Pediatric cerebral palsy is a syndrome caused by non-progressive brain injury and developmental defects from conception to infancy, mainly manifested by motor deficits and postural abnormalities. Reasonable home care can be a good contribution to the rehabilitation of children with cerebral palsy. What are the methods of home care for children with cerebral palsy? Holding method for children with cerebral palsy (For cerebral palsy patients who cannot sit, stand or walk alone, mothers often hold them in their arms. If the posture is not correct, the abnormal posture is reinforced and prevents the correct posture from forming.
Applying the correct method to hold the child with cerebral palsy not only saves energy, but also corrects some abnormal postures of the child; it also stimulates the child’s ability to control the head and neck.
For different types of cerebral palsy, different holding methods should be adopted.
1. Spastic cerebral palsy
The mother of the child holds the child’s hip with one hand, holds the child’s shoulder and arm with the other hand, and stretches the child’s arms out and puts them on the mother’s two shoulders, and puts the two legs apart on the mother’s two hips or one hip before and after. The key to this method of holding is that the child’s legs are separated and the hip and knee joints are flexed, which can correct the abnormal posture of the child with spastic cerebral palsy such as stiff extension of both lower limbs, cross and pointed foot.
2.Hand-and-foot type cerebral palsy
For children with tardive dyskinesia, the main focus is to control the involuntary movements of the child, so that the child can maintain the stability of posture and position.
The specific method: Before picking up the child, the parent puts both hands through the armpits behind the child and presses the child’s abdomen with the palm of the hand so that the child’s back clings to his or her body. At the same time, use their own arms to push the child’s arms forward, so that the child’s head can be controlled to tilt back and the scapular girdle tightened, so that the head is upright, hands on the front of the body, hold when the parents put the child’s hands on the knees respectively, and hold the child’s hands with their own hands, so that the child’s knees and hips are fully flexed, such a hold can stretch the child’s head and trunk, and provide the child with a better Stability, also control the involuntary movements of the child.
3. Hypotonia cerebral palsy
Since the muscle tone is too low, the general principle is not to put the child’s body in an upright position too early without adequate support, so as not to cause back protrusion of the spine and scoliosis deformity.
This type of child with cerebral palsy is weak. When parents hold him, besides helping him to curl up his legs and slightly droop his head, the most important thing is to give him a good reliance, like the method of holding a child with tardive dyskinesia.
Sleep position of children with cerebral palsy
Normal children can lie in bed as they wish, but children with cerebral palsy have difficulty in positioning their heads due to the tension neck reflex, and their heads are tilted to one side for a long time, and their heads are tightly pressed to the pillow.
1. Children with spastic cerebral palsy should not sleep in a supine position for a long time to prevent aggravation of muscle spasm, and it is better for children with spastic cerebral palsy to sleep in a side-lying position, which not only improves the tension of spastic muscles, but also facilitates the symmetry of movements.
2, for children with supine position is prone to shoulder shrugging elbow flexion, hip and knee flexion, long-term this will lead to the risk of this posture hard fixed. So for the child in flexion spasm. So for children with heavy flexion spasticity, let him sleep in the prone position, put a pillow on his chest so that his forearms are stretched forward, and when the child’s head can be lifted or can be turned, the pillow can be removed and sleep in the prone position.
Sitting position.
1.Leg extension sitting position In the leg extension sitting position, the hip joints are flexed and abducted bilaterally and the knee joints are extended. This position is the best position for sitting training of cerebral palsy patients. In this position, the operator can train the patient with balance training, center transfer, body axis rotation and other training. The method is: first, the child is placed in a supine position with legs apart, the operator faces the child in the middle of the legs, lightly presses the legs on the knee joints to extend them, abducts the hip joints, pulls them up to the sitting position, and then gyrates the shoulders and lumbar region.
For children with high extensor muscle tone, the operator reliably sits on the back of the child, with the chest against the child’s back, and the hands pass under the armpits and place them on top of the knee joint to straighten the knee joint, and make the legs separate and press the operator’s legs together, then the operator drives the trunk with itself to perform the corresponding forward-flexion-backward-extension gyration movement.
2.Sitting in the cross-legged position In the cross-legged position, the hip joint is flexed and abducted, and the knee joint is flexed in a state of hip weight bearing. The operator can first make the child’s head to the side after holding the child, and make the cool knee flexion, hip flexion and external rotation, sitting in front of the operator, back against the operator’s body to seek the fulcrum, then the operator hold the elbow forward, fingers apart on the bed, with hands to support the shoulder or head; for children with mild upper limb spasms, the splint can be used to fix the upper limbs, to carry out certain head rotation to induce its The corresponding movement of the trunk can be induced by some head rotation.
Knee-stand position
In clinical practice, children with cerebral palsy have a greater distance between their legs when they stand on their knees in order to obtain better stability due to their poor balance, and often spread their legs apart. In clinical practice, due to their poor balance, children with cerebral palsy often sit in a “W”-shaped posture with the thighs and inner calves on the ground and the hips on the ground in order to gain better stability. For children with cerebral palsy who have severe hip and knee flexion and flexor spasm, the operator must control the hips.
Double knee position: The knees are brought together, the knees are flexed 90 degrees, the hips are fully extended and the trunk is in the same plane as the thighs. The operator can hold the child’s hands on both sides of the hip, or drag the hip with one hand and hold the chest with the other hand, so that the hip can be fully extended to help maintain the correct position of double knee stance: the child can also be made to hold the chair and other objects to maintain the stability of the trunk.
