Cerebral palsy is one of the most severe forms of motor cerebral (brain) disorders in children, arising from different reasons(there are up to 400, 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 common. It occurs in children from 3 months to 3 years (untreated children with this pathology 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 for social adaptation in the future (to 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.
The treatment of cerebral palsy is complex, long-term and is aimed at learning to move, restoring impaired functions, which is achieved by the tireless (selfless!) work of parents. According to statistics, a significant improvement is noted in 25% of patients, and some mitigation of defects - in 50%, 25% of children do not have any positive dynamics.
The complexity of the treatment lies in the fact that drugs can accelerate the process of "maturation" of nerve fibers, normalize muscle tone, but do not affect muscle and joint contractures, which do not allow the child to acquire the experience of normal postures and movements. Daily physical therapy and massage can help the baby develop normally. In any case, coming to terms with a disability is not the solution to this problem. The beginning of physiotherapy exercises at any age gives positive changes: the emotional state of the child improves, muscle contractures decrease (or disappear).
In what form the disease proceeds, a pediatric neurologist should determine. 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 (muscular hypotension), 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 dysfunctions - neurological disorders in the form of lethargy, fatigue, excitability, restlessness, tics, headaches, and at an older age, violations are manifested by poor school performance due to difficulties with learning a new one. These children have difficulties in communication, 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 is a groan, convulsions, a sharp excitement of the child with a piercing cry, respiratory failure;
b) syndrome of increased intracranial pressure (hydrocephalic-hypertensive) - the fontanel is tense or swells, the size of the head increases rapidly, there may be convulsions;
c) convulsive syndrome - convulsions occur several times a day;
d) the syndrome of inhibition of unconditioned (congenital) reflexes - grasping, automatic gait, etc. Incorrect attitudes of the trunk and limbs are formed;
e) diencephalic syndrome - there is a small increase in weight, growth retardation, sleep disturbance, temperature;
2) recovery period:
a) early recovery period (initial chronic-residual stage) - begins after the subsidence of acute manifestations of cerebral hemorrhage. According to different 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 motor disorders; b) late recovery period - lasts up to 1-2 years;
3) the period of residual effects, or the final residual stage, begins at the age of 2 and continues throughout the period of childhood and adolescence. Children of 4-7 years old with intact intelligence attend speech therapy groups kindergartens (motor disorders are combined with speech disorders). Classes in exercise therapy with a methodologist are held every other day, all other days the child is engaged with his parents. A two-year-old child with cerebral palsy can be in motion up to 2.5 hours a day, at 3-7 years old - up to 6 hours.
The task of parents and a pediatrician is to identify the symptoms of the disease as early as possible, and for this there are special tests. Considering that during the neonatal period, the child’s muscle tone is normally increased, it is possible to determine changes in muscle tone by indirect signs only from the end of the first month: with an increased tone, the child from a position on the stomach does not attempt to raise his head and set it in the midline.
To check the muscle tone and symmetry of the child's body from 2 months: put him on a flat and dense surface on his stomach and lift right hand both legs 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 motion along the spine is even (straight), then the child's muscle tone is normal. In case of violation of muscle tone and asymmetry of the body, your hand will drastically change direction on its way; the body of the child at this moment will bend to the side (and not down); at the same time, you will clearly feel the tension of the muscles at hand; the baby's legs will be bent at the knee and hip joints.
At the same age, the child can notice the tilting of the head, tension in the back of the head. With support under the armpits, he does not rest on a full foot, but on the tips of his fingers (“on tiptoe”).
In healthy children, congenital reflexes begin to disappear from 3 months. If the grasping, search reflexes, automatic gait reflex do not disappear after 4 months, but even increase, then there is a high probability of increased muscle tone. In the position on the stomach, such a child bends his arms, legs and raises the 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 clamped inward, and the legs are crossed, this is very similar to spastic paresis of the upper and lower extremities.
If the movements are made, but at the same time the child is lethargic, “flattened”, the palm is unbent, 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 be suspicious? If for 1-3 months the baby is dominated by negative emotions (frequent crying), there is no “cooling”, then the pediatrician should pay attention to this.
Remember: hypertonicity of the muscles of the upper extremities disappears by 2.5 months, in the lower - by 4 months. Only a doctor can distinguish the norm from the 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 makes an attempt to bend it. Normally, the head bends easily, and with cerebral palsy, the head presses on the arm;
2) the doctor takes the baby by the hands and pulls it towards him. 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 unbends 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 (takes 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 raise his head. With cerebral palsy, the chin presses on the doctor's hand. Normally, by 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. It is they who allow you to maintain a vertical position of the body. The newborn does not have these bends, i.e., his spine is almost straight. The cervical bend (lordosis) appears at 2.5 months, which allows the child to keep his head in an upright position. In the spastic form of cerebral palsy, the neck is, as it were, inserted into the shoulders - a “short neck”, and at the same time the formation of cervical lordosis is late.
Lumbar lordosis should be formed at 6 months, after which the baby begins to sit on its own. If the lumbar bend is insufficient, then the torso has a forward tilt, which disturbs the balance (support on the legs). Excessive lumbar bending (hyperlordosis) leads to stiffness (contracture) of the hip joints (one or both), due to which the gait changes 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 the back and try to lift him by the arms (test 2) - the head will hang down.
Tests to determine the correct lumbar lordosis
1. Starting position - lying on your back. Pull the child's knee to the chest. If the other leg at this time rises 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. With shortening of the rectus femoris muscle, this cannot be done.
