1.What is cerebral palsy?
Cerebral palsy, also known as pediatric cerebral palsy, is a non-progressive brain injury caused by various causes from before birth to one month after birth, manifesting as central motor disorders and postural abnormalities, mostly accompanied by mental retardation, seizures, and perceptual disorders. It is one of the main diseases that cause disability in children. Li Huawei, Department of Pediatrics, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine
2.What are the causes of cerebral palsy?
The causes of cerebral palsy are very complex. From the beginning of the mother’s pregnancy to 4 weeks after the child is born, any factors that can cause brain tissue damage in the fetus or newborn can be the cause of cerebral palsy. Broadly speaking, the factors that cause cerebral palsy are divided into three periods: before birth, perinatal period and after birth. Most of the prenatal factors are smoking or passive smoking during pregnancy, alcohol abuse, inappropriate medication, exposure to toxic substances, toxoplasma infection, rheumatism, pre-eclampsia, gestational hypertension syndrome, placental dysfunction, and advanced maternal age; most of the perinatal factors are forceps delivery, fetal malposition, prolonged or emergency delivery, birth asphyxia, preterm delivery, overdue delivery, multiple births, etc.; most of the postnatal factors are due to head Trauma, intracranial hemorrhage, infection, poisoning, etc. Generally speaking, the most children with cerebral palsy are caused by perinatal factors, followed by pre-birth factors, and the least by post-birth factors. In China, neonatal asphyxia, low weight, jaundice and prematurity are the main factors that cause cerebral palsy in children.
3.How to prevent cerebral palsy?
The prevention of pediatric cerebral palsy should start from the following aspects. Firstly, we should do a good job in pregnancy health care, which is an important step to prevent the occurrence of cerebral palsy. Pregnant women should try to stay away from harmful substances, such as tobacco, alcohol, pets (e.g. cats, dogs, etc. may carry toxoplasmosis), poisons, etc.; secondly, during pregnancy, especially in early pregnancy, avoid viral infections, and do not use drugs casually after infection, even if you must use drugs, you should consult your doctor first before using them; thirdly, it is Regular prenatal checkups to prevent and monitor the occurrence of diseases can effectively reduce the incidence of cerebral palsy. Pregnant women at risk, including those with multiple pregnancies and those of advanced age, should pay more attention to pregnancy health care. Obstetricians and pediatricians should also pay attention to the prevention of cerebral palsy and should take appropriate measures to reduce the occurrence of factors that may lead to cerebral palsy, which plays a very important role in the prevention of cerebral palsy; parents are equally important in the prevention of cerebral palsy. In short, the prevention of cerebral palsy requires the joint efforts of parents and doctors.
4.What are the early symptoms of cerebral palsy?
①Low responsiveness and unresponsiveness to name calling. This is the early manifestation of mental retardation, and it is generally considered that low responsiveness at 4 months and unresponsiveness to name calling at 6 months can be diagnosed as mental retardation.
②Hand clenching: If the hand cannot be opened at 4 months, or thumb inward, especially the presence of one upper limb, it has important diagnostic significance.
③Strabismus: the presence of strabismus and poor eye movements in 3-4 month old infants can suggest the presence of brain injury.
④Abnormal head circumference: head circumference is an objective indicator of morphological development of the brain, and brain-injured children often have abnormal head circumference.
⑤ Gaze hand: if it is still present after 6 months of age, it can be considered as mental retardation.
⑥Fixed posture, often due to abnormal muscle tone as a result of brain injury, such as coracobrachialis, frog position, inverted U-shaped posture, etc. It can be seen as early as one month after birth.
(vii) Non-smiling: If you cannot smile at 2 months and laugh out loud at 4 months, you can be diagnosed with mental retardation.
5.Does cerebral palsy have any effect on the intelligence of children?
Among children with cerebral palsy, some of them may have low intelligence, however, there are so many children with cerebral palsy, especially those with hand-footed cerebral palsy, who have normal intelligence, and even reports of children with cerebral palsy going to college are common. Cerebral palsy refers to motor dysfunction and postural abnormalities, not necessarily mental retardation.
6.How can a child with cerebral palsy be rehabilitated?
After the diagnosis of pediatric cerebral palsy is confirmed, early rehabilitation should be carried out.
