Early training and rehabilitation of children with cerebral palsy is more effective. 6 months after birth is an important stage of brain development, when brain nerve cells increase in size, dendrites increase and lengthen, and nerve myelin is formed. At this time, the brain injury of cerebral palsy infants is in the primary stage, and the abnormal posture and movement are not yet fixed, so there is a greater reversibility, and the movement disorder can be easily recovered after treatment.
The infant’s motor development starts from top to bottom, first lifting the head and chest, and then two fetching objects, sitting, crawling, standing and walking, and the movements change from uncoordinated to coordinated and from coarse to fine. Therefore, for immature brain nerves, giving sufficient motor and sensory stimulation can promote brain cell development and myelin formation; early correction is very important to prevent secondary damage (joint contracture, limb deformation) in pediatric cerebral palsy.
How many aspects of rehabilitation training for children with cerebral palsy can be carried out?
1. Head control
You can use the prone position to train the ability to lift the head. Method: Have the child lie on his back, take a toy and stop it at the same height as his eyes, and raise it little by little in order to make the child look up at it. Every day at least 30 minutes prone, to about 10 minutes after meals is most appropriate.
2.Turn over and crawl method
Let the affected child lie on the floor, pull his clothes from behind to help him turn his shoulders and turn over; let him lie on his back, place a bath towel on his chest, lift both ends of the anti-towel, keep only his hands and knees on the floor, you slowly advance along the floor with him while encouraging him; one person help him move his arms, another person help alternately move his feet and help him crawl hard towards a certain goal. Recommended reading: Recognize the type of cerebral palsy, early diagnosis is good for treatment
3.Supporting the back to maintain the sitting posture
Sitting up with the support of his own arm, placing his favorite objects in front of him to attract his attention, in order to maintain a longer sitting posture, gradually reducing the support, and finally sitting alone.
4.Pulling objects to stand up
Adults can pull one hand of the child with cerebral palsy to induce him to move from the seat to a brittle posture with both legs, and then let him stand up again. When the child grabs the crib rails, parents can put both hands under his tuck to support standing, gradually reduce the help and let him keep balance by himself.
5.Walking
The key for children with cerebral palsy to learn to walk is to learn to move their body weight, start pulling both hands forward, gradually over pulling one hand, and finally reach their own walking alone; also available as a toddler sling.
6.Going up and down stairs
At first, let the child hold the railing with one hand and pull the big hand with the other hand to maintain balance, gradually let him get rid of the support of adults, rely on their own arm and leg strength, two steps a step, up and down the stairs. Older children should be encouraged to take one step at a time and alternate between two feet to go up and down the stairs, which can be practiced with music.
7.Jumping
Jumping is an important exercise for the lower femoral muscles, so practice squatting to prepare for jumping. Often pull the affected child’s hands to jump down from the steps, as a preparation for the explosive power of jumping on their own, hang some bright gauze and small toys (on the basis of the above two training) in the room for several children to jump together to touch and pat.
8.Balance coordination training
Choose a site or room without obstacles and let the child walk straight with eyes closed, walk on footprints, walk in a straight line, sit on a rocking horse, swing, ride a small tricycle, shoot a ball, catch a ball, roll on the ground under the protection of adults are good ways to practice balance and coordination movements.
9, fine motor training
Mainly to train the coordination of the hand and brain, improve the child’s manual ability and hand dexterity. The main training methods are grasping, pinching, holding objects or toys, to choose items suitable for children to play, from square, rectangular gradually transition to round. At the age of five or six, the patient is taught to learn to screw bottle caps, wind up toys, build blocks, hold a pencil and write and draw pictures, etc. to lay the foundation for later schooling and reading and improving life skills. Recommendations.
1) Rehabilitation physicians and parents should communicate more with their children and have more contact with the community to establish a communication platform between parents and rehabilitation physicians.
2) The right combination of education and rehabilitation training, let us understand cerebral palsy correctly. Children need education and rehabilitation, parents should understand the rehabilitation of pediatric cerebral palsy.
3) The rehabilitation physician instructs the parents to standardize the wrong techniques of some parents.