The main goals of exercise therapy for cerebral palsy are:
- normalization of muscle tone so that the child can make arbitrary movements;
- training in motor skills in accordance with age; 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 convulsions stop.
Exercises to normalize increased muscle tone
Exercise 1. Designed to identify and eliminate the asymmetry of the body, increased tone muscles of the back, neck (forms the cervical bend and reveals disorders in the hip joints).
It is performed not earlier than 2 months of age (during the formation of cervical lordosis). If there are indications of injury in cervical region spine, then the exercise is performed only after the procedure of therapeutic massage.
The starting position of the child is lying on his back. The instructor leads the child into a flexion position (“fetal position”): arms are crossed over the chest, legs bent at the knees lead to the stomach and bend the head to the chest.
The baby's knees should be bent and as close as possible to the head along the midline of the body (with hip dysplasia and the symptom " short neck” this cannot be done, and the child performs an easy version of the exercise). A few seconds hold the child in this position, making swaying movements.
The posture in the flexion position is natural for a healthy child and does not cause difficulties in its implementation. If the child has an increased tone (rigidity) of the muscles of the back and neck, then he will cry. In no case should you bend the child with great force!
With hip dysplasia, the baby will "slip" out of the hands of the instructor, trying to free himself and tilt in the other direction.
The exercise helps already after 14 days 5-8 month old children with increased muscle tone of the neck and back, unable to hold their heads, roll over and sit down.
Exercise 2. Designed to determine and eliminate the increased tone of the muscles of the thighs, the formation of the lumbar curve of the spine. It is indicated for children who, when performing an automatic gait, do not rely on the entire foot, but on the fingers. It is performed not earlier than at the age of 6 months (at the beginning of the formation of lumbar lordosis) after consulting 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 on the legs bent at the knees, the feet are shoulder-width apart, turned up. The instructor tilts the child back so that the head, shoulders, and back touch the surface of the table.
The right hand of the instructor pulls down the head and shoulders, and the left hand fixes the knees. child with normal muscle tone easily and with pleasure remains in this position.
With tense thigh muscles, the child will try to free himself from the position that causes discomfort, as soon as possible, and sharply straighten 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 normalizes), and then sit down on his own (the exercise forms lumbar lordosis).
Exercises for the development of 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 his shoulders and, fixing him in the pelvic area, stimulate kneeling.
Exercise 2. The starting position of the child is kneeling. Supporting the child under the armpits, move him from side to side so that he learns to independently transfer body weight on one leg, tear off 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 torso forward, unbending his knees.
Exercise 4 The starting position of the child is sitting on a chair. Stand facing the child, fix his legs to the floor with your legs, take his hands. Sip your arms forward and up, prompting 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 to the back, then to the chest 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 them to take a step.
Exercise 7 The starting position of the child is lying on his back. Press with your feet on a solid support (exercise improves support).
Joint exercises
Exercise 1. The starting position of the child is lying on his back. Hold one leg of the child in the extension position, gradually bend the other at the hip and knee joints. Hip, if possible, lead to the stomach, and then slowly produce its abduction.
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 unbend the limbs.
Exercise 4 Starting position - lying on your back. Bend the knee, then straighten it as much as possible.
Exercise 5 The starting position of the child is lying on his stomach, a roller is placed under his chest. Raise the child by outstretched arms, making springy extensor 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 bent arm. After that, bend the arm with the head position in the opposite direction.
Exercises for the abdominal muscles
Exercise 1. Starting position - the child sits on the lap of the mother. Press the back of the child to your chest and tilt with him (so that the baby feels confident). Fix the legs and pelvis of the baby so that he can lift himself. If getting up is difficult, the mother should help him 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 make an attempt to turn from his back to his stomach and back without the help of his hands.
Exercise 3 Starting position - lying on your back. Inhale and exhale with the retraction of the abdomen as you exhale.
Stretching exercises
Exercise 1. Starting position - sitting on the floor. Stretch your legs forward so that the body is at a right angle. Stretch 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 relieves the stiffness of the back muscles, making the spine flexible, improving blood circulation and the function of the spinal nerves.
Exercise 2. Starting position - lying on the stomach, arms along the body. Leaning on the palms, slowly raise the chest up (the body from the waist to the feet should be in contact with the support). The head is thrown back, legs and feet together. slow and deep.
Throughout the entire spine, the tone of muscles and ligaments increases, the function of nerve trunks and blood vessels improves.
Exercise 3 Starting position - lying on your back, legs together. Raise straight legs above your head, do not bend your knees, hands lie on the floor. Try to touch the floor above your head with your fingertips. Slowly return to initial position.
Exercise is useful not only for the spine, spinal cord, all spinal nerves, but also for the muscles of the arms and legs.
Exercise 4 Starting position - sitting on the floor. Bend the right leg so that the heel touches the opposite thigh. Place your left foot on the floor with right side right knee, move the right hand around the left knee and hold the foot of the left foot with it. Bring the left hand behind the back to the right side of the waist as far as possible, turn the head to the left and tilt it so that the chin touches the left shoulder, while the right knee should not come off the floor.
The exercise corrects defects of the back along its entire length. Toddlers can perform the exercise with the help of adults who help them maintain their adopted position.
Position treatment
In the initial stage of cerebral palsy, treatment with position (laying) is carried out after a relaxing massage and relaxing exercises.
