Cerebral palsy (CP) is a movement disorder and postural abnormality caused by brain damage or developmental defects from various causes before birth to 1 month after birth. It is often accompanied by co-occurring disorders such as mental retardation, speech impairment, and epilepsy. Investigation shows that more than 70% of children with cerebral palsy have varying degrees of language impairment. In addition to physical impairments, most children have central neuromotor abnormalities in the organ of speech formation and the feeding system, resulting in difficulty in vocalization and feeding, which seriously affects the development of language, feeding, cognition, social interaction and communication skills of the child.
The normal pattern of language development involves a complete input, output and central processing system. The main brain areas related to language are: frontal and temporal lobes are speech expression and auditory comprehension areas, and basal ganglia, insula and temporal lobes are closely related to the formation of the dysarthria plan, auditory feedback and dysarthria regulation. Due to extensive perinatal brain injury, children with cerebral palsy have direct damage to language brain areas on the one hand, and on the other hand, they often have combined abnormalities in visual and auditory sensory systems, abnormal intelligence, oral-motor abnormalities and behavioral abnormalities. These neuropsychological problems existing at birth impair the input, output and central processing of language, limiting the normal pattern of language development, and the disappointment and inappropriate compensation of the child by the family and society contribute to the development of language disorders. The above-mentioned multiple etiologies and previous studies suggest that the complexity of the pathogenesis determines the complexity of the language characteristics of children with cerebral palsy [1].
Language disorders in children with cerebral palsy are often divided into delayed language development and motor dysarthria. The former is an acquired aphasia, which is mainly due to impairment in the comprehension and expression of language caused by damage to the central nervous system. In children with cerebral palsy, the prevalence of language delay is high, mainly due to delayed language expression and reception compared to the actual age. Children with cerebral palsy are more delayed than normal children in listening comprehension, language expression, and prosody. Most children with cerebral palsy have better language comprehension than expression, often showing unclear expression of their thoughts and requests, lack of organization and coherence in their speech, and inability to make others understand the meaning of their language. In contrast, motor dysarthria is mainly manifested by abnormal sound (including abnormal sound quality, volume and pitch), abnormal diction (including difficulty in diction, slurred speech, short articulation and mid-speech) and abnormal fluency (mainly referring to abnormal rhythm of speech, manifested by stuttering or speech creaking). Foreign scholars Sutcliffe AG et al. found that dysarthria in children with cerebral palsy is due to paralysis or motor incoordination of speech muscles due to central or peripheral nervous system lesions [2], and Wang YT et al. classified dysarthria into six types: spastic, bradykinetic, dysarthric, hyperkinetic, hyperkinetic, and mixed [3].
Since the main cause of motor dysarthria is motor dysfunction of the articulatory organs rather than functional disorders, this study focuses on acupuncture for the treatment of delayed language development in children with cerebral palsy. The clinical manifestations of delayed language development in children with cerebral palsy vary widely due to the location and extent of brain injury. The main symptoms include: inability to speak past the age of speech; late or very late speech; slower or stagnant development than other normal children after starting to speak; low language skills despite speaking; lower language application, vocabulary and grammar application than children of the same age; communication in words but not in sentences; low communication skills; and low response to questions. Low communication skills; slow response to questions; difficulty understanding language and following instructions. In addition to language problems, there are many other problems, such as reluctance to communicate with others, low intelligence, inattention, irritability, hyperactivity, and incompatibility.
Active treatment of delayed language development in children with cerebral palsy is of great significance to improve the quality of life of children with cerebral palsy [4]. Western medical treatment alone is mostly based on nutritive drugs, but they are not easily accepted by parents of children with cerebral palsy because of their high dosage, high price, and damage to liver and kidney functions. The author used acupuncture with language training therapy to treat 31 cases of this disease, and the efficacy was good, and the control observation was made with 30 cases treated with language training alone, which is reported below.
