1.Head control training
This training can enhance the child’s ability to self-control his head and prepare him to improve his function and complete daily life activities. During the training, the child should try to complete the head lifting action on his own initiative, and the trainer should give appropriate help, or use toys or objects of interest to the child to induce head lifting. Head raising training should be done alternately in prone, supine and sitting positions.
(1) Prone head raising training
The child supports his or her body with the forearms. The trainer is located in front of the child’s head and attracts the child with brightly colored, light-emitting or sound-emitting toys, while saying to the child: “Lift your head, lift your head”. If the child does not raise his or her head voluntarily, the trainer can use his or her fingers to tap the back of the child’s neck to induce him or her to raise his or her head. The child is placed prone on a wedge-shaped cushion or pillow, with the higher side under the chest. The child’s legs are straight and the hands are extended forward. Place a toy in front of or above the child’s head and encourage the child to look up at the toy and reach out to grasp it.
(2) Supine head raising training
The child’s lower limbs are flexed and the head and torso are positioned correctly. The trainer holds the child’s elbow with both hands and slowly pulls the child up, stopping when the child’s head is slightly tilted back.
(3) Sitting head control training
The child’s legs are spread apart and the child sits on the trainer’s lap. The trainer faces the child and sits with legs flexed. Through games with the child, the child practices head lifting, head lowering and head turning.
2.Turn over training
Through a variety of methods to train the child to turn over, can expand the child’s range of motion, ready for crawling.
(1) Turning training driven by the lower limbs
The child is lying on his back, and his limbs are naturally relaxed. The trainer is located under the child’s feet, crosses his hands, holds the child’s ankles, and assists the child to turn his body into a lateral position with both lower limbs, and says: “Turn over”. The child is lying prone with both upper limbs extended to the front of the head. The trainer holds the child’s ankles with both hands and assists the child to turn the body to supine position with both lower limbs and says “turn over” at the same time.
(2) Turn over training by the upper limbs
The child is placed in a supine position with all limbs naturally relaxed. The trainer is located above the child’s head and induces the head to turn to the side to be turned. Hold the child’s wrists and shoulders with both hands, assist the child to turn his body into a lateral or prone position with the upper limbs, and say: “turn over” at the same time.
(3) Use toys to attract turning training
The child is lying on his back. The trainer uses brightly colored toys that make sounds or light up to attract the child to turn his head and reach out to grab the toy to induce him to turn over. At the same time say: “turn your head, reach out and grasp, turn over”.
3.Sitting training
This training can improve the child’s ability to maintain sitting and sitting balance, so that the child can complete activities such as eating, communication and learning while sitting. When training, let the child set his head as straight as possible, straighten his back, and keep playing with toys and other activities in a sitting position.
(1) Training to correct abnormal sitting posture
The child is placed in a sitting position with both lower limbs separated. The trainer sits opposite the child and gently presses the child’s knees with both legs to stretch the lower limbs. The trainer holds the child’s elbow joints with both hands and makes the child raise his head, straighten his back and maintain the sitting position. Be careful to avoid abnormal sitting position. The trainer should pay attention to avoid excessive pulling force, which may cause subluxation of the child’s shoulder joint.
(2) Chair sitting training
The child sits on a high-backed chair with legs separated by a cloth pad and feet on the pedals. A small table is placed in front of the child’s chest and some toys can be placed on the table so that the child can move his hands freely on the table. This training is suitable for children with severe tardive dyskinesia or children under the age of 1 year.
(3) Sitting training
This training is suitable for children with lower limb muscle spasm inversion. The child is placed in a sitting position, with both lower limbs separated, and rides on a bench or training roller. Both feet are placed on the ground and leveled. Stretch out both hands and hold the stool surface lightly to maintain the sitting position.
(4) Sitting balance training
Sit the child on a stool without a backrest, with legs slightly apart and feet flat on the ground to sit firmly. Make the child lift up the object and rotate the body.
