Trainee reporter Wang Qiao chaotic rehabilitation market Speaking of pediatric cerebral palsy rehabilitation treatment status quo, China Disabled Person’s Rehabilitation Association of Chinese Medicine Rehabilitation Committee deputy director, pediatric cerebral palsy group leader, Henan Traditional Chinese Medicine College of Hospital pediatric cerebral diagnosis and treatment of rehabilitation center, director of the MaBingXiang a lot of feelings: “this market is too chaotic.” In addition to the previous interview advocated “early rehabilitation”, Ma Bingxiang this time more emphasis on “standardized, scientific rehabilitation”. The First Affiliated Hospital of Henan College of Traditional Chinese Medicine Pediatrics Ma Bingxiang “Many people think that moving limbs and doing massage is rehabilitation. Therefore, hanging the rehabilitation signboard of the small clinic more and more, they even dare to take pediatric cerebral palsy rehabilitation treatment. And the relatives of patients who are equally unaware of rehabilitation do not have a strong ability to recognize it, so they go around and bump into whichever one they want, which not only wastes money, but also delays the treatment.” Ma Bingxiang said. Rehabilitation, not everyone can do Ma Bingxiang once had a small patient called Dot, came to the rehabilitation center, Dot foot inversion, brain development behind. In the year-long rehabilitation treatment, Dot’s grandmother followed the therapist every day to learn to do massage for her grandson. To the experts’ surprise, after the child was discharged from the hospital, Dot Dot’s grandmother opened a “rehabilitation clinic” in her hometown Luyi County, using the techniques she learned from the hospital to give the children massages. These are still later Luyi County patients told Ma Bingxiang, the parents of the child said: “dot grandmother had done rehabilitation for my child, she said her grandson is so cured, but not for me.” This makes Ma Bingxiang cry, but also feel pain: “Rehabilitation therapy needs massage, but massage is not equal to all of the rehabilitation therapy.” Many people think of rehabilitation so simple, which makes Ma Bingxiang very helpless: “Rehabilitation does not only mean massage, rehabilitation is not anyone can do.” Ma Bingxiang introduction, and clinical medicine is different, rehabilitation is not a simple doctor and patient “one to one” mode, but the need for rehabilitation treatment team’s full participation. The team includes rehabilitation doctors and various therapists (including physical therapy, acupuncture, massage, etc.). The patient’s rehabilitation process includes: after admission to the hospital to have an initial assessment, and then based on the results of the assessment to develop an individualized treatment plan, by a number of therapists with the completion of the program, after a course of treatment (generally one month) and then assessed, according to the recovery of the next stage of the development of the treatment plan, and so on and so forth. Ma Bingxiang said: “The principle of cerebral palsy rehabilitation is ‘early, comprehensive, integrated rehabilitation based on motor rehabilitation’, which includes a variety of therapeutic means, and is not something that can be accomplished by massage.” The first step after admission is a detailed assessment, which is the basis of rehabilitation treatment. Only after finding out all the problems, can we carry out targeted training more effectively. Ma Bingxiang example: “a child can not sit up, there are many reasons, it may be the head can not lift up, or the waist has no strength, or may be the lower limbs of high muscle tone, balance ability is not good. Any one of these causes can result in an inability to sit up, and if the assessment isn’t done properly, there’s no way to develop a treatment plan.” Shanshan (a pseudonym), who lives in Kaifeng, has hemiplegia due to localized brain injury. When he came to the hospital, one side of his arm was bent, and the doctor couldn’t even pull it away. Ma Bingxiang found Shan Shan’s arm are needle eyes. Originally, just over two years old Shan Shan has been in the local hospital for more than a year of needles, “the doctor said which nervousness zapping which, has been in this part of the injection, playing closed.” Ma Bingxiang shook his head: “This is the wrong approach.” Ma Bingxiang explained: “If you lack professional knowledge and simply think ‘which tension zap which’ and keep sticking needles in the flexor muscle, you are actually constantly stimulating the flexor muscle. When the flexor muscle is stimulated, it will lead to muscle contraction, and the more stimulation, the more tension. The correct approach should be in the extensor muscle injection, extensor muscle contraction, flexor muscle is not pulled over it.” Many children have a similar treatment experience with Shan Shan, although every day in the treatment, because the main cause of the disease is not found, the treatment for a long time will not be