In order to give the body a physiologically correct (symmetrical) position, special rollers with sand are used, tires with a soft inner lining. In such styling, the child can stay for 2 hours, then rest for 1-2 hours, and the taverns are applied again.
At an older age, use the position with the maximum convergence of the points of attachment of the muscles.
Pose lying on the back: put a cushion (pillow) under the head so that the head is practically lowered onto the chest. Bend your arms at the elbows or cross over your chest. The hips should be flexed and knee joints(put a roller under the knees), the angle of flexion is selected individually. Put your feet on a support, open your hips freely.
The posture allows you to slow down hyperkinesis and reduces the influence of the neck-tonic asymmetric reflex.
Exercises to relax the muscles of the upper limb
Exercise 1. Starting position - lying on your back, the head is located strictly in the midline, the arm and leg on one side are fixed with sandbags. The free arm is bent at the elbow, the instructor (mother) fixes the forearm. 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 in alternation with passive movements in the wrist joint (flexion, extension, abduction, adduction, rotation).
With the help of acupressure, carried out in parallel, it is possible to stimulate active flexion and extension of the hand.
In conclusion, the exercises are performed by shaking and laying the forearm and hand in the middle position with fixation with taverns or rollers with sand.
Exercise 2. Starting position - lying on the stomach, head in the middle position, arms laid aside, forearms lowered from the couch, a pillow is placed under the body, legs and pelvis are fixed. The instructor (mother) holds the child's shoulder until the involuntary movements disappear (weaken), then swings and shakes the forearm, performs passive flexion and extension in elbow joint. Stimulates active movements in the elbow joint of the child with massage techniques, swings the forearm again and finally fixes the hand in the middle position.
Lower limb exercises
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 anterior surface, performs abductions in the hip joints. Then, fixing one leg, holds circular motions 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 hand supports the leg by the lower third of the thigh. The pelvis is fixed with sandbags. The instructor (mother) supports the leg with one hand on the lower third of the thigh, with the other hand conducts a stimulating massage to reduce the gluteus maximus muscle. At the end of the exercise, the child’s leg should “fall” onto a soft support.
At the next stage, the instructor performs passive extension in the hip joint, after which the child holds the leg on his own for a certain amount. Then the free fall of the leg on a soft support is carried out.
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 torso on both sides, slightly sways the body from side to side, paying attention to the fact that the child does not resist. Then the instructor (mother), holding the child's head, shakes it freely, alternating swaying with turning the head (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 hold the starting position during pushes, relaxing the muscles and falling only at the signal of the instructor.
Exercise 3 Starting position - sitting in a chair, hands on the armrests, head down on the chest. The instructor (mother) conducts passive tilts, head turns, flexion-extension (without resistance from the child). The child must fix the head during passive movements, then actively relax the muscles so that the head "falls" on the chest.
Breath Correction Exercises
The starting position for any exercise is lying on your back, with a gradual transition to a sitting and standing position.
Exercise 1. The child must be shown how to take a deep breath and exhale deeply through the nose and mouth, and then invite him to exhale on thin paper (feather, flag), his palm. You can inflate toys and blow bubbles.
Exercise 2. To improve respiratory functions, it is necessary to teach the child to exhale at different volumes, to whistle, play the harmonica, and sing.
Exercise 3 Breathe in for a count of "one, two, three", while raising your hands up, and exhale for a count of "four, five, six", lowering your hands down. Exhale into the water, lowering your head into the bath with.
Mimic exercises
The problem of recognition (identification) of feelings is relevant not only for children with cerebral palsy. In other words, this is not even a “childish” problem at all - not every adult can answer the question: “What do you feel now?” Not to mention the fact that the ability to respond to certain negative emotions in a safe form for yourself and others is the key not only to peace of mind, but also to physical health.
To teach the child to imitate various emotional states in order to distinguish them later in everyday life, and with the help of facial muscles to discharge these emotions is the task of psycho-gymnastics.
Expression of emotions
Interest, attention: show the child how the dog sniffs, how the fox overhears, how the commander studies the map. Ask him to repeat the etudes.
Surprise: make round eyes.
Joy, pleasure: ask the child to show how the kitten behaves when it is stroked; ask to smile imagine that Carlson flew in (Santa Claus came) and brought delicious sweets (toys).
Suffering: show the child how the stomach hurts; how she cries infant; how cold it is in the cold. Ask him to repeat the etudes.
Disgust: Ask your child to imagine drinking salty soda.
Anger: ask the child to show how angry the grandmother (mother, father, grandfather).
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 beloved mother's (grandmother's, grandfather's, father's) thing; To apologize.
Exercise therapy for congenital hip dislocation
In children, dislocation of the hip joint can be acquired (during childbirth) and congenital (due to abnormal development of the hip joint, which is called dysplasia).
Congenital dislocation of the hip is currently the most common malformation and occurs in at least 2 out of 1000 newborns, while girls are 5 times more likely than boys. In addition, it was noted that in girls, the left hip joint.
So, the main cause of congenital dislocation of the hip joint is its dysplasia (underdevelopment), which can occur for several reasons. First, there are anatomical predisposing factors: the joint capsule is thin, and the ligaments that strengthen the joint are underdeveloped. 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 does not consist of bone, but of cartilage, it is smaller than normal in size and with a short neck. Therefore, on 2/3 of its surface it can be outside the acetabulum.
Under adverse conditions (including poor care of the newborn), the hip joint becomes unstable, and the femoral head is shifted upward and backward.
