Children with cerebral palsy have poor self-quality. They are weak in resistance and are frail and sickly. Most of these children have difficulty in following the rehabilitation program. Therefore, they are more likely to have recurring illnesses, or the rehabilitation effect may be bad at times. For this type of children, parents should not only pay attention to increase the child’s nutrition, and training should also pay attention to the principle of moderation, each training time should not be too long, generally about 30 minutes to let the child rest appropriate time. So adhere to the exercise for a long time, the child’s physique will slowly get better. For such children, parents should not be in a hurry. As for children with epilepsy and other diseases, parents should pay attention to the above-mentioned issues, in addition to rehabilitation training, but also symptomatic treatment, not to lose sight of the other.
I. Training methods for spasticity
1, the child supine position, using pulling techniques to passively flex the child’s legs, do hip flexion and extension: using the hip shaking method, hip division method to stretch the adductor muscle group, reduce tension, hold for a moment (this is very important), repeated operations.
2, the use of straight legs with pressure sitting training, fixed double lower limbs outside the booth about 60 ° (if the high tension of the adductor muscle can also be expanded to 75 degrees, but do not be afraid of degrees should not be too large, normal people femoral angle is also 150 – 160 degrees, small month-old children even smaller), in order to pull the spastic muscle, reduce muscle tension, this is static training.
3, heavy hammer hip training chair, the child’s lower extremities to do abduction – abduction – abduction training, in the movement of the same time to achieve the purpose of pulling the muscles, activity of the hip joint, this is dynamic training.
4, “horseback riding” training, (using barrels, wooden horses, wooden chairs, etc. can be) pull the spastic muscles, reduce tension, restore function.
5.”Climbing” and “crawling” training, (using the frog position, that is, the legs as far as possible outward).
6.The child holds the bar and walks sideways, gradually relieving the spasm with its active movement, expanding the range of motion of the joints, achieving proficiency in the splitting and closing of the lower limbs and correcting the scissor gait.
7.Place a pillow or other soft object between the legs of the child at rest, with the toes facing outward as far as possible, and encourage the child to separate his legs.
Second, to relieve the lower extremities bent knee standing, walking training
1.Use supine or prone position to press the knee and whole foot method, or straight leg elevation method to pull the contracted tendons and relieve the spastic muscles.
2.Standing bending and picking up training, pulling the spastic state cord muscle group to relieve tension, while enhancing the strength of the lumbar muscles.
3.Lunge down, knee extension, quadriceps training chair application, improve quadriceps muscle strength, antagonize the spastic N rope muscle group, improve the knee joint autonomic control ability.
4, double bar a ladder and standing knee training, improve the ability of the knee joint independent flexion and extension, the role of coordination of limb movement function.
5, power car, toddler training, improve the function of active movement of the lower limbs, increase the range of motion of the joint.
Third, the training of knee dystocia
1.Pressing knee whole foot method, ankle pulling method, ankle shaking method, bottom flexor pulling training.
2.Knee flexion and extension, foot dorsiflexion training, improve the strength of the extensor muscles, coordination of antagonistic muscle tension.
3.Crawling training, knee flexion position, is conducive to correcting antalgia, while increasing the control of knee movement and coordinating its motor function.
4.Improve the strength of the national rope muscle to reduce the tension of the extensor muscle and coordinate the flexion and extension function of the joint.
5.Up and down step training, for the correction of knee varus and coordination of gait has a greater role.
Correction of “knee dystocia”, the main control of the lower extremity extensor movement, generally mild cases to exercise training correction, the method is as follows: the affected knee kneeling position supported on the mattress, the affected knee to do flexion and extension training, in order to coordinate movement, the two knees alternate flexion and extension training, with the improvement of symptoms, into supine or standing position for correction, severe cases of lower extremity correction or surgical correction.
Fourth, the pointed foot, foot inversion, valgus training
1, self-pulling method – the child to stand facing the wall, and then slowly forward lying until the Achilles tendon at the feeling of pulling, can also turn the toes to the outside (like Chaplin) to do the same action.
2.Foot dorsiflexor muscle strength training and sitting ankle training chair, antagonize the spastic calf muscle, increase the range of motion of the ankle joint, correct the deformity.
3.Supine and prone position knee compression method, ankle pulling and ankle shaking method to correct the deformity. Application of internal and external rotation trigger.
4.Up and down steps and running car training, stretching the spastic muscles during exercise, increasing the range of motion, restoring function and coordinating gait.
V. Training of upper limbs and hand function
(a) Shoulder flexion, internal contraction, internal rotation training
1. Lie prone on a wedge-shaped pillow to improve the head and neck’s ability to control gravitational stretching and lifting, and the ability to support the shoulders and both upper limbs. (Note: keep the hip joint in extension)
2.Lying prone on Babath ball, rolling barrel, balance board, using the continuous change of center of gravity to induce protective stretching response to improve the head and neck anti-gravity lifting ability.
