Rehabilitation training of cerebral palsy rehabilitation

1. When the child is supine, the leg of the child is passively flexed by traction, and the hip joint is flexed and extended: the adductor muscle is pulled by shaking the hip and leaving the hip to reduce the tension and keep it for a moment (this is very important), and the operation is repeated.

2. Adopt straight leg compression sitting training, and fix the abduction of both lower limbs at about 60 degrees (if the adductor muscle tension is high, it can be expanded to 75 degrees, but the degree should not be too large, the thigh angle of normal people is 150- 160 degrees, and the baby is smaller) to stretch spasmodic muscles and reduce muscle tension. This is static training.

3. Hammer the hip joint training chair to train the child's lower limb abduction-adduction-abduction, so as to achieve the purpose of pulling muscles and activating the hip joint while exercising. This is dynamic training.

4. "Riding" training, (using wooden barrels, wooden horses, wooden chairs, etc. ) can stretch spasmodic muscles, reduce tension and restore function.

5. "Climbing high" and "crawling" training, (using frog style, that is, legs as far as possible).

6. The child walks sideways with the handrail, gradually relieves the spasm with his active movement, and expands the range of joint activities, thus achieving the purpose of mastering the opening and closing movements of lower limbs and correcting the gait of scissors.

7. When the child is resting, put a pillow or other soft object between his legs, with his toes facing outwards as far as possible, and encourage the child to separate his legs.

(b) Reduce the training of standing and walking with knees bent.

1. Stretch contracture tendons and relieve spastic muscles by pressing knees or raising straight legs in supine and prone position.

2. Stand, bend over to take things, pull the spasmodic national rope muscles, relieve tension and enhance waist muscle strength.

3. The application of bow and arrow pressing, knee joint stretching and quadriceps training chair can improve quadriceps muscle strength, antagonize spastic hamstring muscle and improve knee joint self-control ability.

4. One-step parallel bars and standing knee lifting training can improve the ability of knee joint to bend and stretch independently and coordinate the motor function of limbs.

5. Power car and walker training can improve the active motor function of lower limbs and increase the range of joint motion.

(3) Knee supination training

There are three reasons for "genu valgus": (1) the bone changes of the knee joint itself, resulting in abnormal position of the knee joint; (2) Under the load-bearing condition, the control ability of the knee joint is poor, which shows that the proprioception of the knee joint disappears, the ligaments around the joint relax, and the muscle strength of the quadriceps femoris and hamstring muscles is weak or does not contract in normal proportion; (3) Flexor contracture or high muscle tension can also lead to excessive extension of knee joint. The main cause of atelectasis of knee joint in children with cerebral palsy is dystonia.

1. Knee pressing, ankle traction, ankle shaking and flexor digitorum traction training.

2. Knee flexion and extension, foot dorsiflexion training, improve extensor strength, coordinate and antagonize muscle tension.

3. Crawling training and knee flexion are beneficial to correct tension, increase the control ability of knee joint movement and coordinate its motor function.

4. Improve the muscle strength of national rope muscles, reduce the tension of extensor muscles, and coordinate the flexion and extension functions of joints.

5. Step-up training plays an important role in correcting genu varus and coordinating gait.

Correcting "knee supination" is mainly to control the extensor movement of lower limbs. Generally, mild symptoms are corrected by exercise training. The method is as follows: the knee of the affected hand is supported on the mattress in kneeling position, and the knee of the affected side is trained in flexion and extension. In order to coordinate the movement, the knee joint is trained alternately in flexion and extension. With the improvement of symptoms, it is changed to supine position or standing position, and in severe cases, lower limbs are corrected or surgically corrected.

(d) Pointed foot, varus and varus training

1. Self-traction method-the child stands facing the wall, then slowly leans forward until the achilles tendon feels traction, or he can turn his toes to the outside (like Chaplin) to do the same.

2. Muscle strength training of flexor dorsi pedis and sitting in an ankle training chair can antagonize spastic calf muscles, increase the range of motion of ankle joint and correct deformity.

3. Lie on your back, press your knees on your stomach, adjust your feet, pull your ankles, shake your ankles, and correct your deformity. The application of eversion.

4. Go up and down the steps, train on the sports car, stretch spasmodic muscles during exercise, expand the range of activities, restore functions and coordinate gait.

(5) Training of upper limbs and hand functions

1. Shoulder flexion, adduction and pronation training

In flexion position (1), the child is supine. The operator holds the forearm with one hand, slowly lifts it along the midline of the body until it is close to the ear and repeats the operation.

