Cerebral palsy is one of the most severe forms of motor cerebral (brain) disorders in children, arising from various reasons(there are up to 400 of them, which means the real cause is unknown) during pregnancy and childbirth. Cerebral palsy is, first of all, impaired muscle tone and improper coordination of movements, and this is a disability. And, unfortunately, this disease is becoming more and more common. It occurs in children from 3 months to 3 years (untreated children with this pathology very rarely live longer than 3 years). However, if the disease is detected in a timely manner and treatment is started without delay, then the child has the opportunity to socially adapt in the future (have a job and a family). The good news is that cerebral palsy does not progress, and as the child grows, the symptoms of the disease may decrease.
Treatment of cerebral palsy is complex, long-term and is aimed at teaching movement and restoring impaired functions, which is achieved through the tireless (selfless!) work of parents. According to statistics, significant improvement is observed in 25% of patients, and some mitigation of defects is observed in 50%; 25% of children do not have any positive dynamics.
The difficulty of treatment lies in the fact that medications can accelerate the process of “maturation” of nerve fibers and normalize muscle tone, but have no effect on muscle and joint contractures, which do not allow the child to gain experience of normal postures and movements. Daily physical therapy and massage can help the baby develop normally. In any case, coming to terms with disability is not the solution to this problem. Starting physical therapy at any age gives positive changes: the child’s emotional state improves, muscle contractures decrease (or disappear).
The form of the disease must be determined by a pediatric neurologist. There are several classifications, and parents can familiarize themselves with them. According to L. O. Badalyan, cerebral palsy manifests itself in a spastic form, in the form of hemiplegia, diplegia, bilateral hemiplegia, in dystonic or hypotonic forms.
According to A.Yu. Ratner, cerebral palsy is divided into spastic tetraparesis (double hemiplegia), spastic hemiparesis (both forms are accompanied by epilepsy), cerebellar syndrome (muscle hypotonia), hyperkinesis (violent movements that interfere with walking).
According to K. A. Semenova, spastic diplegia, double hemiplegia, hyperkinetic form of cerebral palsy, atonic-astatic syndrome, hemiparetic form of pathology are determined.
There is also a rudimentary version of cerebral palsy: minimal brain dysfunction - neurological disorders in the form of lethargy, fatigue, excitability, restlessness, tics, headaches, and at an older age, disorders manifest themselves in low performance at school due to difficulties in learning new things. Such children have difficulties in communication and sleep disturbances.
1) acute period, or early stage (7-14 days, up to 2-3 months), when the disease manifests itself in the form of syndromes:
a) cerebrovascular accident syndrome - there are groans, convulsions, sudden agitation of the child with a piercing cry, breathing problems;
b) syndrome of increased intracranial pressure (hydrocephalic-hypertensive) - the fontanel is tense or bulging, the size of the head quickly increases, there may be convulsions;
c) convulsive syndrome - convulsions occur several times a day;
d) syndrome of inhibition of unconditioned (innate) reflexes - grasping, automatic gait, etc. Incorrect attitudes of the torso and limbs are formed;
e) diencephalic syndrome - there is a slight increase in weight, growth retardation, sleep disturbance, and temperature;
2) recovery period:
a) early recovery period (initial chronic-residual stage) - begins after the subsidence of acute manifestations of cerebral hemorrhage. According to various authors, this period lasts from 2 to 5 months. It is at this time that the doctor can determine the form of cerebral palsy. More often it is mixed and includes various movement disorders; b) late recovery period - lasts up to 1-2 years;
3) the period of residual phenomena, or the final residual stage, begins at 2 years of age and continues throughout the entire period of childhood and adolescence. Children 4-7 years old with intact intelligence attend speech therapy groups kindergartens (motor disorders combined with speech disorders). Exercise therapy classes with a methodologist are held every other day, all other days the child studies with his parents. A two-year-old child with cerebral palsy can be in motion for up to 2.5 hours a day, for 3-7 years old - up to 6 hours.
The task of parents and the pediatrician is to identify the symptoms of the disease as early as possible, and for this there are special tests. Considering that during the newborn period a child normally has increased muscle tone, changes in muscle tone can be determined by indirect signs only from the end of the first month: with increased tone, the child does not attempt to raise his head from a position on his stomach and place it in the midline.
To check the muscle tone and symmetry of the baby’s body from 2 months: place him on a flat and firm surface on his stomach and lift him up right hand both legs are approximately 15-20°. Holding the outstretched legs firmly, with your left hand stroke the back from the tailbone to the neck along the spine with light pressure (so that the baby bends slightly). If your left hand does not feel resistance, and the line of movement along the spine is even (straight), then the child’s muscle tone is normal. If muscle tone and body asymmetry are disturbed, your hand will SHARPLY change direction along its path; at this moment the child’s body will bend to the side (and not down); at the same time, you will clearly feel the tension of the muscles under your hand; The baby's legs will be bent at the knee and hip joints.
At the same age, a child may notice a tilting of the head and tension in the back of the head. When supported under the armpits, he does not rest on his full foot, but on the tips of his toes (“on tiptoes”).
In healthy children, innate reflexes begin to disappear from 3 months. If grasping, searching reflexes, and the automatic gait reflex do not disappear after 4 months, but even intensify, then there is a high probability of increased muscle tone. In the prone position, such a child bends his arms and legs and raises his pelvis.
A newborn baby normally makes rhythmic, automatic movements. If the baby lies motionless, the arms are clenched into fists, brought to the body, thumb squeezed inward, and the legs are crossed, this is very similar to spastic paresis of the upper and lower limbs.
If movements are made, but the child is flaccid, “spread out”, the palm is extended, the hand hangs down, and the legs are in the “frog” position, then flaccid paresis of the limbs can be suspected.
How else can you suspect something is wrong? If for 1-3 months the baby’s negative emotions predominate (frequent crying) and there is no “booming,” then you should bring this to the attention of your pediatrician.
Remember: hypertonicity of the muscles of the upper extremities disappears by 2.5 months, in the lower extremities - by 4 months. Only a doctor can distinguish normality from pathology.
Tests that only a doctor should do, but which are useful for parents to know about.
In the supine position:
1) the doctor places his hand under the child’s head and tries to bend it. Normally, the head bends easily, but with cerebral palsy the head presses on the arm;
2) the doctor takes the baby by the hands and pulls him towards himself. Normally, the child bends his head and tries to sit up. With cerebral palsy, the head is thrown back;
3) the child’s arms are raised up parallel to the head (taken to the sides, crossed). At cerebral palsy child resists these movements;
4) the doctor straightens the child’s legs, grabs them under the knees and bends them towards the stomach. With cerebral palsy, resistance to this movement is determined.
In the prone position:
1) the doctor grabs the child’s hand and tries to place his hands on both sides of the head (pulls his hands out from under the chest). With cerebral palsy, resistance is felt;
2) the doctor puts his hand under the baby’s chin and tries to lift his head. With cerebral palsy, the chin presses on the doctor’s hand. Normally, by the age of 5 months, the baby independently raises his head in a position on his stomach, while leaning on his hands.
The adult spine resembles a spring with several bends (lordosis) - cervical and lumbar. They allow you to maintain a vertical body position. A newborn does not have these bends, i.e. his spine is almost straight. The cervical curve (lordosis) appears at 2.5 months, which allows the child to hold his head in an upright position. In the spastic form of cerebral palsy, the neck seems to be inserted into the shoulders—a “short neck,” and the formation of cervical lordosis is delayed.
Lumbar lordosis should be formed at 6 months, after which the baby begins to sit independently. If the lumbar curve is insufficient, then the torso tilts forward, which disrupts balance (support on the legs). Excessive lumbar curve (hyperlordosis) leads to stiffness (contracture) of the hip joints (one or both), which causes the gait to change greatly: oscillatory movements appear when walking (from side to side or back and forth).