4.Crawling training
By training the child to crawl, the child’s ability to control the body and limbs can be improved, and the child can move around in a wider range, while laying a good foundation for standing and walking.
(1) Assisted knee crawling training
The child supports his body with his hands and knees, and both upper limbs are straightened. The trainer uses both hands to hold the back of the child’s knees and help him/her practice crawling.
(2) Assisted hip crawling training
The child supports his body on his hands and knees. The trainer lifts the child’s hip and helps the child practice crawling.
(3) Assisted ankle crawling training
The trainer is located behind the child and holds the child’s ankle with both hands. The trainer induces the child to move forward, causing the child to extend one hand first and then move the contralateral lower limb forward immediately afterwards. The left and right limbs were alternated for training.
(4) Autonomous crawling training
Use toys to attract the child to crawl on his own.
5.Standing training
This training can prolong the standing time of the child, improve the standing balance, promote the development of hip joint and prepare for walking.
(1) Stand training with the aid of apparatus
Use a belt to fix the child’s waist properly. Use a mat to separate the child’s legs, shoulder-width apart, with the feet flat, to maintain the standing position. Put a table in front of the child’s chest, and let the child play with toys on the table to improve the weight-bearing ability of both lower limbs.
(2) Standing stability training
The child stands with both hands on the table and both feet flat. The trainer is located behind the child and holds both sides of the child’s pelvis with both hands to keep him/her standing and stable.
(3) Standing in the parallel bar training
The child stands inside the parallel bars and holds the bars with both hands to keep standing.
(4) Stand-up training from a sitting position
The trainer is located in front of the child and holds the child’s knee joint with both hands. Let the child repeatedly stand up from a sitting position and practice the posture change from sitting to standing.
6.Walking training
Walking is very important for the child to build self-confidence and participate in various activities. This training can improve the child’s ability to control the trunk and lower limbs in walking, so as to gradually expand his range of motion and increase the opportunity to contact with the outside world. The abnormal gait of the child should be corrected and safety should be paid attention to during the training.
(1) Walking training in parallel bars
The child stands in the parallel bars and holds the bars with both hands. The trainer is located behind the child and holds the knee and ankle joint of the child with both hands. The trainer has the child’s other leg bend at the knee, lift it up, and then land heel-first and palm-back on the ground. The child stands inside the parallel bars and holds the bars with each hand. The trainer is positioned behind the child with his or her body close to the child. The trainer pushes the child’s legs with his or her legs to make him or her walk forward.
(2) Training with a walking aid
Children with foot drop should practice walking after wearing a calf orthosis. The child should walk independently with his hands on the walker. The training personnel should be around the child to protect him/her from danger.
(3) Guided walking training
The trainer stands on the side of the child, pulls the child’s arm and induces the child to practice walking.
7.Up and down step training
This training can improve the child’s walking ability and motor coordination ability, which is of great practical significance for adapting to family, school and social life.
(1) Step training
In the balance bar, practice walking across the wooden blocks of different heights to improve walking ability.
(2) Assisted step-up and step-down training
When going up the steps, trainers hold the child’s hips and shoulders with both hands from the rear to help the child practice, and gradually reduce the help during training until the child can go up the steps independently. When going down the steps, the trainer holds the child’s hips and knees from the front to help the child practice.
(3) Using pull ring to guide up and down the steps training
The trainer is in front of the child and uses the pull ring to guide the child up and down the steps.
(4) Independent step-up and step-down training
Children with better trunk control and more comfortable movement of upper and lower limbs can go up and down the steps with one hand holding the handrail of the stairs. When the child goes up and down the steps independently, the child should also be protected, and the trainer should stand behind when the child goes up the steps, and the trainer should stand in front when the child goes down the steps.
8.Balance and coordination exercise training
Balance and coordination are the prerequisite for stable movement. Balance board, ball, roller and other apparatus can be used for training. Through training, the child can be prompted to adjust his posture, improve his reaction ability and ability to control his head, neck, trunk and balance and coordinate movement.
