Cerebral palsy, also known as cerebral palsy and cerebral palsy.
Cerebral palsy is a syndrome caused by damage or injury to the immature brain before birth, at birth, or during the first month of life, with motor and postural disorders as the main manifestations. The lesions often damage the pyramidal tract and the extrapyramidal system. The disease is directly related to cerebral hypoxia, infections, trauma and hemorrhage, such as rubella, herpes zoster or toxoplasmosis in early pregnancy, severe infections in mid- and late pregnancy, severe gestational hypertensive syndrome and pathological obstructed labor can cause neonatal cerebral palsy.
Causes of the disease:
1, hypoxic asphyxia: including fetal hypoxic asphyxia in the mother’s womb, neonatal hypoxic asphyxia during delivery, respiratory distress syndrome, peripheral circulatory failure, erythrocytosis.
2, brain injury: such as infant brain injury during delivery, neonatal cranial injury or brain infection, cerebrovascular accident.
3. Premature birth and fetal dysplasia: intrauterine infection, intrauterine growth retardation, congenital malformations. The likelihood of cerebral palsy is greatly increased in newborns weighing less than 2500 grams (about 40% of children with cerebral palsy weigh less than 2500 grams)
4. Certain genetic diseases and neonatal jaundice.
5. Maternal causes: including abdominal trauma to the pregnant woman, preterm abortion, prenatal hemorrhage, toxemia of pregnancy and placental causes (placental abruption, placenta praevia, placental necrosis or placental dysfunction), as well as certain chronic diseases of the pregnant woman (hypertension, hepatitis, diabetes, drug addiction, drug overdose, etc.).
Clinical typology:
1) Spastic cerebral palsy is the most typical and common type. The main manifestation is spastic paraplegia mainly of both lower limbs. The child has difficulty walking and standing, and walks with a scissor gait on the toes. There is a marked increase in muscle tone, hyperactive tendon reflexes, and pathological reflexes may be present. It is often accompanied by speech and intelligence impairment.
2) Dystonic cerebral palsy Most often seen in young children, the main manifestation is a marked decrease in muscle tone. The head and neck cannot be lifted, and there are obvious movement disorders and excessive joint movements, but tendon reflexes are active and pathological reflexes may appear. It is often accompanied by aphasia and mental retardation.
3) Tardive cerebral palsy is mostly caused by damage to the basal nucleus due to nuclear jaundice and neonatal asphyxia. The child exhibits choreiform or tachycardia-like movements of the face, tongue, lips and trunk limbs. It is accompanied by dyskinesia and increased muscle tone.
The main clinical manifestations are hypotonia, ataxia, intentional tremor, dysarthria, and motor retardation.
5) Mixed type has some characteristics of all the above mentioned types.
The manifestations of cerebral palsy can be divided into several types.
1) Spasticity: The child’s main manifestation is stiffness of the extremities.
2) Tardive dyskinesia: Involuntary involuntary movements of the limbs and head, and involuntary movements of the whole body increase when purposeful movements are made, such as “squeezing” of the face, difficulty in speaking and swallowing, often accompanied by drooling.
3) Ataxia: characterized by muscle weakness of the limbs, inability to maintain body balance, unstable gait, and inability to perform fine movements such as pointing the nose with the fingers. Simple ataxia is less common. Ataxia can also be associated with tardive dyskinesia. The child is often unable to maintain a fixed posture, and when standing, has to make frequent adjustments in order to maintain the standing position. Walking is learned later than in normal children. When walking to obtain a more stable balance, the feet are widely spaced from side to side and the gait is wobbly and poorly oriented.
The following symptoms can help in the early diagnosis of cerebral palsy.
1) The child often cries little, moves little, cries weakly and is excessively quiet shortly after birth. Or they cry a lot, are easily agitated, startle easily or have recurrent flesh jumping.
2) Difficulty in feeding after birth, such as weak sucking, difficulty in swallowing, and poor oral closure.
