I. Head control training
This training can enhance the child’s ability to self-control his head and prepare him to improve his function and complete daily life activities. During the training, the child should try to complete the head lifting action on his own initiative, and the trainer should give appropriate help, or use toys or objects of interest to the child to induce head lifting. Head raising training should be done alternately in prone, supine and sitting positions.
1. Prone head raising training
The child is supported by the forearms, and the trainer is located in front of the child’s head, using brightly colored, light-emitting or sound-emitting toys to attract the child, while saying to the child: “Lift your head, lift your head. If the child does not raise his or her head voluntarily, the trainer can use his or her fingers to tap the back of the child’s neck to induce him or her to raise his or her head.
The child is lying prone on a wedge-shaped mat or pillow, with the higher side under the chest, the child’s legs straight, hands outstretched, and the toy placed in front of or above the child’s head, encouraging the child to look up at the toy and reach for it.
2.Lifting training in supine position
The child’s lower limbs are flexed, the head and trunk are squared, the trainer holds the child’s elbows with both hands and slowly pulls the child up, stopping when the child’s head is slightly tilted back.
3.Sitting head control training
The child’s legs are separated, sitting on the trainer’s lap, the trainer faces the child, taking the sitting position with legs flexed, and through games with the child, the child practices head lifting, head lowering and head turning.
Turning training
Through a variety of methods to train the child to turn over, can expand the child’s range of motion, ready for crawling.
1.Turning training driven by the lower limbs
The child is lying on his back, the limbs are naturally relaxed, the trainer is located under the child’s feet, hands crossed, hold the child’s ankles, assist the child to use the lower limbs to drive the body into a lateral position, and at the same time say: “turn over”.
The child is lying prone with both upper limbs extended to the front of the head, the trainer holds both ankles of the child with both hands and assists the child to turn the body to supine position with both lower limbs, and says: “Turn over” at the same time.
2.Turn over training driven by the upper limbs
The child is in supine position, the limbs are naturally relaxed, the trainer is located above the child’s head and induces the head to turn to the side to be turned. Hold the child’s wrist and shoulders with both hands, assist the child to use the upper limbs to drive his body into a lateral or prone position, and at the same time say: “turn over”.
3.Turn over training with toys
The child is lying on his back, and the trainer uses brightly colored, audible or luminous toys to attract the child to turn his head and reach for the toys to induce him to turn over. At the same time say: “turn your head, reach out and grasp, turn over”.
Sitting training
This training can improve the child’s ability to maintain sitting and sitting balance, so that the child can complete activities such as eating, communication and learning while sitting. During the training, let the child set his head and back as straight as possible, and keep playing with toys and other activities in the sitting position.
1.Correct abnormal sitting posture training
The child is in a sitting position with both lower limbs separated. The trainer sits opposite the child and gently presses the child’s knees with both legs to stretch the lower limbs. The trainer holds the child’s elbow joint with both hands and makes the child raise his head, straighten his back and maintain the sitting position. Pay attention to avoid abnormal sitting posture, and trainers pay attention to avoid pulling too much force, which may cause the child’s shoulder joint subluxation.
2.Chair sitting training
The child sits on a high-backed chair with legs separated by cloth pads and feet on the pedals, and a small table is placed in front of the child’s chest. This training is suitable for children with severe tardive dyskinesia or children under the age of 1 year.
3.Riding and sitting training
This training is suitable for children with lower limb muscle spasm inversion. The child takes a sitting position, separates both lower limbs, rides on a long stool or training roller, steps on the ground with both feet, flattens, extends both hands, lightly holds the stool surface, and maintains the sitting position.
4.Sitting balance training
The child sits on a stool without a backrest, with legs slightly apart and feet flat on the ground to sit firmly, so that the child lifts up the object and rotates the body.
Crawling training
Training the child to crawl can improve the child’s ability to control the body and limbs and move in a wider range, while laying a good foundation for standing and walking.
1.Assisted knee crawling training
The child supports his body with his hands and knees, with both upper limbs straight, and the trainer holds the back of his knees with both hands to help him practice crawling.
2.Assisted hip crawling training
The child supports the body with hands and knees, and the trainer lifts the child’s hip to help the child practice crawling.
3.Assisted ankle crawling training
The trainer is located behind the child, holding the child’s ankle with both hands, and the trainer induces the child to move forward, so that the child first extends one hand, and then moves the opposite lower limb immediately afterwards. The left and right limbs alternate for training.
4.Autonomous crawling training
Use toys to attract the child to crawl on his own.
5.Standing training
This training can prolong the standing time of the child, improve the standing balance, promote the development of the hip joint, and prepare for walking.
1.Standing training with the aid of apparatus
Use a belt to fix the child’s waist properly, use a mat to separate the child’s legs, the same width as the shoulders, put the feet flat and keep the standing position, put a table in front of the child’s chest, let the child play with toys on the table to improve the weight-bearing ability of both lower limbs.
2.Standing stability training
The child stands with his hands on the table and his feet flat, the trainer is located behind the child, holding both sides of the child’s pelvis with both hands to keep him standing and stable.
3.Standing training in the parallel bar
The child stands inside the parallel bars, holding the bars with both hands to keep standing.
4.Standing up training from sitting position
The trainer is located in front of the child, holding the child’s knee joint with both hands, allowing the child to repeatedly stand up from a sitting position and practicing the posture change from sitting to standing.
Walking training
Walking is very important for the child to build self-confidence and participate in various activities. This training can improve the child’s ability to control the trunk and lower limbs in walking, so as to gradually expand his range of motion and increase the opportunity to contact with the outside world. Training should be timely correction of the child’s abnormal gait and attention to safety.
