Reflexive inhibitory maneuvers include: reflexive inhibitory stretching posture maneuver and reflexive inhibitory flexion posture maneuver. 1. Reflex inhibition stretching postural maneuver: Indications: suitable for children with cerebral palsy and spastic cerebral palsy with dorsiflexion of the head, obvious stretching postures of the whole body, or asymmetric tense cervical reflexes, and in severe cases, angular reflexes. Inhibitory maneuver: The child is naturally supine, and the trainer sits on his/her knees below the child’s feet and uses one hand to flex the lower limb of the back side of the head on the abdomen, and then flex the lower limb of the front side of the head on the child’s abdomen, so that the child’s two lower limbs are flexed and fixed in front of the trainer’s chest (Fig. 22-4, A). The trainer then holds the child’s hands with both hands and fixes them on the child’s chest after internal retraction and internal rotation. Then the trainer lifts the child’s head with one hand and fixes the child’s hands with the other hand, so that the child sits in a seated position on the trainer’s thighs bilaterally with the child’s head flexed forward and the knees and hips flexed to form a state of total body flexion, and the trainer then stretches the lower limbs bilaterally and abducts them so that the angle of the femur gradually expands. The trainer presses the child’s feet on the extended and abducted legs, holds the child’s thumbs with both hands, and makes the child’s upper limbs flex, extend, upward, downward, and adjusts the head position, so that the head is adjusted to an upright neutral position. The above is the basic technique of reflexive inhibition of the whole body stretching posture, which inhibits the stretching posture and at the same time promotes the flexion posture, so that the whole body stretching or anomalies of the coracoid process are corrected, Bobath said that this kind of inhibition of stretching posture is the basic technique. Bobath said that this kind of inhibition of extension, due to the head, neck trunk forward flexion, upper limb internal rotation fixed in front of the chest, flexion of the medulla oblongata, flexion of the knees, similar to the spherical, so it is known as holding the ball posture, this posture can inhibit the whole body stretching, promote the flexion, maintain symmetrical posture, which is conducive to the formation of the functional movements of the upper limbs. 2.Reflexive inhibition of flexion posture manipulation: Indications: This manipulation is used in patients with cerebral palsy with generalized flexion posture, or in patients with the child’s head flexed forward, spine curved into an arched dorsum, or affected by the tense labyrinthine reflex (TLR), with the hip high and the head low, and with the spine not fully extended. Inhibitory maneuver: First, make the child prone position, both upper limbs stretch to the front, so that the head and spine form a straight line, in order to strengthen the effect, the trainer can use both hands to press on the child’s back, one hand to the head direction, one hand to the sacrococcygeal direction of the pressure wiggle, so that the child’s spinal column to get fully stretched. Then the trainer moved to the side of the child’s body (right side for example), the right hand from the child’s chest to the left upper limb, and hold the left upper limb, and gently dragged up, the trainer’s left hand placed on top of the child’s buttocks, to play the role of fixation, the right hand gently shake, the left hand forcefully press, so that the flexed torso gradually stretched. When the child’s spine is fully extended, the trainer moves to the child’s head, so that the child is supported by the elbow joint, elevate the head, so that the spine is fully extended, to promote the development of anti-gravity muscles, and then the elbow can be used to support the side of the side of the epithelium upward extension, the trainer can gently shake up and down the upward extension of the upper limbs, alternating between the two sides, the maneuver is conducive to the extension of the spine; conducive to the adjustment of the head, and even more conducive to the development of the anti-gravity muscles. If the child can not raise his head, the trainer must use one hand to fix the child’s upper arm at the same time, use the middle finger to support the child’s lower jaw, so that he can raise his head, repeated, so that the child will experience the feeling of raising his head. The extension of the spine is the most powerful inhibition of the flexed posture. To enhance the effect, the child can be made to lie on his or her back. Placing a round roll on the lumbar or sacrococcygeal region allows the trunk to be fully stretched and thus the flexed posture is corrected. These are the basic maneuvers to reflexively inhibit the flexed posture, and it can be said that the basic maneuver to inhibit generalized flexion is the head-up position with the elbows and hands supporting the weight. The head-up posture of supporting the weight with both elbows and hands in the prone position is similar to the posture of a small dog when it is lying down, so it is also called the small dog posture. This posture is conducive to head adjustment, inhibit flexion, can