Pediatric cerebral palsy, fully known as pediatric cerebral palsy, is a non-progressive brain injury caused by various reasons from before birth to one month after birth, which mainly manifests clinically as central motor disorders and postural abnormalities.
I. The manifestations of cerebral palsy are various due to different etiologies and typologies, but early symptoms are mostly seen in the first half of the infant with cerebral palsy (within 6 months of age).
This is a symptom of hypotonia, which can be seen at one month. If it persists for more than 4 months, it can be diagnosed as severe brain injury, mental retardation or muscular system disorder.
2. Stiffness of the body, which is a symptom of hypertonia and can be seen at one month and diagnosed as cerebral palsy if it persists for more than 4 months.
This is an early manifestation of mental retardation. It is generally believed that mental retardation can be diagnosed at the age of 4 months and unresponsiveness at the age of 6 months.
4, abnormal head circumference: head circumference is an objective indicator of the morphological development of the brain, and children with brain injury often have abnormal head circumference.
5. Difficulty in breastfeeding, no sucking after birth, weak sucking or refusal of breast milk, fatigue and weakness after sucking, frequent choking and coughing, spitting up milk, mouth not closing well, poor weight gain.
6, fixed posture, the child is very quiet after birth, crying faint or continuous crying, often due to brain injury so that muscle tone abnormalities, such as angular arches, frog position, inverted U-shaped posture, etc., can be seen in the month after birth.
7, not smiling: if 2 months can not smile, 4 months can not laugh loudly, can be diagnosed as mental retardation.
8, hand clenched fist: if 4 months still can not open, or thumb inward, especially the presence of one side of the upper limb, has important diagnostic significance.
9.Body twisting: If 3-4 months old infants have body twisting, it is often suggestive of extra-pyramidal injury.
10, head instability: if 4 months prone can not lift the head or sitting position when the head can not be upright, is often an important sign of brain injury.
11, strabismus: 3-4 months of age infants with strabismus and poor eye movement, can suggest the presence of brain injury.
12.Inability to reach out and grasp objects: If the infant cannot reach out and grasp objects at 4-5 months, it can be diagnosed as mental retardation or cerebral palsy.
13. Gaze at hand: if it still exists after 6 months, it can be considered as mental retardation.
14. The child is easily startled: convulsions, screaming or irritability.
15.Less spontaneous movement or immobility or easy to jerk, general flabbiness, muscle relaxation or general hardness, often scurrying out of swaddling clothes.
Second, some brain injuries are milder and often have no obvious symptoms in early infancy, but in the second half of the infant’s life (6-12 months), there are some other symptoms manifested as follows.
1, can not turn over: after 6 months still can not turn over, there is a diagnostic significance.
2.Not using lower limbs: 6-7 months of age do not use lower limbs to support weight briefly.
3.Do not use one hand: 7-10 months old infants do not use one hand to grasp and play.
4.Hand clumsiness: fine hand movements, such as pinching small objects, unbuttoning, and belt-tying are inflexible and uncoordinated, appearing at 7-10 months of age, and are diagnostic.
5.Can’t sit alone: 7 months old can’t sit alone.
6.Can’t grasp the station: 10 months old can’t grasp the station.
7.Can’t say goodbye to people: diagnostic significance after 10 months.
8.Standing on toes: 10 months old still standing on toes.
9.Can’t take a step: after 13-15 months, still can’t take a step.
10. Drooling and “hand eating”: diagnostic value after 12 months of age.
I. Surgical treatment
For severe joint contracture and deformity, appropriate surgical treatment can be provided. The common ones are tendon release, selective peripheral nerve partial excision, Hoke Achilles tendon tendon slide lengthening, rectus femoris distal transfer, etc.
Second, drug treatment
1.There is no cure for this disease, and the drugs are also auxiliary treatment, mainly brain activator, cytidine, botulinum toxin type A, cerebrolysin, baclofen, valium, etc.
