In this case, "action" means the ability acquired in the process of life to plan and execute coordinated movements. A child with cerebral palsy experiences difficulties in performing usual for his level of development activities - for example, tying shoelaces, riding a bicycle or writing letters. Details you will find in the article on "Physical rehabilitation of children with cerebral palsy".
The modern approach
Until recently, these children were considered simply sluggish, clumsy and slow. This often led to an underestimation of the problem and the lack of adequate treatment. As a result, the child could develop a number of behavioral disorders associated with frustration, because it is impossible to get your body to perform the necessary movements at the right pace. At present, it is considered that these children have certain disorders of higher nervous activity (with complete or partial absence of deviations from the nervous system, musculoskeletal function or reflexes), leading to a decrease in the ability to count and carry out targeted movements. There is no connection between cerebral palsy and mental decline.
Morbidity
According to an approximate estimate, up to 10% of the population suffers from mild forms of cerebral palsy. In 2-5%, more severe forms of the disease are observed. 70% of these patients belong to the male sex. It is assumed that the cause of cerebral palsy is the underdevelopment of the nervous system. In turn, this may be due to a congenital neurologic defect or hypoxia (oxygen starvation) of the brain during childbirth. The first movement of the fetus takes place in the prenatal period as a result of involuntary reflexes. In the process of child development, these reflexes are gradually being perfected, become more precise, and are subject to conscious, volitional control. Full maturation of all motor systems comes to the end of adolescence. The organization of arbitrary movements depends on a number of factors. The child normally receives accurate information about the environment through the sense of touch, the work of the vestibular apparatus and proprioception (sensation of position in space). Effective generalization of this information allows you to correctly calculate and execute the desired movement. Cerebral Palsy may be associated with certain abnormalities in any one or all three sources of information. In this regard, the manifestations of cerebral palsy in different children can be different: one child finds it difficult to button up, and another - to clearly and clearly pronounce the words.
Sense organs
A child with cerebral palsy often can not adequately perceive and process the following information:
• Touch - the inability to recognize an object by the sensations that arise when you touch it (stereotype);
• the vestibular apparatus - an organ of balance located in the inner ear, can give insufficiently accurate information about the posture, movement, balance and position of the body in space;
• Proprioceptors are sensory nerve endings that are present in all muscles, tendons and joints and transmit information about their position in space in the brain. Interacting with the organs of vision and hearing, they provide coordination of movements and maintaining balance. The manifestations of cerebral palsy may be due to the deficiency of the proprioceptive system. In most cases, parents are the first to alarm parents, noticing the child has specific symptoms or a lag in certain developmental indicators for the corresponding age. It is very important that such a child be examined in a timely manner by a pediatrician and a child psychologist, best before entering primary school. This will not only ensure early initiation of treatment and the development of effective individual methods that the school will be able to use in working with the child, but will also help to minimize social isolation, peer ridicule and decrease self-esteem.
Forms of cerebral palsy
A child psychologist conducts a series of special tests to assess the degree of cerebral palsy, as well as to identify the sides of daily activities in which it affects. In the classification of forms of cerebral palsy observed in childhood, four main criteria are singled out, depending on the prevalence of disability of various motor skills (although all spheres are usually affected to varying degrees). The groups of skills that can be violated in cerebral palsy include:
• large motor skills - control of muscular activity, coordination of movements and balance necessary to perform large movements;
• fine motor skills - necessary for performing small movements, for example tying shoelaces;
• verbal skills - difficulties in understanding verbal instructions and explanations;
• Speech skills - difficulties in pronunciation of words.
Depending on the form of cerebral palsy, a child psychologist can refer the child to a consultation with the appropriate specialist, for example, a rehabilitation specialist, a speech therapist or an ergotherapist.
Long-term treatment
Timely detection of signs of cerebral palsy in the child and their correction are extremely important. However, it is equally important not to stop the prescribed treatment during the entire period of schooling, and, if possible, longer. Part of this is due to the fact that as you grow, you need to master more complex skills that require a higher level of coordination of movements. In addition, there is often a tendency to return old problems and the emergence of new ones during and after the next jump in growth. Cerebral Palsy may manifest itself in a number of different symptoms depending on its shape and severity:
• awkward movements, clumsiness;
• Reduced concentration of attention - a child can quickly forget what he has just heard;
• restlessness;
• Awkwardness in food - a child holds a spoon or fork in a fist;
• dislike of drawing and coloring;
• inability to catch a ball or kick it;
• Lack of interest in games with other children;
• Inability to jump on one or two legs or jump over an obstacle;
• in infancy - the inability to crawl (the child moves, sliding on the stomach);
• The child is sloppy, often loses his things;
• The child wears clothes for a long time, does not know how to tie laces or button up buttons;
• Constantly bumps into objects, overturns things.
For the selection of the optimal treatment it is necessary to clarify the nature of the violations. For this purpose, a number of special tests are used to assess the child's physical abilities. Before the tests, the rehabilitator will ask parents to fill out a questionnaire that reflects information about the family composition, the presence of brothers and sisters, the illnesses borne by the child, his academic performance and behavior in school, social skills, friendships, interests and fears.
Evaluation of child development
Testing takes about an hour and is conducted one-on-one with the child, in the absence of parents. Based on the information in the questionnaire and the results of performing various tasks, the rehabilitologist makes a conclusion about the degree of physical development.