1.Walking training in the parallel bar
The child stands in the parallel bars, holding the bars with both hands, the trainer is behind the child, holding the knee and ankle joint on one side of the child with both hands, the trainer makes the child bend the other leg, lift it up, and then land on the ground heel first and palm second.
The child stands in the parallel bars, holding the bars with both hands, the trainer is behind the child, the body is close to the child, and the trainer pushes the child’s legs with his legs to make him walk forward.
2.Walker-assisted training
Children with foot drop should practice walking after wearing calf orthoses. The child should walk independently with both hands on the walker, and the trainer should be around the child to protect him/her from danger.
3.Guided walking training
Trainers stand on the side of the child, pull the child’s arm, induce the child to practice walking.
Seven, up and down the steps training
This training can improve the child’s walking ability and motor coordination ability, which is of great practical significance for adapting to family, school and social life.
1.Step training
In the balance bar, practice walking across the wooden blocks of different heights to improve walking ability.
2.Assisted up and down step training
When going up the steps, trainers hold the child’s hips and shoulders with both hands respectively from the rear to help the child practice, and gradually reduce the help during training until the child can go up the steps independently.
When going down the steps, the trainer will hold the child’s hip and knee from the front to help the child practice.
3.Guiding up and down the steps with pull ring training
The trainer is in front of the child, using the pull ring to guide the child up and down the steps.
4.Independent up and down step training
Children with better trunk control and more comfortable movement of upper and lower limbs can go up and down the steps with one hand by holding the handrail of the ladder, and when children go up and down the steps independently, they should also be protected.
VIII. Balance and coordination exercise training
Balance and coordination are the prerequisite for stable movement. Balance board, ball, roller and other apparatus can be used for training. Through training, the child can be prompted to adjust his posture, improve his reaction ability and ability to control his head, neck, trunk and balance and coordinate movement.
1.Training on the therapy ball
The child sits on the therapy ball, the trainer holds the child’s body with both hands and gently rolls the therapy ball to the left, right, front and back, the amplitude of shaking the ball should be such that the child can keep sitting steadily to prevent the child from falling.
2.Training on the balance board
The child stands on the balance board with his feet apart, and the trainer holds the child’s hips on both sides to help him shift his body weight between his feet.
3.Training on the roller
The child’s hands are stretched out in front, lying prone on the roller, and the trainer slowly moves the roller to make the child move with the roller, when the child’s palms can touch the ground mat.
4.Lifting and throwing ball training
The child should stand with both limbs properly separated, lift and throw the ball to the ground with both hands, and catch the ball when it bounces.
9.Eating training
The child should be encouraged to eat independently, which is very beneficial to improve the dexterity of the child’s hands and the motor ability of the upper limbs. For children with good swallowing function, feeding training is best done in the sitting position. Children with poor hand grasping ability can eat with assistive devices.
1.Feeding training in semi-recumbent position
The child is placed in a semi-recumbent position with legs apart, and the child is allowed to eat with both hands, with appropriate assistance from the trainer. The trainer should pay attention to avoid choking and coughing when the child eats to ensure safe swallowing.
2.Seated feeding training
If the child is unstable in sitting position, a belt can be used to fix the body, and the trainer will put the child’s palm down flat and fix it on the table, and assist the child to grasp the sheet spoon with the other hand to eat.
3.Eating training with aids
For children who have difficulty in grasping, the spoon handle can be thickened, and the thickness of the spoon handle should be as thick as the child can hold firmly.
4.Drinking training with special cups
The child can use a double-handled cup to drink water, and train the child to coordinate with both hands to complete the action.
X. Dressing and undressing training
This training is to enable the child to gradually put on and take off his own clothes and improve his ability to take care of himself.
1.Choose suitable clothes
In order to facilitate the child to dress and undress by himself, he should choose clothes with wide cuffs and collars, preferably without buttons and zippers, instead of Velcro.
2.Dressing training in prone position
The trainer will lay the child with severe spasticity prone on his or her legs and help the child to put on the more impaired side of the limb first and then the other side.
3.Posterior-assisted dressing training
For children with unstable sitting, the trainer should fix the child’s body and both lower limbs from the rear to keep its sitting position stable, and when dressing, put on the more impaired limb first. When undressing, the limb with the lighter obstacle should be taken off first.
4.Sitting position dressing training
The child sits on a stool, and the trainer should keep the child’s body stable to prevent the child from slipping off the chair.
Washing and toileting training
The child should be taught to perform daily personal hygiene activities, such as brushing teeth, washing, post-poop handling and bowel control, as early as possible to improve his or her ability to take care of himself or herself.
1.Tooth brushing training
The child should hold the handle of the toothbrush and the trainer should hold the child’s arm and assist him/her to brush his teeth up and down.
2.Face washing training
Put the bristles on the child’s hand in sets and wash the face.
3.Sitting training
Children with unstable sitting position can use a toilet seat with a backrest.
4.Safe toileting
Handrails should be provided near the toilet seat for the child to clean and put on and take off pants after defecation.
Communication and participation in group activities
Children with cerebral palsy should be encouraged to play with other children as much as possible, participate in group activities, get to know the surrounding environment, use public facilities and learn more knowledge in order to train the children to form a healthy personality and better integrate into social life.
1. Expressing will with pictures
Children who have difficulty in expressing themselves verbally can express their wishes by pointing to pictures or using gestures.
2.Participate in group games
Encourage the children to play with other children and communicate with others in the game.
3.Getting to know the environment
Take the children out of their homes, get to know the environment around the community and learn about life in general.
4.Accept education
Create conditions for the child to attend kindergarten and school in time to receive education.