal postural reflexes, such as asymmetrical tense neck reflex (ATNR), symmetrical tense neck reflex (STNR), tense vagal reflex (TLR); inhibition of abnormal postures, such as elimination of excessive tension, reduction of pointed feet, scissor gait, etc.; inhibition of abnormal motor patterns, such as double upper limbs anterior kneeling extension support pattern, double lower limbs stiffening straight pattern, coracobrachial pattern overall motor pattern promotion through normal Motor pattern refers to the method to enable the child to obtain normal responses and spontaneous movements and to induce the maximum potential ability of the child. It mainly refers to the emergence of upright reflexes such as sitting uprightness and standing uprightness and the promotion of balance reflexes, so as to achieve the completion of the most basic movements in life, such as turning over, sitting, crawling, standing and walking.
4.Intervention methods for infant motor development (according to the law of infant motor development)
0～3 months: Main objectives Visual, auditory and tactile development, vestibular function training, body turning, head control and hand holding.
The main methods of visual, auditory and tactile information stimulation are visual and auditory stimulation with language, toys, picture cards, music, etc. at awakening; gaze with affectionate eyes, always accompanied by verbal communication is also the basis of all future training; gaze at the red ball is not good, multiple times a day with a red flashlight to guide gaze; poor auditory response to strengthen the sound stimulation; tactile stimulation is mainly used to touch, chiropractic, infant gymnastics, etc.
Vestibular function training can be used to hang the sheet inside the left and right flip, swing, lift high, cradle / bouncer, swivel chair, inflatable ball training. At this age, the inflatable ball training can be performed on prone and supine balls. Bending and rolling on the prone/supine ball not only feeds the vestibular system with information about horizontal head orthostatic rotation in all directions, but also promotes head control and antigravity extension of the trunk.
Body flip and head control Support the legs/arms to flip from supine to lateral, use words and toys to guide the child to flip to prone, alternating between left and right; after flip to prone, guide elbow support and head control. Head control training can also be used to pull sitting and holding standing position. Hand grip object support hands touching each other in the middle line, put small objects in the hands to promote hand grip, put.
4-6 months: The main goal: active rolling over, promote sitting alone, reach for objects, continue vestibular and other sensory training, and begin the development of good habits and emotions and implement in future training.
Main methods: using language and toys to guide the turning over, using language and toys to lead to not turning over, plus acupuncture point stimulation to promote turning over. After holding the baby on its side, press and push the double Fengchi points, or press the upper side shoulder well or the ring jump point. Pull the arms from supine to sitting position, training head control and sitting alone; support sitting or sitting alone when the bowed back is more obvious can press the double lumbar eye points. Use small toys in front of the child’s hands and eyes to guide them to reach out and grasp. At five months, you can hold the child’s pelvis in an upright position facing forward, and use toys and language to guide bending and lifting movements. The ball movement in sensory training adds lateral up and down rolling to the previous movement, which not only inputs the horizontal head lateral rolling information to the vestibular system, but also promotes the lateral bending function of the trunk. Six months plus prone forward and backward roll with toys, language to guide the hands alternately forward to reach the object, not only can input information to the vestibular system head down position, but also promote the formation of protective parachute reflex. Support cushion bouncing and leaning forward to guide the protective support of hands when leaning in sitting position.
7 to 9 months; Main goals: prone crawling, knee-hand crawling, start of standing training, position change for transition to standing, thumb/index finger pinching of small objects, chewing and articulation training, new items added to sensory training. Main methods: methods to promote crawling include language, toys to guide crawling; acupuncture point stimulation to promote crawling, such as prone elbow support position, a forearm slightly forward hand back up, fix the hand while pressing the side of the shoulder well point, triggering the upper limb force; at the same time or slightly backward flexion of the opposite side of the lower limb, support the foot thumb stirrup ground while pressing the side of the Yongquan point, left and right alternately, stimulate crawling; push the foot / push position / crawl mode to promote crawling. After crawling down, you can crawl over the mother’s thighs and other methods to the knee-hand crawl transition. Use support bouncing, holding station, leaning station, etc. to exercise the lower limbs to hold weight, with sitting up training exercise hip, knee flexion and extension, to promote sitting and standing position conversion. This period should also guide or support the thumb/index finger to pinch small objects. In terms of chewing and articulation training, face-to-face demonstration of articulation and chewing, use hands to help jaw movement, press the chewing muscles and related acupuncture points or use fingers to do intraoral massage, use “teething cookies” to promote chewing, swallowing and articulation, etc.
In the sensory training, there is an increase in ball movement, such as sitting and bouncing and tilting from side to side to guide the protective support of the hands for tilting.
10～12 months:Main goals: stand alone, help walk/walk alone, hand-eye coordination, reach and grasp objects.