1. Information and methods
1.1 General data
Sixty-one cases of children with cerebral palsy who were treated in the outpatient clinic of the acupuncture department of our hospital from February 2014 to February 2015 were selected, and all of them met the diagnostic criteria of pediatric cerebral palsy. Inclusion criteria: 1. Those who met the diagnostic criteria of pediatric cerebral palsy and had combined language delay; the determination of language delay in this study mainly applied the “S-S language delay evaluation method”, which was developed by the Japanese Society of Phonetic and Speech Medicine in 1987 and introduced to China by the China Rehabilitation Research Center in 1991. The Chinese version of the S-S evaluation method was developed according to the linguistic characteristics and cultural habits of the Chinese language. The examination was centered on the evaluation of the relationship between speech symbols and the content of instructions, and the comparison criteria were divided into five stages (Table 1). The evaluation results were compared with the age level of normal children, and if they were lower than the normal age level, the presence of delayed language development was determined (Table 2).2 The child was between 1.5 and 6 years old; 3. The parents of the child were informed and agreed to cooperate with the clinical observation; 4. Normal or mild hearing impairment in both ears, brainstem auditory evoked potentials: hearing response threshold ≤50 dB in both ears; 5. Normal or mild intellectual screening for intelligence 5, normal or mild mental retardation in intelligence screening, DST intelligence screening ≥60 points. The 61 children with cerebral palsy were randomly divided into 2 groups, 31 cases in the treatment group and 30 cases in the control group. The 31 children in the treatment group included 15 males and 16 females, aged between 1.5 and 6 years old, with a mean age of 4 years. In the control group, there were 17 male and 13 female children aged between 2 and 5 years old, with a mean age of 3.5 years. There was no statistical significance in the age composition and gender composition of the two groups of children, and the clinical data were comparable.
Table 1. stages of the relationship between symbolic form and indicated content
Stage
Content
Stage
Content
Stage 1
Difficulty in understanding things and states of affairs
Early childhood language (related symbols)
Stage 2
Basic concepts of things
Adult language (arbitrary symbols)
2-1
Functional operations
Stage 4
Words and sentences, major sentence components
2-2
Matching
4-1
Two-word sentences
2-3
Select
4-2
Three-word sentences
Stage 3
Symbols of things
Stage 5
Words and sentences, grammar rules
3-1
Gesture symbols (related symbols)
5-1
Word order
3-2
Speech Symbols
5-2
Passive voice
Table 2. Symbolic form-indicative content relationship and age stage
Age
1.5-2.0 years
2.0-2.5 years
2.5-3.5 years
3.5-5.0 years
5.0-6.5 years
Stages
3-2
4-1
4-2
5-1
5-2
Speech Symbols
Subject-verb+verb-object
Subject-verb-object
Discourse rules
Passive voice
1.2 Methods
Thirty children in the control group were treated with language training, which consisted of the training of the relationship between symbolic form and instruction content and the training of expression. The training of the relationship between symbolic form and instruction content was as follows: (1) Using auditory stimuli such as sound and tactile stimuli such as touching with hands to make the children gaze at things and continuously follow things with activities, such as toy balls and toy cars. (2) Through classification games, recognize the properties, characteristics and uses of things, and establish the concept of categories of things, which can be grouped by matching and selecting balls of different colors and sizes. (3) gesture symbols training: such as sleep training, the child can be led to the bedside and say “sleep sleep”, while the child’s hands picked up between the therapist’s two hands placed together on the side of the child’s head, do sleep gesture symbols, repeated training. The gesture symbols can also be chosen for going to the toilet, putting on and taking off clothes, eating, etc. (4) Vocabulary expansion training: For example, use various different toys and pictures of dogs, cats and elephants for classification training to form differentiation of animal concepts. (5) Expression training: Let the affected children imitate the marks that cannot be made naturally, such as a, i, u, ai, o, bu, etc. All the above trainings were conducted in a one-to-one manner for 30 minutes each time, once a day, for a treatment period of 3 months. The 31 children in the treatment group were treated with acupuncture on top of the language training treatment. The acupuncture points were mainly Baihui, Sishencong, language area, temporal three acupuncture points and Zhisan acupuncture points. The procedure was: after routine sterilization, acupuncture was performed with disposable milli-needles, and the needles were left for 10-15 minutes, once a day, for a period of 3 months, and the efficacy was determined after 1 course of treatment.
1.3 Efficacy evaluation criteria
After treatment, the children’s language development delay was re-evaluated using the Chinese version of the S-S evaluation method, and the results were compared with those before treatment. Significant effect: the language development ability improved by two stages. Effective: One stage of improvement in language development. Ineffective: insignificant improvement in language development [5].
1.4 Statistical methods
SPSS 16.0 software was used for statistics, and X2 test was used for measurement data, and P<0.05 was statistically significant. < span="">
2. Results
The specific results are shown in Table 3.
Table 3. Analysis of clinical outcomes of children in two groups
Group name
Number of cases
Apparent effect
Effective
Ineffective
Total effective rate
Number of cases
Percentage
Number of cases
Percentage
Number of cases
Percentage of cases
Control group
30
13
43.3%
11
36.7%
6
20 %
80 %
Treatment group
31
16
51.6%
12
38.7%
3
9.7%
90.3
The total effective rate of the two groups was analyzed by columnar information independent sample rate X2 test, X2=4.657, P=0.032 (bilateral),P<0.05, the difference is statistically significant, indicating that the total effective rate of the treatment group is better than that of the control group. < span="">
3. Discussion
There are many treatments for children with cerebral palsy with delayed language development, and language training in modern rehabilitation medicine is one of the indispensable conventional treatments and also an important part of the comprehensive rehabilitation treatment [6]. Human language function is very complex and involves three levels: linguistic, physiological, and acoustic. Abnormalities at any one of these levels may affect language function. The main reasons why delayed language development occurs in children with cerebral palsy are: deprivation or removal from the language environment early in the child’s development can lead to delayed language development, and because children with cerebral palsy often have concomitant auditory impairment, intellectual backwardness, and visual impairment, both language comprehension and expression can be affected if there is a long-term impairment of input to spoken language during the language development period. In addition, damage to a specific area of the cerebral cortex as a result of brain injury can create a disorder that corresponds to that area and hinders language development.