With cerebral palsy (increased back muscle tone), a newborn can hold his head from a position on his stomach earlier than 2 months. To understand this, you need to put the child on his back and try to lift him by the arms (test 2) - the head will hang down.
Tests to determine correct lumbar lordosis
1. Starting position - lying on your back. Pull the child's knee towards the chest. If the other leg rises at this time so that it cannot be pressed down, this is evidence that the hip flexor muscles are shortened.
2. Starting position - lying on your stomach. Bring the child's heel to the buttock. If the rectus femoris muscle is shortened, this cannot be done.
The main goals of exercise therapy for cerebral palsy are:
- normalization of muscle tone so that the child can make voluntary movements;
- age-appropriate motor skills training; strengthening the sense of posture, training the vestibular apparatus.
It should be remembered that any intense (careless) impact can lead to an increase in muscle tone (pain increases muscle tone). Exercise therapy should be started as soon as the symptoms of increased intracranial pressure subside and the convulsions stop.
Exercises to normalize increased muscle tone
Exercise 1. Designed to identify and eliminate torso asymmetry, increased tone muscles of the back, neck (forms the cervical curve and reveals disorders in the hip joints).
Performed no earlier than 2 months of age (during the formation of cervical lordosis). If there are indications of injury in cervical spine spine, then the exercise is performed only after the therapeutic massage procedure.
The starting position of the child is lying on his back. The instructor brings the child into a flexion position (“fetal position”): arms are crossed on the chest, legs bent at the knees lead to the stomach and the head is bent towards the chest.
The baby’s knees should be bent and as close as possible to the head along the midline of the body (for hip dysplasia and the symptom “ short neck“This cannot be done, and the child performs an easy version of the exercise). Hold the child in this position for several seconds, making rocking movements.
The flexion position is natural for a healthy child and does not cause difficulties in its implementation. If a child has increased tone (rigidity) of the muscles of the back and neck, he will cry. Under no circumstances should you bend your child with great force!
With hip dysplasia, the baby will “slip” out of the instructor’s hands, trying to free himself and tilt in a different direction.
The exercise helps after 14 days for 5-8 month old children with increased muscle tone in the neck and back, who cannot hold their head up, roll over and sit down.
Exercise 2. Designed to identify and eliminate increased tone of the thigh muscles and the formation of the lumbar curve of the spine. It is recommended for children who, when performing an automatic gait, rely not on the entire foot, but on the toes. It is performed no earlier than 6 months of age (at the beginning of the formation of lumbar lordosis) after consultation with an orthopedic doctor. The exercise promotes internal rotation of the hip, and therefore, before performing it, you need to make sure that the child does not have (if the spine is eliminated) dysplasia or subluxation of the hip joint.
Starting position - the child sits between the heels with legs bent at the knees, feet shoulder-width apart, turned upward. The instructor tilts the child back so that the head, shoulders, and back touch the surface of the table.
The instructor's right hand pulls the head and shoulders down, and the left hand fixes the knees. Child with normal muscle tone remains in this position easily and with pleasure.
If the thigh muscles are tense, the child will try to free himself from the position that causes discomfort, as soon as possible, and sharply straightens his legs. In this case, you should do a warming massage of the lower extremities and repeat the exercise, trying to overcome muscle resistance. As soon as the child begins to perform the exercise without resistance, he will be able to stand on his entire foot (the tone of the thigh muscles is normalized), and then sit down independently (the exercise forms lumbar lordosis).
Exercises to develop motor skills
Exercise 1. The starting position of the child is sitting on his heels. Stand in front of the child, put his hands on your shoulders and, fixing him in the pelvic area, encourage him to kneel.
Exercise 2. The starting position of the child is kneeling. Supporting the child under the arms, move him from side to side so that he learns to independently transfer his body weight to one leg, lift the other leg from the support and spread his arms.
Exercise 3. The starting position of the child is squatting. Stand behind the child, pressing on your knees. Move the child's body forward, straightening his knees.
Exercise 4. The starting position of the child is sitting on a chair. Stand facing the child, use your legs to fix his legs to the floor, and take his hands. Pull your arms forward and up, encouraging you to stand up on your own.
Exercise 5. The starting position of the child is standing, one leg in front of the other. Alternately push the child in the back area, then in the chest area so as to teach him to maintain balance.
Exercise 6. The starting position of the child is standing. Take the child by the hand, pull and push in different directions, encouraging him to take a step.
Exercise 7. The starting position of the child is lying on his back. Press your feet onto a solid support (the exercise improves your ability to support yourself).
Exercises for joints
Exercise 1. The starting position of the child is lying on his back. Keep one leg of the child in an extension position, gradually bend the other at the hip and knee joints. If possible, bring the thigh to the stomach, and then slowly abduct it.
Exercise 2. Starting position - lying on your side. Slowly abduct the hip with the knee bent.
Exercise 3. Starting position - lying on your stomach on the edge of the table so that your legs hang down. Gradually straighten your limbs.
Exercise 4. Starting position - lying on your back. Bend your knee, then straighten it as far as possible.
Exercise 5. The starting position of the child is lying on his stomach, with a cushion placed under his chest. Raise the child by the outstretched arms, making springy extension movements of the upper body with light jerks.
Exercise 6. The starting position of the child is lying on his back. Bend the child's arm so that his face is turned towards the arm being bent. After this, bend the arm with the head positioned in the opposite direction.
Abdominal exercises
Exercise 1. Starting position - the child sits on the mother's lap. Press the baby's back to your chest and tilt with him (so that the baby feels confident). Secure the baby's legs and pelvis so that he can lift himself. If getting up is difficult, the mother should help him get up.
Exercise 2. The starting position of the child is lying on his back, arms pressed to the body.
With the help of a swinging movement of the leg, he should try to turn from his back to his stomach and back without using his hands.
Exercise 3. Starting position - lying on your back. Inhale and exhale with the abdomen drawn in as you exhale.
Stretching exercises
Exercise 1. Starting position - sitting on the floor. Stretch your legs forward so that your body is at a right angle. Extend your arms in front of you (parallel to the support), inhale. As you exhale, bend your body forward so that your palms touch your toes. Tilt your torso more and more until your forehead touches your legs.
The exercise eliminates stiffness in the back muscles, making the spine flexible, improving blood circulation and the function of the spinal nerves.
Exercise 2. Starting position - lying on your stomach, arms along your body. Leaning on your palms, slowly lift your chest up (the body from the waist to the feet should be in contact with the support). At the same time, the head is thrown back, legs and feet are together. slow and deep.
Throughout the entire spine, the tone of muscles and ligaments increases, and the function of nerve trunks and blood vessels improves.
Exercise 3. Starting position - lying on your back, legs together. Raise your legs straight above your head, do not bend your knees, and keep your hands on the floor. Try to touch the floor above your head with your fingertips. Slowly return to starting position.
Exercise is beneficial not only for the spine, spinal cord, and all spinal nerves, but also for the muscles of the arms and legs.
Exercise 4. Starting position - sitting on the floor. Bend your right leg so that your heel touches the opposite thigh. Place your left foot on the floor with right side right knee, move your right hand around your left knee and hold the foot of your left foot with it. Place your left hand behind your back to the right side of your waist as far as possible, turn your head to the left and tilt it so that your chin touches your left shoulder, while your right knee should not leave the floor.
The exercise corrects back defects along its entire length. Children can perform the exercise with the help of adults who help them maintain the position they have taken.
Treatment by position
In the initial stage of cerebral palsy, treatment with positioning (laying) is carried out after a relaxing massage and relaxation exercises.
In order to give the body a physiologically correct (symmetrical) position, special rollers with sand and tires with soft inner lining are used. The child can remain in such positions for 2 hours, then rest for 1-2 hours, and the splints are applied again.
At older ages, a position with maximum approximation of muscle attachment points is used.