3) Uncoordinated, asymmetrical movements and little random movement.
4) Frequent abnormal muscle tone, abnormal posture and movement patterns.
5) Motor development is delayed. For example, at 3 to 4 months of age, the child cannot hold his head in the prone position; at 4 months of age, he is still unable to support weight with his forearms; his hands often make fists and he cannot put his hands in his mouth to suck; at 6 to 7 months of age, he is still unable to roll over and sit alone for a few moments; when he is supported to stand, he cannot bear weight with his toes on the ground or with his legs flexed, or his two lower limbs are too straight or crossed.
Diagnosis of cerebral palsy.
1) Ask if there is any history of upper motor neuron dysplasia or damage, such as premature birth, difficult birth, high fever, cerebral ischemia, cerebral hypoxia, cranial injury, cerebral infection, etc.
2) Check for spastic paralysis, muscle movement disorders, increased muscle tone, hyperreflexia, muscle atrophy, joint deformities, ataxia, and mental retardation.
Cerebral palsy auxiliary examination.
Children diagnosed with cerebral palsy based on clinical manifestations must also undergo the following auxiliary examinations: ① intelligence test; ② electroencephalography; ③ brainstem auditory evoked potential measurement; ④ imaging and other examinations to confirm the diagnosis.
Cerebral palsy treatment.
There is no special treatment. Except for seizures, which are controlled by drugs, the rest of the symptoms are mostly treated symptomatically. Early education and training of intelligence and psychology should be implemented.
1) Comprehensive treatment including intellectual and language training, physiotherapy, physical therapy, acupuncture, massage, brace and plaster orthopedics is recommended.
2) Orthopedic surgery is only suitable for those with spasticity, fair intelligence, age 5 years or older, and non-surgical treatment is ineffective. The purpose of surgery is to reduce spasticity, improve muscle balance, correct deformity, and stabilize joints. The surgical methods can be divided into four categories: ① posterior root neurectomy; ② neurectomy: cutting the nerve branches that innervate the spastic muscles; ③ tendon surgery; ④ bone and joint surgery.
Cerebral palsy prevention.
1. Firstly, before the child is born.
1) Pregnant women should actively conduct early prenatal checkups and do perinatal health care to prevent congenital diseases in the fetus.
2) should abstain from bad habits such as smoking, drinking alcohol, and not abusing drugs such as anesthetics and sedatives
3) prevention of viral infections such as influenza and rubella, and no contact with cats, dogs, etc.
4) Avoid contact with harmful and toxic substances such as radiation and frequent ultrasound examinations.
2) Fetal birth, i.e. during delivery. Fetal asphyxia and intracranial hemorrhage caused by delivery is an important cause of pediatric cerebral palsy. Preterm delivery and obstructed labor should be prevented. Medical personnel should carefully and meticulously handle all aspects of delivery and do all the treatments for difficult fetuses.
3.The fetus should be given better care and reasonable feeding within one month after birth, and intracranial infection and traumatic brain injury should be prevented.
4.Pregnant women with the following conditions should have prenatal checkups as early as possible.
1) Older pregnant women (over 35 years old) or men over 50 years old
2) Marriage between close relatives.
3) history of unexplained miscarriage, premature birth, stillbirth and neonatal death
4) Pregnant women with mental retardation or both close relatives with a history of epilepsy, cerebral palsy and other genetic disorders. If fetal abnormalities are detected early in pregnancy, the pregnancy should be terminated as soon as possible.
5) Speech impairment in children with cerebral palsy
About 70-80% of children with cerebral palsy have varying degrees of language impairment. They are affected by brain damage in respiration, resonance, speech and brain synthesis, and are unable to properly control the movements required for speech, resulting in speaking too fast or too slow, or inaccurate or incoherent, or even aphasic. Most speech disorders in children with cerebral palsy are dysarthria, which manifests as a result of dysarthria in muscle control, resulting in weak, sluggish, and uncoordinated organs of speech. This condition is known as dysphasia.