(1) Training on a therapy ball
The child sits on a therapy ball. The trainer holds the child’s body with both hands and gently rolls the ball to the left, right, front and back, shaking the ball to the extent that the child can remain seated to prevent the child from falling.
(2) Training on the balance board
The child stands on the balance board with both feet apart. The trainer holds the child’s hips on both sides and helps him/her to shift the body weight between the feet.
(3) Training on the roller
The child is lying prone on the roller with his or her arms outstretched in front of him or her. The trainer slowly moves the roller to make the child move with the roller, when the child’s palms can touch the ground mat.
(4) Throwing ball training
The child should stand with both limbs properly separated, lift the ball up with both hands and throw it to the ground, and catch it when it bounces.
9.Eating training
The child should be encouraged to eat independently, which is very beneficial to improve the dexterity of the child’s hands and the motor ability of the upper limbs. For children with good swallowing function, feeding training is best done in the sitting position. Children with poor hand grasping ability can eat with assistive devices.
(1) Semi-recumbent feeding training
The child is placed in a semi-recumbent position with legs apart. The child is allowed to eat with both hands while the trainer gives appropriate assistance. The trainer should pay attention to avoid choking and coughing when the child eats to ensure safe swallowing.
(2) Sitting feeding training
If the child is unstable in sitting position, use a strap to fix the body. The trainer puts the child’s palm downward and fixes it on the table, and assists the child to grasp the sheet spoon with the other hand to eat.
(3) Feeding training with aids
For children with difficulty in grasping, the spoon handle can be thickened, and the thickness of the spoon handle should be as thick as the child can hold firmly.
(4) Drinking training with special cups
The child can use a double-handled cup to drink water and train the child’s hands to coordinate and complete the movement.
10.Dressing and undressing training
This training is to enable the child to gradually dress and undress himself and improve his self-care ability.
(1) Choose suitable clothes
In order to facilitate the child’s own dressing and undressing, you should choose clothes with wide cuffs and collars, preferably without buttons and zippers, and with Velcro instead.
(2) Prone position dressing training
The trainer will lay the child with severe spasticity prone on his or her legs. Help the child to dress the more impaired side of the limb first, then the other side.
(3) Rear-assisted dressing training
For children with unstable sitting, the trainer should fix the child’s body and both lower limbs from the rear to keep the child in a stable sitting position. When dressing, put on the limb with the heavier obstacle first. When undressing, the limb with the lighter obstacle should be undressed first.
(4) Dressing training in sitting position
The child sits on a stool. The trainer should keep the child’s body stable to prevent the child from slipping off the chair.
11. Washing and toileting training
The child should be taught to perform daily personal hygiene activities, such as brushing teeth, washing, post-poo handling and bowel control as early as possible to improve his or her self-care ability.
(1) Tooth brushing training
The child should hold the toothbrush handle. The trainer holds the child’s arm and assists him/her to brush his teeth up and down.
(2) Face washing training
Put the bristles on the child’s hand in sets and wash the face.
(3) Potty training
Children with unstable sitting position can use a toilet seat with a backrest.
(4) Safe toileting
A handrail should be provided near the toilet seat for the child to clean and put on and take off pants after defecation.
12. Communication and participation in group activities
Children with cerebral palsy should be encouraged to play with other children, participate in group activities, get to know their surroundings, use public facilities and learn more knowledge, so as to train them to form a healthy personality and better integrate into social life.
(1) Expressing wishes with pictures
Children who have difficulty in expressing themselves verbally can express their wishes by pointing to pictures or using gestures.
(2) Participate in group games
Encourage the child to play with other children and communicate with others in the game.
(3) Get to know the environment
Take the child out of the home, get to know the environment around the community, and learn about life in general.
(4) Receive education
Create conditions for the child to attend kindergarten and school in time to receive education.