Hip dislocation is easy to identify and cure only in a newborn child, and therefore, the earlier this pathology is diagnosed, the more effective the treatment will be. Usually, at the first examination of a newborn, the pediatrician performs the following test (a “slip” or “click” symptom): he 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 “click” symptom decreases already on the 3rd-7th day of life, and instead, movements in the joint are limited.
Other signs of hip dislocation are:
1) asymmetrical skin folds in the buttocks (in the position on the stomach) and on the inner surface of the thighs (front and back);
2) a symptom of "restricted abduction" - difficult passive abduction of the legs bent at a right angle in the hip and knee joints (it is difficult to spread the legs when the child is on the back);
3) a 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 dislocation. If the 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 defined shortening of one limb and a smoothly waddling gait (“duck”), only surgery can help him at this age.
Treatment of congenital dislocation of the hip begins already in the maternity hospital (immediately after the detection of the disease): up to 3 months, a wide swaddling of the child is shown, in which the hips do not close, but remain divorced to the sides. To do this, a diaper folded four times is placed 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. Not without reason, for example, in Africa, a child is worn from birth tied to the back, while his legs are always divorced to the sides!
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.
In the treatment of dislocation, one should adhere to the following rules(position treatment):
1) when the child is on the stomach, make sure that the feet are outside the mattress, otherwise the spasm of the adductor muscles of the thigh increases;
2) as soon as the child begins to sit (from 6 months), he should be seated on his knees with legs apart, facing himself, holding his back with both hands;
3) when the child is held in his arms while standing, his legs should cover the torso of an adult.
For orthopedic treatment, special devices are used: up to 3 months, Pavlik's stirrups, after 3 months - CITO, Vilensky tires, from 6 months - Volkov, Polonsky tires. Exercise therapy for congenital dislocation of the hip is carried out as prescribed by an orthopedist. All conservative methods of treatment are aimed at gradual and sparing restoration of the shape of the joint. This is achieved by long-term fixation in a pose that is therapeutic (corrective). Exercise therapy for hip dysplasia not only helps to shape the joint, but is also the only way to develop the child's motor skills.
Therapeutic exercises help to eliminate stiffness (contracture) of the thigh muscles (adductor muscles), strengthen the muscles that set the joint in motion, and also correct the position of the joints (valgus) that develops after the use of orthopedic splints.
Physical 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 especially “suffered”. Scientists have proven that the electrical excitability of these muscles is reduced. This is especially true of the adductor muscles, hip flexors, gluteal muscles, in which contractures are formed. For treatment, systematic stretching exercises, massage and thermal procedures are needed.
Exercise 1. Traction along the longitudinal axis of the limb. Starting position - lying on your stomach. With one hand, the instructor (mother) fixes the shoulders of the child, with the other - pulls the leg towards him (there may be a click). The procedure is repeated 1 time in 3-4 days.
Exercise 2. Leading 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 of the 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 knee and hip joints and gently spread the hips to the sides. Grab the child's thigh with the palm of your hand so that the thumb lies on the inner surface of the thigh, 2-3 cm below the inguinal fold (7th point). With the pads of the II and III fingers, touch the skin at the site of the projection of the hip joint to feel the deepening.
In this place (the projection of the entrance of the femoral head into the acetabulum), apply soft pressure. Relaxation of the adductor muscle is carried out with acupressure vibration massage of the area of the 7th point and slight shaking of the thigh.
Exercise 5 Lowering straight legs to the sides. Starting position - lying on your back.
Bend the straightened legs of the child at the hip joints and make several leads to the sides.
Exercise 6 Alternate bending of the legs in a divorced position. Starting position - lying on your back. Bend the legs at the hip and knee joints, gently spread the hips to the sides. Alternately bend and straighten the child's legs. Repeat 4-6 times.
Exercise 7 Internal hip rotation. Starting position - lying on your back. With the left hand, fix the left hip joint of the child, with the bent hand of the right hand, embracing the knee, gently rotate the thigh inward, while pressing on the knee and moving the lower leg outward. Repeat 4-6 times for each leg.
Exercise 8. Bending the legs. Starting position - lying on your stomach. Place the palm of the left hand on the right buttock of the child, with the right hand, grabbing the lower leg, bend the leg at the knee and hip joints. Repeat 4-6 times for each leg.
Therapeutic exercises for children of the second half of life (with the tire removed)
Exercise 1. Starting position - lying on your back, straight legs laid aside. Stimulate the rise of the child to a sitting position with the legs abducted horizontally. Repeat 4-5 times.
Exercise 2. Starting position - sitting, legs laid aside. 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 a baby walker, a spacer cushion is installed opposite the child’s perineum, measuring 15x10x3 cm. tricycle with a wide saddle (without pedals).
Approximate set of special exercises for preschoolers with congenital hip dislocation
For children 5-6 years old, to consolidate the results of conservative treatment (or for aftercare), exercise therapy is carried out 3 times a week for 20 minutes.
Exercise 1. Starting position - sitting on a chair. Alternately bend and unbend the feet. Repeat 4-6 times.
Exercise 2. Starting position - lying on your back. Alternately bend and unbend the 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 a straight leg without support on the floor, pull the toe towards you with the vertical position of the foot. Repeat 4-6 times with each leg.
Exercise 4. Starting position - standing, arms lowered along the body. Raise your arms through the sides up, 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. Gently 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. It is easy to beat the heels on the buttocks 4-6 times.