Spastic children typically present with increased muscle tone and inability of the resistance muscles to contract with each other in a coordinated manner. When the child speaks, spasms in the muscles of the face, mouth and tongue often lead to abnormal articulation.
The involuntary movements of the head and articulatory organs contradict the movements required for articulation, and the articulatory organs collide incompletely and inaccurately with each other during vocalization, making it difficult to lift the tongue.
In children with ataxia, speech is slurred due to insufficient muscle contraction strength.
Children with cerebral palsy have aura.
It is a syndrome of non-progressive brain injury due to various causes before birth to 1 month after birth. It is mainly characterized by central motor deficits and postural abnormalities, and is often accompanied by a variety of impairments in intelligence, vision, hearing, eating, swallowing, speech, and behavior, which can seriously affect the child’s life.
The earlier a child with cerebral palsy is identified, the better the outcome of treatment. There are several easy-to-learn and reliable methods that can be used to observe and determine if a child has signs of pediatric cerebral palsy.
1. Sleeping for too long or not sleeping.
2. No sound when crying or a low, straight cry.
3. Poor swallowing.
4. Uncoordinated movement of arms and legs, with more lateral movement.
5.Can’t hold the legs when peeing.
6.Can’t lift head at 3 months, can’t turn over at 6 months, can’t sit at 8 months.
7.No eye contact with parents, and often convulsions.
If you find that your child has the above phenomenon, you should pay attention to it and go to a regular hospital or a specialist for examination as soon as possible, and get timely treatment after diagnosis.
Abnormal posture performance of cerebral palsy.
Some children show obvious abnormal posture when lying down, while others show obvious postural abnormalities when moving. Postural abnormalities at rest include tense neck reflex posture, coracobrachial posture, hemiplegic posture, etc.; postural abnormalities during movement include choreiform tics and torsional spasms, spastic paraplegic gait, cerebellar ataxic gait, etc.
1. Tense neck reflex posture
When the head position changes, it affects the change of muscle tone and eye position of the limbs. It is divided into symmetrical tension neck reflex posture and asymmetrical tension neck reflex posture. Asymmetrical tense neck reflex posture appears about 1 week after birth and is dominant for 2 to 3 months, and then gradually disappears under the control of the superior center.
2. Hemiplegic posture
The child often shows the movement of one limb and the disuse of the other limb, with obvious asymmetry of the left and right limbs.
3.Corsiflexion posture
The child shows increased muscle tone of the limbs and dorsiflexion of the head.
4.Dance-like tachycardia posture
The child exhibits involuntary movements, often in the form of dance or twisting, which appear uninterruptedly. The appearance of movement is continuous and loose, and the amplitude is large and uncontrollable.
5. Ataxic gait
The child has a drunken gait. They often cannot maintain a fixed posture and must constantly adjust when standing in order to maintain the standing posture.
6. Other
Recommendations for rehabilitation and education of cerebral palsy.
For ordinary children, education is nothing more than adding a little more knowledge or a little less knowledge, but for children with disabilities, education becomes a condition for them to adapt to life, from being unable to live to being able to live on their own, from being unable to live to being able to live. — Deng Pufang. This is more realistic for children with cerebral palsy, but most children with cerebral palsy can only stay at home, unable to go to school like children of the same age, and some children with severe cerebral palsy can even only spend time in bed, which is a very cruel fact. This fact is not unchangeable, because most children with cerebral palsy can still approach the level of normal people or reduce to moderate, unfortunately many children with cerebral palsy fail to get a better In the 21st century, in a very competitive society, if a normal child does not receive any education, he is bound to become a social invalid in the future, let alone a child with cerebral palsy who is in a very special situation. The author believes that most of the children with moderate cerebral palsy will not spend their time at home at least. Some children with cerebral palsy will feel helpless when they grow up and understand because they missed school when they were young, they can’t go to school and they can’t get a job, they can only spend their time in boredom. I think it is better to run a compulsory school specifically for children with cerebral palsy that parents can accept, because most parents do not want their children to go to ordinary schools for complicated reasons, so I think it is better to build a special school for cerebral palsy.
