CP treatment

脑瘫发病率 CP morbidity
脑瘫高危因素High risk factors of CP
脑瘫分型 CP type
运动疗法Physical therapy
作业疗法Occupational therapy、
语言疗法Speech-language pathology、
高压氧治疗hyperbaric oxygen treatment
肉毒杆菌注射Bacillus botulinus injection
传统康复疗法tradition rehabilitation therapy
中药熏蒸疗法traditional Chinese drug fumigate therapy
手术疗法operative treatment
水疗hydrotherapy
文体治疗Recreation and music therapy
矫形器辅助orthosis adjunctive therapy
超声治疗ultrasound therapy
感统训练Sensory integration training
引导式教育Conductive education
脑循环仪cerebral circulation equipment
寓教于乐Learning through playing
感觉刺激疗法stimulation of senses therapy

Incidence of a disease(发病率)

The reported CP morbidities are variable in different country .In 1988,Jiamusi region ,the CP morbidity is about 1.8~4/1000.According to a survey carried during 1977 to 1999,in Jiangsu province and other 6 provinces ,the morbidity of 1 to 7 years old children ,is 1~2.7/1000,while in western countries the number is 1.5~2.5/1000 .Compared with Sweden ,Australian ,the United Kingdom ,North Ireland ,during 1959~1992,the average level is beween 1.5~2.5/1000.Although male rate is a bit higher than female, there is no significant difference between countries ,or city and countryside .In 1985,there are 750,000 CP patients be amounted in USA .Every year ,2,000 more CP children are diagnosed in the United Kingdom .In China ,there are 2,600,000~3,000,000 CP children ,and the number is increasing in the speed of 60,000~70,000/year.

High risk factors of CP(高危因素)

According to the relationship between high risk factors of CP and pregnancy processing , the factors are divided into 3 groups ,they could happen before pregnancy ,during pregnancy ,and after pregnancy .
Including
1.Before pregnancy:heritage factor ,mother's infection during pregnacy ,multiple pregnancy ,preeclampsia.
2.During pregnancy :anomaly of placenta ,fetal distress ,respiratory distress syndrome ,high forceps operation ,intracranial hemorrhage ,premature delivery ,postterm pregnancy ,low birth weight infant ,fetal macrosomia (over 4000g).
3. After pregnancy:infectious diseases ,uninfectious diseases during neonatal period ,accidental injuries.

Types(类型)

1.spastic type (痉挛型)
2. rigid type (强直型)
3. Athetoid CP (手足徐动型)
4. ataxic type (失调的)
5. tremor type (震颤)
6. atonia type (肌张力低下型)
7. mixed type (混合型)
8. unclassified (无法分类者)

The classification of cerebral palsy ( CP ) by position
monoplegia﹑pareplegia﹑hemiplegia﹑diplegia﹑triplegia﹑quadriplegia﹑double hemiplegia.

Physical therapy (PT) (运动疗法)

Bobath neurodevelopmental treatment (Bobath神经发育疗法)

It is the main treatment for cerebral palsy and limb dysfunction in the world, and it’s pioneered and developed by Dr Karel and Mrs Berta Bobath in 1950s. Our center sends annually the person to Japan and England to study since 1984, introduce this method, cure 8560 patients, total efficient 93.5﹪, get the sufferer's approbation. Bobath mainly adopt the method of inhibiting abnormal posture and advancing the normal to treat CP , so it’s also called the neuro-developmental treatment via reflex to inhibition and promotion.

The treatment skills including (治疗手技)
1.Reflex inhibition （inhibit extension and flexion）:the former is suited for the patients of head dorsiflexion﹑the whole body with ATNR﹑opisthotonus ,the latter is suited for the head anteflexion ﹑spinal curvature ﹑hip flexion and genuflex.
2.The modulation of the key point : it means that the trainer regulate the particular part of patients’ body, making spasm alleviative, induct the normal posture and movement at the same time with the athletic skill.
3.Promote the stellreflexe : do not need to get the patients to make an effort excessively, just guide to get the biggest potential of them to form the sport posture of the functional activity, and study the experience from the functional activity, eventually attain the purpose of cure.
4.Tapping technique: tapping on the body regularly or randomly, the result is muscular tone in the homologous part , the normal posture can be kept by repeated exercise. The concrete manual skill of that method varies from person to person, can have the thousands of kinds.