Norms of development
The development of certain skills in children occurs in approximately the same order and at approximately the same time. The transition to mastering the next skills depends to a certain extent on mastering the previous ones. For example, the first movements of the child are coups from the abdomen to the back and back; a little later he begins to sit, crawl, then - get up on his knees and, at last, stand. Learning to stand, he takes the first steps. The ability to walk gives impetus to the development of new skills - the child learns to run, jump on one and two legs, jump obstacles. In the process of developing these skills, the child achieves sufficient control over limb movements, which allows him to master more complex skills - for example, throwing and catching objects, drawing with crayons or eating a spoon. Failure to "fall out" any of the stages of physical development listed above makes it difficult to absorb and consolidate the more complex skills that make up an integral part of growing up. That is why the timely detection of cerebral palsy is so important. The doctor-rehabilitologist carries out a series of tests, allowing to estimate:
• the state of the muscular system - children with cerebral palsy do poorly with the performance of certain movements, which often leads to insufficient muscle load and their weakening. The evaluation uses muscle strength tests; special attention is paid to the condition of the muscles of the shoulder and pelvic girdle, as well as the tonic (postural) muscles. The movements performed by these muscles form the basis of all other movements, for example, balancing while maintaining balance;
• joint condition - in some children with cerebral palsy, the joints are "loosened up" - excessive amount of passive movements, which leads to a decrease in control over them. This is accompanied by a violation of the ability to perform precise actions, for example, by writing;
• Equilibrium - the rehabilitator assesses the child's ability to maintain balance when the motor tasks appropriate to his age are met (for example, balancing on one leg or slow walking on an inclined gymnastic bench). There are excess movements that help the child to keep his balance (for example, waving his hands);
• Coordination of movements - ball games are used to assess the visual coordination of the movements of the arms and legs. In younger children, they can be replaced by playing to insert objects of various shapes into suitable holes in the size and shape;
• function of interhemispheric interaction - many children with cerebral palsy "skip" the stage of crawling, moving by sliding on the abdomen. However, creeping stimulates the ability of the brain to transmit information from one hemisphere to another, which plays an important role, for example, in coordinated movements with both hands or feet. The ability to perform such actions is necessary for many types of physical activity. The rehabilitologist assesses the naturalness of the movements of the hands relative to the midline of the body when "drawing" figures in the air;
• Ability to comply with instructions - the doctor checks the child's ability to understand and perform simple verbal instructions (it is assessed whether further clarification or demonstration of the actions is required).
The choice of methods of physical rehabilitation depends on the individual needs of the child. The treatment is based on exercises and games, motivating him to make full use of his physical abilities. Such training is the basis for a versatile work with the child, if necessary, including the help of an ergotherapist, speech therapist, support from parents, educators and health workers. The goal of the treatment is to increase the self-esteem of a small patient through performing simple tasks before moving on to working out more complex skills. This approach is based on the hypothesis that physical activity improves the function of existing pathways in the brain and the formation of new ones. Usually the child visits the physical rehabilitation room 1-2 times a week for several months. At the same time, he must study daily at the recommended program at home. Classes continue after completion of visits to the rehabilitation specialist. Control over the success of the child is the responsibility of the parents. If the condition worsens or the effect is insufficient, a new cycle of rehabilitation therapy is recommended.
General approaches to treatment
A number of general methodological approaches operate in the treatment of cerebral palsy.
• Swimming
Swimming is recommended for all children with cerebral palsy. It helps to strengthen the muscles. Movement in the water is slow, which gives the child time to calculate the actions. The ability to maintain a balance in the water is less important, so he can engage in peer-to-peer activities, which increases his self-esteem.
• Phased development
After mastering the next skill classes are focused on achieving the next. For example, at first the child learns to roll on a mat spread on the floor, then - roll off a small slope, then roll with a big ball, then - move the arms in the prone position on the abdomen. Then the child learns to sit still, with the support of his feet on the bench, for example, drawing (with a gradual increase in the time of classes).
• Training of the interhemispheric interaction function
Particular attention is paid to improving the functions of interhemispheric interaction. Exercises of this group include crawling through the pipe, breaking along the Swedish wall with the overflow of hands, an exercise in which the child moves on all fours, blowing on a tennis ball rolling in front of him, walking with alternately lifting unlike arms and legs.
• Balance training
As the function of interhemispheric interaction improves, they move on to work on coordination of movements and balance. Begin with attempts to hold in position standing on two legs on a "swinging board" with a wide base, then - on one leg. After this, go to slow walking.
Correction of motor problems associated with cerebral palsy is based on the use of special exercises. At the same time, an individual treatment plan is developed for each child. Exercises on balance, coordination of movements and orientation in space are aimed mainly at improving overall motor skills. The methods of ergotherapy are used to correct minor motor disorders. The physical methods of treatment of cerebral palsy are
• Balance exercises - slow walking on an inclined gymnastic bench; balancing on one leg on a "swinging board"; catching a ball or fabric pouches filled with plastic balls, standing on a "swinging board"; jumping rope; play in "classes" or leapfrog;
• exercises for coordination of movements - exercises with a skipping rope; "Drawing the eights" in the air with your hands; exercises in the "sitting in Turkish" position; crawl; exercise "wheelbarrow" (walking on hands with support for the legs); swimming; playing with the ball and racket; play in "classes" or in leapfrog; jumping "star";
• Orientation exercises in space - using "tunnels", playing with a large ball on the mat; catching balls of different sizes or balls with thorns;
• exercises for the development of fine motor skills - the collection of rods; mosaic; a game of "fleas". Now you know what physical rehabilitation of children with cerebral palsy is.