Concept of Early Intervention
Early intervention refers to the organized and purposeful comprehensive rehabilitation activities for at-risk children whose development deviates from normal or may deviate from normal. The goal of early intervention is mainly to seize the critical period of brain development and intelligence development, use sensory and motor stimulation to alleviate or repair brain tissue lesions and block neural cell apoptosis, thus alleviating or preventing neurological sequelae. Early treatment generally refers to treatment within 6 months after birth, and treatment within 3 months is also called ultra-early treatment. The purpose and significance of early intervention: to promote the development of brain cells and myelin formation; to develop normal postural reflexes and muscle tone of anti-gravity muscles, to promote the formation and development of normal motor functions, and to prevent the development of abnormal postural reflexes and abnormal muscle tone; to prevent secondary damage caused by postural and motor abnormalities, such as joint contracture, muscle atrophy, limb deformation, etc.
The brain tissue is not mature at birth, the cerebral cortex is thin, cell differentiation is poor, and the nerve myelin sheath is not fully formed. The brain is in the stage of rapid growth and development within 6 months after birth, the number of nerve cells does not increase much, but mainly the volume increases, the dendrites increase, and the formation and development of neuromyelin sheath, the nerve repair and brain injury are also in the early stage during this period, the abnormal posture and movement are not yet fixed, and the motor function can be easily restored after treatment; timely treatment during this period can get the best treatment effect.
Early intervention methods: At present, comprehensive rehabilitation interventions are used at home and abroad, mainly including drug interventions, early education interventions, motor development interventions, physical therapy interventions, TCM massage interventions, music early interventions, Chinese medicine bath type hydrotherapy, etc.
1.Pharmacological intervention: Since 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, the intracranial hemodynamics is 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.
The following types of drugs are commonly used.
(1) Improving 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) Nourishing brain cells and improving brain metabolism: 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 condition of the child, gangliosides can also be used for intravenous infusion.
(3) Promote the growth and repair of nerve cells drugs: currently the clinical use of nerve growth factor. Nerve growth factor, usage and dose: 18-20ug/d, intramuscular injection or acupuncture point 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) The regulation of muscle tension drugs: mainly Antan, Lioresal, Sulepine and other muscle tension relaxation drugs.
(6) Combined with epilepsy to give anti-epileptic drugs: mainly luminal, sodium valproate, Toltea and other drugs.
2, early education intervention: mainly according to the different age of infants and young children physical, movement, perception, language, attention, memory, thinking, as well as mood, emotional development, phased individualized targeted educational training for children.
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, etc. Up to 1 year old, perceptual and motor training is the main focus. In addition to systematic comprehensive training, therapeutic interventions such as acupuncture and nerve nutrition are also given to those who are significantly behind in development.
The CCSOS (Synchronized Sensory Combination Stimulation) neonatal infant swimming water therapy and the CCSOS (Chinese Character – Sensory Combination Stimulation) infant intelligence development reading and literacy method were proposed by Dr. Zhan Li of the Second Xiangya Hospital after years of dedicated research and practice. CCSOS is an abbreviation of chinesecharactor and sense organsstimulations, 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 development psychology, brain science, neuromolecular biology and pediatric health care in recent years, combined with the basic properties of Chinese characters.
3.Motor development therapy intervention: It is based on gross motor and motor function training, using mechanical and physical stimulation to conduct a series of training for 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 intervention can effectively promote the recovery of motor function and the overall development of the child’s physical and mental health.
(1) Doman-Delecato therapy in Philadelphia, U.S.A.: Founded in the U.S.A. in the 1970s by Doman, a physical therapist, in cooperation with Delecato, an educational psychologist, the therapy focuses on comprehensive rehabilitation and intensive training of the six channels: visual, auditory, tactile, superficial tactile, balance, and temperature perception, to promote the overall development of the child.
(2) Vojta induction therapy: Created and applied by Dr. Vojta, it has two basic techniques: reflexive turning and reflexive belly crawling, which are effective in promoting normal motor reflexes and correcting abnormal postures.
(3) Bobath method: This method was co-founded by British scholars Karel Bobath and Berta Bobath. It is a method to treat cerebral palsy by using techniques to inhibit abnormal postural movements and promote normal postural reflexes and motor development according to the laws of neural development of children.
Inhibiting abnormal postural movements mainly includes three aspects: inhibiting abnormal postural reflexes, such as asymmetrical tense neck reflex (ATNR), symmetrical tense neck reflex (STNR), tense vagal reflex (TLR); inhibiting abnormal postures, such as eliminating excessive tension, reducing pointed foot, scissor gait, etc.; inhibiting abnormal movement patterns, such as anterior kneeling extension support pattern of both upper limbs, rigid straight pattern of both lower limbs The overall movement pattern of coracobrachial pattern and coracoid pattern. Facilitation of normal movement patterns 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 of life, such as turning over, sitting, crawling, standing and walking.