Vojta treatment(Vojta 疗法)

That therapy is invented by Dr. Vojta from W. Germany through years of clinical practice , and it integrates diagnosis ,therapy, prevention as a whole. This method induce the systematic and coordinated reflex movement by pressing the part of body, promote and improve the patients’ movement function, so it’s also called the induction treatment. This method has its own systematic Vojta posture reflex, it’s used to early diagnose cerebral palsy.
This method induce the patients’ ability of moving﹑supporting the body with each part of body﹑lifting the body by refle-kriecen and reflex-umdrechen，and promote the conversion of the direction in which the muscle contract, aim to improve abnormal posture﹑motor pattern and advance the development of normal ones. We introduce it from 1980s as the main therapy for child cerebral palsy, now still is used widely. To summarise the 9850 cases, total efficiency is 94.9﹪.

Ueda therapy(上田法)
It is a new approach which is developed by a plastic surgeon (a Japanese namedshangtianzheng).It’s mainly used for spastic cerebral palsy. It can decrease muscle tone, alleviate muscle spasticity , prevent muscle contracture and joint deformity, inhibit the development of abnormal posture, and promote the growth of normal posture. It is currently applied with other therapy ,can enhance the efficiency .We began to introduce that therapy in 1987, obtaining the good result.

Occupational Therapy(作业疗法)

It’s a method to train varying dysfunction or disability in body﹑mind﹑development with purposeful and selective occupational activities, and aim to achieve maximal potentiality in living and learning ability, adapt to the society as much as possible. When used for cerebral palsy, the aim is:
1.Promote movement development, keep normal posture. For example ,when the child lie on his tummy, we can use triangle cushion﹑therapist or mother’s body to train the child lifting his head up, or supporting himself with his arms or elbows. When lying on the back, in order to promote the middle functional position, we can make the child extend upward his arms and fixed in the middle.
2.Promote functional development of the upper limb, improve gross motor function.
For example, design setting to promote the separate motion between arm and shoulder, to advance shoulder’s voluntary control, to induce extending elbow joint, and so on.
3. Improvement consciousness cognition function.
4.To decrease weight-bearing of the body: the orthopedic instrument can support the body.
5.Improve the function: using orthopedic instrument can improve the patients’ daily living, such as walking﹑drinking and eating and so on. Now we have accumulated lots of experience about making and using the instrument. It plays an important role in preventing and rectifying limb deformity. The upper limb orthopedic instrument cause for rectifying flatfoot﹑pes valgus and pes varus

Speech Therapy(语言疗法)

CP is caused by a variety of reasons for the non-change brain injury. In addition to performance of central motor dysfunction, About 3 / 4 of the performance of children have varying degrees of the speech disability, so speech disability seriously affect children the exchange of speech and feelings, daily life and learning,. Speech therapy is important issues that shuold not to be ignored. Therefore, children with cerebral palsy to be the early speech therapy, especially accompanied by the children with speech disability should be of particular attention. We primarily use active training and training equipment combination of methods. Training initiative used to all the functional training exercise. The parade study design is based on speech development neurology, neuro-psychology, linguistics, phonetics, speech pathology, and other basic theory. From simple to complex for the first, second prefer functional training exercise. Speech therapy for dysarthria, include training for relaxation therapy, respiratory training, pronunciation organ training. For voice training, continuing pronunciation, and so overcome the nasal training children to control the volume, pitch and rhythm, auxiliary system training. Training equipment is used certain equipment and modeled on the normal children's pronunciation and articulation model for training. Application of equipment include voice workstations, inspired voice, special education and music therapy and so on. We used the above treatment method for 8,560 passengers, the total effective rate is 85.7%.