Pose lying on your back: place a bolster (pillow) under your head so that your head is almost lowered to your chest. Bend your arms at the elbows or cross them over your chest. You should flex your hips and knee joints(place a cushion under your knees), the bending angle is selected individually. Place your feet on a support, spread your hips freely.
The pose allows you to inhibit hyperkinesis and reduces the influence of the cervical-tonic asymmetric reflex.
Exercises to relax the muscles of the upper limb
Exercise 1. Starting position - lying on your back, your head is located strictly along the midline, your arm and leg on one side are fixed with sandbags. The free arm is bent at the elbow, the forearm is fixed by the instructor (mother). The instructor (mother) holds the child's hand until the increased tone (hypertonicity) of the muscles weakens, after which he shakes the child's hand, alternating with passive movements in the wrist joint (flexion, extension, abduction, adduction, rotation).
With the help of acupressure, carried out in parallel, you can stimulate active flexion and extension of the hand.
At the end of the exercise, the forearm and hand are shaken and placed in the middle position with fixation with shreds or rollers with sand.
Exercise 2. Starting position - lying on your stomach, head in the middle position, arms extended to the sides, forearms lowered from the couch, a pillow placed under the body, legs and pelvis fixed. The instructor (mother) holds the child’s shoulder until involuntary movements disappear (weaken), then swings and shakes the forearm, performs passive flexion and extension in elbow joint. Stimulates active movements in the child's elbow joint with massage techniques, swings the forearm again and finally fixes the arm in the middle position.
Exercises for the lower extremities
Exercise 1. Starting position - lying on your back, head in the middle position, arms fixed, legs bent so that they touch the stomach. The instructor (mother), holding the shins in the upper third of the front surface, performs abductions in the hip joints. Then, fixing one leg, he carries out circular movements with leg extension (for each leg).
Exercise 2. Starting position - lying on your stomach. The instructor (mother) fixes the child’s pelvis with one hand, and with the other, supports the leg by the lower third of the thigh. The pelvis is fixed using sandbags. The instructor (mother) supports the leg by the lower third of the thigh with one hand, and with the other hand performs a stimulating massage to contract the gluteus maximus muscle. At the end of the exercise, the child’s foot should “fall” onto a soft support.
At the next stage, the instructor performs passive extensions in the hip joint, after which the child holds the leg independently for a certain count. Then the leg falls freely onto a soft support.
Exercises for the muscles of the trunk and neck
Exercise 1. Starting position - lying on your back, head in the middle position. The instructor (mother), holding the child's body on both sides, gently rocks the body from side to side, making sure that the child does not offer resistance. Then the instructor (mother), holding the child's head, rocks it freely, alternating rocking with head turns (without resistance).
Exercise 2. Starting position - lying on the right (left) side, the right (left) hand is under the head, the left (right) is along the body. The instructor (mother) gently pushes the child so that he falls on his back or stomach. The child must maintain the starting position when pushing, relaxing the muscles and falling only at the instructor’s signal.
Exercise 3. Starting position - sitting in a chair, hands on the armrests, head lowered to the chest. The instructor (mother) performs passive bending, turning the head, flexion-extension (without resistance from the child). The child must fix his head during passive movements, then actively relax the muscles so that the head “falls” on the chest.
Exercises to correct breathing
The starting position when performing any exercise is lying on your back, with a gradual transition to a sitting and standing position.
Exercise 1. The child needs to be shown how to take a deep breath and exhale deeply through the nose and mouth, and then invite him to exhale onto thin paper (a feather, a flag), or his palm. You can blow up toys and blow bubbles.
Exercise 2. To improve respiratory functions, you need to teach your child to pronounce at different volumes while exhaling, whistle on a whistle, play the harmonica, and sing.
Exercise 3. Inhale to the count of “one, two, three,” while raising your arms up, and exhale to the count of “four, five, six,” lowering your arms down. Exhale into the water, lowering your head into the bath with.
Facial exercises
The problem of recognizing (identifying) feelings is relevant not only for children with cerebral palsy. In other words, this is not even a “children’s” problem at all - not every adult can answer the question: “How do you feel now?” Not to mention the fact that the ability to respond to certain negative emotions in a form that is safe for yourself and others is the key to not only peace of mind, but also physical health.
Teach the child to imitate various emotional states in order to distinguish them later in everyday life, and with the help facial muscles to discharge these emotions is the task of psycho-gymnastics.
Expressing emotions
Interest, attention: show the child how a dog sniffs, how a fox eavesdrops, how a commander studies a map. Ask him to repeat the sketches.
Surprise: make your eyes round.
Joy, pleasure: ask the child to show how a kitten behaves when petted; ask to smile; imagine that Carlson arrived (Santa Claus came) and brought delicious candies (toys).
Suffering: show the child how his stomach hurts; how he cries infant; how cold it can be in the cold. Ask him to repeat the sketches.
Disgust: Ask your child to imagine drinking salty soda water.
Anger: ask the child to show how angry grandma (mom, dad, grandpa) is.
Fear: ask the child to imagine how the little fox lost his home.
Guilt and shame: ask the child to remember how he lost his mother’s (grandmother’s, grandfather’s, father’s) favorite thing; ask for forgiveness.
Exercise therapy for congenital hip dislocation
In children, hip dislocation can be acquired (during childbirth) or congenital (due to abnormal development of the hip joint, which is called dysplasia).
Congenital hip dislocation is currently the most common malformation and occurs in at least 2 out of 1000 newborns, with girls 5 times more likely than boys. In addition, it was noted that in girls the left side is predominantly affected. hip joint.
So, the main cause of congenital dislocation of the hip joint is its dysplasia (underdevelopment), which can occur for several reasons. Firstly, there are anatomical predisposing factors: the joint capsule can be thin, and the ligaments that strengthen the joint are not sufficiently developed. Secondly, the glenoid cavity (it has its own name - the acetabulum) is shallow immediately after birth. Thirdly, the head of the femur of a newborn consists not of bone, but of cartilage, and is smaller than normal in size and has a short neck. Therefore, 2/3 of its surface can be outside the acetabulum.
Under unfavorable conditions (including poor care of the newborn), the hip joint becomes unstable, and the femoral head moves upward and posteriorly.
Hip dislocation is easy to identify and treat only in a newborn child, and therefore the earlier this pathology is diagnosed, the more effective the treatment will be. Usually, during the first examination of a newborn, the pediatrician performs the following test (symptom of “slipping” or “clicking”): pulls the legs of the child lying on his back together, bends them at the knees, presses them to the tummy, and then spreads them apart. When the hip is dislocated, a characteristic click is heard. It should be remembered that the severity of the “clicking” symptom decreases already on the 3-7th day of life, and instead, movements in the joint are limited.
Other signs of a hip dislocation include:
1) asymmetrical skin folds in the buttocks (in the prone position) and on inner surface hips (front and back);
2) symptom of “abduction limitation” - difficult passive abduction of legs bent at right angles at the hip and knee joints (it is difficult to separate the legs when the child is lying on his back);
3) symptom of “reduction and dislocation”;
4) atrophy (underdevelopment) gluteal muscles;
5) there may be an excessive range of motion in the joint (hypermobility);
6) external rotation of the hip on the side of the dislocation. If congenital dislocation of the hip was not treated before the age of 1 year (or the treatment was ineffective), then the baby will not be able to start walking in time. By the age of 3, such a child has a clearly visible shortening of one limb and a smoothly waddling gait (“duck-like”); only surgery can help him at this age.
Treatment of congenital dislocation of the hip begins in the maternity hospital (immediately after the disease is detected): up to 3 months, wide swaddling of the child is indicated, in which the hips do not close, but remain apart. To do this, place a diaper folded in four between the hips, bent at the joints and abducted. By the way, such swaddling is not only a method of treatment, but also the prevention of hip dislocation. It is not for nothing that, for example, in Africa, from birth a child is carried tied to his back, while his legs are always spread apart!