3.Crawling training, through the child’s active movement to increase the head control ability.
(B) Prone position training
1. Prone on the wedge pillow to improve the control of head and neck gravity stretching upward and the support ability of shoulders and upper limbs. (Note: the hip joint remains in extension)
2.Lying prone on Babath ball, rolling barrel, balance board, using the continuous change of center of gravity to induce protective stretching response to improve the head and neck anti-gravity lifting ability.
3. Crawling training, through the child’s active movement to increase the head control ability.
(C) Sitting training
1.Sit cross-legged, long sitting position to increase the child’s head control ability, and improve the lumbar strength and sitting balance training.
2.The child rides across the mother’s chest, mother and child face to face head control training (Note: mother and child should look at each other), and at the same time improve the emotional communication between mother and child.
3.Adopt the neck exercise to regulate the muscle tone of the neck and increase the strength of the neck muscles to enhance the neck control ability. (Specific method: the operator’s hands lightly support the child’s double mandibular surface, do head flexion, extension, lateral flexion, lateral rotation and ring rotation to adjust the tension of the neck muscle group).
4, can also be used to walk with a toddler, in the process of walking the child, gradually self-adjustment of abnormal tension, restore muscle strength, to achieve the purpose of increased control.
Finally, in practice, whether the head is on the symmetrical midline is measured according to the following three methods.
(1) When the child looks upward in supine, the head does not turn to the sides and remains in line with the median line of the trunk.
(2) When the child is in prone position (e.g., wedge pillow, Bobath ball, rolling barrel), the head and body are in a straight line;
(3) In the seated position, the child’s head is in the middle in the lateral view, not tilted forward and backward, in line with the midline of the trunk.
(D), the training of limb movements and postural abnormalities
Based on the principle of “improve muscle strength, reduce muscle tone, and suppress abnormal primitive reflexes”, and combined with the actual condition of the child, adopt the corresponding training methods.
1.Apply ladder back frame, strip bed, square stool to train the child to maintain the symmetrical posture in the midline position when sitting, lying, kneeling, standing and walking, so as to suppress involuntary tachycardia and strengthen the establishment of their own normal movement patterns.
2, step machine, power car, quadriceps training chair use, has increased lower limb muscle strength, reduce abnormal muscle tone, inhibit involuntary movements, strengthen the role of normal movement patterns.
3, double bar a step training, coordination of limb incomplete muscle tone and motor function.
4.Training of upper limbs and hands for gross and fine movements, with the effect of strengthening hand and glance coordination, suppressing abnormal patterns and involuntary movements, and restoring the motor functions of upper limbs and hands.
According to the current condition of the child, we can use the suspension walker, walker belt and push walker to improve the muscle strength, correct the muscle dystonia and coordinate the motor function, and then correct the deformities such as pointed foot, foot inversion and exotropia.
Training routines for mixed cerebral palsy
(A) Ghost face training method
1.Temporomandibular joint training, the child passively (or actively) does mandibular lifting, descending, forward, backward and lateral movements to coordinate facial muscle tension, enhance joint flexibility and restore function.
2.Facial expression muscle training
(1)Do the action of baring teeth and chewing bubble gum to exercise the coordination of facial muscles.
(2) Manipulate and knead the facial muscles by pointing and rubbing the relevant acupuncture points (draping root, hearing, cataract, dicang and Chengjiao points) to regulate the muscle tension.
(3) Practicing mouth shape, pronunciation, blowing up balloons, etc. in front of the mirror.
(2) Medical gymnastics (is the basic form and main measure of exercise therapy)
1, upper limb exercises (passive, active movement)
Preparatory posture: supine position, the operator faces the child, holding the child’s wrists with both hands, the operator’s thumbs are placed on the child’s wrists, and the operator’s thumbs are placed on the child’s palms. Place his or her arms on the side of the body. The first section of chest expansion exercise; the second section of stretching exercise;
The third section is flexion of the elbow; the fourth section is rotation of the ring. Scope of application: children with cerebral palsy whose upper limb joint movement is limited.
2.Lower limb exercises (passive and active exercises)
Prepared position: supine position with both lower limbs straight, the operator holds both ankles of the child with both hands. The first section is flexion of knee and hip; the second section is abduction of both hips; the third section is internal and external rotation of hip; the fourth section is flexion and extension of knee;
Section 5: Ankle-holding and ankle-shaking exercises; Section 6: Flexion and extension of ankle exercises. Scope of application: lower limb movement disorders in children with cerebral palsy of various types.
The principle of training method for spastic type: relieving muscle tension and enhancing muscle strength is the basis of training. The specific methods are to stretch the tendons, loosen the muscles, move the joints, correct the deformed limbs with biomechanical methods, bring them to a functional position, and then coordinate the motor functions so that the child can be fully rehabilitated.