①In order to strengthen the control of the child’s head, the child can be made to lift his head and chest with the support of both hands in the prone position or to extend both upper limbs when lying on his back, and slowly pull him from the supine position to the sitting position. When the child sits on the bed, he or she should be induced to reach for objects to the front and side, gradually forming a protective response in all directions to enhance the stability of the sitting position.
②For children who cannot turn over, flex the lower limb of the turning side when they are lying on their back, and assist the flexed leg to drive the body to rotate or hold the upper limb of the turning side to make it stretch and inward to drive the trunk to turn over.
③ Crawling training is an important method of brain injury rehabilitation. Children need both upper limbs to stretch support, lower limbs to knee support so that the trunk and thighs into 90 °. After the posture remains stable, you can place toys with sound and bright colors in front of the child to induce him to reach forward and grab alternately, while pushing forward the soles of the child’s feet to assist him in moving forward.
④ For children who cannot land on their heels when standing, the trainer can hold the heels while lying on their backs and press the palms of their hands toward the center of their feet to dorsiflex the back of their feet toward their calves, with the angle between the back of their feet and their calves being less than 90° as much as possible. Foot and ankle orthoses can also be worn to help correct the pointed foot and stabilize the ankle joint for better standing and walking training.
⑤ Some children make a fist with both hands and cannot grasp things, the trainer should insist on doing passive finger stretching activities to stretch their thumbs out, so that the other fingers can be easily stretched out.
⑥Strengthen language training along with motor training. Use brightly colored toys to attract the child’s attention and strive to imitate the trainer’s vocalization and pronunciation. Create a good speech environment and correct abnormal pronunciation in time.
7.How can children with cerebral palsy be rehabilitated?
Children with cerebral palsy mainly have motor disorders, so they should be promoted through various methods to promote motor and brain development. Commonly used methods include motor therapy, including Vojta therapy, Bobath neurodevelopmental therapy, Ueda method, etc.; physical therapy, including cerebral circulation therapy, spastic muscle therapy, muscle excitation therapy, meridian guiding and leveling therapy, neuromuscular electrical promotion therapy, etc.; hydrotherapy, including herbal fumigation, herbal fumigation, swimming, etc.; acupuncture, including scalp acupuncture, electro-acupuncture, body acupuncture, etc.; tui na massage, which is the main means of Chinese medicine treatment. It is the main and most effective method of treating cerebral palsy, which is to promote the recovery of children with cerebral palsy by reducing muscle tone, improving muscle strength, and inhibiting abnormal postures through various techniques. Other methods include educational therapy, speech therapy, sensory training, occupational therapy, pharmacotherapy, orthopedic appliances, etc.
For children with cerebral palsy, the main comprehensive rehabilitation should not be pinned on one or several rehabilitation treatments.
8.What are the drugs used to treat cerebral palsy? Are they effective for children with cerebral palsy?
At the early stage, the application of drugs to promote brain development and improve brain function has a relatively obvious effect on children with cerebral palsy. Commonly used drugs include cerebrolysin (brain protein hydrolysate), cytidyl phosphorylcholine, vitamin B12, ganglioside, nerve growth factor, calf serum deprotein extract, etc. For improving intelligence, you can also use oracetam, aniracetam, piracetam, compound cerebrolysin hydrolysate, etc. There are also drugs such as Antan, Lioresin, levodopa, etc. which can reduce muscle tone and improve muscle tone fluctuation. These drugs have a relatively obvious effect on children with cerebral palsy. However, when applying drugs, parents must mainly listen to the opinions of professional doctors in regular hospitals, instead of listening to biased beliefs and believing in the so-called secret recipes, such as ××storm, ×Snake capsule, etc. This will not only cause economic damage, but also delay the best treatment time for the child, resulting in greater motor impairment.
9.What is Vojta therapy?
Vojta therapy, created by Dr. Vojta, a West German scholar, after years of clinical practice, is a kind of movement therapy that integrates diagnosis, treatment and prevention. This method is also known as induction therapy because it induces a coordinated reflexive movement of the whole body through compression stimulation of certain parts of the body to promote and improve the motor function of the child.
The Vojta method uses two manual techniques: reflexive abdominal crawling and reflexive rolling to induce the child’s motor ability, ability to support the body with various body parts, ability to lift the body, and ability to move, as well as to promote the conversion of the child’s muscle contraction direction, thus improving the child’s abnormal posture and motor pattern and promoting the development of normal posture and motor pattern. The development of normal posture and movement patterns.