Chinese medical therapy(传统康复疗法)

Our traditional rehabilitation therapy center main use Chinese medicine, scalp acupuncture, body acupuncture, massage and other treatment of children with cerebral palsy significant effect. Chinese medicine used mainly oral, medicine and Chinese medicine bath fumigation three methods, including Luanfukang, Buzhongyiqitang and Xiaoxumingtang. Bath medicine is to add chinese medicine into warm water, put the patient in whole or in part into warm water with chinese medicine . Achieve the purpose of alleviating cramps. Chinese fumigation is the use of fumigation and drug hot double effection, and the muscle spindle temperature influence conduction characteristics, for children with cerebral palsy can release muscle spasm and reduce muscle tension, improve motor function.
Scalp Acupuncture is the chinese medical therapy, acupuncture therapy and modern medicine cerebral cortex function theory. With medical practice a new method of acupuncture improve. Point main selection include top center line, the next to the top line, the parietal, temporal ago slash, Porcelain Pillows Made midline, suboccipital adjacent lines, and The total efficiency is 85.3%. Massage is the treatment to children with cerebral palsy ,an important way conciliatory Yin-Yang, meridians dredge stasis, make joint better. Our massage is different from other hospital, is based on Chinese medicine theory of meridian massage theory, modern neurophysiology, kinematics of the knowledge massage therapy. Diocesan including bombs, refers to a vital point, the attending hammers tapping, Manakegui massage system, Segmental massage -- Mobile, sawing, drilling, traction, shoulder and forearm supination, scissors further pointed feet and abnormal posture correction methods. Manakegui system which massage with segmental massage was the most effective and efficient for its 80%.

Orthosis (矫形器)

We use orthosis to get better promote rehabilitation, the role of prevention, correction, treatment of osteoarthritis and neuromuscular diseases, compensation and the application of functional orthoses. Currently in the clinical application include brace, frame, plywood and other orthopedic shoes.
The basic role of orthosis :
1.Stability and supporting role : use limiting joint abnormalities or role to stabilize the joint, ease the pain or restore its load-bearing function.
2. Fixed and protection : If the fracture treatment of orthopedic devices ,through the lesions limb or joint fixed to the promotion and protection of the healing lesions.
3. Prevention correction role : children stage, muscle imbalance, Bone dysplasia or abnormal external force can be generated. But for the growth stage of bone, bone growth are biological plasticity, orthopedic applications can be received for correction.
4. Reducing load-bearing role : as application loading orthopedic devices reduce limb or trunk of the long axis of loading, play a role in the treatment and loading.
5. Improved function : as the application of orthopedic devices can improve handicapped children walking, eating and dressing and other daily activities, work capacity.
Currently hospital orthopedic center have produced many years with development and construction, and accumulated a wealth of experience, According to children's conditions ,we make differences in the production of orthopedic devices, to prevent and correct the children, the deformity of the lower limbs, and tap their potential to play an important role. It can produce lower extremity orthopedic shoes and upper limb orthoses. Lower extremity orthopedic devices can correct flatfoot, sharp foot and the inside foot and may well inhibit the Over-extension knee for stability, support bearing a better result

HPO (high pressure oxygen) therapy(高压治疗法)

It’s a method to breath pure oxygen to cure the disease.

The therapy of Chinese crude drug fumigate (中药熏蒸疗法)

Using the effect of thermy and heat, and the conductivity of the muscle spindle being influenced by temperature, this method can alleviate the muscle spasticity , decrease muscular tension, improve motor function. Combining with other treatment, the patients can quickly recover.