fully extend the spine. Second, key point adjustment The so-called key point adjustment refers to the trainer in a specific part of the patient’s body adjustment, so that the patient’s spasticity to reduce the promotion of normal posture and movement of the maneuver. bobath this specific part of the body is called the key point, the best effect of the key point in the proximal end of the body. The following are the main key points: 1. Head key points: (1) Make the head forward flexion, whole body flexion. It can inhibit whole body stretching and promote whole body flexion posture and flexion movement. (2) Make the head dorsiflexion, the whole body extension, can inhibit the whole body flexion, promote the whole body extension posture and extension movement. (3) Rotation of the head from side to side can destroy and inhibit generalized flexion and extension, promote spinal rotation, and facilitate the formation of limb abduction, external rotation and internal rotation. If the child has serious spasm or intermittent spasm, avoid direct operation on the head, and should be adjusted on other parts of the body. 2, shoulder, upper limb key point adjustment: (1) make the shoulder joint forward flexion, facilitate the formation of generalized flexion posture, while inhibiting the head dorsiflexion, inhibit the generalized extension posture. (2) Make the shoulder joint extend backward, and the whole body form the stretching posture, which can inhibit the head flexion and the whole body flexion posture, and promote the anti-gravity stretching Generally use the upper limb to adjust the shoulder joint, and do not adjust it on the head, so as to prevent the occurrence of spasm. (3) Make the shoulder joint abducted and the upper limb lifted, which is beneficial to the spine, hip joint, lower limb stretching, and inhibit the whole body flexion posture. (4) Make the upper limbs abducted and externally rotated toward the back of the spine, which can inhibit spasm of the flexor muscles, especially the neck and chest muscles, and promote the spontaneous extension of the fingers, and this kind of adjustment can be carried out in the seated position and the standing position. (5) External rotation of the forearm can facilitate thumb abduction and full finger extension. 3, pelvis, lower limb key point adjustment: (1) Flexion of the lower limb, to promote the medullary joint abduction and external rotation, ankle dorsiflexion. (2) Extend and externally rotate the lower limbs, promote double lower limb abduction, external rotation, open the angle of the femur, and correct the lower limb interlocking and scissor gait. (3) Dorsiflexion of the foot, inhibition of lower limb extensor spasm. Promote ankle dorsiflexion. (4) Make the pelvis tilted back, make the pelvis tilted back in sitting position, promote the flexion posture due to the upper trunk compensating forward, and make the pelvis tilted back in standing position, promote the whole body extension posture. (5) Make the pelvis anteriorly tilted, make the pelvis anteriorly tilted in sitting position can promote trunk extension, and pelvis anteriorly tilted in standing position can make the spine forward and promote whole body extension posture. 4, the trunk of the key points of adjustment: (1) so that the trunk forward flexion, can inhibit the whole body extension posture, so that the whole body into a flexed posture, and thus can promote the whole body flexion posture and flexion movement. (2) When the trunk is tilted back (flexed), the whole body forms an extended posture, suppressing the flexed posture and promoting the spinal extension posture and extension movement. 5, a variety of positions under the key point adjustment: (1) prone position ① head, upper limbs, shoulder joint extension can promote the trunk and hip joint extension. ② head dorsiflexion, horizontal abduction of the upper limbs, shoulder joint extension, can promote spinal extension, finger extension and lower limb abduction. ③ Head dorsiflexion and rotation to one side, which can promote the lower limbs on the face side to flex and abduct and move toward the upper limbs. (2) Supine position ①Upper limb to the front with both hands together in front of the chest. The lower limbs are abducted and the knees are flexed at the abdomen. This adjustment can promote postural symmetry. (2) supine position ① hip flexion, flexion, can facilitate foot dorsiflexion, correct pointed foot. (3) sitting position ① make the lower limbs adduction, two lower limbs stretch into a sitting position (long sitting position or leg extension sitting position), hip joint full flexion, can promote spinal extension and head extension. ② make the upper limb internal rotation, can make the shoulder joint stabilization, when pulling up or supine to facilitate the adjustment of the head. ③When pulling up, the hand presses the sternum in front to make the posterior protrusion of the thoracic vertebrae in the shape of rounded back, which can inhibit the neck and shoulder joints from receding. (4) Adjusting the head and upper limbs forward and inhibiting the abnormal posture of hyperextension is used for patients with severe spasticity. (4) Standing position Adjusting the upper limb forward, shoulder joint forward flexion, and upper chest forward flexion can inhibit