In the past 50 years, with the rapid development of obstetric technology, perinatal medicine and neonatal ICU medical technology, the neonatal morbidity and mortality rate has decreased significantly, although many critically ill newborns were saved by resuscitation, but cerebral palsy was caused by premature birth, severe hypoxia and jaundice. Data show that there are 4-5 million children with cerebral palsy (cerebral palsy) in China, and 30,000-40,000 new children with cerebral palsy are added every year [1], of which 20%-30% are cerebral palsy with involuntary movements, which has become a serious social problem. The author used comprehensive rehabilitation therapy to achieve obvious results, which are reported as follows.
1. Information and diagnostic criteria
1.1 Data There were 68 cases in this group, 49 males and 19 females; age ranged from 2 to 8 months, 29 cases from 2 months to 5 months, 39 cases from 5 months to 8 months; 36 cases were preterm babies and 32 cases were full-term babies; 22 cases had a history of bilirubin encephalopathy, 27 cases had a history of hyperbilirubinemia, 9 cases had prolonged jaundice, 11 cases had prolonged asphyxia before birth and at birth due to factors such as hypoxia in utero, prolonged labor or obstructed labor. All of the selected cases had unstable vertical head or skewed head and neck, abnormal ATNR posture, different degrees of head dorsiflexion, corkscrew-like, and increased muscle tone of the limbs.
1.2 Diagnostic criteria Inclusion criteria according to early diagnosis and intervention of cerebral palsy [2]: ① symptoms and signs of central movement disorders within 1 year of age; ② abnormal muscle tone; ③ abnormal posture at rest or during movement. Cerebral palsy was diagnosed by having both ① and ② or ① and ③, except for central motor disorders due to progressive diseases.
2. Methods
2.1 Traditional rehabilitation
2.1.1 Acupuncture point injection Combining with clinical symptoms, the head is selected with Baihui, Sishenzhen, frontal five needles, bilateral upper limb motor area and sensory area, tremor area, heart and liver area, temporal three needles, and language area; the neck and shoulder are selected with Fengchi, Mute Gate, cervical pinch spine, Tian Ding, Fu Tuo, Ren Ying, chest Huatuo pinch spine, shoulder three needles, Tian Zong, Bing Feng, Qu Yuan, Dazhi, Tianzhu, shoulder well, Qu Ji, and Hegu.
VitB1200mg and VitB121mg diluted with 100ml of physiological saline were selected, and the scalp was mainly stabbed flat in the head, and the injection volume was limited to the appearance of 1~1.5cm-sized mound at the site, and 1~1.5ml of medicine was injected at each point of body acupuncture, once every other day, 10 times as a small course of treatment, 3 small courses as a large course of treatment, and the interval between small courses was 1~2 weeks.
2.1.2 Acupuncture The acupuncture points and treatment course are the same as those for acupuncture injection, and the acupuncture method is based on vertical acupuncture, with some acupuncture points being flat or oblique as required.
2.1.3 Tui Na Tui Na mainly applies rolling, kneading, pressing, pointing, pinching, pinching, shaking and stretching methods to the head and neck, upper limbs and shoulders and back of the child in a rhythmic operation from light to heavy, with the whole operation process being light but not floating and heavy but not stagnant. The above acupuncture points were integrated into the massage process, with emphasis on the impact point of rubbing Fengchi and the back of the neck.
2.1.4 Chinese herbal fumigation The formula is used: 30g of elixir, 30g of penetrating herb, 30g of Chuan Mu Gua, 20g of mugwort, 15g of Chuan Xiong, 20g of Qiang Wu, 30g of safflower, 30g of red peony, 30g of white peony, 20g of raw licorice, 30g of geranium, 30g of salvia, 30g of gui Zhi. The drugs and water are decocted together in a decoction bin and then put into the hydrotherapy pool, controlling the temperature at 38-42 degrees.
2.2 Modern rehabilitation Bobath therapy, Vojta therapy and Ueda therapy, which are the most widely used in the world today, are mainly used to treat movement disorders caused by abnormal posture and abnormal primitive movement patterns dominating their overall movement due to residual primitive reflexes and increased muscle tone after brain damage, which prevent normal random movements. Pull-up training, elbow and hand wedge plate and barbell compression support training, supine shoulder, elbow and hand triple joint compression load training, and training to increase upper extremity shoulder, elbow and hand triple joint mobility;
Vojta therapy was applied with reflexive rollover and reflexive prone crawl variation2; Ueda method was applied with neck method, neck and pelvis method, upper limb method, neck 2 method, and scapular girdle method. Each time 8 training items were selected, the treatment was 60 minutes, twice a day, and parents were instructed to maintain the ball holding position for 5 minutes after the treatment to consolidate the treatment effect.
