Training principles.
Relieving muscle tension and enhancing muscle strength is the essence of training. The specific approach is to stretch the tendons, loosen the muscles, move the joints, correct the deformed limbs with biomechanical methods to achieve a functional position, and then coordinate the motor functions so that the child can be fully rehabilitated.
(I) Scissor gait and training
1, the child supine position, using the pulling technique to passively flex the child’s legs, do hip flexion and extension: use the hip splitting method to stretch the adductor muscle group, reduce the tension, hold for a moment (this is important), repeated operations.
2, the use of straight-legged pressure sitting training, fixed double lower extremities 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 degrees not too large, normal people femoral angle is only 150 – 160 degrees, small 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) pulling 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 much as possible, and encourage the child to spread his legs apart.
(B) Training to relieve the lower limbs to stand and walk on bent knees
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
(C) training of knee dystocia
There are three reasons for “knee dystocia”.
1, bony changes in the knee joint itself, resulting in abnormal knee joint position.
2. poor control of the knee joint under weight-bearing conditions, as evidenced by loss of proprioception of the knee joint, laxity of the periarticular ligaments, weakness of the quadriceps and N cord muscles, or contraction of the normal ratio.
3. Hyperextension of the knee joint can also be caused by contracture of the soleus muscles or high muscle tone. The main cause of knee hyperextension in children with cerebral palsy is muscle hypertonia.
(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 correcting knee varus and coordinating gait has a greater effect.
Correction of “knee dystocia”, the main control of the lower extremity extensor movement, generally mild cases to exercise training to correct, the method is as follows: the affected knee kneeling position supported on the mattress, the affected side of the knee joint to do flexion and extension training, in order to coordinate movement, the two knees alternate flexion and extension training, with the improvement of symptoms, to supine or standing position for correction, severe cases of lower extremity correction or surgical correction.
(D) pointed foot, foot inversion, valgus training
1, self-pull method – the child to stand facing the wall, and then slowly forward lying, until the Achilles tendon at the feeling of pulling, but also can turn both toes to the outside (like Chaplin) to do the same action.
2.Foot dorsiflexor muscle training and sitting ankle training chair, antagonize the spastic calf muscle, increase the range of motion of the ankle joint, and correct the deformity.
3.Supine and prone position press knee and whole foot 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 in the movement, increasing the range of motion, restoring function and coordinating gait.
(E) 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, 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 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 the wrist with the other hand and flexes the elbow joint, 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) arm touch shoulder (bending brachial paddle), forked chest (fledgling practice flying) training.
2.Elbow flexion training
(1) active and passive elbow joint flexion and extension exercises.
(2) upper limb weight-bearing, elbow extension and grasp training.
(3) flexion and extension of the joint (picking basket), shoulder flexion and elbow flexion (force plucking a thousand pounds), shoulder and elbow flexion and extension (white ape offering fruit), hands up (holding fire to the sky).
3.Wrist and finger joint flexion, thumb inward training
(1) Passive wrist manipulation: the operator’s hands side by side at the lower end of the wrist joint, the 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 root to the end of the finger, alternating twisting method and finger holding method, and finally using the stroke method to close at the end of the batch, repeated operations.
(2) Palm grasping, holding each other with both hands, grasping with the palms upward. (Golden Dragon probing claws)
(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, palm-to-finger training, cross-training of hands. Hand function training follows the process from simple to complex, from easy to difficult, from coarse to fine.