Exercise 9. Starting position - standing on all fours. divert bent leg to the side. Repeat 3-4 times with each leg.
Exercise 10. Hit the ball suspended at a height of 0.5 m with the heel 4-6 times with each foot.
With the ineffectiveness of conservative methods of treatment, arthrotomy with arthroplasty is performed. In the period before the operation (1.5-3 months), general strengthening and tonic exercises are carried out, the skill of voluntary muscle relaxation is trained (which is necessary for skeletal traction with a high standing of the femoral head).
On the second day after the operation, therapeutic exercises are prescribed to strengthen the gluteal muscles, increase mobility in the hip joint. The plaster bandage is removed 1 month after the operation.
Approximate complex special exercises in the postoperative period
Exercise 1. Starting position - lying on your stomach, legs extended. Alternately bend and unbend the 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, lift straight legs up. Repeat 6-8 times.
Exercise 4. Starting position - lying on a healthy side. Retract the leg bent at the knee. Repeat 5-6 times for each leg.
Exercise 5. Starting position - lying on a healthy side. Take a straight leg to the side. Repeat 5-6 times for each leg.
Exercise 6. Starting position - lying on the stomach, on the leg (on the side of the operated joint), and the area middle third fasten weights (sandbag) on the lower leg. Take a straight leg with weights up. Repeat 3-5 times for each leg.
Exercise 7. Starting position - lying on a healthy side. Take a straight leg with weights to the side. Repeat 3-5 times for each leg.
Unlike spastic, flaccid paralysis is characterized by deeper dysfunction of the motor apparatus. Patients cannot move independently. The tone of the muscles of the paretic limbs is sharply reduced, they are flabby, atrophic. While maintaining passive movements, active ones are carried out with difficulty due to muscle weakness. Profound disturbances of trophism are characteristic. Therapeutic effects should include, along with stimulation of the neuromuscular apparatus, improved nutrition of the tissues of the paretic extremities. For this purpose, massage is introduced into the complex of physiotherapy exercises. A deep massage is applied using kneading, vibration, tapping, as well as a stimulating acupressure technique. With flaccid paralysis, passive movements are combined with massage and active restorative movements, with paresis - with active movements for paretic limbs.
Passive exercises for flaccid paralysis, along with massage, help restore active movements. The most important for the restoration of the function of movement and support are active exercise. 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 elementary exercises are prescribed in the most favorable initial positions.
Assisted movements are widely used. Initially, the movements are performed in the horizontal plane, as the motor function increases - in the vertical one, which allows you to turn on the severity of the exercised limb. With flaccid paresis of the upper limbs, it is advisable to use swing movements of the entire limb in different directions. To complicate the exercises of the paretic hand, they grab (or tie to it) a light dumbbell, a mace. It is advisable to carry out the exercise of the hands and fingers with a stable support of the forearm (sitting at the table). Commonly used exercises for the hand and fingers are used with the help of small equipment.
With flaccid paresis of the lower extremities, movements are shown that contribute to the development of the support function. 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. With flaccid forms of paralysis, general strengthening gymnastics is important. It is especially important to pay attention to the compensatory development of the muscles of the upper limbs and shoulder girdle on which the main load falls when moving patients on crutches.
In table. 8 shows an exemplary scheme of classes therapeutic gymnastics in 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). With the loss of function of individual muscle groups, the method of physical therapy is the same as with damage to the peripheral nerves. Massage treatment. Repetition of therapeutic gymnastics procedures in the afternoon under the supervision of a ward sister.
Demidenko T. D., Goldblat Yu. V.
"Physiotherapy with flaccid paralysis" and others
Exercise therapy for cerebral palsy can help to live normally, because cerebral palsy is the most severe violation of motor function that can occur for a variety of reasons, of which there are about four hundred. With cerebral palsy, muscle tone and coordination are disturbed. Cerebral palsy makes people disabled.
Cerebral palsy occurs in children who are less than three years old. The statistics are very sad: in general, children do not live to an older age. But still, if you start taking some measures to treat paralysis in time, then the child will have a chance for a good future.
Needed for many years. The treatment itself is aimed at restoring the functions of the motor apparatus, memorizing elementary movements. This is a very, very hard work of mom and dad, as well as the child himself.
One medicines there is no cure for this disease. It is necessary to constantly engage in physiotherapy exercises, which will allow the baby to learn how to move correctly. Physical therapy for cerebral palsy gives a positive result in any case. Parents of children with cerebral palsy should 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 impact of exercise therapy on children's health
Therapeutic exercise has a positive effect on the human body. It gives an incentive to the tissues and muscles in the body to strengthen. The body regulates metabolic processes. brain activity and of cardio-vascular 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 an integral complex, which will include massage, physiotherapy, manual therapy, various hardening of the body.
Designed for every child individual complex exercises. All complexes include the following types of exercises: with a ball, in a lying and sitting position, relaxing exercises, stimulating exercises.
Tips and recommendations on the correct implementation of physiotherapy exercises
Absolutely all methods, when physiotherapy exercises are carried out for cerebral palsy, have general recommendations. Classes should be systemic, they should be held regularly and continuously. Only such a schedule of gymnastics will help to achieve a good positive result. A set of exercises should be selected by a qualified specialist for each small patient individually.
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 exercise 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 exercises:
- for muscle stretching;
- to develop muscle strength and sensitivity;
- to develop sensitivity nervous system;
- to strengthen the main muscle groups that take part in all movements;
- that all organs have good endurance;
- to relax muscles, relieve cramps and spasms;
- to teach the child to walk correctly;
- so that the sense organs are developed;
- to improve the patient's balance and sense of support.
