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Physical rehabilitation of children with cerebral palsy

In this case, under the "action" means acquired in the course of life the ability to plan and execute coordinated movements.A child with cerebral palsy have difficulty in carrying out its usual level of action - such as tying shoelaces, cycling or writing letters.Details you will find in the article titled "Physical rehabilitation of children with cerebral palsy."

modern approach

Until recently, these children were considered to be slow, awkward and clumsy.This often leads to an underestimation of the problem and the lack of adequate treatment.As a result, the child can develop a number of behavioral disorders associated with frustration, because of the inability to make the body perform the necessary movement at the right pace.At present, it is assumed that these children have certain disorders of higher nervous activity (full or partial absence of abnormalities in the nervous system, musculo-skeletal function or reflexes), leading to a decrease in the ability to calculate and perform purposeful

movements.Any connection between cerebral palsy and mental decline does not exist.


rough estimate, milder forms of cerebral palsy affects up to 10% of the population.At 2-5% are observed more severe forms of the disease.70% of these patients belong to the male sex.It is assumed that the cause of cerebral palsy is hypoplasia nervous system.In turn, this may be due to congenital neurological defect or hypoxia (oxygen starvation) of the brain at birth.The first movement of the fetus in utero does result in involuntary reflexes.In the process of development of the child, these reflexes gradually improved, becoming more accurate and are subject to the conscious volitional control.Full maturation of motor systems begins at the end of adolescence.Organization of voluntary movement depends upon a number of factors.The child normally receives accurate information about the environment through touch, the work of the vestibular apparatus and proprioception (sense of position in space).Efficient synthesis of this data allows to calculate and perform the desired movement.Cerebral palsy may be associated with certain abnormalities in any one or all three sources.In connection with this manifestation of cerebral palsy in different children may be different: one child is difficult to button buttons, and the other - clearly pronounce the word.


child with cerebral palsy often can not adequately perceive and process the following information:

• touch - the inability to recognize objects by feel occurring to the touch (stereognosis);

• vestibular apparatus - the balance organ, located in the inner ear, can provide enough accurate information about the position, movement, balance and body position in space;

• proprioceptors - a sensory nerve endings are available in all the muscles, tendons and joints, and transmitting information about their position in space to the brain.Interacting with vision and hearing, they provide coordination and maintaining balance.The manifestations of cerebral palsy may be caused by lack of proprioceptive system.In most cases, parents are the first to sound the alarm, noting the child's specific symptoms or lag in the development of specific indicators for the appropriate age.It is important that a child has been examined by a pediatrician in a timely manner and a child psychologist, best before entering primary school.It will not only provide early treatment and the development of effective methods of the individual, which the school can use to work with the child, but also to minimize social isolation, ridicule of peers and low self-esteem.

forms of cerebral palsy

's psychologist conducts a series of special tests to assess the degree of cerebral palsy, and to identify the part of the daily activities, in which it affects.The classification of the forms of cerebral palsy, observed in children, there are four main criteria, depending on the prevalence of violations of certain motor skills (although usually in varying degrees, are affected all areas).To a group of skills that can be broken at the cerebral palsy include:

• gross motor skills - control muscle activity, motor coordination and balance required to perform large movements;

• fine motor skills - necessary to perform small movements, such as tying shoelaces;

• verbal skills - difficulty understanding verbal instructions and explanations;

• language skills - difficulty in pronouncing words.

Depending on the form of cerebral palsy child psychologist can refer the child for consultation to a specialist, such as Rehabilitation, speech therapist or occupational therapist.

long-term treatment

Timely detection of symptoms in a child with cerebral palsy and their correction are very important.However, it is equally important not to stop treatment prescribed during the whole period of schooling, and possibly longer.This is partly due to the fact that as the need arises in the development of more sophisticated skills, requiring a high level of coordination.In addition, often there is a tendency to return to old problems and the emergence of new during and after the next growth spurt.Cerebral Palsy can be shown by a number of different symptoms, depending on its form and severity:

• clumsiness, awkwardness;

• reduced concentration - a child can quickly forget just heard;

• restlessness;

• awkwardness in food - a child holding a spoon and a fork in his hand;

• dislike of drawing and coloring;

• inability to catch a ball or hit it on foot;

• lack of interest in games with other children;

• inability to jump on one or two legs or jump an obstacle;

• in infancy - the inability to crawl (the child moves, sliding on his stomach);

• sloppy child often loses things;

• the child wears a long time, does not know how to tie shoelaces or fasten buttons;

• constantly encounters objects upsetting things.

For selection of optimal treatment is necessary to clarify the nature of the existing violations.For this purpose, the number of special tests to assess the physical abilities of the child.Before the test rehabilitologist offer parents fill out a questionnaire, reflecting information about the structure of the family, the presence of brothers and sisters, carried the child diseases, its progress and behavior in school, social skills, friendships, interests and fears.

Evaluation of Child Development

test takes about an hour and held one-on-one with a child, in the absence of parents.On the basis of this information in the questionnaire, and the results of various tasks Rehabilitation concludes degree of physical development.