10.What is the Bobath method of neurodevelopmental therapy?
Bobath neurodevelopmental therapy is the main treatment method for cerebral palsy and all limb infirmities in the world, which was established by British scholars Karel Bobath and Berta Bobath in the 1950s. The Bobath method is also known as a neurodevelopmental treatment method achieved through reflex inhibition and facilitation.
The treatment techniques include.
①Reflexive inhibition techniques (inhibition of extension posture and inhibition of flexion posture techniques), the former is applicable to children with dorsiflexion of the head, ATNR of the whole body, and coracoacusis, and the latter is applicable to cerebral palsy with forward flexion of the head, spinal curvature, and flexion of the hip and knee in a flexed state.
②Key point adjustment refers to the technique in which the trainer adjusts specific areas on the child’s body to reduce spasticity and promote normal posture and movement at the same time.
③Posture reflex promotion is a technique that does not require the child to exert excessive force and directs the child to his or her maximum potential to develop a motor posture for functional activity and to learn to experience this motor posture for functional activity for therapeutic purposes.
Percussion method is a technique to promote the normal posture of the child by increasing the muscle tension of certain parts of the child’s muscles, and by maintaining the normal posture of the child after regular or arbitrary percussion on the trunk of the limbs. The specific technique of the method varies from person to person and can have more than a thousand kinds.
11.What is occupational therapy?
It is a treatment method for patients with physical, mental and developmental dysfunctions or disabilities that lead to different degrees of loss of self-care ability and vocational labor ability to recover, improve and enhance their life and learning ability and help them return to society by applying purposeful and selected occupational activities.
It is used for cerebral palsy mainly to.
①Promote motor development and maintain normal posture. For example, in the prone position, the child can be trained to lift the head and support the weight with both hands and elbows using a triangular mat, therapist or parent’s body. In the supine position, the two upper limbs can be stretched upward and fixed in the middle position to promote the median functional position, and both lower limbs can also be lifted upward to promote the balance function. Sitting position head is adjusted upright. Lateral and posterior balance reflex induction movement exercises, etc. Upright posture maintenance can be performed using a standing frame.
② Promote the functional development of the upper limbs, gross motor function, such as designing the field to promote the separation action of the arm and scapular girdle; increase the autonomic control of the scapular girdle and improve the stability of the upper limbs; induce elbow joint extension, hand-to-mouth movement and the movement of the hands on the midline. Fine motor function of the hand, promotion of hand grasp, better controlled sensory activities of the upper limbs, hands and fingers; hand grasp and release of objects and hand-eye coordination activities.
③Improve perceptual and cognitive functions.
④Activities of daily living, clothing, food, housing and transportation training.
⑤ Promote emotional and social development to make them take care of themselves and return to society
12.What is speech therapy?
Pediatric cerebral palsy is a non-progressive brain injury caused by various reasons. In addition to central motor dysfunction, about 3/4 of the children have different degrees of language impairment, which seriously affects the children’s language communication, emotional communication, daily life and learning. Therefore, early training is necessary to enable the child to participate in society as soon as possible. Language therapy can be divided into active training and instrumental training methods. Active training uses the lip and tongue function training drill. The research design of this drill is based on the basic theories of neurology of language development, neuropsychology, linguistics, phonetics, and speech pathology, and the first and second sets of lip and tongue function training drills are carried out from simple to complex. The training treatment of dysarthria includes relaxation therapy, breathing training, motor training of articulatory organs; dysarthria training includes vocalization training, continuous articulation, doing training to overcome nasal sounds, training the affected children to control volume, pitch and rhythm, communication aid system, etc. Instrument training is to use certain instruments and equipment to imitate the normal child’s speech formation and pronunciation pattern. The instruments and equipment used include voice workstation, sound, intelligence and music therapy instruments, etc.
13.What are the types of cerebral palsy?