Therapeutically, language training stimulates the language function of the brain through listening, speaking, reading, and writing stimuli to induce its reorganization, and the adjustment of the physiological level is carried out through linguistic and acoustic stimulation-feedback. Therefore, language training can not only improve the delayed language development of children with cerebral palsy, but also improve the dysarthria, and in the process of training, it can also modify and reinforce the child’s own behavior, gradually enhance social adaptation, and build up language skills and social communication skills.
In TCM theory, pediatric cerebral palsy is mainly due to congenital deficiency of endowment, deficiency of liver and kidney, loss of nourishment, weakness of qi and blood, and loss of filling of brain orifices. Acupuncture treatment for pediatric cerebral palsy is based on the holistic concept of TCM and the discriminatory treatment, starting from the meridians and viscera acupoints, taking acupoints by following the meridians, distant channels and adjacent acupoints, and achieving the effects of harmonizing yin and yang, unblocking the meridians and channels, calming the mind, and supporting the righteousness and dispelling the evil through the stimulation of acupoints, so as to reduce muscle tone, improve muscle strength, enhance intelligence, and improve the motor and cognitive abilities of the affected children [7]. Yao Baozhen et al [8] pointed out that acupuncture of head acupoints could increase blood flow to the lesion, improve the ischemic state of the cerebral cortex, awaken brain nerve cells in a dormant state, improve the oxygen-carrying capacity of brain cells, promote the repair and regeneration of damaged neurons, and compensate for the damaged areas, thus improving the language development and intelligence level of the affected children. Liu Weimin et al [9] found that Jin San Acupuncture can improve the high resistance state of intracranial blood supply, accelerate the blood flow rate of the whole cerebral artery, and increase the blood supply to the brain through the study of Jin San Acupuncture in the treatment of pediatric cerebral palsy, which has important significance in the rehabilitation of pediatric cerebral palsy. In the clinical study of this paper, 31 children in the treatment group were treated with acupuncture and massage, which can mainly wake up the brain and open up the meridians, and therefore can receive good clinical treatment effect.
The combination of language training and acupuncture can improve the three different levels of linguistics, physiology and acoustics on the one hand, and realize the combination of traditional Chinese medical theory and modern medical theory on the other hand, so the combination of acupuncture and language training is an ideal choice for the treatment of delayed language development in children with cerebral palsy [10]. The reason why the acupuncture points in this study were mainly head acupuncture and not common tongue acupuncture or body acupuncture is that in actual clinical practice, head acupuncture can be used without affecting other treatments and training of the child to the greatest extent, and can be used in conjunction with other aspects of rehabilitation treatment during needle retention [11].
With the continuous development of society, acupuncture has made new breakthroughs in the treatment of speech delay in children with cerebral palsy. Acupuncture points such as “Neiguan”, “Hegu”, and “Feosanli” can be used to effectively regulate the meridians and improve blood circulation. In addition, acupuncture can be applied to the spinal cord to regulate the excitatory response of the human center. Studies on the treatment of speech delay in children with cerebral palsy have shown that acupuncture can promote nerve regeneration and cause functional recovery of peripheral nerves, which is very effective in treating speech delay in children with cerebral palsy.
Other studies have shown that the degree of speech delay is closely related to the condition and type of cerebral palsy. The incidence and severity of involuntary, mixed, dyscalculia and spastic quadriplegia are the highest, followed by spastic diplegia, and the incidence and severity of hemiplegia are the lowest. Therefore, whether there is a correlation between acupuncture treatment for speech delay, especially the efficacy and the type of cerebral palsy, can be further studied.
In conclusion, the total effective rate of clinical treatment in the treatment group was 90.3%, and the total effective rate of clinical treatment in the control group was 80%. The total effective rate of the treatment group was significantly higher than that of the control group, and the difference was statistically significant (P<0.05) when comparing the total effective rate of the two groups. This experimental study fully combined the advantages of the two treatment methods, with the characteristics of good effect, easily accepted by the children, easy to operate and adhere to, suitable for the treatment of children with cerebral palsy with delayed language development, and worthy of clinical promotion.