The World Health Organization Expert Committee in 1981 proposed community-based rehabilitation for persons with disabilities, i.e., rehabilitation measures at the community level that draw on and rely on the community’s capacity resources. This includes relying on the disabled and handicapped persons themselves as well as their families and society. In China at present, community rehabilitation for children with cerebral palsy has been an important part of community rehabilitation in addition to community-based institutional rehabilitation, and family rehabilitation.
There are many comprehensive rehabilitation methods for cerebral palsy, among which the Bobath method (neurodevelopmental therapy) is a widely used and effective method. Bobath believes that cerebral palsy is mainly caused by the persistence of primitive reflexes and changes in muscle tone after brain damage, resulting in many abnormal and complex postures and movements, and the theoretical basis of its treatment is to promote the establishment of normal postures and movements by inhibiting abnormal postures and movement patterns. Bobath also emphasizes that the treatment of cerebral palsy must be multifaceted, starting from the perspective of whole-person developmental disorders and following the laws of pediatric growth and development to provide extensive long-term treatment, including language training, occupational therapy and daily living skills training.
The family motor rehabilitation method, on the other hand, is based on the Bobath method as the theoretical basis and operates in the order of normal motor development of children, giving early intervention and treatment to children with cerebral palsy, and has the advantages of simplicity, long-term, continuity and practicality. Family rehabilitation plays an extremely important role in the whole rehabilitation. It is not only the continuation and consolidation process of rehabilitation in the hospital, but also the most long-term rehabilitation place for cerebral palsy and the basis for entering the society, in which the parents of the child are the most important executors of the rehabilitation treatment. This article introduces the essentials and hand techniques of the rehabilitation method for infants and toddlers.
I. Home care
1. Correct holding posture: Children with cerebral palsy are held by parents most of the time. They should be held correctly according to their condition to promote the control of the head and trunk and to correct the abnormal posture of the child.
Spastic cerebral palsy: Let the child sit or lie on the bed with legs apart and curl the child up first. The key of such holding method is to separate the child’s legs and flex the hip and knee joints, which can correct the abnormal posture of the child with spastic cerebral palsy such as hard extension of both lower limbs, cross and pointed foot. This can correct the abnormal posture of the child with spastic cerebral palsy such as rigid extension of both lower limbs, crossed and pointed feet.
The mother’s left hand reaches under the child’s abdomen to lift the child from the bed, while her right hand presses the child’s legs toward the abdomen from the child’s N fossa to make the child bend at the hips and knees, and then holds the child toward the mother’s chest so that the child’s head and back rest on the mother’s chest and her hands are placed at the midline in front of the body. The mother uses her jaws, upper arms or shoulders to control the child’s head, so that the head is in the middle position, and slightly forward. The key to this method of holding is to keep the child’s hands and legs together and bend the hips and knees as much as possible. Legs pressed as far as possible to the abdomen, head and neck, torso slightly tilted forward. This can inhibit the coracoid and asymmetrical posture of the child and promote the stability of the head and neck.
2.Sleeping position: When a child with cerebral palsy is in the supine position, the head is difficult to be placed in the center and often tends to be on one side, which can deform the head and bend the spine, so it is not advisable to sleep in the supine position for a long time.
3, feeding: for swallowing difficulties, oral closure difficulties, head and neck back and forth, left and right swing, open mouth does not close the child can appear sucking and feeding difficulties, affecting physical development, language development. The correct way to feed: assume a good position, often in a semi-sitting position, with hips and knees flexed, upper body leaning on the mother’s chest and forearms, head slightly bent forward, and both feet on the parents’ thighs. If you can’t suck, use a small spoon to feed, and larger children can sit in a corner, chair (corner chair) or corner of the bed.
4, Clothing: Dress loosely, not too tight, too tight to restrict the movement of hands and feet, not conducive to reducing muscle tone; sleeves, pants can not be too small, minimize the winter clothing.
5.Language training: within 3 months, often speak face to face with the child, tease, cause the child to look, pronounce, laugh, after 3 months, often speak with the child, sing children’s songs, pronounce monotone, increase the child’s comprehension.