effective. “The initial evaluation of rehabilitation, must be specific to which muscle.” Ma Bingxiang said. Drugs, not the more the better 5-year-old Xiaodong (a pseudonym) came to the hospital with limb movement disorders, intellectual and language development behind, is a typical cerebral palsy children. Xiao Dong’s condition has lasted for several years, and his parents have not taken him to the doctor since his family’s condition was not very good before. Now with the New Farmers’ Cooperative Program, Xiaodong has reached the age of going to school, and his parents think it’s time to treat their child. To the county hospital pediatrics, the hospital asked Xiaodong hospitalized, in fact, that hospital does not have a professional rehabilitation doctor and treatment facilities, the doctor said to Xiaodong parents: “brain disease should be cured brain, playing the most effective medicine nutritional nerve.” Since then more than a year, the doctor kept giving Xiaodong injections, infusions, tens of thousands of dollars spent in the blink of an eye, Xiaodong’s condition has not progressed at all. Listened to the parents of the story, Ma Bingxiang gas said: “The child this way, is another three years of injection is useless.” Ma Bingxiang said, many parents think that the more drugs for children the better. “Theoretically, patients with acute brain injury with nutritional nerve drugs will be more effective, and to be used by children within 1 year old.” “Many doctors will use some plausible-sounding reasons to convince parents to give their children medication, but in fact, after the child is two or three years old, the development of brain cells is basically mature, and at this time, the use of nutritive nerve medication no longer has any effect. At this time, the treatment should be based on sports rehabilitation, sports therapy to improve the role of the nerve is stronger than the role of drugs.” Ma Bingxiang explained: “For example, when moving the hand, the brain area that innervates the nerve of hand activity will be excited, thus stimulating the development of nerve cells, so that the function is perfected.” Surgery is not a panacea In pediatric cerebral palsy rehabilitation, many parents hold this idea: “When is the end of the child’s daily training? It’s better to do surgery and solve the problem at once.” Ma Bingxiang corrected: “In fact, the role of surgery only accounts for three points, seven points or rely on sports training.” Ma Bingxiang said, pediatric cerebral palsy rehabilitation surgery is mainly divided into three kinds of surgery: nerve surgery, muscle and tendon surgery, bone surgery. Several types of surgery have strict indications. Before the surgery, the patient must undergo a strict evaluation, but many hospitals are only responsible for doing the surgery, do not do the evaluation at all, as long as the patient wants to do it, in fact, some surgeries can not play a role at all. Most cerebral palsy surgeries require the child to be more than five or six years old, but Ma Bingxiang has seen the youngest patient who underwent surgery at only two years old. Huanhuan (a pseudonym) because of cerebral palsy led to pointed feet, parents held her everywhere to seek medical treatment, a claim to specialize in cerebral palsy children’s surgery hospital doctors told them: “do a tendon surgery, the child will be completely good.” The parents were so happy that they let Huanhuan have the surgery right away. After the surgery, the doctor didn’t have any more instructions, they thought Huanhuan’s disease was definitely cured, so they hugged Huanhuan and went home happily. But after half a year of recuperation at home, Huanhuan’s pointed foot is not only not cured, but more serious, and then rushed to find Ma Bingxiang. Ma Bingxiang explained that the doctor in the operation to cut the muscle tendon tension, but such a small child’s muscles are not fully developed, cut the place will grow again to live, and then later to do the treatment effect will be worse. In addition to being too young, the lack of rehabilitation after the surgery also contributed to the worsening of Huanhuan’s condition. “Surgery is only one aspect of cooperation with the treatment, if the child is 5 years old after muscle contracture, joint deformation, pointed foot is still very serious, just rely on sports training will not work, the effect will be very slow, need to cooperate with the surgery, but the surgery is mainly to alleviate the spasm, in order to improve the function, you must carry out postoperative rehabilitation training.” Clinically, Ma Bingxiang has seen many cases of failed surgeries, so he hopes that parents will not be superstitious about the role of surgery, but will go to the Pediatric Cerebral Palsy Rehabilitation Department of regular hospitals for treatment, so that professional doctors can develop individualized treatment plans for children with cerebral palsy. Rehabilitation doctors do rehabilitation for a child with cerebral palsy File photo of this newspaper