2.3 Rehabilitation guidance The rehabilitation training for children with cerebral palsy of this type is long-term and arduous. Obtaining the cooperation of parents, who spend the longest time with the children and have the closest contact with them, can often achieve twice the effect with half the effort. Parents should be taught the common home rehabilitation techniques and correct holding postures for children with cerebral palsy with involuntary movements, and be required to give the child 30 minutes of rehabilitation training once or twice a day; maintain the correct holding posture of the child with cerebral palsy in daily life: the child should face outward and forward, with the back against the parent’s chest, and the parent should hold the child’s buttocks with one hand and place one hand under the armpit of the child’s side on the child’s chest and abdomen; the child should try to sleep in a lateral position or use a suspended bed to sleep. When the child sleeps, try to adopt the side position or apply the suspension bed to sleep, always pay attention to correct the abnormal posture of the child; listen to some soothing music for the child every day, such as the five elements music of Chinese medicine and some music of Buddhist scriptures, which is conducive to the relief of the child’s muscle tone.
2.4 Efficacy criteria and results
2.4.1 Efficacy criteria The symptoms of head dorsiflexion completely disappeared, and the random movements returned to normal, similar to those of normal children of the same age. Significant effect: significant improvement of head dorsiflexion symptoms, significant reduction of upper limb posterior extension, restoration of random motor function, flexible movement of certain parts of the limb; Improvement: significant improvement of head dorsiflexion symptoms, with some differences from normal children; Invalid: no improvement of symptoms.
2.4.2 Results After 2 major courses of treatment, 14 cases of 68 children had disappearance of head dorsiflexion symptoms and recovery of random movement, accounting for 20.6%; 41 cases of significant effect, accounting for 60.3%; 11 cases of improvement, accounting for 16.2%; 2 cases of invalidation, accounting for 2.9%; the total effective rate was 97.1%.
3.Discussion
The posture and motor development of normal children develop from cephalad to caudal and from proximal to distal, and good head control is
Good head control is the basis and milestone of all human motor development, and poor head control inevitably leads to delayed motor development such as rolling over, sitting, kneeling, crawling and walking.
Poor head control inevitably leads to delayed development of movements such as rolling, sitting, kneeling, crawling and walking. Poor head control inevitably leads to delayed motor development such as rolling, sitting, kneeling, crawling and walking.
The control of abnormal postures such as head tilting, shoulder contraction, midline movement difficulties, and trunk twisting starts with head correction, and the treatment course is relatively long and requires long-term adherence.
Comprehensive treatment for more than 3 months to see significant results.
Acupoint injection is a treatment method that uses the most direct method to deliver the most effective drugs to the most needed place. It integrates the dual effects of acupuncture and drugs, transmits stimulating information to the brain, stimulates its residual and potential functions, and achieves the purpose of unblocking meridians, harmonizing qi and blood, correcting abnormal postures and movements, and inducing normal postures and voluntary movements.
Local tui-na and acupuncture points can relieve the tense muscles in the neck and shoulders and reduce their tension, and the impact pressure on Hua Tuo’s chiropractic points can give a benign stimulation to the deep spinal nerve roots and regulate muscle tension. Activating blood circulation and warming the meridians can improve peripheral and local blood circulation, enhance metabolism, and reduce muscle spasm in three ways: the rapidly rising warming effect can directly cause a temporary and complete inhibition of muscle shuttle activity, or reduce the frequency of impulses issued by it; the large-scale heat therapy reduces the activity of some fibers controlled by the central nervous system, and the response to muscle pulling action The massage effect of hydrotherapy on the skin can relax and sedate the child and improve spasticity.
The Bobath method uses inhibition and facilitation techniques to inhibit abnormal postures and movements and induce the appearance of correct postures and movements through the control of key points; the Vojta method produces temporal and spatial accumulation through the stimulation of the evoked zone, accelerates the speed of muscle resuscitation, promotes the disappearance of primitive reflexes, and improves muscle nutrition and dysarthria.
Although the two techniques are different, they both emphasize that infant brain tissue is highly compliant and plastic, and through external stimulation, they induce the formation of new neuronal side branches, promote myelination of nerve fibers, and increase synaptic potentials, thus exerting compensatory effects. The Ueda method used in this paper can reduce muscle tension in the perioral region, neck, upper limbs and trunk, promote the reduction and disappearance of coracoid state, neck kyphosis and forward flexion, improve respiratory movements, and enhance oral function.