Standards Development

development of certain skills in children occurs in approximately the same order and in about the same time.The transition to the next skill development to a certain extent depends on the mastery of the previous ones.For example, the first movement of the child becoming coups from stomach to back and back;later he begins to sit, crawl, and then - to get up on his knees and, finally, to stand.Learn to stand, he makes the first steps.The ability to walk gives impetus to the development of new skills - a child learns to run, jump on one and two legs, jump obstacles.In the development of these skills the child reaches sufficient control over the movements of the limbs, which allows him to master more complex skills - such as throwing and catching objects, draw with crayons or eat with a spoon.Undershoot or "loss" of any of the above stages of physical development greatly complicates the assimilation and fixation of more complex skills that constitute an integral part of growing up.That is why it is so important to the timely identification of cerebral palsy.Medical Rehabilitation is conducting a series of tests to assess:

• condition of the musculoskeletal system - children with cerebral palsy do not cope with the implementation of some of the movements, which often leads to a lack of stress and muscle weakening.In evaluating the tests are used muscle strength;attention is drawn to the condition of the muscles of the shoulder and pelvic girdle, and tonic (postural) muscles.The movements performed by these muscles, form the basis of all other movements, such as balance while keeping the balance;

• condition of joints - in some children with cerebral palsy observed "looseness" of the joints - the excessive amount of passive movements, resulting in reduced control.This is accompanied by an impaired ability to perform precise operations, such as writing;

• harmony - physiotherapist assesses a child's ability to maintain balance when performing age appropriate motor tasks (such as balancing on one leg or slow walking on an inclined bench gymnastics).There have extra movement helps the baby maintain balance (for example, waving his hands);

• coordination - to assess the visual coordination of hands and feet using a ball game.In young children, it may be replaced by playing the insertion of objects of different shapes into the appropriate size and shape of the opening;

• function hemispheric interaction - many children with cerebral palsy, "passed" the stage of crawling, moving by sliding on his stomach.However crawling ability of the brain to stimulate the transfer of information from one hemisphere to the other, which is important, for example, in coordinated movement with both hands or feet.The ability to perform such activities is essential for many types of physical activity.Rehabilitation estimates the natural movements of the hands in relation to the median line of the body with the "draw" shapes in the air;

• ability to carry out instructions - doctor checks the child's ability to understand and follow simple verbal instructions (estimated, if necessary with the repeated explanations or a clear demonstration of the workflow).

choice of methods of physical rehabilitation depends on the individual needs of the child.Treatment is built on exercises and games that motivate him to make full use of their physical abilities.Such training is the basis of versatile work with the child, if necessary, include assistance occupational therapist, speech therapist, supported by parents, teachers and health workers.The goal of treatment - increased self-esteem of the patient through a small performance of simple tasks before moving on to working out a more complex skills.This approach is based on the hypothesis that physical activity improves functions of existing pathways in the brain and the formation of new ones.Typically, the child attends physical rehabilitation room 1 to 2 times a week for several months.He must deal with on a daily basis for a suggested program at home.Classes continued after the end of the visits to rehabilitation.Monitoring the progress of a child rests with the parents.At deterioration or lack of effect it is recommended a new cycle of rehabilitation therapy.

Common treatment approaches

in the treatment of cerebral palsy are a number of common methodological approaches.

• Swimming

Swimming is recommended for all children with cerebral palsy.It helps to strengthen the muscles.Movement in the water slowed, giving the child extra time to calculate the action.The ability to preserve equilibrium in the water is less important, so it can deal with on an equal footing with their peers, thereby increasing his self-esteem.

• phased development

After mastering the skills of the next sessions are focused on achieving the following.For example, at first the child learns to roll on a mat spread on the floor, then - roll with a slight slope, then - roll with the big ball, then - to perform movements with his hands in the prone position.Then, the child learns to sit still, with the support feet on the bench, for example, engaged in painting (with a gradual increase in training time).

• Training function hemispheric interaction

Particular attention is paid to the functional improvement of hemispheric interaction.Exercises of this group include crawling through the pipe, broken on the wall bars with overlap arms, exercise, in which the child moves on all fours, blowing on rolling a tennis ball in front of him, walking with alternate lifting of opposite arms and legs.

• balance training

With the improvement of hemispheric interaction functions go to work on the coordination of movements and balance.Begin by trying to be kept standing on two feet on the "swinging board" with a broad base, and then - on one leg.After that, go to a slow walking.

correction motor problems associated with cerebral palsy, is based on the use of special exercises.At the same time for each child to develop individual treatment plan.Exercises for balance, coordination and orientation in space aimed mainly at improving the overall motor skills.In order to correct violations of fine motor skills using methods of occupational therapy.The physical treatments include cerebral palsy

• balance exercises - slow walking on an inclined bench gymnastics;balancing on one leg in the "rocking the board";catch the ball or fabric bags filled with plastic balls, standing on the "rocking the board";jumping rope;game in the "classes" or leap-frog;

• coordination exercises - exercises with a rope;"Drawing eights" hands in the air;exercises in posture "sitting cross-legged";creeping;Exercise "Cars" (walking on his hands supporting legs);swimming;playing with a ball and a racket;game in the "classes" or leap-frog;jumping "star";

• exercises on the orientation in space - the use of "tunnel" game with a ball on the mat;catching balls or balls of various sizes with thorns;

• exercises to develop fine motor skills - picking sticks;Mosaics;game "Fleas."Now you know what the physical rehabilitation of children with cerebral palsy.

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