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 one without the other.
I. Scissor gait and training
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, split hip 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 high tension of the adductor muscle can also be expanded to 75 degrees, but do not be afraid of the degree 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
There are three reasons for “knee dystocia”: (1) bony changes in the knee joint itself, resulting in abnormal knee position; (2) weight-bearing conditions, poor control of the knee joint, as evidenced by the loss of knee proprioception, ligamentous laxity around the joint, quadriceps and N cord muscle strength is weak or does not contract in the normal ratio; (3) bottom flexor contracture or muscle (3) Hyperextension of the knee joint can also occur with high tension. The main cause of knee dystocia in children with cerebral palsy is dystonia.
1.Knee compression, ankle pulling, ankle shaking, and 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 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
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, increase upper limb muscle strength, expand the range of motion of the joint, and restore motor function.
2, prone on the wedge pillow, improve the head and neck anti-gravity stretching and lifting control ability and shoulder and double upper limb support ability. (Note: keep the hip joint in extension)
3.Lying prone on Babath ball, rolling barrel, balance board, using the continuous change of the center of gravity to induce protective stretching response to improve the head and neck anti-gravity lifting ability.
4.Crawling training, through the child’s active movement to increase the head control ability.
Prone position training
1. Prone on the wedge pillow to improve the control ability of the head and neck to lift up against gravity and the support ability of the 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 the 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.
VII. 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 trunk midline: (2) when the child is in prone position (e.g., cuneiform 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 trunk midline.
Eight, 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.
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 tone, coordination of motor function, and then, for the emergence of pointed foot, foot inversion, ectropion and other deformities to be corrected.
Nine, 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.
Ten, 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, 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.