One-knee stance
This is a double knee stance with one lower limb flexed 90 degrees at the hip joint and landing on the foot, while the other lower limb remains in the original position. The process of shifting the body’s weight from the double knee position to the knee joint is the process of shifting the body’s weight from the double knee to the single knee. For children with cerebral palsy who have difficulty adjusting the weight shift, the single knee stance training must be supported adequately, and the operator must especially control the hips for the purpose of hip extension and knee flexion to keep the upper body upright. At the same time, brightly colored toys that make sounds can be hung above the child’s head to induce him/her to reach out and grasp them, which can increase the mobility of the shoulder joints and improve the ability to move the center of gravity.
Standing position
Standing is the basis of walking. The correct static standing position is to stand straight, with the head centered, the trunk extended, and the shoulders and hips in a horizontal flat position. The dynamic standing position means that the head, trunk and limbs can be moved appropriately while standing, and the balance can be maintained. After the child can maintain the balance in the sitting position, he/she can be trained to stand.
1.Standing support
(1) Children with low muscle tone
The operator first fixes the feet of the child, then holds the chest with one hand and the knees with the other hand, and supports the child with the chest if the lumbar and abdominal muscles are weak and the spine cannot be fully extended. Make him stand up.
(2) Children with spastic diplegia
The operator first encourages the child to stand and, if necessary, gives some support to the knee from behind and guides him/her to swing slowly forward, backward, left and right.
Keep the body in balance and train the foot to follow when the body is bent forward.
2.Standing against the wall
The operator can help the child stand against the wall by placing his or her hands on both sides of the body, leaning the arms and trunk against the wall, separating the feet and synchronizing them with the shoulders, and fixing the child’s feet and placing them flat on the ground. For children with prevertebral convexity, the operator can gently push the abdomen with the hand to stretch the spine or add a certain amount of gravity to the abdomen so that the child’s center of gravity is perpendicular to the ground and placed in the middle of the feet. For children with lumbar and abdominal weakness, the operator holds the child’s shoulders with his hands to achieve the purpose of standing against the wall, then fixes both feet and can use the method of moving his pelvis from side to side to adjust the child’s center of gravity so that the child’s balance can be further improved. The child’s knees are held in a forward-flexed position at a certain angle so that the knee joints are well controlled. For children with knee joints in forward flexion, the operator can use splints and hands to correct them, and then release the splints after achieving the purpose of making them exert themselves actively. For children with knee joints in hyperextension, the knee joints are fixed, and when they stand against the wall, the hands hold the cool knee joints to make them out of a certain angle of forward flexion, so that the knee joints can be well controlled.
For all children with cerebral palsy, learning to stand correctly is the basis for learning to walk correctly, and gradually reducing the support until the child can stand alone. The correct standing posture is: head in a neutral position, upper body straight, hips and knees straight, legs slightly apart, feet flat on the ground, feet shoulder-width apart. The operator’s hands control the control of the shoulders and waist, the feet are placed on the outer edge of their feet and clamped, the operator’s feet are fixed on the child’s foot surface, and then depending on the situation, the operator’s hands from half off to full detachment from their body approach to train their ability to stand alone, according to the child in the case of detachment from the help of various postures to correct or induce, such as allowing the child’s hands to make forward or backward reaching and other actions to To induce a protective response from the child. At the same time, the operator should calculate the time the child stands and use “one, two, three, four, five ????” etc. to stimulate the child’s motivation, in order to match the various training movements can be completed, using the method of immobilization of the feet for training.
Walking position
Step training from standing to walking is actually the process of breaking the static balance of the body to obtain dynamic balance, which is a comprehensive embodiment of dominance, balance and coordination ability. On the basis of the child’s ability to stand alone and stride, stride training can be conducted on a flat surface. At the beginning, the child may be passive, and the operator may first help the child to move the trunk from side to side to gain the ability to adjust the center of gravity. When the child is able to master this action, push forward one shoulder and the same side of the lower limb to induce him/her to step forward, fix the lower limb on that side, and then adopt the same technique to push the other side of the limb to step forward; so on and so forth until the child is able to walk alone.
In children who are just walking, the lack of trunk rotation causes internal rotation or basal widening of both lower limbs and uncoordinated movements of both hands and both lower limbs due to poor balance and trunk adjustment during walking. Therefore, it is necessary to correct the gait and gait speed of these children, to promote the correct posture of leg lifting, to control the stride length and speed and to maintain the proper distance between the left and right legs, so that they can obtain the correct movement pattern.
Points to note in walking training
1.Straddling obstacles
You should start training with a narrow board, and slowly widen and raise the board, and then hold the handrail on the steps for up and down contact.
Walking is a comprehensive embodiment of balance, coordination and dominance. In training the child to walk, you can place some different small toys at intervals in front of the child to induce it to walk faster and farther to increase the speed and walking distance of the child.
2.Children with hyperextended knees
During training, the operator controls the knee joint with both hands to keep it in a certain degree of flexion, and with language to make the child walk forward. It is worth noting that children with knee hyperextension should strengthen squatting, knee and hip flexion training to strengthen the lower limb extensor and flexor muscles and muscle capacity of the lower limb, so that they can control their knee hyperextension, stride length and stride speed.
3.Children with adductor spasm
The child can be made to abduct the lower limb to relieve the spasm of the adductor muscle. When practicing walking, the operator can pull the child with both hands, insert the foot or ankle between the two legs and step forward. Training can directly correct the child’s feet crossed or toe forward posture, but also can be part of the knee open up and measured walking, can correct and alleviate the tightness of the adductor muscle.
4, not random movement type of children
First of all, the child should be braked by static, try to control the frequency of the child’s involuntary movements. As the child walks with irregular stride length and fast stride speed, it is difficult to control during training, so the operator should first control the child’s double lower limbs and feet, control the speed and instruct the child to master the appropriate stride speed and stride length. Step by step towards the front, colleagues should correct the abnormal exertion and abnormal posture to cause normal movement patterns.