Exercises that need to be done in order to develop movement skills
The most common form of cerebral palsy is atonic. It is manifested by 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, to raise and lower the torso from the starting position lying on your back. You can also perform these movements while lying on your stomach. You can make a variety of slopes 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 the arms and legs.
It must be understood that cerebral palsy also affects the functionality of the child's brain.
Physical therapy should help the brain learn to be responsible for those movements that directly depend on its work: the movements of the arms and legs, crawling on all fours, squatting, running, walking. The development of the brain regions responsible for these movements is achieved through regular, repeated repetition of the same actions.
As a result of this, there is a “feeling” effect, 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 fixed the child in the pelvic region, begin to put 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 another, alternately lifting them off the floor.
- Starting position: the child is sitting on a chair. Take the baby by the hands, and fix his legs on the floor. Awaken in the child the desire to stand up by pulling his arms up and forward.
- Starting position: the child stands with one leg forward. It is very easy to push the baby in the back and chest to develop the skill of balance.
- Starting position: the child is standing. Take him by the hand and push in different sides so he can take a step on his own.
- Starting position: the child lies on his back. The child's support is improved if the child presses his feet on some hard surface.
Exercises that are used to develop joints
- Starting position: the child lies on his back. One leg must be held in an extended position, and the other must be bent. It is desirable that the thigh reaches the stomach.
- The child lies on its side. Bend the child's leg at the knee and gently abduct the hip.
- The child lies on his stomach on some surface so that his legs hang down. Very slowly, the limbs must be straightened.
- The child lies on his back. You need to bend and unbend the knees of the baby.
Additional exercises
Exercises that train the abdominal muscles:
- Starting position: put the child on your lap. Pull his back towards you. Make slopes with the baby, and he must rise on his own.
- Starting position: the child lies on his back with his hands pressed to the body. The baby should try to roll over from his back to his stomach, while not using his hands.
- Starting position: the child lies on his back. It is necessary to take a deep breath, and as you exhale, the baby should draw 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 kid should take a deep breath, and as you exhale, bend over and touch your toes with your fingers.
- Starting position: the child lies on his stomach with outstretched arms. Focusing on the palm of your hand, the baby should lift upper part body above the floor.
As for developmental exercises fine motor skills, then here it is simply necessary to perform turns of the child’s hand in different directions.
Ball exercises:
- It is necessary to put the child with his back to the ball. The legs should rest on the toy. Put the child in the center of the ball and roll back a little. This exercise is good for developing balance.
- Place the baby on their stomach on a ball that fits 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 the ball and easily rock it back and forth, then the muscle tone is perfectly reduced.
Walking exercises:
- Take the child by the hips, stand behind him. Gradually turn the baby by the hips in different directions to provoke him to take an independent step.
- Help your child do squats - 50 per day.
A great helper is a special device called a verticalizer. It can fix the baby in a standing position. It is simply indispensable in training or in preparing a child for independent performance of basic functions. The verticalizer fixes the child's torso, and, if necessary, his feet and knees.
A congenital cerebral palsy disease is a paralysis of the central nervous system that can occur in a child due to damage to some parts of the brain. Violation of motor functions can begin to progress in the prenatal or birth period, as well as in the first days of life. With cerebral palsy, spastic syndrome is often found - a painful increase in muscle tone and tendon reflexes. reduce Negative consequences disorders at home can be done with the help of gymnastic exercises recommended for cerebral palsy.
Therapeutic effect of exercise
Therapeutic Physical Culture(exercise therapy) helps to learn to control your body. By doing special therapeutic exercises for children with cerebral palsy, you can improve coordination, braking processes, and motor amplitude. The technique is an integral part of a holistic complex aimed at reducing the manifestations of the disease caused by cerebral disorders.
The therapeutic effect 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:
- development of the necessary basic skills in the child;
- mastering simple labor activity;
- self-care without outside help.
It is necessary to start exercise therapy as early as possible, in the first days of life, gradually complicating the exercises. Moreover, physical education should be carried out if the newborn does not have symptoms of cerebral palsy, but he is predisposed to its development.
Basic principles of the methodology
- Physiotherapy exercises are based on a number of basic principles:
- Classes are held regularly, without gaps and long breaks.
- Gradual increase in physical activity.
- Individual approach.
- Conducting classes taking into account the stage of the disease, age, state of mind.
Along with exercise therapy, corrective and educational measures must be taken to compensate for functional disorders.
Types of exercises and features of conducting classes
Any recreational gymnastics should be selected taking into account the needs of each individual patient. However, every program exercise therapy include the following types of exercises:
- relaxing;
- contributing to the improvement of dynamics;
- stimulating motor activity;
- performed lying down;
- performed while sitting;
- with a gaming focus.
If the gait is difficult, or the patient is not able to walk, the lesson should be carried out near the bars or a rigid support. On next step occupation 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 one limb, for example, with the right arm or leg, then with the other. The weaker side is given a greater burden. Squats should not be performed deep, most often they are performed only from the knee to the foot (semi-squat).
Classes for the development of the motor apparatus
With damage to the central or peripheral nervous system, there may be a violation of the movement of the upper or lower extremities - tetraparesis. Appropriate gymnastic exercises can strengthen the motor skills of children with disabilities, increase the level of control over the actions performed.