II. Basic rehabilitation training
1.Infant touch: an effective tactile skin training, for brain development, relieve muscle spasms are useful. 2 times a day. 15~20 minutes each time. Methods: Head and face, chest, bilateral upper limbs. Bilateral lower limbs, back waist hip.
2, muscle movement training (passive exercise): forearm flexion and extension exercise, upper arm cross exercise, lower limb flexion and extension exercise.
3, audio-visual training: sounding red balls or colored bells, distance 20-30cm, shaking swing. Train the child to gaze and chase, chase and listen and turn the head, also can speak with the child face to face, tease the child to gaze and chase.
III. Gross motor rehabilitation training
Principle: Follow the normal sequence of motor development.
Normal order of development
Head lifting, hand support, rolling over, abdominal crawling, sitting, four crawling, support standing, support walking, standing alone, kneeling, walking alone.
1, head lift training.
Supine head lift: hold the child’s shoulders with both hands, slowly pull up to 450, stay for a moment, adjust back and forth, and then put flat.
Prone head lift (elbow support): ring the bell to tease, verbal teasing, make their elbow support, parents can hold the child’s head on both sides, exercise the child’s head lift and hand support ability; also available Bobath ball training (two elbows and shoulder width, shoulder joint, elbow joint flexion 900).
Hold the ball posture training: parents will be the child’s lower extremities flexed, crossed hands in a ball holding posture, for head dorsiflexion, limb muscle tone increased in children.
2, hand support training.
Parents kneel on the back side of the child, hands holding the child’s elbow joints, as far as possible to make its upper limbs and the ground vertical, hold for 3 to 5 minutes, can also lie prone on the mother’s chest, or the use of inclined plate, and can be shaken from side to side to train its balance.
3. Training of turning over.
Inhibition of asymmetrical posture.
Trunk gyration exercise: in the prone position, promote trunk gyration with the lower limbs of the child, and in the supine position, promote trunk gyration with one upper limb.
Hand-mouth-eye coordination training: at 4-5 months, make the child grasp the entrance of the foot with both hands, which can promote symmetrical flexion of the limbs and balance response in supine position, and promote the ability to turn over.
One-armed support training: the final completion of the turning movement, must go through the one-armed support of weight and then to the two-armed support. Method: Fix one upper limb at a position of 450 with the trunk, hold the other upper limb along the direction of 450, pull the child up, first to support the weight with the elbow, then to the position of supporting the weight with the hand, and then push back to the elbow support and supine position.
Inhibit head-low-hip-high posture training: train in full-body extension mode.
Bridge and rowing training: Bridge: child in supine position, legs flexed, feet flat on the bed, parents hold up the hips so that the hips are raised off the bed, so that the hips are fully extended. Rowing: prone position, can four-point support position, parents hold the hip to make back and forth movement, increase hand support and balance ability.
4.Sitting training.
Sitting development sequence: support sitting, forward leaning position sitting (arch back sitting) straight back sitting straight back, cross-legged sitting, split-legged sitting (to relieve lower limb muscle spasm)
Side seat training: conversion training from supine, prone to side sitting position respectively.
Support sitting training: the child’s legs are separated, the parent holds the child’s shoulder back, one hand presses the lower limbs, so that the child becomes a straight sitting position, both hip joints are flexed, abducted, externally rotated, the foot is not crossed, the back of the leg is straightened, and the general knee joint is straightened in an extended leg seat.
Sitting percussion training: The child sits in a forward leaning position, supported by both arms, the parent holds the shoulder with one hand and gently percusses the child’s waist and back with the other five fingers, so that the child gradually sits in a straight back position, slowly releasing the hands holding the shoulder and continuing to percuss to train the straight back sitting position.
Sitting alone training: Let the child sit on the corner chair, or lean on the back of the chair, reduce the support to sit, and slowly become sitting alone.
Sitting balance training: Take a sitting position with extended legs, the parent is located on the front side of the child, hold the child’s ankle with both hands, lift and lower the lower limbs, so that the child’s center of gravity moves back and forth, left and right, inducing the direction of the child’s upper limbs to extend the action. You can also sit on the roller and roll slightly from side to side to experience the feeling of moving the center of gravity and maintain body balance.