Cerebral palsy schools that combine rehabilitation therapy and education; since children with cerebral palsy need long-term rehabilitation therapy, but they cannot give up education because of rehabilitation therapy, it is very necessary to combine rehabilitation therapy and education, so that the rehabilitation value of each child with cerebral palsy can be enlarged to the maximum, while not affecting their learning and education. Kindergartens mainly focus on rehabilitation therapy, elementary schools use a combination of rehabilitation therapy and education, and junior high school general classes focus on coping with midterm exams and adapting to society and ordinary school life. The difference between regular classes and special classes is that the teaching materials are different, the quality index is different, and the promotion is different. Regular classes use the teaching materials of regular schools and focus on the promotion rate, while regular classes must cooperate with the current general education system and the promotion system. The special classes use the teaching materials of special education schools and focus on self-care ability and employment rate, etc. Junior high school graduates from special classes continue to receive vocational education or attend special education schools. Although the author is not in favor of special cerebral palsy schools, and this kind of segregated education has a great negative impact on the growth of children with cerebral palsy, the special nature of cerebral palsy is taken into consideration because cerebral palsy requires long-term treatment to reduce the damage of cerebral palsy to children from the maximum extent. The children who graduated from junior high school are older and have little rehabilitation value, and they will also go to society and face university life. Therefore, I think it is not necessary to run a special general high school department, and let them continue their education in ordinary schools to prepare for university and work in the future. However, considering the students who cannot receive general education, I think it is better to have a special vocational high school for special classes only. Because of the relatively short period of time to learn the test-taking curriculum, I think we should run a middle school exam review class, in order to prevent middle school graduates in the general class from having nothing to do at home because they failed the middle school exam and have no school to go to. The purpose of such a school is to help children with cerebral palsy return to normal school and have a normal life as much as possible, not to encourage them to separate from normal students and society. For example, when a child with cerebral palsy cannot write and cannot adapt to normal school study life, etc., after rehabilitation and training in a cerebral palsy school, he or she can adapt to normal school study life and then can choose to stay and continue to complete compulsory education or transfer to a normal They can choose to stay and complete their compulsory education or transfer to a regular school.
Cerebral palsy is detected at the age of zero.
Cerebral palsy is a non-progressive motor dysfunction that occurs before birth, or at birth, or after birth due to infection, and in severe cases is accompanied by mental retardation, convulsions, hearing and visual impairment, and abnormal behavior. Early detection and treatment can be extremely helpful for the future self-care of cerebral palsy patients.
How to detect early?
In the first month after birth: If the infant has stiffness of both lower limbs when lying supine, difficulty in passive flexion and abduction, head and neck extension, shoulder and arm retraction, and arm abduction …… these suggest parents to pay attention to cerebral palsy. Most infants with cerebral palsy do not show signs of spasticity in the neonatal period, but rather varying degrees of hypotonia.
After 3 months of age: If the child makes a fist with both hands, when the thumb is clenched in the palm of the hand, one hand can open while the other hand is clenched, and also shows difficulty in raising the head when in prone position, these can prompt attention to the presence of cerebral palsy. 6 months of age or less is the most difficult period to recognize cerebral palsy, and if there are signs, you should see a specialist immediately for examination.
After 7 or 8 months of age: Not being able to crawl or sit is the most common symptom in children with cerebral palsy.
At 1 year of age: If the child often uses one hand to reach for things and shows asymmetrical voluntary movements, this is a sign of cerebral palsy.
Methods of measuring muscle tone in pediatric cerebral palsy.