At 2-3 months, a child with suspected congenital dislocation of the hip should have an x-ray of the hip joints. After consultation with an orthopedic doctor, the diagnosis is either confirmed or removed.
When treating a dislocation, you should adhere to following rules(position treatment):
1) when the child is positioned on his stomach, make sure that the feet are outside the mattress, otherwise the spasm of the adductor muscles of the thigh intensifies;
2) as soon as the child begins to sit (from 6 months), he should be seated on his knees with his legs apart, facing himself, holding the back with both hands;
3) when a child is held in his arms while standing, his legs should cover the adult’s torso.
For orthopedic treatment, special devices are used: up to 3 months, Pavlik stirrups, after 3 months - CITO, Vilensky splints, from 6 months - Volkov, Polonsky splints. Exercise therapy for congenital hip dislocation is carried out as prescribed by an orthopedic doctor. All conservative treatment methods are aimed at gradually and gently restoring the shape of the joint. This is achieved by long-term fixation in a position that is therapeutic (corrective). Exercise therapy for hip dysplasia not only helps to form the joint, but is also the only means of developing a child’s motor skills.
Therapeutic exercises help eliminate stiffness (contracture) of the thigh muscles (adductor muscles), strengthen the muscles that move the joint, and also correct the position of the joints (valgus), which develops after the use of orthopedic splints.
Exercise therapy for children of the first year of life is carried out 3-5 times a day for 5-10 minutes together with massage.
Therapeutic exercises for children in the first 6 months of life
With congenital dislocation of the hip, the muscles surrounding the hip joint are particularly affected. Scientists have proven that the electrical excitability of these muscles is reduced. This is especially true for the adductor muscles, hip flexors, and gluteal muscles, in which contractures form. Treatment requires systematic stretching exercises, massage and thermal treatments.
Exercise 1. Traction along the longitudinal axis of the limb. Starting position - lying on your stomach. With one hand the instructor (mother) fixes the child’s shoulders, with the other he pulls the leg towards himself (there may be a click). The procedure is repeated once every 3-4 days.
Exercise 2. Abduction of straight legs to the sides. Starting position - lying on your back. Holding the child's shins in the lower third, spread the straight legs to the sides. Repeat 6-8 times.
Exercise 3. Circular movements with legs. Starting position - lying on your back.
Bend the child's legs at the knee and hip joints, holding the legs by the shins. Make 5-
Exercise 4. Retraction of bent legs to the sides. Starting position - lying on your back.
Bend the child's legs at the knees and hip joints and gently spread the hips to the sides. Grasp the child’s thigh with your palm so that the thumb lies on the inner surface of the thigh, 2-3 cm below the inguinal fold (7th point). Using the pads of the second and third fingers, touch the skin at the projection site of the hip joint to feel the depression.
In this place (projection of the entrance of the femoral head into the acetabulum), apply gentle pressure. Relax the adductor muscle with acupressure vibration massage of the 7th point area and lightly shaking the thigh.
Exercise 5. Lowering straight legs to the sides. Starting position - lying on your back.
Bend the child's straightened legs at the hip joints and make several abductions to the sides.
Exercise 6. Alternating leg bending in a spread position. Starting position: lying on your back. Bend your legs at the hip and knee joints, gently spread your hips to the sides. Alternately bend and straighten the child's legs. Repeat 4-6 times.
Exercise 7. Internal rotation of the hip. Starting position - lying on your back. With your left hand, fix the child’s left hip joint, with the bent hand of your right hand, covering the knee, gently rotate the thigh inward, while simultaneously pressing on the knee and moving the shin outward. Repeat 4-6 times for each leg.
Exercise 8. Leg bending. Starting position - lying on your stomach. Place the palm of your left hand on the child’s right buttock, with your right hand, grabbing the shin, bend the leg at the knee and hip joints. Repeat 4-6 times for each leg.
Therapeutic exercises for children in the second half of life (with the splint removed)
Exercise 1. Starting position - lying on your back, legs straight to the sides. Encourage the child to rise to a sitting position with his legs abducted horizontally. Repeat 4-5 times.
Exercise 2. Starting position - sitting, legs extended to the sides. Leave the baby in this position for 2-3 minutes, then let the child lie on his back on his own. Repeat 4-5 times.
As soon as the child begins to sit independently, the highchair should be modified (changed) so that the baby can sit in it with his hips wide apart. To do this, an insert measuring 12-15 cm is attached to the front edge of the seat. In baby walkers, a spacer cushion is installed opposite the child’s crotch measuring 15x10x3 cm. Recommended toys: horse (seat with hips wide apart), tricycle with a wide saddle (no pedals).
An approximate set of special exercises for preschool children with congenital hip dislocation
For children 5-6 years old, to consolidate the results of conservative treatment (or for follow-up treatment), exercise therapy is carried out 3 times a week for 20 minutes.
Exercise 1. Starting position - sitting on a chair. Alternately bend and straighten your feet. Repeat 4-6 times.
Exercise 2. Starting position - lying on your back. Alternately bend and straighten your legs at the knee and hip joints. Repeat 6-8 times for each leg.
Exercise 3. Starting position - standing with support on the crossbar. Abduct and adduct the straight leg without support on the floor, pull the toe towards you with the foot in a vertical position. Repeat 4-6 times with each leg.
Exercise 4. Starting position - standing, arms down along the body. Raise your arms up through your sides, reach for your arms, lower your arms, return to the starting position. Repeat 3-4 times.
Exercise 5. Hang the ball at a height of 0.5 m. Kick the ball 4-6 times with each foot.
Exercise 6. Starting position - sitting on a chair, legs bent, feet on the floor. Smoothly spread your hips to the sides and just as slowly return to the starting position. Repeat 4-6 times.
Exercise 7. Starting position - lying on your stomach. Tighten and relax the muscles of the buttocks 6-8 times.
Exercise 8. Starting position - lying on your stomach. Lightly tap your heels on your buttocks 4-6 times.
Exercise 9. Starting position - standing on all fours. Withdraw bent leg to the side. Repeat 3-4 times with each leg.
Exercise 10. Hit a ball suspended at a height of 0.5 m with your heel 4-6 times with each foot.
If conservative treatment methods are ineffective, arthrotomy with arthroplasty is performed. In the period before the operation (1.5-3 months), general strengthening and toning exercises are carried out, the skill of voluntary muscle relaxation is trained (which is necessary for skeletal traction when the femoral head is high).
On the second day after surgery, therapeutic exercises are prescribed to strengthen the gluteal muscles and increase mobility in the hip joint. The plaster cast is removed 1 month after surgery.
Approximate complex special exercises in the postoperative period
Exercise 1. Starting position - lying on your stomach, legs extended. Alternately bend and straighten your legs at the knee joint. Repeat 8-10 times for each leg.
Exercise 2. Starting position - lying on your stomach, legs extended. Alternately raise straight legs up. Repeat 8-10 times for each leg.
Exercise 3. Starting position - lying on your stomach, legs extended. At the same time, raise your straight legs up. Repeat 6-8 times.
Exercise 4. Starting position - lying on your healthy side. Abduct the leg bent at the knee. Repeat 5-6 times for each leg.
Exercise 5. Starting position - lying on your healthy side. Move your straight leg to the side. Repeat 5-6 times for each leg.
Exercise 6. Starting position - lying on your stomach, on your leg (on the side of the operated joint), and the area middle third Attach a weight (a bag of sand) to your shins. Extend your straight leg with weights upward. Repeat 3-5 times for each leg.
Exercise 7. Starting position - lying on your healthy side. Move the straight leg with the weight to the side. Repeat 3-5 times for each leg.