5.Crawl training.
Hand support training: the same as the head raising training section.
Four crawl position spine, pelvic separation training: boat-sliding exercise.
One-handed support training in the lateral recumbent position: make the child lie on his side to the lower side of the lower limb hip, the upper limb elbow joint two points to support the weight, the upper side of the lower limb flexion, the upper side of the lower limb extension.
Lower limb interactive movement training.
Three-point, two-point support: set up a four-crawl position, so that one upper limb lifted into a three-point support, weight-holding, cross two-point weight-holding.
Lateral sitting – four crawl position – lateral sitting training: posture change adjustment training.
Lateral weight shifting training: child in prone position, both arms extended forward, parent at the side of the child, one hand holding the shoulder. One hand holds the leg, push the child to the left and right respectively, so that its weight moves left and right, the upper limb on the weight-bearing side is externally rotated and internally rotated, the lower limb is internally rotated and internally rotated, and the head is lightly dorsally curved, alternating between left and right.
Support crawling training: let the child crawl, parents bend the child’s knee on one side and against the abdomen, the other lower limb straight, gently press the hip on the knee bending side, let his hip touch the heel, first one side, then practice the other lower limb, then simultaneously. Then the four limbs interacting movement pattern is completed, the standard crawling movement must be one side of the upper limb and the opposite side of the lower limb at the same time to extend and flex, alternating between the two sides.
6.Standing position and walking training.
Crawling training is required when crawling is not perfect: crawling is a necessary prerequisite stage for standing.
Sit-to-stand training: from sitting to standing training
Standing balance training: hold the pelvis to promote correct standing, then move the center of gravity back and forth to induce the child to actively maintain balance.
Kneeling balance training: hold the weight on both knees, kneel steadily, then suddenly let go, and when it’s time to fall, then help, repeatedly. (Straight kneeling, single-leg kneeling, kneeling forward training)
Help stand, stand alone and help walk training: make the child stand with both hands on the bed rail, chair back and other objects, hands on 10 seconds after holding on, stand with one hand on the object, then stand alone training, in help walk training, then walk alone training, then cross the obstacle training.
Four, fine motor training
1, reach training: sight reaching training, teasing with brightly colored toys, shaking in front of the child 15 ~ 20cm, can lead the child’s attention, and then touch the back of the child’s hand with a toy to induce it to reach out, such as no reaching action, parents can hold their elbow to help the hand to the toy, repeatedly. (3 to 4 months of age)
2, finger grasping training.
Pull the hood training: when the child is awake, gently cover the face with a hood, let the child use his hands to pull the hood down, causing the child to laugh, repeatedly.
Thin-handled toys for children to grasp training: use thin-handled toys to touch their hands or wrists and let children grasp.
Grasping small pills into the bottle training: at 6 months.
Grasp object import training: At 6 months.
Building block training: Around 1 year old.
Inserting sticks training: around 1 year old.
V. Suggestions for family rehabilitation assessment
In recent years, family rehabilitation of children with cerebral palsy has become an important part of the comprehensive rehabilitation of children with cerebral palsy. Parents of children with cerebral palsy should not only master the methods and skills of home rehabilitation training after training in the rehabilitation center, but also encourage parents to master or be familiar with the methods of home assessment, so that they can promptly compare the defects and deficiencies of the children, revise the rehabilitation procedures according to the laws and order of growth and development, and strengthen the content of rehabilitation training, so as to better develop the potential and development of the children and reduce the degree of disability of the children.
However, since children with cerebral palsy develop their functions in motor, cognitive, language, and social aspects as they grow older, a static assessment method based only on before-and-after comparisons obviously ignores the important factor of growth and development of the child, which is a common problem in family rehabilitation with parental involvement in the assessment. We recommend that the parents of children with disabilities insist on regular visits to the rehabilitation center for systematic evaluations and receive guidance on stage training and modification of the rehabilitation program.