The motor impairment in children with cerebral palsy is caused by uncoordinated muscle contraction after brain injury, therefore, muscle strength determination is generally not appropriate. Instead, muscle tone determination is used. The determination of muscle tone can help to understand the degree of uncontrolled uncoordinated muscle contraction.
The measurement methods are as follows.
(1) Holding
By picking up the baby’s hand, the initial understanding of the child’s muscle tone can be obtained. If the infant has low muscle tone, it is difficult to pick up the infant, and there is a feeling of sinking, and the infant tends to slide down from the hands of the tester. The infant with spasticity will have a sense of tonicity and resistance when picked up.
(2) Posture observation
A normal infant over 3 months of age, if placed in the supine position, will lie down naturally and constantly move against gravity, freely maintaining a certain position and posture. In contrast, a child with hypotonia flaccid palsy, if placed in the supine position, often has flexion and abduction of the upper and lower extremities and lacks active movement. In spastic children with hypertonia, if they are placed in the supine position, they tend to have an asymmetrical abnormal posture with few active movements and seem to move in a stereotyped manner. The higher the muscle tone, the less active movement. The stronger the primitive reflex, the more severe the postural abnormality.
(3) Touch
The tester can feel the tension of the muscle tissue by touching the muscles of the upper and lower limbs of the child (biceps and triceps of the upper limbs, gastrocnemius and quadriceps of the lower limbs) with the hand. If the child has low muscle tone, then the hand feels soft and flaccid and is less resistant to finger pressure. If the muscle tone is normal, the hand feels moderately soft, firm and elastic when touched. If the muscle tone is high, the hand feels tense and has stronger resistance to finger pressure.
(4) Passive movement
If the test subject makes passive flexion and extension movements to the limb, if the muscle tone is low, the test subject will feel heavy, no resistance, and the limb has no self-control ability. If the muscle tone is high, the tester will feel obvious resistance, and this resistance is often greater at the beginning of the movement than at the end of the movement. A limb with normal muscle tone can make both resistance and synergy when making passive movements, and within a certain range, there is self-control. The tester’s hand feels neither heavy like a limb with low muscle tone, nor does it have great resistance like a limb with high muscle distension.
Methods of oral motor training for children with cerebral palsy
Oral sensory stimulation: using silicone finger cots and toothbrushes on the perioral area, lips, cheeks, tongue, gums, buccal mucosa and pharyngeal promontory, twice a day for 10 min. the purpose is to reduce oral hypersensitivity and increase oral sensation.
Oral-facial muscle group exercise: stimulate with ice or repeatedly tap the perioral and cheek muscles with fingertips twice a day for 5 min each time; if the child can cooperate, ask him/her to bite the incisors as hard as possible; open the mouth as wide as possible and then shut it, repeat 10 times; after the lips are closed tightly, open them suddenly, repeat 30 times a day. The purpose is to enhance the function and motor coordination of the orbicularis oris muscle, buccal muscle and occlusal muscle, reduce salivation, and enhance the oral control of the food group.
Tongue muscle motor training: Wrap the thumb and index finger with gauze, gently pinch the tongue body of the child, carry out left and right, up and down movements, then release the tongue body to restore its original position, repeatedly for 5 min each time, twice a day; use the tongue depressor to apply repeated pressure to the central part of the tongue, 20 times a day; if the child can cooperate with the training, he/she should be induced to extend the tongue, swing left and right laterally, lift and pop. The purpose is to increase the tongue’s ability to control the food mass and prevent it from passing through the mouth prematurely, which may lead to accidental aspiration before swallowing.
Swallowing training: Use a silicone toothbrush dipped in a little ice water to gently stimulate the soft palate, tongue root and posterior pharyngeal wall; use the thumb to apply pressure on the hyoid bone to induce swallowing action and improve swallowing strength for 5 min each time, twice a day. The purpose is to enhance the swallowing reflex and avoid the aspiration before swallowing caused by the weakened or delayed swallowing reflex.