generalized extension, and is used to inhibit extensor spasms in manual cerebral palsy. Making the upper limbs abducted and externally rotated and closed behind the trunk can inhibit spasticity of spastic cerebral palsy trunk, hip joints, and lower limbs, and promote spinal extension, medullary joints, and lower limbs abduction, externally rotated and extended. The above briefly describes the methods of adjusting each key point, but in practical application, we should clarify the disorder of the child, find out the main problems, and adjust the key points to induce the correct response and inhibit the abnormal response. With the deepening of the treatment, from passive regulation to active movement, we can promote the formation of children’s independent movement and give full play to the children’s active regulation ability. The promotion of postural reflexes has an important role to play in activating basic movements and reproducing normal postural reflexes. There are many techniques to promote postural reflexes, and the parts used are different, but the following is a description of the most commonly used technique to promote the cervical reflexes, which is operated from the head. Starting position: the patient is lying on his back, the trainer is located on top of the child’s head, the left hand fixes the child’s lower jaw (taking the left hand as an example), and the right hand fixes the back of the child’s head. Methods of operation: The trainer slowly lifts the back of the head with both hands, lifts the back away from the bed, the lower jaw against the chest, so that the surrounding muscles of the neck are contracted at the same time and spread to the shoulders and abdomen, then the head in the hands of the trainer has a feeling of lightness, then continue to lift the head, so that the head to the left side of the rotation, when the head is rotated to the left side of the shoulder, the upper limbs, the torso, the hip, the lower limbs are rotated to the left to form a side-lying position in the order of the trainer. From the side-lying position, the head was rotated to the left to form the prone position. When the formation of the prone position, the trainer’s two hands in the same position, (one hand to fix the lower jaw, one hand to fix the back of the head), rotate the head left and right, the child with the elbow joints or hand support, the front chest off the bed, the trainer continued to pull the head, left and right rotation and pull forward, inducing a side of the lower limb flexion to the front to move. This maneuver is mostly used in patients with spastic diplegia to promote alternating forward movement of the two lower limbs. When the child is supported by both hands, the child continues to rotate the trunk from side to side, so that the pelvis is lifted from the bed, forming a four-crawl position. At this point, the trainer slowly pulls the head upward to move the weight backward, forming a knee stand due to the anti-gravity extension of the hip and trunk. After the child formed the knee position, the trainer moved the child’s side, still using the hands to fix the head, so that the weight shifted to the side of the knee (trainer’s side) and continue to rotate the head to the trainer’s side, the other side of the lower limb forward to form a single-knee stance, at this time the trainer still fixed the head of the patient, is located in front of the patient, and forcefully induced to make the weight to the soles of the lower limbs forward to the bottom of the foot, and gradually support the weight, the trainer continues to use both hands to The trainer continues to fix the head with both hands, pulling upward, the child’s hip joints extend and rotate the head to the other side, at this time the child stands up and supports the weight with the soles of the feet bilaterally, inducing a standing position. The above is a head operation to promote the neck upright posture reflex, which is an unconscious action and is the basis of basic human motor function. This reflex is an unconscious action, which is the basis of basic human motor functions. The treatment can be combined with verbal instructions to mobilize the subjective initiative of the child. This kind of promotion technique can be operated from the head or from the shoulder, the choice of method should be based on the actual situation of the patient, the important thing is to be able to induce the normal posture reflexes. Tapping, also known as knocking or tapping, is a stimulation technique for superficial and intrinsic receptors. The purpose is to improve the muscle tone of a certain part of the patient’s muscles, enriching the patient’s sensorimotor experience. According to the purpose of percussion, it is divided into the following four methods: 1, inhibitory percussion method: the use of inhibitory percussion, the purpose is to stimulate the superficial receptors and intrinsic receptors, so that the neck, trunk, limbs of the postural tension. Through a small range of repeated gentle percussion, activate the opposite muscle group of the spastic muscle, so that it produces the opposite inhibition of the spastic antagonist muscle. For example, when biceps spasticity elbow flexion, the trainer can support one hand under the elbow, the other hand knocking the patient’s