Cerebral palsy is also known as cerebral palsy, or cerebral palsy for short. It is a condition in which the affected child suffers from brain cell damage caused by stimulation of various injurious factors before or within one month after birth, resulting in upper motor neuron damage. It leads to mental retardation, motor ataxia, motor and sensory impairment. The main manifestation of motor disorders in infants is a developmental delay in head lifting, rolling over, sitting and standing, which parents often call “soft”.
The most common symptoms of postural abnormalities are head tilting back, eye strabismus, inward rotation of the upper limbs with hands behind the back, and inward tiptoeing of the lower limbs. Most children with cerebral palsy have a history of obstructed labor and delivery, and most of them have hypoxia and asphyxia before and after birth.
This “softness” in children with cerebral palsy is often misunderstood by many people, because many parents think that only children with calcium deficiency are “soft”. In fact, pediatric calcium deficiency is a malignant chronic nutritional disease due to abnormal calcium and phosphorus metabolism caused by vitamin D deficiency. The main manifestations of rickets in infancy are crying, frightening, sweating, etc. There are absolutely no postural abnormalities or mental retardation, and the mother has no history of difficult births or cerebral hypoxia before or after the birth of the child.
It can be seen that cerebral palsy is fundamentally different from calcium deficiency. Therefore, parents should pay attention to their baby’s daily performance, and if they find that the child’s movement development is delayed, they should take him to the hospital for examination as soon as possible, as early treatment is always the most crucial for any pediatric disease.
The key to treating cerebral palsy is “early”.
With the development of medical science and a lot of research, the key to treating cerebral palsy is the word “early”. Many experts believe that the brain tissue is not yet mature within one year of age and is still in the rapid growth stage, while the brain injury of cerebral palsy is also in the primary stage and the abnormal posture and movement are not yet fixed.
If the child has had a history of prematurity, low birth weight (less than 2500 grams) and a history of severe hypoxia and convulsions at birth or during the neonatal period, the possibility of pediatric cerebral palsy should be alerted. This is a congenital or perinatal occurrence of cerebral motor center disability syndrome, which is extremely dangerous to the health of children and a serious burden to families and society.
If parents find one of the above signs in their child, they should immediately take the child to the hospital for further examination and should not be careless. With the development of medical science and a lot of research, the key to treating cerebral palsy is the word “early”. According to the experts of cerebral palsy department of Shanghai Nanshan Hospital, brain tissue is not yet mature within one year old and is still in the stage of rapid growth, while brain injury of cerebral palsy is also in the primary stage, abnormal posture and movement are not yet fixed.
Treatment methods of pediatric cerebral palsy
1.Rehabilitation treatment
Medical workers should scientifically grasp the principles of cerebral palsy rehabilitation treatment for children with cerebral palsy, and make a targeted, comprehensive and systematic rehabilitation plan for different children with different conditions.
For premature infants with a history of asphyxia at birth and pathological jaundice after birth, close tracking and observation should be conducted. If you find that a child within 3 months of age is easily startled, cries more than once, has difficulty sleeping, has difficulty eating milk, has difficulty swallowing and chewing, has hug-like fright when hearing sounds or changing positions, cries, has reduced voluntary activity, and has his head and body jerked backward when crying; at 4-5 months of age, the child’s head is still not straight, his eyes do not follow objects, and he does not reach for objects; at 6-8 months of age, the child still does not sit alone, and other such manifestations, parents should Parents should bring their children to the hospital promptly.
Children with risk factors and clinical signs and symptoms should be given comprehensive rehabilitation treatment. These include: motor training and upper limb occupational therapy for limb movement dysfunction; speech therapy and music therapy to promote language and intellectual development; special education, stylistic therapy and sensory integration training for older children; application of drugs (nerve growth factor, gangliosides, etc.) to improve the nutritional metabolism of brain tissue and protect neurons; Chinese massage, hydrotherapy and surgery to reduce and improve the range of motion of limb joints. surgical procedures, etc. In addition, depending on the age of the child and the degree of dysfunction, the use of necessary orthopedic devices can help to improve motor function.
Because of the damage to the brain tissue of the child, rehabilitation of children with cerebral palsy is a lifelong process. Whichever means of treatment is used is an integral part of comprehensive rehabilitation. Parents and health care providers should establish the concept of comprehensive rehabilitation.
2.Surgical treatment
There are three main types of commonly used orthopedic surgery for cerebral palsy as follows.
(1) Neurosurgery mainly involves the cutting of motor nerve branches, commonly used are the cutting of the anterior branch of the closed nerve and the cutting of the nerve branches of the floundering muscle.
(2) Muscle tendon surgery includes muscle and/or tendon severance, tendon transposition, tendon lengthening, such as adductor tendon severance, rouge muscle transposition, Achilles tendon lengthening.
(3) Osteotomy and joint fusion, such as osteotomy to correct rotational deformity of the femur and triple joint fusion of the foot in older children.
Surgery requires moderate reduction of muscle tone. The new muscle balance should be established and not be overdone so as to cause new deformities. For example, correction of a flexed knee deformity by a partial cervical cordotomy alone can result in a reverse knee flexion deformity, which is inappropriate.
The mechanism by which FSPR relieves limb spasticity is based on experimental evidence from physiology: the downstream conduction bundle of the spinal cord has an inhibitory effect on motor neurons, while the posterior root fibers entering the spinal cord have an excitatory effect.
In the late 1970s, Fasano first reported the use of SPR surgery for the treatment of spastic cerebral palsy and received significant results. Most of the FSPR techniques currently used follow his method with some improvements. In China, Xu Lin et al. lowered the surgical plane to the lumbosacral segment and selectively cut the posterior roots of L2-S1 spinal nerves to eliminate the intersegmental connection from the posterior roots of the lumbosacral nerves to the adjacent anterior horn motor neurons of the spinal cord, thus weakening the lower limb muscle spasm and improving the motor function of the limbs of the children.
One of the meanings of selectivity refers to the selection of spinal nerve branches with low threshold for severance. After incision of the dura mater during surgery, the anterior and posterior spinal nerve roots are carefully separated under a microscope or surgical magnification, and each posterior root nerve is divided into 4 to 10 bundles of small branches, and their thresholds are measured separately with an electrical stimulation instrument, usually by hooking each small bundle with a stimulation electrode and observing the threshold at the appearance of limb spasm after electrical stimulation, and those with low thresholds are considered abnormal, and l/2 to 3/4 of these small posterior root bundles with low thresholds are cut.
Generally, the severed posterior root nerve branches are limited to 50% to avoid excessive severing to produce hypotonia after surgery. Postoperative bed rest is required for at least 3 weeks. Rehabilitation training is the key to successful surgery. Unsystematic postoperative care can also lead to surgical failure. It has been reported that the efficiency of FSPR in relieving spasticity is more than 95%, and the functional improvement rate is 80% after surgery compared with the preoperative myotonia reduction of 3 levels, and the long-term efficacy is subject to further follow-up.
The indications for FSPR surgery are children with normal or near normal intelligence and simple spastic cerebral palsy; although the muscle tone is high, the fixed contracture is mild and the limbs have some active motor function, which is also suitable for surgery. Children with low intelligence, weak muscle tone, poor active motor function, children with cerebral palsy types such as tardive dyskinesia and ataxia, or children with severe spinal deformities are considered contraindications to surgery.