Main methods: holding stand, leaning stand, stand alone under protection; holding hands walking, holding parallel bars walking, walking alone under protection. Can not stand alone, support walking or support walking posture abnormal, plus bundle station straddle station, bundle station kick objects. To carry out the above training, with the foot in / out of rotation with the appropriate wedge plate correction, with a pointed foot wedge plate pad in the forefoot; with knee dystocia bundle stand behind the knee pad; sit up chair training to rise when the knee arch between the knee pad. Stand training must be carried out on the basis of correction of abnormal posture, which not only enhances muscle strength and bone and joint stability, but also helps in the correction of abnormal posture. In sensory training, add exercises on the ball, stand with the back against the ball pillow and neck against the ball, slowly withdraw the ball and use language to guide the head to tilt forward and stand straight. Stand/hold the ball facing the ball, hold the ball with both hands, roll the ball forward to guide the protective reflex of reaching forward to hold the ball.
IV. Tui Na intervention in Chinese medicine
It is a method of massage therapy based on the traditional Chinese medicine meridian theory, using the method of following the meridian to take points. The main techniques are segmental massage method, chiropractic treatment method, muscle strength promotion massage method, joint mobility massage method, abnormal posture correction method, etc.
Tui Na, also known as massage, is based on the action of force, through a variety of techniques, stimulating the meridian acupuncture points of the child, causing a series of physiological effects, so that the circulation of qi and blood, yin and yang harmonization, so as to achieve the purpose of treatment. The main techniques are Tongdu tonic kidney point massage method, brain puzzle method, spleen benefit method, chiropractic, foot massage method.
In the massage and home training is best with background music, choose the five elements of Chinese medicine music (heart, liver, kidney, spleen CD), Buddhist sutra music, Mozart effect music, etc.. Listening mode: 25 to 35 minutes / each time, 4 to 6 times a day. Music intervention has the effect of promoting brain development, educational enlightenment, stabilizing emotions and relaxing the mind and body.
Massage method: The operator pushes the Governor’s Vessel from the initiation point Changqiang, focusing on the thirteen points of the Governor’s Vessel, Changqiang, Lumbar Acupoint, Lumbar Yangguan, Life Gate, Hanging Hub, Jiaozhong, Central Hub, Tendon Shrinkage, Zhiyang, Lingtai, Shen Dao, Body Column, Tao Dao, Dazhi, Fengfu, Baihui, etc.; pushing and tapping 5 to 7 times to harmonize Yin and Yang, replenish Qi and Blood, and cultivate vital energy. Finger pushing and tonic method to press the kidney acupoints 4 to 5 times. To tonic the kidney meridian, use the thumb off-center to directly push the ribbed surface of the little finger of the child, which has the function of tonifying the kidney and benefiting the brain and warming the lower yuan. Each time 5 to 10 minutes, once a day.
Brain puzzle massage method: through the head and face and trunk, limbs parts of the acupuncture point massage, to unblock the qi and blood meridians, regulate the internal organs, regulate the role of the two veins, so as to achieve the purpose of brain puzzle. Mainly selected from the Shen Ting, Ben Shen, four Shen Cong, head dimension, Shang Xing, brain household, dumb door, Feng Chi, Shen Men, Tongli, Neiguan, Laogong, Lian Quan, Tan Zhong, Zhonghua, Guan Yuan, Qi Hai, etc.. 3-5 minutes each time, once a day.
Chiropractic therapy: The operator pushes the index finger of both hands upward against the skin and presses the thumb downward. Slowly push along the Governor’s vein from the bottom (Changqiang point) to the top (Dazhi point) a total of 7 times, and perform point pressure several times when pushing to Spleen Yu and Kidney Yu points to strengthen the spleen and benefit the kidneys. 3 to 5 minutes, 1 to 2 times a day.
Massage method for strengthening the spleen and Qi: massage techniques for strengthening the spleen and Qi can eliminate food and regulate Yin and Yang, regulate Qi and blood, and internal organs, promote the spleen and stomach transport, nutrient absorption, so as to improve the physical condition of the child. Massage techniques for strengthening the spleen and Qi: abdominal massage, the child to supine position, the operator with one hand four finger abdominal pressure on the abdomen, the Shen I point as the center of the clockwise rotation of 5 minutes, pushing and kneading in the hypochondrium, kneading 50 to 100 times, divided into pushing abdominal Yin and Yang 50 to 100 times. Massage of the foot three miles and chiropractic therapy consists.
Foot massage method: by stimulating the reflex zones of the corresponding brain, cerebellum, heart and kidney on the bottom of the foot, regulate the internal functions of the body and coordinate their balance. Manual method: pressure method, massage method, twisting method. 1 to 2 times a day, 3 to 5 minutes each time.