Exercises that improve motor activity:
- Starting position - sitting on the heels. An adult conducting exercise 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, you should start moving from side to side so that he learns to independently transfer body weight to one leg. He tries to tear off the second leg from the fulcrum and spread his arms to the sides.
- It is necessary to turn to face the child sitting on a chair. An adult fixes his legs on the floor with his own and takes his hands. Hands stretch forward and up, so the patient with cerebral palsy learns to stand up on his own.
- Starting position - standing, feet are placed in one line (one after the other). It is necessary in turn to lightly push the small 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, it is necessary to swing his different sides so that he tries to step on his own.
The position is lying on the back, next to a wall or other support. We must try to press our feet on a hard surface, training the ability to stand firmly on the ground.
Exercises to strengthen joints
With cerebral palsy, various articular pathologies, cramps and joint pain are often encountered. Exercises needed 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 taken back.
- Being on your side and keeping your knee bent, you need to start slowly retracting the thigh.
- It is necessary to lean against the table with your stomach so that your legs can hang freely, then gradually straighten them.
- The starting position is on the back. First you need to bend the knee, then, as far as possible, straighten it.
- The starting position is lying on the stomach, a roller is placed under the chest. Holding the patient by the hands, you need to raise the upper part of the body, slightly abruptly making springy movements.
- The arm of the 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 to the other side.
Strengthening the abdominal muscles
Within the framework of exercise therapy, classes are held that develop and strengthen a group of muscles located in the abdominal cavity:
- The child needs to be put on his knees, pressing his back to his chest, after that you need to bend over with him. In the next step, the legs and pelvis of the little patient are fixed so that he can stand up on his own.
- Starting position - lying on your back, arms pressed to the body. Making swing 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 with the retraction of the abdomen as you exhale.
Stretch improvement
Stretching and flexibility exercises help to achieve the following results:
- the degree of severity of pathologies of the back of the spine decreases;
- improves the condition of the spinal cord and spinal nerve endings;
- the muscles of the limbs are strengthened.
Sitting on the floor, you need to straighten your legs, while the body should form a right angle with them. Inhaling, stretch your arms in front of you. Exhaling, you must try to bend down to reach your toes with your hands. An adult can help by lowering the body even more so that the forehead also touches the legs.
Starting position - on the stomach, arms extended along the body. Emphasis is placed on the palms, with a gradual rise in the chest. It is important to make sure that the head is thrown back, and the breathing is even.
Lying on your back, legs, without bending at the knees, connect and rise above your head. You need to try to get the floor above the crown with your toes. Hands should not be torn off the floor.
From a sitting position on the floor, you need to bend your right leg so that the heel reaches the left thigh. The left foot should be on the right side of the other knee joint.
The right hand is transferred around the left knee, she 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. In this case, the head turns to the left side, an inclination 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 limbs:
- To give rest to the upper limbs, you need to lie down, then fix the head, arm and leg on one side using weighting agents, for example, sandbags.
- The free arm is bent at the elbow joint, the forearm is held by an adult doing gymnastics. The hand should 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 prone position, the fixed arms and legs are in contact with the abdomen. The adult holds the shins, moving the 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
You need to perform all the actions while lying on your back, sitting down some time later, then move on to a standing position. Breathing exercises:
- The child needs to be shown how to take a deep breath and exhale through the nose and mouth. You can inflate balloons, rubber toys, soap bubbles.
- Different vowel sounds are pronounced with different loudness. You can alternate with singing and playing wind instruments.
- At the count of times, the arms are stretched up, a breath is taken, at the count of two, the arms are down and exhaled. The exercise will be more difficult if the head is immersed in water as you exhale.
Game exercises
Such elements of exercise therapy help maintain interest in the lesson, at the same time contributing to relaxation. game elements exercise therapy:
Tower destroyer. 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.
Better get out. Again need pillows. This time the child is lying on the gymnastic mat, the adult puts about 6 pillows on him and explains that on the count of three he needs to free himself.
Folding knife. Starting position - the position of the embryo. 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 to the chest, and the legs to the stomach. "Knife" is complicated. The exercise is repeated three times on each side.
Sausage. The starting position is lying on your back. The adult gently grabs the baby's ankles and begins to slowly turn the child in different directions. Gradually the pace picks up.
Lion on the hunt. Good for group lessons. 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”). Adult tells a little story about a lion: “There lived a lion in the world. He was brave and agile, and he also liked hunting. He waited in an ambush for prey so that no one could see him (children should, without straining, group themselves, resting their heads on their palms, pressed to their knees). Then he quietly crept (they show how the lion sharpens its claws and stretches its back) and jumped (they rise on their hands, helping themselves with their legs, and fall on a soft surface).
It is impossible to say in advance exactly when improvements will come. Much depends on the degree of damage and how strongly the spastic syndrome manifests itself. To achieve a significant reduction in the manifestations of cerebral palsy, exercise therapy with such children should be done regularly, observing gradualness and listening to the personal needs of each of them.
Cerebral palsy (CP) is a paralysis of the central nervous system, which manifests itself 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 this article will focus on exercise therapy for cerebral palsy, or, in other words, all about the use of physiotherapy exercises for the treatment of patients with cerebral palsy.
Cerebral palsy manifests itself in the difficulty of performing certain movements or, conversely, in the 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 is engaged with a child on rollers
Physical activity by the method of exercise therapy has the following goals:
- Teaching household skills and abilities.
- Acquaintance of patients with labor (method of occupational therapy).