forearm, activate the biceps antagonist muscle, triceps contraction, so that the elbow joint by biceps contraction of the flexion state, the emergence of extension, which is due to the knocking to activate the antagonist muscle of the biceps brachialis muscle, the triceps brachialis contraction of the cause. Such as gastrocnemius muscle spasm, can make the patient prone position, knee flexion calf elevation, then you can knock the soles of the feet, can make the dietary intestinal muscle antagonist muscle tibialis anterior muscle is activated, due to the contraction of tibialis anterior muscle, so that the lower limb extension and inhibit the gastrocnemius muscle spasm. Clinically, it is mostly used in spastic cerebral palsy, the purpose is to activate the opposite muscle group of spasm, make it contract, and play the opposite inhibitory effect. 2.Compressive percussion: Compressive percussion is mostly used to fight against gravity, maintain posture, and increase postural tension. It is suitable for cerebral palsy with bradykinesia or ataxia because of its involuntary movement, excessive range of motion, and poor stability and inability to maintain a certain posture. During the treatment, the patient mostly takes a sitting position, with both hands in front for support. The trainer can be at the back of the patient, and give compressive percussion from the shoulder downward, first pressing downward, and then releasing it, and repeating it again and again, so as to make the shoulder joint muscles contract, and to maintain the symmetrical posture. Pressure percussion can be carried out in a variety of positions. 3, interactive percussion: interactive percussion therapy, is the use of the opposite innervation stimulation to establish the balance of reflexes. Treatment trainer with one hand lightly vertebrae certain parts of the body, so that the body forward, backward, left, right loss of balance, and then use one hand to make the light armor and restore the balance of the therapeutic techniques. Interactive percussion is suitable for patients with cerebral palsy balance dysfunction. 4, light wipe (sweep) percussion: light wipe percussion method along the direction of want to induce a movement, in a certain muscle corresponding to the skin to give light wipe (sweep) stimulation, so that the specific muscle group contraction to produce movement, so that the active muscle and antagonist muscle synergistic effect. For example, in the prone position when the upper limbs support, for head-up training, when the patient raises his head, in the jaw to stop the light wipe percussion, and when the patient lowers his head is immediately wiped with the hand light wipe (buckling) jaw, so that the child’s head up to keep the head in the center, to promote the development of the antagonist muscle. For patients with upper limb flexion, the trainer can use both hands on both sides of the upper limb, from the proximal end to the distal end of the light wipe percussion, which can make the limb triceps muscle contraction, the effect of upper limb extension. Above introduced four commonly used percussion techniques, in the treatment of the patient’s condition before the selection of appropriate percussion techniques, treatment to observe the patient’s response, too strong percussion can cause abnormal reaction, too weak stimulus often does not achieve the therapeutic effect, treatment, such as abnormal muscle tension, should stop percussion, find the cause. Percussion therapy in the beginning, the response is not obvious, this is because the stimulus has not reached the threshold, should not stop, to insist on the effect can occur. The intensity of percussion should be adjusted according to the patient’s response. Early training for infants and young children and typical demonstration, there is no uniform treatment method for pediatric cerebral palsy, now we introduce some early training for infants and young children, as well as selected classic materials of Bobath Center in London, England and Bobath Hospital in Japan on the most common spastic biparesis, spastic quadriplegia in older children, for reference. Early training for infants and toddlers: Early use of movement therapy is effective. Introduce the main method of functional training into developmental training. Figures 4-2 and 4-3 show normal stretching pattern exercises, with the child’s lower limbs slightly abducted and externally rotated, and the neck, spine, and medullary joints partially and fully extended. Normal support of the upper extremity is induced simultaneously in Figure 4-3. This position is enhanced by compression stimulation of the buttocks and can be combined with the next phase of the parachute response of the upper extremity. Training the stretching pattern is essential for the stance. Figure 4-4 shows a good use of the mother’s knee and abdomen to induce trunk and neck extension by extending the child’s upper extremities slightly backward. Figure 4-5 In pulling up while inducing active flexion of the neck, the child is pulled back and forth from this position, a little at a time, especially to practice neck uprighting of the upper trunk. Bringing both hands together in the center and touching the mouth with the hands is the most basic motor behavior of infant development.