V. Music rehabilitation therapy intervention
Music therapy is a systematic intervention process in which the music therapist helps the patient to improve, maintain or regain health and achieve a state of well-being through music experience and the good therapeutic relationship established and developed by music.
In his book “Music Therapy for Life”, Donald, an American music therapist, says: “Music therapy is the use of music to restore, maintain, or improve an individual’s physical and psychological health, allowing the individual to achieve good changes in mind and body. Such change means that the individual has a greater range of development of themselves and their environment through exposure to music, which in turn leads to positive social adaptation.”
The development of musical abilities plays a decisive role in early childhood, especially during the critical period of motor function, language, and intellectual development of infants and toddlers between the ages of 0 and 3. During this period, a rich musical environment can lay a good foundation for the development of the child’s future musical abilities and multiple potentials.
The period from 0 to 6 months is a sensitive period for infants to receive caresses. When listening to songs for infants, mothers can sing to their babies while holding them, while showing them pictures and reading the poems on the cards repeatedly and rhythmically, when the auditory, visual and tactile senses have effects at the same time.
From 7 to 12 months is the period of development of the infant’s expressive abilities (creativity), when the infant’s independence and creativity are strongly expressed. Try to arrange activities that require the child to use his body and hands to accomplish. For example, play dynamic music, let him move freely, let him enjoy playing small instruments, tearing paper, painting at will, etc.
From 13 to 18 months, the child can walk and eat, and has an understanding of the world, what he or she wants to do, and how he or she feels about himself or herself and about others. It is helpful to improve thinking skills by playing a game that corresponds music to pictures at a set time. This is the time to expose your child to musical instruments, musical picture books, cards, etc.
From 19 to 24 months, this is the period when children are able to walk well, are physically agile, and are moving more and more. During this period, children begin to talk more and babble and sing alone more, so parents have to bring their child along when they let him listen.
From 25 to 30 months, the child begins to form his or her own self and learn to become an independent person with rapidly improving expressive skills. Parents should give their children a range of choices during this period, such as the choice of musical instruments and the choice of musical role playing. The child should be allowed to develop fine motor skills using small manipulable musical instruments, etc. More interactive parent-child games, especially musical stories and musical fairy tales with role-playing, can help the child become more aware of himself or herself and understand others.
From 31 to 36 months, children in this period are in a sensitive period and need an orderly environment to help them recognize things and become familiar with their environment. In terms of music, children at this stage like to explore and listen to various sounds, can imitate sounds with distinction, can sing in imitation of parents, can perform rhythms with slow and medium tempo music, use simple percussion to tap a steady beat rhythm, and appreciate music through playfulness. Parents need to model more for their children, tell them more musical stories, and even act out a musical fairy tale together so that the child can promote skill and comprehension development through imitation.
Sixth, the Chinese medicine bath hydrotherapy intervention
Herbal bath hydrotherapy is one of the tools of comprehensive rehabilitation. It uses water temperature, static pressure and Chinese herbs to act on the body surface of the child in different ways to relieve muscle spasm, improve circulation, regulate respiratory rate, increase joint mobility, enhance muscle strength to improve balance and promote recovery of gross motor sitting, standing, crawling and walking through temperature, mechanical and chemical stimulation.
Method: 10 kinds of herbs such as stretching herbs, windproof, red peony, hyssop, safflower, etc. to soothe tendons and activate blood circulation and remove blood stasis are made into Chinese herbal bathing solution and stored in sterile plastic bags. According to the age and severity of the disease, add 3000-6000ml of herbal bathing solution in the hydrotherapy pool, water temperature 36℃～38℃, slowly put the child into the water, you can wear a life jacket, so that the child can move in the water, with massage, time 15-30 minutes each time, 1～2 times a day.
Chinese medicine bath hydrotherapy course and effect: 20 days for a course of treatment, the course of rest between 7 to 10 days. Chinese herbal bath hydrotherapy has a good effect of relieving muscle spasm for children with spastic cerebral palsy, especially for those with gastrocnemius spasm, and can increase the mobility of foot and ankle joints and improve motor function within 2-3 weeks.
Precautions for Chinese medicine bath type hydrotherapy: the water temperature of children with increased muscle tone should be about 38 degrees; poor physical condition of children and small infants in the water should not be too long, generally 10-15 minutes; water temperature should not be too high, the hydrotherapy room should pay attention to ventilation, good ventilation; hydrotherapy process to observe the child’s face, breathing, sweating, to prevent the occurrence of deficiency; pay attention to warmth, to prevent colds; pay attention to care, to prevent Drowning; treatment should be suspended in case of cold and fever.