Unlike spastic paralysis, flaccid paralysis is characterized by more profound dysfunction of the motor system. Patients cannot move independently. The muscle tone of paretic limbs is sharply reduced, they are flabby and atrophic. While passive movements are maintained, active ones are carried out with difficulty due to muscle weakness. Deep trophic disturbances are characteristic. Therapeutic effects should include, along with stimulation of the neuromuscular system, improved nutrition of the tissues of paretic limbs. For this purpose, massage is introduced into the physical therapy complex. A deep massage is used using kneading, vibration, effleurage, as well as a stimulating acupressure technique. At flaccid paralysis passive movements are combined with massage and active general strengthening movements, with paresis - with active movements for paretic limbs.
Passive exercises for flaccid paralysis, along with massage, help restore active movements. The most important factors for restoring the function of movement and support are active exercises. When an active impulse to movement appears, one should strive to systematically evoke it, using the sending of impulses to reduce paretic muscle groups. When a motor reaction appears, the most basic exercises are prescribed in the most favorable starting positions.
Assisted movements are widely used. At first, the movements are performed in the horizontal plane, and as the motor function increases, they are performed in the vertical plane, which makes it possible to include the heaviness of the limb being exercised. For flaccid paresis of the upper limbs, it is advisable to use swinging movements of the entire limb in different directions. To complicate the exercises with a paretic hand, grab (or tie to it) a light dumbbell or mace. It is advisable to carry out the exercise of the hands and fingers with a stable support of the forearm (sitting at a table). Generally accepted exercises for the hand and fingers are used using small equipment.
With flaccid paresis of the lower extremities, movements that promote the development of support function are indicated. Patients with dysfunction of the pelvic organs should include exercises that improve blood and lymph circulation in the pelvic area and strengthen muscles pelvic floor and sphincter. For flaccid forms of paralysis, restorative gymnastics is important. It is especially important to pay attention to the compensatory development of the muscles of the upper limbs and shoulder girdle, which bear the main load when moving patients on crutches.
In table 8 shows an approximate lesson plan therapeutic exercises with flaccid spinal paralysis.
Guidelines: the choice of positions and movements, as well as the method of their use, are determined by the clinical picture (spastic, flaccid forms, disorders of the pelvic organs). In case of loss of function of individual muscle groups, the method of physical therapy is the same as for damage to peripheral nerves. Massage treatment. Repeating the therapeutic exercise procedures in the afternoon under the supervision of the ward nurse.
Demidenko T. D., Goldblat Yu. V.
"Therapeutic exercise for flaccid paralysis" and others
Physical therapy for cerebral palsy can help people live normally, because cerebral palsy is the most severe disorder of motor function that can arise for a variety of reasons, of which there are approximately four hundred. With cerebral palsy, muscle tone and coordination are impaired. Cerebral palsy makes people disabled.
Cerebral palsy occurs in children under three years of age. The statistics are very sad: most children do not live to an older age. But still, if you start taking some measures to treat paralysis in time, the child will have a chance for a good future.
Necessary for many years. The treatment itself is aimed at restoring the functions of the motor system and remembering basic movements. This is very, very hard work for mom and dad, as well as for the child himself.
Alone medicines it is impossible to cure this disease. It is necessary to constantly engage in physical therapy, which will allow the baby to learn to move correctly. Physical therapy for cerebral palsy gives a positive result in any case. Parents of children suffering from cerebral palsy must decide on the age at which it is necessary to carry out various exercises with cerebral palsy. The answer is very simple: from birth, but under the careful supervision of a doctor.
The influence of exercise therapy on children's health
Therapeutic exercise has a positive effect on the human body. It stimulates the tissues and muscles in the body to strengthen. Metabolic processes are regulated in the body. Brain activity and cardiovascular system improves a lot.
But it is worth remembering that physical therapy alone is unable to cope with such a serious disease as cerebral palsy. It is necessary to create a holistic complex that will include massage, physical therapy, manual therapy, various hardening of the body.
Developed for each baby individual complex exercises. All complexes include the following types of exercises: with a ball, in a lying and sitting position, relaxation exercises, stimulating exercises.
Tips and recommendations regarding the correct performance of physical therapy
Absolutely all methods when performing physical therapy for cerebral palsy have general recommendations. Classes must be systematic; they must be conducted regularly and continuously. Only such a gymnastics schedule will help achieve a good positive result. A set of exercises should be selected individually by a qualified specialist for each small patient.
In this case, it is necessary to take into account the complexity of the disease and all the features of the course of the disease. Physical activity should gradually increase.
Exercises for children who have cerebral palsy should develop absolutely all muscles and joints. To do this, the gymnastics complex should include the following exercises:
- for muscle stretching;
- to develop muscle strength and sensitivity;
- for the development of sensitivity nervous system;
- to strengthen the main muscle groups that take part in all movements;
- so that all organs have good endurance;
- to relax muscles, relieve cramps and spasms;
- to teach a child to walk correctly;
- so that the senses are developed;
- to improve the patient's balance and sense of support.
Exercises to do to develop movement skills
The most common form of cerebral palsy is atonic. It manifests itself in the fact that the child has severely impaired coordination and low muscle tone. With this form of paralysis, special attention must be paid to those activities that can strengthen the muscles, especially the muscles of the trunk. After all, it is muscle corset- the main core of the human motor system as a whole.
In this case, elementary exercises are effective, for example, raising and lowering the torso from the starting position lying on your back. You can also perform these movements while lying on your stomach. You can make various inclinations from sitting position. From the same position you can try to make circular turns of the body. This complex can also include exercises that will strengthen your arms and legs.
It is necessary to understand that cerebral palsy also affects the functionality of the child’s brain.
Therapeutic exercise should help the brain learn to be responsible for those movements that directly depend on its work: movements of the arms and legs, crawling on all fours, squatting, running, walking. The development of the areas of the brain responsible for these movements is achieved through regular, repeated repetition of the same actions.
As a result, a “feeling” effect occurs, after which you can perform a number of specific exercises:
- Starting position: the child sits on his heels. You need to stand in front of the baby, take his hands and put them on your shoulders. Having secured the child in the pelvic area, begin to place him on his knees.
- Starting position: the child is on his knees. It is necessary to support the baby under the arms. Transfer the weight of his body from one leg to the other, alternately lifting them off the floor.
- Starting position: the child sits on a high chair. Take the baby by the hands and fix his legs on the floor. Encourage your child to stand up by pulling his arms up and forward.
- Starting position: the child stands with one leg extended forward. It is very easy to push the baby in the back and chest to develop balance skills.
- Starting position: the child is standing. Take him by the hands and push him in different sides so that he can take a step on his own.
- Starting position: the child lies on his back. The baby's support ability improves if the child presses his feet on some hard surface.
Exercises used to develop joints
- Starting position: the child lies on his back. One leg must be kept in an extended position, and the other must be bent. It is advisable that the thigh reaches the stomach.
- The child lies on his side. Bend the child's leg at the knee and gently move the hip away.
- The child lies on his stomach on some surface with his legs hanging down. The limbs must be straightened very slowly.
- The child lies on his back. You need to bend and straighten your baby's knees.
Additional exercises
Exercises that train the abdominal muscles:
- Starting position: place the child on your lap. Press his back to you. Bend over with your baby, but he must climb up on his own.
- Starting position: the child lies on his back with his arms pressed to his body. The baby should try to roll over from his back to his stomach, without using his arms.
- Starting position: the child lies on his back. It is necessary to take a deep breath, and as you exhale, the baby should pull in his stomach.
A set of stretching exercises:
- The child is sitting on the floor. Stretch your legs forward, your back is straight. Stretch your arms forward parallel to your legs. The baby should take a deep breath, and as he exhales, bend over and touch his toes with his fingers.
- Starting position: the child lies on his stomach with his arms outstretched. Focusing on the palms, the baby should raise top part bodies above the floor.