(2) In the retracted position, supine position or sitting position, hold the upper arm with one hand and the forearm with the other. When the horizontal direction moves to 90 degrees (abduction), the palm will continue to move upward until it reaches the ear root, and repeat the operation.

(3) In the internal rotation position, sitting position or supine position, the performer presses the shoulder with one hand and bends the elbow with the other hand, and then performs external rotation and downward pressure, and repeats the operation.

(4) Upper limb weight training, dumbbell training, stick training and sandbag training can increase upper limb muscle strength, expand joint range of motion and restore motor function.

(5) Raise your arm and touch your shoulder (bend your arm and dial the knife), lift your hips and hold out your chest (the chicken is flying).

2. Elbow flexion training

(1) Active and passive elbow flexion and extension.

(2) Upper limb weight bearing and elbow grasping training.

(3) When bending and stretching, the joints (Cai He is carrying a basket), stretching the shoulders and bending the elbows (pushing a close call), bending the shoulders and stretching the elbows (white apes offering fruits), and raising their hands (raising the fire to the sky).

3. Wrist and finger joint flexion and thumb adduction training

(1) Passive wrist-hand exercise: The performer puts his hands side by side at the lower end of the wrist joint, his two thumbs side by side at the back of the wrist, the fingertip points to the forearm, and the other four fingers rest on the palm of his hand, so that the child's wrist bends, stretches, shakes and pulls, and then the fingers twist and pull alternately from the base of the finger to the fingertip, and finally a batch of operations are finished by drawing, and the operations are repeated.

(2) Grasp with the palm of your hand, hold hands with each other, and grasp with the palm upward. (golden dragon probe claw)

(3) Grasping (holding a pen) training, thumb and forefinger pinching (buttons, soybeans, mung beans, holding a spoon, holding a key to open the door, etc. ).

(4) Wrist extension (dorsiflexion), flexion (palmar flexion), finger abduction and adduction training (fingers closed separately).

4. Thumb adduction training

Thumb adduction, abduction, stretching training, thumb flexion, palm-to-palm, finger-to-finger training and hands crossing training. Hand function training follows the process from simple to complex, from easy to difficult, from coarse to fine. Years of clinical experience in treating cerebral palsy has proved that "treatment is the foundation and training is the key". Training without treatment is either impossible or ineffective. On the contrary, the treatment without training can neither consolidate its therapeutic effect nor achieve the expected effect. Treatment and training get twice the result with half the effort

According to different places and different people, he has formed his own set of training methods. The order is to raise his head, straighten his waist, do limbs and do four gymnastics.

A, hands and feet crawling training method:

(Training of Head Control Ability)

(A) supine pull-ups training

1. Sit-ups training, through the process of anti-gravity activities to improve the head control ability;

2. Lie on your back and roll gently on the Bobath ball and barrel to elicit the protective response of the child's trunk buckling;

3. When lying on the back, use various toys to induce the child to turn left and right, so as to improve the control ability of the child when his head rotates freely;

4. The child lies on his back in the hammock, so that the trunk and limbs of the child are in the flexion position, so as to suppress the hunchback caused by the increase of extensor tension (affected by TLS in supine position).

(2) Prone position training

1. Prone on the wedge pillow to improve the head and neck's ability to control gravity stretching and lifting and the support ability of shoulders and upper limbs. (Note: Keep the hip joint in the extended position)

2. Prone Babath ball, bucket and balance board, and use the constant change of center of gravity to induce children's protective stretching reaction, so as to improve the ability of defying gravity lifting in the head and neck.

3. Crawling training, through the child's active movement to increase the control ability of the head.

(3) Seat training

1. Cross-legged sitting and long sitting posture can improve children's head control ability, and at the same time improve waist strength and sitting posture balance training.

2. The child straddles the mother's chest, and the mother and son face to face to train the head control ability (note: mother and son should look straight), and at the same time enhance the emotional communication between mother and son.

3. Use the neck movement to adjust the muscle tension of the neck and increase the muscle strength of the neck to enhance the control ability of the neck.

(Specific methods: The operator gently holds the child's double mandibular surface with both hands, and makes head flexion, extension, lateral flexion, lateral rotation and circular rotation to adjust the tension of the neck muscles).

You can also walk with a walker. In the process of walking, the child gradually adjusts the abnormal tension, restores muscle strength, and achieves the purpose of enhancing control ability.

