The incidence of cerebral palsy in China is about 1.8%-4%. With the development of rehabilitation medicine, the treatment of pediatric cerebral palsy is gradually accepted by everyone, and the earlier the treatment, the better the effect. However, for various reasons, many children are misdiagnosed and underdiagnosed, and the best time for early rehabilitation is lost, so it is important to improve the early diagnosis rate of pediatric cerebral palsy. Because the brain tissue of newborns from 0 to 6 months old is not yet mature, and they are in the stage of rapid growth and development, their brain injury is also in the early stage, abnormal posture and movement disorders are not yet fixed, and the brain plasticity is large, compensatory ability is high and recovery ability is strong in this period. Early diagnosis, early treatment and early intervention can improve the recovery rate of cerebral palsy children, reduce the disability rate and improve the quality of survival of cerebral palsy children.
Cerebral palsy is a syndrome caused by non-progressive brain injury and developmental defects from conception to infancy, mainly manifested as motor impairment and postural abnormalities. It is clear from the definition of cerebral palsy that the main impairment of cerebral palsy is motor dysfunction and postural abnormalities of the limbs, which is known as paresis. In addition to paralysis, cerebral palsy is often combined with other disorders such as intellectual and psychological disorders, which gradually manifest themselves as the months and years go by. Therefore, a certain amount of time is often required to establish a diagnosis. Therefore, the children who are the target of early rehabilitation are not necessarily children with cerebral palsy with a definite diagnosis, but mostly infants and toddlers who may develop cerebral palsy in the future. It can also be said that the meaning of early diagnosis is not necessarily a definite diagnosis of cerebral palsy, but a judgment of whether they should be the target of early rehabilitation.
The diagnosis within 3 months after birth is generally called ultra-early diagnosis; the diagnosis within 6 months (or within 9 months) is called early diagnosis.
Cerebral palsy can be detected early by the following tests.
1. inability to support the body with the hands in the prone position
2. unstable sitting position without protective stretch reflexes
3. extension of both lower limbs in the inverted position.
4. positive asymmetric tension neck reflex (ATNR).
5, delayed disappearance of the grip reflex.
6. delayed disappearance of the cross-extension reflex.
7, strong startle reflex.
8, positive stepping reflex.
Early diagnosis based on.
High-risk factors; poor motor development, little active movement; abnormal posture; abnormal reflexes; abnormal muscle tone. The diagnosis is mainly based on medical history and physical examination combined with cranial CT or MRI, EEG, somatosensory evoked potentials and other comprehensive examinations.
The diagnosis is easily misdiagnosed due to the lack of sufficient knowledge of cerebral palsy among doctors, neglect of high-risk history, complex clinical manifestations and lack of specific diagnostic indicators in early cerebral palsy, lack of detailed medical history and comprehensive examination, and failure to reasonably rely on auxiliary examinations. In particular, the lack of specificity of early symptoms and atypical clinical manifestations in children before 6 months of age are particularly likely to cause misdiagnosis.
Therefore, the diagnosis of early cerebral palsy should pay attention to the following points.
1. the presence or absence of high-risk factors during the perinatal and neonatal periods
2. the presence of symptoms such as easy startling, abnormal crying, difficulty in breastfeeding, reduced spontaneous movements, and delayed regression of jaundice during the neonatal period
3. whether motor development is lagging.
4. the presence or absence of abnormal reflexes
5, the presence of abnormal posture.
6. the presence of abnormal muscle tone.
In 70% to 80% of the misdiagnosed children, rickets was misdiagnosed. However, primary care physicians are not sufficiently aware of the possibility of cerebral palsy in children with high-risk factors, and parents lack knowledge in this area, so these high-risk children are not regularly reviewed and followed up, and the opportunity for early treatment is lost. Therefore, children with high-risk factors should be followed up regularly, once a month, in order to achieve early detection, early diagnosis and early treatment.
Once a child with cerebral palsy is diagnosed early, the efficiency of timely rehabilitation treatment can reach 100%. Treatment is based on functional training, supplemented by drugs, acupuncture and massage. Vojta induction therapy or acupressure, reflex rolling and belly crawling are especially important for small infants, and young children can practice with climbing ladders, inclined boards, standing frames, etc. Those with obvious spasticity can increase the Ueda method to reduce spasticity with manipulation training of upper and lower limbs and shoulder pelvis. Massage and functional exercise should be carried out continuously. Acupuncture mainly uses head acupuncture and stimulates motor and sensory areas. Necessary medication such as ganglioglycerides, nerve growth factor and compound salvia can help improve microcirculation and promote brain cell metabolism. Early treatment and functional training for children with cerebral palsy is one of the most critical factors in determining future development and prognosis. Treatment of comorbidities such as visual and hearing impairment should be carried out at the same time. For those with combined epilepsy or those with epileptiform discharges on EEG, long-term regular anti-epileptic drugs should be insisted on, as convulsive seizures can aggravate brain damage.
For children who already have high-risk factors, since infancy is the period with the fastest brain development, the strongest brain plasticity and the strongest compensatory brain function, early intervention and early rehabilitation to effectively prevent and treat cerebral palsy is the key to protect the health of high-risk children and reduce disability.