Training of knee hyperextension (knee dystocia) in children with cerebral palsy

  1, Achilles tendon pulling training: child supine or long sitting position, parents hold the child’s ankle with one hand, the other hand palm under the child’s heel, then hold the heel, let the child’s foot against the forearm, pull upward along the horizontal direction with force. Note that the palm of the ankle should be fixed in a good position, and the whole foot should not be pulled up; also note that the force we use is mainly to pull the Achilles tendon, not to press the palm of the foot, otherwise it will easily lead to the destruction of the arch of the child’s foot. Each pulling time can last 1 to 3 minutes, and the number of pulls depends on the degree of plantar flexor contracture of the child.  2, use both hands to help the child or let him hold the bed rails or table and other objects, slowly squatting down Note that when doing this action, the body can not bend, knees try to move forward, the heel can not leave the ground. You can also let the child stand triangular plate, each pulling time can last 1-3 minutes.  3, improve the muscle strength of the front thigh group: the child in a long sitting position, do knee extension training, such as a towel roll placed under his knee joint, so that the knee joint from the bed or a certain distance from the ground. Then, have the child press the knee joint downward, hook the toe, and tense the thigh after 6 to 10 seconds, then relax. This can also be done in a seated position. Have the child sit on the edge of a chair or bed, hold the edge of the chair or bed with both hands, kick the foot straight for 6 to lO seconds, and then put it down. You can also have the child bend the knee and hip first, and we apply the block at the ankle of the calf, and then order him to straighten the leg to improve the muscle strength of the anterior thigh group. Or use the quadriceps trainer for training.  4, improve thigh, posterior group muscle strength training: let the child in a prone position, parents with one hand fixed his thigh, with the other hand holding the child’s ankle, help the child do flexion and extension of the knee action. When the child is able to perform this movement on his or her own, the parent can use both hands to hold the child’s hips to prevent them from buckling during forceful knee flexion. Likewise, parents can use their hands or other heavy objects such as sandbags tied to the ankle as resistance for this training.  5.Improve dorsiflexor strength training: This training is especially important for children who have hyperextended knees due to plantar flexor contracture or high tension. Let the child is in a long sitting position, force to hook the toes upward, or use a rubber band or make a rubber band, set on both feet, one foot downward, one foot upward hook.  In addition to the above-mentioned training methods, in order to increase the interest, parents can also use colorful cloth sewn several sandbags of varying weights, so that the child try to pick up with the toes and put not far from the basin, which can also achieve the purpose of training.  6, knee joint control training: parents face the child, let the child put his hands on the shoulders of parents, parents put their hands on the outer side of the child’s knee joint, help the child control the knee joint activities. Then put the child in an upright position, slowly squat down and then slowly stand up. Note that the knee should be in a normal position when the child is upright and should not be overextended. The magnitude of the squat should be determined by the child’s ability to control the knee joint. Generally, the child should move from small to large amplitude and from double to single leg.