Regarding development exercises fine motor skills, then here it is simply necessary to rotate the child’s hand in different directions.
Exercises with the ball:
- It is necessary to place the child with his back to the ball. The legs should rest on the toy. Place the child in the center of the ball and roll it back a little. This exercise develops balance well.
- Place the child with his stomach on a ball that is suitable for the baby in size. Hands should be extended forward. Hold the child by the hips and push the ball forward a little.
- If you put the baby on a ball and easily rock it back and forth, muscle tone is greatly reduced.
Walking development exercises:
- Hold your child by the hips and stand behind him. Gradually turn your baby's hips in different directions to encourage him to take an independent step.
- Help your child do squats - 50 per day.
An excellent assistant is a special device called a verticalizer. It can hold the baby in a standing position. It is simply irreplaceable during training or when preparing a child to independently perform basic functions. The verticalizer fixes the child’s torso, and, if necessary, his feet and knees.
The congenital disease cerebral palsy is a paralysis of the central nervous system that can occur in a child due to damage to certain parts of the brain. Impaired motor functions may begin to progress in the prenatal or childbirth period, as well as in the first days of life. With cerebral palsy, spastic syndrome is often encountered - a painful increase in muscle tone and tendon reflexes. Reduce negative consequences disorders at home can be achieved with the help of gymnastic exercises recommended for cerebral palsy.
Therapeutic effect of exercise
Medical physical culture(physical therapy) helps you learn to control your body. By doing special therapeutic exercises for children with cerebral palsy, you can improve coordination, inhibition processes, and motor amplitude. The technique is an integral part of an integral complex aimed at reducing the manifestations of the disease caused by cerebral disorders.
Therapeutic effects of exercise therapy on the body:
- Strengthens the tissues and organs of the child's body.
- Activates weakened muscles.
- Improves posture.
- Normalizes metabolism.
- Improves the functioning of the brain and circulatory system.
- Promotes overall health.
With regular training, you can achieve the following results:
- developing the child’s necessary basic skills;
- mastering simple work activities;
- servicing yourself without outside help.
It is necessary to begin exercise therapy as early as possible, in the first days of life, gradually complicating the exercises. Moreover, physical education must be carried out if the newborn has no symptoms of cerebral palsy, but is predisposed to its development.
Basic principles of the technique
- Physical therapy is based on a number of basic principles:
- Classes are held regularly, without absences or long breaks.
- Gradual increase in physical activity.
- Individual approach.
- Conducting classes taking into account the stage of the disease, age, and mental state.
Along with exercise therapy, correctional and educational measures must be carried out to compensate for functional impairments.
Types of exercises and features of classes
I love it health-improving gymnastics should be selected taking into account the needs of each individual patient. However, every program exercise therapy classes include the following types of exercises:
- relaxing;
- helping to improve dynamics;
- stimulating motor activity;
- performed lying down;
- performed while sitting;
- having a gaming orientation.
If gait is difficult, or the patient is unable to walk, the exercise should be carried out near bars or rigid support. On next stage The lesson continues near the wall. In order for the center of gravity to be equally distributed on both sides of the body, actions are performed first with some limbs, for example, the right arm or leg, then with others. The weaker side is given a greater load. Squats should not be performed deeply; most often they are performed only at a distance from the knee to the foot (half squat).
Exercises for the development of the musculoskeletal system
If the central or peripheral nervous system is damaged, a disturbance in the movement of the upper or lower extremities may occur - tetraparesis. Appropriate gymnastic exercises can strengthen the motor skills of disabled children and increase the level of control over their actions.
Exercises that improve motor activity:
- Starting position - sitting on your heels. The adult conducting physical therapy puts his palms on his shoulders, then holds the child in the hip area, gradually pushing him to kneel.
- At first, the child sits on his lap. Holding him in the armpit area, you should start moving from side to side so that he learns to independently transfer his body weight to one leg. He tries to lift his other leg away from the fulcrum and spread his arms to the sides.
- You need to turn to face the child sitting on the chair. An adult fixes his legs on the floor with his own and takes him by the hands. The arms are extended forward and upward, so the patient with cerebral palsy will learn to stand up on their own.
- Starting position - standing, feet placed in one line (one after another). You need to take turns lightly pushing the little patient in the back, then in the chest. Such actions will teach him to maintain balance.
- Starting position - standing. Holding the child by the hand, you need to swing him in different directions so that he tries to step on his own.
Position lying on your back, with a wall or other support nearby. We must try to press our feet onto a hard surface, training our ability to stand firmly on the ground.
Exercises to strengthen joints
With cerebral palsy, various joint pathologies, cramps and joint pain are common. Exercises necessary for their development:
- The exercise is performed lying down. One leg needs to be straightened and fixed, the other should be gradually bent at the knee. If possible, the thigh should be pressed to the stomach, then pulled back.
- While on your side and keeping your knee bent, you need to slowly begin to abduct your hip.
- You need to lean your stomach against the table so that your legs can hang freely, then gradually straighten them.
- The starting position is on your back. First you need to bend your knee, then straighten it as far as possible.
- The starting position is lying on your stomach, with a cushion placed under your chest. Holding the patient's hands, you need to lift the upper part of the body, making slightly jerky springy movements.
- The arm of a child lying on his back must be bent so that his face remains turned in the same direction. Then the limb bends when turning the head in the other direction.
Strengthening your abdominal muscles
As part of exercise therapy, classes are conducted that develop and strengthen a group of muscles located in the abdominal cavity:
- The child needs to be placed on his knees, pressing his back to your chest, and then you need to bend down with him. In the next step, the legs and pelvic area of the small patient are fixed so that he can rise on his own.
- Starting position - lying on your back, arms pressed to your body. Making swinging movements and not helping yourself with your hands, you should try to roll onto your stomach and back.
- Lying on your back, inhale and exhale, drawing in your stomach as you exhale.
Improved stretching
Activities that increase stretching and flexibility help achieve the following results:
- the severity of pathologies of the back and spine decreases;
- the condition of the spinal cord and spinal nerve endings improves;
- the muscles of the limbs are strengthened.
Sitting on the floor, you need to straighten your legs, while your body should form a right angle with them. While inhaling, you should extend your arms in front of you. As you exhale, you should try to bend down to reach your toes with your hands. An adult can help by lowering the body even further so that the forehead also touches the legs.
Starting position - on your stomach, arms extended along the body. The emphasis is placed on the palms, with a gradual rise of the chest. It is important to ensure that your head is thrown back and your breathing is even.
Lying on your back, your legs, without bending at the knees, are connected and raised above your head. You should try to reach the floor above the top of your head with your toes. Hands should not be lifted off the floor.
From a sitting position on the floor, bend your right leg so that your heel reaches your left thigh. The left foot should be on the right side of the other knee joint.
The right hand is moved around the left knee, it needs to hold the left leg. After performing these actions, the left hand is removed behind the back to the other side of the waist. At the same time, the head is turned to the left side, a tilt is made to touch the chin to the left shoulder. The right knee remains pressed to the floor.
Relaxation exercises
There are exercises for the upper and lower extremities:
- To give your upper limbs a rest, you need to lie down, then fix your head, arm and leg on one side using weights, for example, sandbags.
- The free arm is bent at the elbow joint, the forearm is held by the adult conducting the gymnastics. The hand must be fixed until the muscle tone decreases, after which the hand is shaken, then it must be alternately bent, rotated and moved to the side.
- In the lying position, the fixed arms and legs are in contact with the stomach. An adult holds his shins, abducting his legs at the hip joint. After fixing one leg, you should make circular movements, trying to pull the leg. Legs need to be alternated.
Breathing exercises
All actions must be performed lying on your back, sitting down some time later, then moving to a standing position. Gymnastics that correct breathing:
- The child needs to be shown how to take a deep breath and exhale through the nose and mouth. You can inflate balls, rubber toys, soap bubbles.