(I) Spasticity type
This type is characterized by increased muscle tone. Generally, low birth weight babies and asphyxiation are prone to this type of cerebral palsy, accounting for 60% to 70% of children with cerebral palsy. As the child grows, joint contractures and deformations occur, and the legs are crossed in a standing and walking position. The foot may show pointed feet, pointed in-foot, valgus, flexion contracture of the knee joint, and hip joint flexion, inversion, and internal rotation. The upper limbs may show abnormal limb positions such as palmar flexion of the hand joints, thumb inversion, finger joint flexion, forearm rotation forward, elbow joint flexion, etc., resulting in contracture and deformation. Clinical examination may show cone bundle signs.
(B) Tonic type (tonic stiffness type)
The tonic type is for a group of patients with stiffness of the extremities in the spastic type. The extensor reflex is specifically hyperactive, and sometimes it is difficult to distinguish strictly. When performing passive movements, the limbs resist both flexion and extension, giving the impression of bending a lead pipe or moving a gear. The tendon reflexes are normal or weak. The common tendency of spastic and tonic types is that they are often accompanied by intellectual, emotional, and speech disorders, as well as epilepsy, strabismus, and salivation. Many patients require surgery.
(C) Tardive dyskinesia
The tardive dyskinesia type is characterized by involuntary movements, and some people call it involuntary movement type. Most patients with a history of neonatal asphyxia and nuclear jaundice have tardive dyskinesia. The lesions are mainly in the deep basal nucleus and the extrapyramidal tract of the brain.
The child mostly shows asymmetrical unnatural posture, inflexible and incomplete movements, and the whole body movements are extended by involuntary movements contrary to the intention. The involuntary movements disappear when the child is quiet and appear when he or she is nervous or wants to do something. The involuntary movements are heavy in the extremities, especially in the upper extremities, but also in the face (e.g., frowning, blinking), neck, head, and arms, hands, and fingertips. The sitting stability of the trunk appears later, and the shaking of the upper limbs can cause the trunk and lower limbs to lose balance and often fall down, giving the impression of weakness. In the most severe cases, the whole body can be suddenly and strongly stretched and straightened with mental tension and excitement, thus preventing the completion of conscious and purposeful movements.
This type has a high IQ, but it is a type of disease with difficulty in independent living because of the upper limb and language disorder.
(D) Dyscalculia
Dyscalculia is a disease type with balance dysfunction as a result of cerebellar and brainstem injury. The child is unable to perform correct movements. Mild tremor can be seen in the hands and head. The standing balance is unstable and the pace cannot be adjusted, and most of them can walk with a cane. In severe cases, not only do they often fall when walking, but they are also unstable in the sitting position and have significant upper limb dysfunction. Mild to moderate cases are often associated with mental retardation, lack of intonation of speech, and are characterized by bradykinesia. Nystagmus is very common. The finger-nose test, finger-to-finger test, and heel-tie-knee test are all difficult to perform in children with this condition.
(E) Tremor type
The tremor type refers to a part of the body that moves in a plane in an involuntary, rhythmic manner. However, typical tremor symptoms are extremely rare in cerebral palsy. It is occasionally present in children with tardive dyskinesia.
(vi) Hypotonia
It is usually characterized by a lack of random and involuntary movements and unresponsiveness in severe cases, and is the opposite of spastic and tonic types.
(VII) Mixed type
A mixed type of cerebral palsy is characterized by the presence of typical symptoms of each type. In fact, it is cerebral palsy caused by a mixture of spastic and involuntary motor symptoms, or a mixture of three different characteristic symptoms.
14.What is central coordination disorder? What is the difference between it and cerebral palsy?
Central coordination disorder was introduced in 1976 by Dr. Vojta, a German scholar, as a synonym for early diagnosis of cerebral palsy. It is mostly used for infants under 1 year of age. For the purpose of early diagnosis and early treatment, central coordination disorder is diagnosed for those children who have a history of brain injury, developmental disorders, and clinical manifestations such as central motor coordination disorder, but cannot be diagnosed as cerebral palsy with certainty and are at risk of developing cerebral palsy in the future. In fact, central coordination disorder is a child at risk for cerebral palsy. It is a synonym for early manifestations of cerebral palsy. If the central coordination disorder is treated early and the condition is mild, it is a normal child afterwards; if it is more severe and treated late, it will develop into cerebral palsy.
15.What is botulinum toxin injection?
