Pediatric Cerebral Disease Treatment and Rehabilitation Center, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine, Zhengzhou, Henan 450000, China
Abstract】This paper proposes that the clinical treatment of pediatric cerebral palsy should aim at improving the overall function of the child by applying the concept of modern rehabilitation medicine; it advocates the combination of local rehabilitation and overall treatment, functional reconstruction and abnormal posture correction, modern rehabilitation techniques and traditional Chinese medicine massage and acupuncture, active motor rehabilitation and passive functional training, drug application and non-drug treatment, medical rehabilitation Only by combining medical rehabilitation with family rehabilitation and social rehabilitation can we improve the therapeutic effect, which is the direction of clinical rehabilitation for pediatric cerebral palsy. Zhou Zheng, Department of Pediatrics, The First Affiliated Hospital of Henan College of Traditional Chinese Medicine
[Keywords] Modern rehabilitation medicine; rehabilitation concept; cerebral palsy; function; treatment
【Category】R272 【Reference Code】A 【Article Number
Modern rehabilitation medicine is based on the concept of improving the quality of survival of the body and thus the quality of life and healthy social behavior. Dr. G. H. Brundtland, Director-General of the WHO, said that the greatest challenge for human health in the 21st century will be to improve the quality of life, and that health will be the most important prerequisite for people to enjoy life.
Pediatric cerebral palsy (hereafter referred to as cerebral palsy) is a syndrome caused by non-progressive brain injury and developmental defects from conception to infancy, and is characterized by motor and postural abnormalities, mental retardation, epilepsy, visual, auditory, and speech behavior abnormalities, and sensory abnormalities [1]. The basic goal of cerebral palsy rehabilitation is to achieve maximum physical, psychological, and social recovery and compensation through medical, educational, and social rehabilitation means. To improve motor function and achieve optimal functional status; to improve self-care ability and quality of life; to improve communication ability; and to improve social adaptation ability [2]. Rehabilitation medicine improves the quality of life of patients by restoring motor, language, psychological, cognitive and other functions necessary for personal independence; the clinical approach is based on a variety of non-clinical “functional treatments”, such as physical, occupational, speech and psychological therapy and orthopedic devices, with particular emphasis on the initiative and motivation of the injured or ill patient. In the rehabilitation of children with cerebral palsy, we advocate comprehensive intervention and integration with daily life and social life; the ultimate goal is to establish function, return to society and improve the quality of life.
Therefore, with the progress of society and technology, the concept and technology of rehabilitation treatment are yet to be further improved and enhanced. In the principle of rehabilitation treatment for pediatric cerebral palsy, we should correct the status quo of emphasizing motor rehabilitation over comprehensive rehabilitation, local rehabilitation over holistic treatment, drug application over non-drug treatment, and open up new ideas for the development of pediatric rehabilitation medicine in China.
1. Combination of local rehabilitation and holistic treatment.
Pediatric cerebral palsy is a disabling disease, mainly manifesting as central motor disorders and postural abnormalities; children with the disease are often combined with mental retardation, language disorders, epilepsy, visual impairment, hearing impairment, orofacial dysfunction, growth retardation, dental dysplasia, emotional and behavioral abnormalities, and other manifestations. Early detection and early intervention can reduce the disabling effects of the child. On the other hand, children with cerebral palsy are prone to recurrent respiratory and digestive diseases due to their weakness and young age of rehabilitation, which not only affects the rehabilitation effect, but also increases the economic and mental burden of families. Children with cerebral palsy have motor disorders and are often accompanied by various cognitive dysfunctions, which affect each other; the improvement of cognitive function can sometimes promote the development of motor function. Therefore, it is important to pay attention to the overall treatment while functional training and limb movement rehabilitation, and to enhance physical fitness and prevent the occurrence of respiratory and digestive diseases and complications; and related diseases also directly affect the rehabilitation of limb movement function. The recurrent seizures of epilepsy also further aggravate the brain damage; it directly affects the overall rehabilitation effect of cerebral palsy. Therefore, during the functional assessment of cerebral palsy, a comprehensive assessment including cognitive aspects must be conducted, and early detection and systematic comprehensive treatment should be done to achieve a combination of local rehabilitation and overall treatment in order to achieve the rehabilitation effect with half the effort.
2. Combination of functional reconstruction and abnormal posture correction.
Children with cerebral palsy have been ill for a long time, and those who are older often have serious postural abnormalities and functional disorders, and some severe children even have muscle contractures and fixed joints, which are difficult to recover from surgical treatment. According to the modern rehabilitation concept, the ultimate goal of rehabilitation for children with cerebral palsy is to enable them to live independently and participate in society, so we focus our treatment on functional reconstruction, improvement of daily living ability and cognitive ability. In order to improve the motor function of children with cerebral palsy, it is unnecessary to train every posture, as long as the basic motor function is induced and reinforced from the normal posture and movement. The elicitation and strengthening of their basic motor functions should be considered in combination with the acquisition of gross motor movements and fine motor movements. To maximize the improvement of their abnormal motor patterns while conducting normal developmental induction; to promote the development of their normal motor patterns, to improve their quality of life and to be able to return to society is the fundamental purpose of rehabilitation treatment.