Finally, in practical work, whether the head is on the symmetrical main line is measured according to the following three methods:

(1) When the child looks up, the head does not turn to both sides, which is consistent with the midline of the trunk: (2) When the child is prone (such as wedge pillow, Bobath ball, bucket), the head and body are in a straight line; (3) Children sit with their heads centered on the side, not tilted back and forth, and consistent with the trunk centerline.

(4) voluntary movement and abnormal posture training.

Based on the principle of "improving muscle strength, reducing muscle tension and inhibiting abnormal primitive reflex", combined with the actual situation of children, corresponding training methods are adopted.

1. Use ladder back frame, bar bed and square stool to train children to keep the posture of midline symmetry when sitting, lying, kneeling, standing and walking, so as to restrain involuntary peristalsis and strengthen the establishment of their normal movement mode.

2. The use of treadmills, powered bicycles and quadriceps training chairs can increase the muscle strength of lower limbs, reduce abnormal muscle tension, inhibit voluntary movement and strengthen the normal exercise mode.

3. One-step parallel bars training coordinates the muscle tension and motor function of quadriplegia.

4. The training of coarse and fine movements of upper limbs and hands can strengthen the coordination ability of hands and eyes, inhibit abnormal patterns and involuntary movements, and restore the motor function of upper limbs and hands.

5. "Walking Trilogy", according to the child's condition, choose hanging walkers, walking belts and pushing walkers in turn to improve muscle strength, correct dystonia and coordinate motor functions, and then correct toe, varus and other deformities.

For older, seriously ill children, mixed children who mainly wriggle their hands and feet, children's general spasms tend to increase in a vicious circle due to the influence of tension labyrinth reflex (TLS), and at the same time, due to the influence of asymmetric heterosexual cervical tension reflex (ATNR), the trunk and limbs partially rotate. On the back, one muscle is shortened, the trunk is shortened, and one pelvis is lifted, which leads to hip flexion and hip flexion.

The operator relaxes spastic muscles through manipulation or neck exercise, gradually enhances the head control ability of children, corrects scoliosis, relaxes tense muscles, enhances their antagonistic muscle strength, prevents more serious deformity, fully moves joints, pulls spastic upper limbs or lower limbs, and inhibits involuntary peristalsis (lower limb fixation and upper limb splint restraint can be adopted), so as to achieve the purpose (principle) of inhibiting abnormal primitive reflex and establishing normal movement mode.

According to the main symptoms, highlight the key points, and master the principles of raising your head, holding your waist, practicing limbs and gymnastics in the training sequence. According to different signs, refer to the method of hand and foot spasm or peristalsis for training.

(A) grimace training method

1. Temporomandibular joint training, children passively (or actively) do mandibular upward, downward, forward, backward and lateral movements, coordinate facial muscle tension, enhance joint flexibility and restore function.

2. Facial expression muscle training

(1) Grind and chew bubble gum to exercise the coordination of facial muscles.

(2) Massage facial muscles, massage related acupoints (vertical root, hearing, wind, base and pulp), and adjust muscle tension.

(3) Practice mouthing, pronouncing and blowing balloons in front of a mirror.

(2) Medical gymnastics (the basic form and main means of exercise therapy)

1. Upper limb movements (passive and active movements)

Preparation posture: supine position, with the operator facing the child, holding the child's wrist with both hands, putting the thumb on the child's wrist and the thumb on the child's palm. Put your arms at your sides.

The first section is the chest expansion exercise; Section 2 stretching exercise;

The third quarter elbow flexion movement; Section 4 Circular motion.

Scope of application: Children with cerebral palsy with limited upper limb joint movement.

2. Lower limb exercise (passive and active exercise)

Preparation posture: supine position, both lower limbs straight, and the operator holds the ankle of the child with both hands.

The first section bends the knees and hips; Section 2 Hip abduction exercises

In the third section, the hip joint rotates inside and outside; The fourth section is knee flexion and extension;

Section 5: Pull the ankle and shake the ankle; Section 6 ankle flexion and extension.

Scope of application: Lower limb dyskinesia in children with various types of cerebral palsy.

Many of the above rehabilitation training are professional operations, and it is recommended to operate under the guidance of professionals. At the same time, it should be reminded that rehabilitation training is an indispensable treatment for cerebral palsy. Hospitals can give children surgical treatment, but they all need to cooperate with rehabilitation training to help them recover their limb functions in the later stage. A detailed understanding of rehabilitation training can enable patients to choose more suitable rehabilitation training to cooperate with their children's treatment.