- Different vowel sounds are pronounced at different volumes. You can alternate with singing and playing wind instruments.
- On the count of one, raise your arms up and inhale; on the count of two, extend your arms down and exhale. The exercise will be more difficult if, as you exhale, your head plunges into the water.
Game exercises
Such elements of exercise therapy help maintain interest in the activity, while at the same time promoting relaxation. Game elements Exercise therapy:
Destroyer of towers. For this game, special soft modules or ordinary pillows can be used. If a child is able to build a tower, he does it himself; if not, adults help him. The main task is to destroy the tower.
Get out quickly. You'll need pillows again. This time the child lies on a gymnastics mat, the adult puts about 6 pillows on it and explains that on the count of three he needs to free himself.
Folding knife. Starting position - fetal position. The command is given: “the knife opens”: at the same time you need to pull your arms up and your legs down, remaining on your side. The action is performed at a measured pace. Then the “knife” must be folded. Slowly, the arms are pulled up to the chest, and the legs are pulled up to the stomach. The “knife” is complicated. The exercise is repeated three times on each side.
Sausage. The starting position is lying on your back. The adult carefully grabs the baby's ankles and begins to slowly turn the child in different directions. Gradually the pace accelerates.
Lion on the hunt. Good for group activities. Children sit on their heels with emphasis on their knees around a large soft module (you can purchase a special one or use gymnastic mats as an “island”). An adult tells a little story about the lion: “Once upon a time there lived a lion. He was brave and dexterous, and he also liked hunting. He waited in ambush for prey so that no one could see him (children should, without straining, group themselves with their heads on their palms pressed to their knees). Then he quietly crept (they show how a lion sharpens its claws and stretches its back) and jumped (they rise on their hands, helping themselves with their legs, and fall onto a soft surface).”
It is impossible to say in advance exactly when improvements will occur. Much depends on the degree of damage and how severe the spastic syndrome is. To achieve a significant reduction in the manifestations of cerebral palsy, exercise therapy with such children needs to be done regularly, gradually and listening to the personal needs of each of them.
Cerebral palsy (CP) is a paralysis of the central nervous system that occurs as a result of damage to one or more parts of the brain. There are a huge number of methods used to treat such patients, but in this article we will talk about exercise therapy for cerebral palsy, or, in other words, all about the use of physical therapy for the treatment of patients with cerebral palsy.
Cerebral palsy manifests itself in difficulty performing certain movements or, conversely, involuntary performance of certain movements. Exercise therapy is designed not only to strengthen the patient’s body, but also to teach him to exercise control over his body. We can say that cerebral palsy and the gym are inextricably linked with each other.
Mom works out with her child on rollers
Physical activity using the exercise therapy method pursues the following goals:
- Teaching everyday skills and abilities.
- Introducing patients to work (occupational therapy method).
- Teaching the patient self-care techniques.
Basic principles of physical therapy
- systematic and regular (the continuous nature of classes is extremely important, since muscle memory quickly forgets some points);
- the increase in load should not occur abruptly, but smoothly, taking into account the patient’s condition;
- individual approach (in such a situation, only work individually, a group approach is excluded);
- taking into account the child’s age and condition.
So what role do they play? physical exercise on the body of a child suffering from cerebral palsy:
- general health;
- prevents the formation of adhesions between nerve endings;
- strengthening;
- promotes activation of weakened muscles;
- eliminates scoliosis (curvature of the spine);
- improves blood circulation (due to this, brain activity is activated).
Fitball exercise
You can use Dr. Bandurin’s method for exercise therapy. Which includes thirty-minute physical therapy sessions and an hour-long massage session.
Examples of exercise therapy for cerebral palsy
Exercise therapy for children with cerebral palsy includes several independent areas. As a rule, this is not always gymnastics, but also some other forms, including exercises:
- to support motor functions;
- strengthening joints;
- abdominal muscles;
- torso and neck;
- breathing correction;
- facial expressions;
- emotions.
Among other things, there are such subtypes of exercise therapy as treatment:
- Regulations.
- By stretching.
- Walking.
By the way, massage and yoga are used to treat cerebral palsy.
There are spastic forms of the disease and asthenic ones. In the first case, all exercises must be continuous in order to obtain maximum effect, and in the second they should be short in time with mandatory breaks.
Motor support
To support the baby’s motor functions, the following set of exercises is used:
From heels to knees
Starting position - the child sits on his heels.
The doctor (parent) stands in front of him and puts his hands the patient on your shoulders. The child should kneel from the starting position. The doctor’s task is to stimulate such attempts
Shifting weight from one leg to the other
Starting position - the specialist supports the child with his armpits from behind.
The doctor gently moves the child left and right so that the patient learns to shift weight from one leg to the other. It is important that when transferring body weight to one leg, the second leg is lifted off the floor and the arms are spread to the sides.
An option for transferring weight from one leg to the other
Starting position - the child is in a squatting position.
The specialist presses on the baby’s knees with his hands from behind the back and gradually tilts the patient’s torso. In this position, the knees should begin to straighten spontaneously.
Exercise option
Getting up
Starting position - the child sits on a chair
The doctor stands in front of him and lightly steps on his feet. The doctor's foot should not cause pain or discomfort to the baby. The patient’s arms rise up and the specialist stretches slightly, which provokes independent rise from the chair.
Equilibrium
Starting position - the baby is standing, with one leg put forward.
This exercise requires the presence of two adults. One stands in front of the patient’s face, the second behind the patient’s back. The pushes are made alternately (not diagonally, but directly into the chest and back). This exercise trains your baby's balance.
Balance exercise
First steps
Starting position - the child is standing.
The doctor begins to pull the patient by the arm, slightly pushing him in different directions to provoke him to take a step. 
Foot pressure
Starting position - the child lies on his back, legs bent at the knees.
The doctor controls that the patient's feet press into the floor surface. This exercise allows you to increase your support ability.
Foot pressure on the floor
Joints
Exercise therapy for children with cerebral palsy consists of large quantity exercises as in gym, and without the use of special devices. Working on joints is an important component of successful treatment of a patient. A set of exercises to activate joint function includes:
Alternate bending
Starting position - the child lies on his back, with his limbs straightened along the body.
The doctor alternately bends the right and then the left leg at the knee, trying to reach the stomach (if this causes discomfort, you can limit yourself to the usual bending of the limb at the knee).
Hip abduction
Starting position - the patient lies on his side.
The specialist helps the patient move the thigh of the upper leg to the side. This exercise helps develop the joints of the lower extremities.
Exercise option
Exercise with a table
Starting position - the child lies on his stomach on the table, with his legs hanging down.
Since a sick child will most likely tighten his legs, this adaptive exercise consists of encouraging the baby to gradually straighten his legs.
Leg extension order
Spring
Starting position - the baby lies on his stomach, and there is a cushion under his pelvis (you can use a folded terry towel).
The doctor lifts the child by the arms and begins to make small jerks so that springing movements occur.
Arm Curl
Starting position - the child lies on his back, his head is turned to the left or right, depending on which hand will perform the exercise.
The doctor bends the arm the patient is looking at. This allows you not only to practice automaticity when bending, but also helps the baby to understand what exactly is happening to his body at one time or another.
Abdominal muscles
The abdominal muscle training technique is similar to the training of ordinary athletes performing muscle exercises abdominals, with the difference that a child with cerebral palsy needs the help of an outsider.
Flexion and extension
Starting position - the baby is located on the mother’s lap and presses his back to her chest.
The mother leans forward with the baby, and then holds his legs and hip joint so that the baby returns to the starting position on his own. Perhaps at the initial stage he will not be able to do this, then his mother will have to help.
Coup
The doctor helps the baby swing his left or right leg, thereby provoking him to roll over from his back to his stomach and back. You should not involve your hands in the revolution.