3. Combination of modern rehabilitation techniques and traditional Chinese medical techniques of tui na and acupuncture.
Modern rehabilitation techniques are based on the theory of central neuroplasticity, and functional recovery training is considered an important element of neurological rehabilitation and motor rehabilitation, including motor therapy, physical therapy, occupational therapy, and speech therapy. TCM massage and acupuncture can also be considered as a component of functional training. The motor joint type of Tui Na manipulation is closely related to and different from continuous passive movement, joint release, and McKenzie mechanics therapy. According to TCM, the main pathogenesis of cerebral palsy is the blockage of phlegm and stasis and the blockage of meridians and channels; the principle of treatment should be to unblock meridians and channels, improve movement and correct abnormal posture. This technique includes “pushing and pressing by meridians, point pressure, abnormal muscle massage and posture correction”, which absorbs the essence of traditional and modern rehabilitation techniques, mainly pushing and pressing by meridians to unblock meridians; point pressure and abnormal muscle massage to relieve spasm, reduce muscle tone and promote motor function; posture correction to suppress abnormal posture and promote normal movement. This technique is consistent with the etiology of cerebral palsy and modern rehabilitation theory [3]. Tui na massage, Chinese acupuncture and modern rehabilitation theory are closely related and have significant therapeutic effects.
4. Combination of active motor rehabilitation and passive functional training.
Active motor training should be emphasized in the clinical rehabilitation of pediatric cerebral palsy. Because motor training is also called recovery training, its method is functional training, its purpose is functional recovery, its characteristics are easy to implement, active and interesting, with the transition of clinical treatment and daily life activities, progressive and selective, using local treatment and systemic treatment integrated. The muscle activities and various functions performed by exercise training induce and develop advanced automatic responses, regulate neural reflexes, and change neurohumoral factors, so that the body’s various functions can be affected and changed accordingly. In the process of active movement, the child can not only improve muscle strength, reduce muscle tone, correct abnormal posture, and improve local and general functions, but also try to use interesting games during the treatment process to guide the child to do independent movement, active participation, and active training; and add fun to the child in the treatment, which can obviously improve the clinical rehabilitation effect This can significantly improve the clinical rehabilitation effect and prevent the occurrence of psychological disorders. Especially for children with cerebral palsy, strengthening active turning, active crawling, active grasping and standing training along with physiotherapy such as Bobath method, Vojta method and massage therapy can have a positive effect on the recovery and improvement of motor function, life ability and intellectual level of the child. Moreover, active motor function training can also promote the recovery of brain injury function and play a good multi-treatment effect. The fundamental of cerebral palsy rehabilitation is to promote the normal development of the child’s body and mind, that is, to promote normal motor posture development and control abnormal posture and movement through motor function training and other therapies; therefore, motor function training is the core of cerebral palsy rehabilitation.
5. Combination of drug application and non-drug cooperation therapy.
The commonly used drugs for children with cerebral palsy include cerebral neurotrophic agents, muscle relaxants, etc. Especially, there are many different kinds of biological agents for cerebral neurotrophic agents in China, how do some of them work for cerebral palsy? There is a lack of strong evidence. It should be analyzed scientifically and treated carefully to prevent drug abuse so as not to cause adverse consequences to the child and bring economic burden to the family. We have found that drug treatment is effective for small infants and children with organic injuries. This is because the most vigorous period of human brain development is from 0 to 3 years old, especially within the first year after birth, when the brain develops most rapidly and is a critical period of brain development. Based on the theory of brain plasticity and the theory of functional reorganization of the brain is the basis of rehabilitation treatment [4]. Therefore, in the early stage of pediatric brain injury, pharmacological treatment with non-pharmacological integrated rehabilitation therapy can provide good results. Medication should be used with caution after the age of 3 years in older children, and pharmacotherapy should be used only when necessary, but it cannot replace other functional training. Therefore, it is undesirable to have a clinical practice that is dominated by drug therapy and simply emphasizes drug application, acupuncture point injection, hyperbaric oxygen therapy and ignores functional training and comprehensive rehabilitation.
6. Combination of medical rehabilitation with family rehabilitation and social rehabilitation.
We are using the treatment model of combining medical rehabilitation, family rehabilitation and social rehabilitation for children with cerebral palsy, and giving modern rehabilitation therapy combined with traditional rehabilitation techniques, both to carry out surprise hospital treatment, improve the function of nerve cells in the encephalopathy injury area, inhibit abnormal motor patterns and abnormal postural reflexes, and implement effective, regular and lasting family rehabilitation. And this method is integrated into family rehabilitation, which is a more ideal rehabilitation model at present, suitable for our national conditions. Because the brain of a child with cerebral palsy is damaged during development, not only is motor development affected, but also sensory aspects such as vision, hearing, object recognition and external communication skills are affected to varying degrees. It is the responsibility of doctors, therapists, parents and teachers to help patients overcome their intellectual deficits so that they can grow up happily as children of the same age; parents play a very important role. Parents play a very important role because all daily activities and actions such as dressing, brushing teeth, going to the toilet, etc. need to be done with the help or guidance of parents. As the saying goes, “Parents are the first teachers of their children”. Compared with normal children, children with cerebral palsy are more irritable, withdrawn, strange, inferior, dependent and other pathological psychology. Therefore, parents should not only help their children overcome their physical defects in a special way, but also teach them how to do what they can do and help them communicate with the outside world in various ways. Parents must be taught how to do this, build confidence, and learn and practice seriously and diligently in order to promote the child’s early recovery! Cerebral palsy is a lifelong disease, and the family and society are the home of the affected child. The survival and quality of life of children with cerebral palsy should be concerned by the whole society.
References
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