2, timely treatment of comorbidities. For those with audiovisual impairment, language training for those with language impairment, special education for those with mental retardation, and seizure control with drugs for those with epilepsy.
Rehabilitation treatment
1, to correct motor disorders and abnormal posture, restore normal motor development, should use physical therapy, physical therapy, surgical therapy and other measures for correction and training.
2. Comprehensive measures should be taken for the treatment of motor abnormalities. Commonly used methods include functional training, daily life skills training, physical therapy, physiotherapy, etc. Massage, acupuncture, tui na, etc. can also promote the improvement of symptoms.
3, comprehensive care for the child, pay attention to life care and nutrition assurance.
4.Functional and intellectual training: Taking the “0-3 years old early intervention program” proposed by Bao as the guide, different treatment plans are formulated to deal with different functional disorders caused by disease damage, and perception, audio-visual, language, memory and movement training are carried out, combined with comprehensive treatment of baby exercises.
5.Motor therapy: weight loss gait training, Bobath method, Bojta method, Ueda therapy, work therapy, balance training, sensory integration therapy, cultural and physical therapy, etc.
IV. Psychotherapy
Talk with the children, observe their emotions, psychology and interests, induce and inspire them, adjust their pathological psychology, and develop their intelligence through games and music.
Chinese medicine treatment for pediatric cerebral palsy
I. Acupuncture treatment
1. Body acupuncture: Main points: Baihui, Dazhi, Kidney Yu, Liver Yu, Spleen Yu, Foot Sanli, Guan Yuan. For mental retardation, add Sishencong and Yin Tang; for lower limb paralysis, add Huanjiao, Chibian and Yanglingquan; for wrist prolapse, add Waiguan and Yangchi; for foot entropion, add Jiejiao and Kunlun; for foot exotropia, add Sanyinjiao and Taixi. Choose 2-3 main points and 4-5 matching points each time, and give tonic method or flat tonic and flat diarrhea, without leaving needles, once a day, for 2-3 months as a course of treatment. After 1-2 weeks, you can continue the second course of treatment.
2, the head of the needle: the main take the motor area, can be matched with language two, three areas, vision area, balance area, dance tremor area, etc.. Use 26 or 30 gauge needles, twist the needle handle rapidly, 200 times per minute for 2-3 minutes, keep the needle for 5-10 minutes, then repeat the above treatment, twist the needle 2-3 times, once a day, 10-15 times for a course of treatment. Treatment should pay attention to strict sterilization, to avoid scalp infection.
3, acupuncture point injection method: select Dazhi, feet three miles, Yanglingquan, Quchi, Hegu. 0.9 sodium chloride injection, vitamin B1, B12 injection, etc., each time each point injected 0.5-1 ml, once every other day.
4.Auricular acupuncture: select occipital, subcortical, heart, brain, kidney, liver, spleen, and Shen Men. Milli-needle pricking, or buried with snap-needle or with Wang Bu Liu Xing seed paste pressure.
Second, tui na massage method
Choose Baihui, Yin Tang, Sun and Fengchi points for the head, shoulder well, Quchi, Shuzhe and Hegu points for the upper extremities, and Huanjiao, Yinmen, Zhizhong, Yanglingquan, Foot Sanli, Taixi, Taichong and Kunlun points for the lower extremities. For aphasia, add mute gate and Tianzhu points; for tongue strabismus, add pupil and eyelid points. The order of application is limbs – head – spine. The technique should be smooth, from light to heavy, in order not to cause muscle spasmodic contraction. Generally, the first use of the Mo method, gradually switch to the kneading method, rolling method, pushing the limbs, from the distal end of the limb gradually pushed to the proximal end. Each time 15 minutes, once every other day, 3 months for a course of treatment.
Commonly used traditional Chinese medicine
Liou Wei Di Huang Wan, Tonic Zhong Yi Qi Wan, Da Yin Wan, Hu Qian Wan, commonly used tonics.