Botulinum toxin A is a neurotoxin, which is a mainstream drug for cosmetic surgery. Its role in treating children with cerebral palsy is to reduce the excessive stiffness of spastic muscles by blocking the transmission of signals between the nerve and the target muscle, allowing the developing muscle to grow normally. The increased length of the spastic muscle reduces the risk of contracture and increases the chance of normal movement development. Not every child with cerebral palsy is a candidate for this treatment. Before administering Botulinum Toxin A to a child, a rigorous examination is required to determine the suitability of the drug for the child and to determine whether the treated limb has contractures. Only by assessing the child’s symptoms in detail and formulating a specific rehabilitation plan for each child, together with the use of drugs, can the best rehabilitation effect be achieved.
16.What are the benefits of massage for cerebral palsy?
Tui-na massage can relieve muscle spasm by the following mechanisms: (1) strengthening local circulation and increasing the temperature of local tissues; (2) fully elongating the tense or spastic muscles, thus releasing the tense spasm. Adequate elongation of tense and spastic muscles is achieved by forcing the relevant joints to stretch and pulling the tense and spastic muscle bundles to relax them. Reducing muscle tension has the following mechanisms: ① strengthen the circulation of injured tissues and promote the repair of injured tissues; ② on the basis of strengthening the circulation, promote the absorption of hematoma and edema caused by injury; ③ for those who have adhesions in soft tissues due to long-term muscle tension spasm, it can help loosen the adhesions.
17.What are the effects of scalp acupuncture?
Scalp acupuncture has the function of unblocking meridians, running qi and blood, and balancing yin and yang. It can accelerate the blood flow in the brain, improve the blood circulation of children with cerebral palsy, promote brain metabolism, facilitate the rehabilitation of children with cerebral palsy, improve the intelligence of children with cerebral palsy, and promote the language and hearing development of children with cerebral palsy. At the same time, through the stimulation of the scalp, it can indirectly stimulate the corresponding cerebral cortex, that is, different centers, such as the language center, motor center, balance area, visual center, etc., thus promoting the recovery of the child with cerebral palsy in all aspects.
18.What is the effect of herbal fumigation?
The increased muscle tone and spasm in children with cerebral palsy is a manifestation of the detrusor reflex, and the receptor is the muscle shuttle. Under the effect of fumigation, the local temperature of skeletal muscle rises and the excitability of afferent and efferent fibers of the muscle shuttle decreases, resulting in a decrease in muscle tone, relief of muscle spasm and reduction of spastic pain. The active ingredients of the drug can be absorbed directly through the skin and enter the blood circulation to exert its therapeutic effect. The use of Chinese medicine fumigation treatment is to make use of the dual effect of heat and medicine during fumigation, as well as the characteristics of the muscle shuttle conduction affected by temperature, to effectively relax the spasm, reduce muscle tone, improve the child’s motor function, and create a good basis for limb rehabilitation exercise.
19.Is neural stem cell transplantation useful for cerebral palsy?
In recent years, neural stem cell transplantation for cerebral palsy has been carried out in many hospitals in China, but is neural stem cell transplantation really useful for cerebral palsy? Neural stem cells do exist in a large number of areas in the brain and spinal cord of adult animals, and if humans know enough about “neural stem cells”, they can “create” enough “neural stem cells” with manual intervention, and then transplant them as needed. If we know enough about “neural stem cells”, we can “create” enough “neural stem cells” with human intervention, and then send them to where they are needed, so that many neurological problems can be solved. The two most important challenges are: Can neural stem cells differentiate into neural cells of a certain purity? After the neural stem cells are transplanted into the brain, can they “grow” nerve cells in the right place, and can these “grown” nerve cells “survive” for a long time? “The above two problems aside, there are many other clinical problems.
In addition to the above two challenges, there are many details of clinical use that are not followed, such as the method, route, adjuvant, indications, etc. of transplantation. Moreover, the evaluation of the effect of neural stem cell therapy is also a topic under research. Many domestic and foreign neurological scientists are devoted to solve these problems. Although scientists are optimistic and confident about the future clinical application of neural stem cell transplantation, they have to face the fact that it is still far from mature clinical application. Even in the laboratory, the desired results have not been achieved. Therefore, the treatment of cerebral palsy by neural stem cell transplantation can only be described as a hope for now. Therefore, there is not yet a very authoritative institution or organization to make a fair and objective evaluation of the efficacy of neural stem cell transplantation in the treatment of cerebral palsy.