Botulinum toxin A injecting therapy (肉毒杆霉菌素A等注射疗法)

Injecting the BTXA into muscle , it combines with the motor nerve end-plate, then inhibit Ach release to block the excitation transmitting of the neuromuscular junction, eventually to relieve muscle tension or spasticity. It is used to cure the spasticity of upper motor nerve syndrome in rehabilitation medicine.
Indication(适应症)
It’s used for various dysfunctions because of obvious regional muscle spasm:
1.The obvious disability of the joint, including the function of hand﹑walking and daily living;
2.Almost dysfunction in daily living;
3.Spasm of ocular muscle﹑facial spasm ﹑spasmodic torticollis﹑partial abnormal muscle tension (writers’ spasm﹑occupation spasm) and so on.
Generally it’s not used in the spasm all over the body.
Counterindication(禁忌症)
1.Hypersensitive constitution and hypersensitive over this medicine;
2.Partial infection or cutaneous breakage;
3.Patients with fever or acute infections disease;
4.Patients with sever organ disease﹑ pregnant women﹑lactation femme and child should be cautious.

Hydrotherapy (HT) (水疗)

Soak in warm water to relieve the spastic muscle, and make use of the child’s play aqueous disposition and aqueous characteristics to treat the cerebral palsy.
The principle as follows:
1.Temperature stimulation: keep the room in 20-25℃, the water in 27-30℃, can relieve the spastic muscle;
2.Eddy impact: using the mechanical stimulation to relieve the muscular tension;
3.The effect of cheirapsis : to improve the blood circulation.
4.The effect of floatage : to make the child surmount the weight’s effect, and develop the ability of self-control and normal movement.

Operative Treatment(手术疗法)

Our surgical correction center will be completed in June, 2007 ,then will develop various correction operation for the child with cerebral palsy.

Sensory Integration Training(感觉统合训练)

That sensory integration imbalance means the sensory system of the brain can not work effectively and normally. The brain has the ability of sensory integration, but the development of this ability should depend on the stimulation of environment and requirement. Most children obtain it in playing game﹑motion and daily activity.
Children with cerebral palsy have sensory imbalance, due to: ⑴central nervous system unsoundness; ⑵environmental factor: premature delivery﹑not enough room for activity. The training provide the stimulation in vestibule﹑noumenon﹑tactile impression for the child, and challenge the children’ ability, require their suitable reaction. Through training, the curative effect of rehabilitation will be improved obviously, attain half effort and double results.
Approach : keeping balance , revolution , drill the cage and so on.

Ultrasonic Therapy(超声治疗)

As a therapy, it has been used over a half century. Its wave length is 800-1000KHZ, sound power density is under 3W/cm2, and generally it will not damage the tissue. The research shows that ultrasonic wave can change the blood-supply condition of the brain, rise tissue’s metabolism, improve the function of brain cell, which is helpful for the regeneration of brain cell. Besides, the mechanic vibration﹑warm and heat is helpful for the formation of lateral branch circulation, the result is increasing blood-supply for the damaged brain tissue.
For the child with cerebral palsy, it can decrease the nervous excitability, slow the velocity of nervous conductivity and decrease the muscular excitability.

Cerebral Circulation Equipment(脑循环仪)

When the cerebellar roof nucleus is stimulated by electricity, the cerebral vessels will dilate, then mini-circulation will be improved, and the neuron excitability also be decreased. This therapy mainly initiates the mechanism of endogenous nervous protection to preserve nerve cell, stabilize membrane potential of cerebral nerve cell ,inhibit the depolarization.

Conductive Education(引导式教育)

Peto therapy emphasize that the children positively take part in learning and training to inhibit and overcome the abnormal movement and posture. Then every learned activity should be repeated with the help of special equipment and environment in order to make the child to live and learn as independently as possible. Now it has been adopted worldwide because of its obvious effect, convenience and child’s anticipation.
It’s a curative system combining therapy and education, including five basic factors:
1.Conductor: a teacher who can deal with the problem of the disabled under any circumstance;
2.Team: a group who have the similar problem and can study together;
3.Environment: a place which is suitable for implementing the therapy;
4.Studying procedure: the children studying and practicing their learned skills;
5.Password with rhythm and intention: that is helpful for developing movement﹑language﹑creativity and characteristics.
Peto therapy claim to perform various training for the disabled, including physical ability﹑intellectual ability and daily living skills, and look forward to normal communication ability and perfect personality