4) Give parents more opportunities to learn and improve themselves.
5) Take the child out more to contact the society, themselves and other children. This will train the child to better integrate into society.
Spastic cerebral palsy rehabilitation training
I. Scissor gait and training
1.With the child in the supine position, adopt the pulling technique to passively flex the child’s legs and do hip flexion and extension: adopt the hip shaking method and hip splitting method to stretch the adductor muscle group, reduce the tension and hold it for a moment (this is important), and repeat the operation.
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 at 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
”Knee dystocia” has three causes.
(1) Bone changes in the knee joint itself, resulting in abnormal knee joint position;
(2) Poor knee joint control under weight-bearing conditions, as evidenced by loss of knee joint proprioception, laxity of the periarticular ligaments, and weakness or non-contraction of the quadriceps and N-flexor muscles at normal ratios;
(3) Hyperextension of the knee joint can also be caused by contracture of the plantar flexors or high muscle tone. The main cause of knee dystocia in children with cerebral palsy is muscle hypertonia.
1.Pressing knee and whole foot method, ankle pulling method, ankle shaking method, plantar flexor pulling training.
2.Knee flexion and extension, foot dorsiflexion training, to improve the strength of the extensor muscles and coordinate the antagonistic muscle tone.
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 cord muscle to reduce the tension of the extensor muscle and coordinate the flexion and extension functions 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
1.Training of shoulder flexion, internal contraction and internal rotation
(1) In the flexion position, the child lies on his back, and the operator holds the forearm with one hand and slowly lifts it along the midline of the body until it is close to the ear, repeatedly.
(2) In the inversion position, the child is placed in the supine or sitting position, the upper arm is held in one hand and the forearm is held in the other hand, and the forearm is moved horizontally to 90° (abduction) with the palm of the hand facing upward and then continued to move up to the root of the ear.
(3) Internal rotation position, sitting or supine position, the operator presses the shoulder with one hand, holds his wrist with the other hand after flexing the elbow joint, and then does external rotation and downward pressure action, repeatedly.
(4) Upper limb weight training, dumbbell exercises, bar exercises, sandbag pulling training to increase upper limb muscle strength, expand the range of motion of the joint and restore motor function.
(5) Raise the arm and touch the shoulder (bending brachial paddle), fork the waist and chest (fledgling practice flying) training.
2.Elbow flexion training
(1) active, passive elbow flexion and extension movement.
(2) upper limb weight-bearing, elbow extension and grasping training.
(3) flexion and extension of the joint (picking a basket), shoulder flexion and elbow flexion (force a thousand pounds), shoulder and elbow flexion and extension (white ape offering fruit), hands up (raising fire to the sky).
3.Wrist and finger joint flexion, thumb inward training
(1) Passive wrist hand exercise: the operator’s hands side by side at the lower end of the wrist joint, two thumbs side by side on the dorsal side of the wrist, finger ends toward the forearm, the other four fingers resting on the palm of the hand, the child’s wrist to do flexion, extension, shaking, holding and other techniques, and then from the finger root to the end of the finger, using the twisting method and finger pulling method alternately, and finally using the stroking method at the end of the batch closing, repeated operations.
(2) palm grasp, hold each other with both hands, grasp with palms up. (Golden dragon tan claw)
(3) flexor grip (pencil grip) training, thumb-index fingertip pinch method (button, soybean, mung bean, hold a spoon, hold the key to open the door, etc.).
(4) wrist extension (dorsiflexion), flexion (palmar flexion), finger abduction, inward training (five fingers apart, together action).
4.Thumb induction training
Thumb induction, abduction, straightening training, thumb flexion, palmar, finger training, cross training. Hand function training follows the process from simple to complex, from easy to difficult, from gross to fine.
Hysteretic cerebral palsy rehabilitation training
Clinical experience in treating cerebral palsy over the years has confirmed that “treatment is the foundation, training is the key”. Training without treatment is either impossible or ineffective. On the contrary, treatment without training can neither consolidate its therapeutic effect nor achieve the expected effect. Treatment and training are twice as effective!