Inhale - exhale
Starting position - the patient lies on his back.
Fitness has many exercises related to breathing, one of which is used during exercise therapy for children with cerebral palsy. The child inhales and exhales, and as you exhale, the stomach should retract and as you inhale, round.
Bends to the feet
Starting position - the child sits on the floor, legs extended forward and slightly apart.
The doctor sits behind the patient and helps him bend forward. The tilt is performed until the hands reach the floor. Ideally, you should touch the tip of your forehead to the floor.
This exercise has different effects. Besides the fact that it is classic exercise for the abdominal muscles, it trains flexibility, stretching, eliminates problems with spinal curvature and normalizes blood circulation.
Deflection
Starting position - the child lies on his back, legs together, arms along the body.
The doctor helps the patient bend the spine, and it is important that his limbs do not come off the floor.
It is better to perform bends with one of the parents
Incomplete somersault
Starting position - the child lies on his back, straight legs raised up.
The doctor controls the baby so that he can touch the floor surface behind his head with his toes. A kind of tilting is performed. Control when performing this exercise must be total to avoid injury to the patient.
Throwing your legs behind your head (option)
Muscles of the trunk and neck
To develop the muscles of the torso and neck, you can perform the following exercises:
Wiggles
Starting position - the child lies on his back.
The specialist fixes the patient’s body in the shoulder area with both hands and begins to perform rocking movements to the left and right. After this, the same exercise is performed with the head, supplemented by turning the neck to the left and right.
It is important that the child should not resist.
Fall on signal
Starting position - the child lies on the left or right side, bottom hand under the head, upper along the body.
The doctor’s task is to gently push the baby in the chest or back, provoking him to maintain balance. You can only fall if given a signal from a specialist.
"Articulated head"
Initial position - the patient sits on a chair, hands on the armrests, head lowered and pressed to the chest.
The specialist begins to turn his head in different directions. The patient should not resist this. When fixing the head in one of the positions, it is necessary to relax the neck muscles so that the head is under own weight“fell” back onto my chest.
For a more complete assimilation of the exercises, it is necessary to demonstrate to the patient by your own example what they want from him.
Breathing correction
Gymnastic exercises are not only about developing the muscles of the body and training muscles, breathing exercises occupy not the last place in physical therapy for children with cerebral palsy.
It is not necessary to go to a rehabilitation center to have this complex performed with your baby; parents will be able to perform exercises to correct breathing at home.
All exercises are performed either lying on your back or standing.
Blowing on the feather
The child is explained how to properly take a deep breath and exhale through the nose and mouth. To develop interest in the exercise, it is recommended to exhale onto some light object (sheet of paper, pen) or blow soap bubbles. 
We count while breathing
In this exercise, the baby will have to take a deep breath on the count of 1,2,3 and exhale deeply on the count of 4,5,6. You can use the finger technique and show numbers on your fingers. To develop interest, the child can be asked to exhale into a bowl of water.
We speak while breathing
The baby learns to pronounce various sounds while exhaling with different intensities. It would be useful to bring in this exercise elements of the game (using a whistle or harmonica, learning songs.)
Facial expressions
Emotions are inextricably linked with a person’s facial expressions, and children with cerebral palsy are not always able to express certain feelings with facial expressions. It is important to teach your baby to show a smile or sadness. This is achieved by regular repetition and training. The specialist shows by his own example what a smile or sadness, etc. looks like.
This section of exercise therapy is called psycho-gymnastics.
Emotions
The manifestation of emotions, as well as facial expressions, are no less important, and teaching a child with a disease such as cerebral palsy to express surprise or suffering is not so difficult. This will require close contact with the baby.
An important condition is a friendly attitude, since such children are extremely sensitive.
To express a particular emotion, it is necessary to awaken the appropriate feelings in the child, for example:
- Joy - ask your child to imagine that he was given a huge toy or to portray a baby elephant who found his mother.
- Disgust - the patient must reproduce the consumption of tasteless porridge or bitter medicine.
- Fear - imagine a little mouse that saw a cat.
- Guilt - imagine that the child broke his parents’ favorite vase.
And so on, there can be a huge number of variations with the expression of emotions, the main thing is to turn on your imagination and share it with your baby.
Treatment by position
Physical therapy for cerebral palsy, based on fixing one position (kinesiological method) for 1–2 hours, is a common rehabilitation option. As a rule, it is performed in the early stages of the disease.
At later stages, they try to fix the position in such a way that the fixing splints are located directly next to the patient’s muscles. 
It looks like this: the child is placed on his back, a cushion is placed under the neck, so as to tilt the head to the chest as much as possible. In addition, the roller is installed under the knee joints so that the legs are in a semi-bent state. The baby should spend from one to two hours in this position, depending on the patient and his condition.
Exercises in the pool for cerebral palsy
Regarding this summer look treatments, like exercises in water, they can be carried out at any time of the year, in the pool. A modern swimming pool for patients with cerebral palsy has a huge number of special simulators, which make it easier to conduct classes for the most complicated cases and for all ages.
The benefits of exercise on water are obvious. Even for a healthy person, a few minutes spent in swimming pool akin to several hours of relaxing massage. The body not only feels the relaxation of all muscles, it is filled with energy.
It is better to conduct classes in the morning, when the baby has recently woken up.
For children with hemiparesis or especially severe cases shows the use of a special Gross support simulator, which you can read more about in this article.
The following exercises can be performed in the pool:
Leg abduction
Initial position - the patient is at the side of the pool in the water, leaning on it with both hands.
Alternately, the left and right legs are pulled back (five times for each leg), after which the legs are spread apart (at least ten times).
Back to board
Starting position - the baby is turned with his back to the side of the pool and holds on to it with his hands.
It is necessary to raise two legs up and spread them apart as much as possible (repeat up to ten times).
Abdominal exercises
Starting position - the patient lies on his stomach and holds the side with his hands (the instructor supports the patient under the stomach).
It is necessary to lift up the left and right leg(five times for each limb), spread your legs apart (up to ten times), bend alternately the right and left leg in the knee near the chest (five times for each limb).
Bend legs to chest (option)
Back exercises
Starting position - the patient lies on his back and holds the side with his hands.
You need to lift two legs up at the same time (up to ten times), spread your legs to the sides (up to ten times), and perform the scissors exercise (up to ten times).
Sedentary exercises
Starting position - in a semi-sitting position, you need to press your back to the side of the pool.
Perform a bicycle exercise (up to 1020 repetitions on each leg), raise your legs at an angle of 90 degrees and perform circular movements with them
Games
The human central nervous system is quite delicate and capricious, just like the mood of a sick child, so sometimes for productive activities it is necessary to introduce elements of play into them. For example, classes using a fitball (simply a special ball).
Ball training includes the following exercises:
Ball ride
Starting position - the baby is positioned with his back to the ball.
It is required to rest the patient’s feet on the fitball and roll it back, and then return it to its original position.
Lying on the ball
Starting position - baby lies on the ball on his stomach
Holding the patient's legs (hips), push the ball forward while keeping the baby straddling it.
Wiggles
Starting position - the child sits on the ball.
Rocking from side to side reduces muscle tone.
Fitball exercise options
Children with cerebral palsy also want to participate in various types sports So, it is possible to hold competitions with them in a sport such as table tennis. It has been proven that patients with cerebral palsy are quite capable of holding a racket and performing the movements necessary for this game. Moreover, the patient not only trains his muscles, but also adapts socially.
In addition to general strengthening exercises, increased attention should be paid to improving gross motor skills hands in children with cerebral palsy. To do this, there are various exercises with small objects, which are based on sorting them out and performing various other actions.
Thus, exercise therapy for cerebral palsy is a serious process that requires close attention from parents, as it can alleviate the patient’s suffering and simplify his life. It is important to understand that regular exercise plays a huge role in exercise therapy.