Depending on the location and dialectical treatment, we have formed our own set of training methods, the order of which is a head lift, two waist, three limbs, four gymnastics.
First, the training methods of the hand-footed type.
(head control training)
A, supine pull-up training
1, supine pull-up training, through the process of anti-gravity activities to increase the head control ability;
2, supine Bobath ball, rolling barrel on the gentle rolling to elicit the protective response of the child’s trunk flexion;
3.Supine position with a variety of toys to induce the child to turn his head left and right, to increase the child’s head control ability when free rotation;
4.Supine the child in a hammock, so that the child’s trunk and limbs are in a flexed position, in order to inhibit the coracoacusis due to the increased tension of the extensor muscles (influenced by the supine tense vagus reflex TLS).
Second, prone position training
1, prone on the wedge pillow, improve the head and neck anti-gravity extension up control and shoulder and double upper limb support ability. (Note: the hip joint remains in extension)
2.Lying prone on Babath ball, barrel, balance board, using the continuous change of center of gravity to induce protective stretching response to improve the ability of head and neck to lift up against gravity.
3.Crawling training, through the child’s active movement to increase the head control ability.
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 on 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 is in line with the midline 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) when the child is in sitting position, the head is in the midline when viewed laterally, does not tilt forward or backward, and is in line with the midline of the trunk.
IV. Training for abnormal limb movements and posture
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.
5, “walking three steps”, according to the current condition of the child choose to suspend the walker, walker belt, hand push walker application in turn, to improve muscle strength, correct muscle dystonia, coordination of motor function, and then, for the emergence of pointed foot, foot inversion, ectropion and other deformities to be corrected.
For older children with severe disease, the mixed type of children with mainly tardive dyskinesia, often due to the influence of the tonic labyrinth reflex (TLS), the child’s generalized spasticity is increasing in a vicious circle, while the influence of the asymmetric anisotropic neck tension reflex (ATNR), resulting in the phenomenon of partial rotation of the trunk and limbs, dorsal observation: one side of the muscle shortening, and trunk shortening. The pelvis on one side is lifted, the hip joint is flexed, inward and internally rotated, the upper limbs cannot be brought together in front of the chest, and at the same time, the head is tilted to one side, resulting in hypertrophy of the sternocleidomastoid muscle over time.
The operator uses manipulation or neck exercises to relax the spastic muscles, gradually make the child’s head control ability increase, correct scoliosis, relax the tense muscles, strengthen their antagonistic muscle strength, prevent more serious deformities, fully move the joints, pull the spastic upper limbs or lower limbs, inhibit involuntary tachycardia (can take the lower limbs fixed, upper limbs splint restraint), so as to achieve the inhibition of abnormal primitive reflexes, establish normal movement The purpose is to suppress abnormal primitive reflexes and establish normal movement patterns.
Rehabilitation training for mixed cerebral palsy
(Principle)
The training sequence should be based on the principles of head raising, waist raising, limb training and gymnastics. According to the different signs, the training should be carried out with reference to the methods of spastic type or hand-foot-movement type.
I. Ghost face training method
1.Temporomandibular joint training, the child passively (or actively) do 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.
Second, medical gymnastics (is the basic form and main measures of exercise therapy)
1, upper limb exercises (passive, active movement)
Preparatory posture: supine position, the operator faces the child, hold the child’s wrists with both hands, the operator’s thumbs are placed on the child’s wrists, 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 circular rotation exercise.
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 of knee and hip flexion exercise; the second section of double hip abduction exercise
The third section of internal and external rotation of the hip; the fourth section of flexion and extension of the knee;
The fifth section of ankle-holding and ankle-shaking exercises; the sixth section of flexion and extension of ankle exercises.
Scope of application: lower limb movement disorders in children with cerebral palsy of various types.
Many of the above rehabilitation exercises are professional operations, so it is recommended to operate under the guidance of professionals. It should also be reminded that rehabilitation is an indispensable treatment in the recovery of cerebral palsy. A detailed understanding of rehabilitation training will enable the patient to choose the most appropriate rehabilitation training for the child.