- Teaching the patient self-care techniques.
Basic principles of physiotherapy exercises
- systematic and regularity (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 age of the child and his condition.
So what is the role of physical exercise on the body of a baby suffering from cerebral palsy:
- health-improving;
- prevents the formation of adhesions between nerve endings;
- strengthening;
- promotes the 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 the method of Dr. Bandurin for exercise therapy. Which includes a thirty-minute exercise therapy session 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 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 subspecies of exercise therapy as treatment:
- Regulation.
- Stretching.
- Walking.
By the way, massage and yoga are used to treat cerebral palsy.
There are spastic form of the disease and asthenic. 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 obligatory breaks.
Support for motor functions
To support the motor functions of the baby, 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 the patient's hands on his shoulders. The child should kneel from the starting position. The task of the doctor is to stimulate such attempts.
Transferring weight from one leg to the other
Starting position - the specialist supports the child under the armpits, being behind.
The doctor smoothly moves the child to the left and right so that the patient learns to transfer weight from one leg to the other. It is important that during the transfer of body weight to one leg, the second leg is torn off the floor, and the arms are spread apart.
Option to transfer weight from one leg to another
Starting position - the child is in a squatting position.
The specialist presses the baby’s knees with his hands from behind the back and gradually tilts the patient’s torso. In this position, the knees should spontaneously begin to unbend.
Exercise variant
getting up
Starting position - the child is sitting on a chair
The doctor stands in front of him and lightly steps on his feet. The doctor's leg should not cause pain or discomfort to the baby. The patient's hands rise up and are slightly stretched by a specialist, which provokes an independent rise from a chair.
Equilibrium
Starting position - the baby is standing, with one leg forward.
This exercise requires the presence of two adults. One stands in front of the face, the second behind the back of the patient. Pushes are alternately made (not diagonally, but directly to the chest and back). Exercise trains balance in the baby.
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 are bent at the knees.
The doctor controls that the patient's feet press against the floor surface. This exercise allows you to increase support.
Foot pressure on the floor
joints
Exercise therapy for children with cerebral palsy consists of a large number exercises as in gym and without the use of special tools. Work on the joints is an important component of the successful treatment of the patient. A set of exercises to activate the work of the joints includes:
Alternate bending
Starting position - the child lies on his back, and his limbs are 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 to move the thigh of the upper leg to the side. This exercise helps to develop the joints of the lower extremities.
Exercise option
Table exercise
Starting position - the child lies on his stomach on the table, and his legs hang down.
Since a sick child is likely to draw in his legs, this adaptive exercise is to stimulate the baby to gradually straighten his legs.
Leg extension order
Spring
Starting position - the baby lies on his stomach, and under his pelvis there is a roller (you can use a folded terry towel).
The doctor lifts the child by the arms and begins to make small jerks so that springy 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 that the patient is looking at. This allows not only to work out automatism when bending, but also helps the baby to realize what exactly is happening with his body at one time or another.
Abdominal muscles
The method of training the abdominal muscles 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 lap of the mother and presses her back against her chest.
Mom, together with the baby, leans forward, after which she holds his legs and hip joint, so that the baby returns to its original position on its own. Perhaps at the initial stage he will not be able to do this, then the mother will have to help.
coup
The doctor helps the baby to swing the left or right leg, thereby provoking him to roll over from his back to his stomach and back. Hands should not be connected to the coup.
Inhale - exhale
Starting position - the patient lies on his back.
Fitness has many breathing exercises, one of which is used during exercise therapy for children with cerebral palsy. The child inhales and exhales, and on exhalation the stomach should be drawn in, and on inhalation it should be rounded.
Leaning towards the legs
Starting position - the child sits on the floor, legs are extended forward and slightly apart.
The doctor is located behind the patient and helps him perform a forward bend. The slope is performed until the hands reach the floor. Ideally, you need to touch the tip of your forehead to the floor.
This exercise has a different effect. In addition to being classic exercise for the abdominal muscles, it trains flexibility, stretching, eliminates problems with curvature of the spine and normalizes blood circulation.
Deflection
Starting position - the child lies on his back, legs together, arms along the body.
The doctor helps the patient to perform a deflection in the spine, and it is important that his limbs do not come off the floor.
Tilts are best done with one parent.
Incomplete somersault
Starting position - the child lies on his back, straight legs are raised up.
The doctor controls the baby so that he can touch the surface of the floor behind his head with his toes. A kind of backsliding is performed. Control during this exercise should be total, in order to avoid injury to the patient.
Throwing the legs behind the head (option)
Muscles of the trunk and neck
To develop the muscles of the trunk and neck, you can perform the following exercises:
wiggle
Starting position - the child lies on his back.
The specialist fixes the patient's body in the area of the shoulders with both hands and begins to perform swinging movements to the left and right. After that, the same exercise is carried out with the head, supplementing it with turns of the neck to the left and right.
Important - the child should not resist.
Fall on cue
Starting position - the child lies on the left or right side, lower hand under the head, upper along the body.
The task of the doctor is not painful to push the baby in the chest or back, provoking him to keep his balance. You can only fall at the signal of a specialist.
"Hinged Head"
Starting 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 muscles of the neck so that the head is under own weight"fell" back on the chest.
For a more complete assimilation of the exercises, it is necessary to demonstrate to the patient by example what they want from him.
Breath Correction
Gymnastic exercises are not only in the development of the muscles of the body and muscle training, breathing exercises occupy not the last place in physical therapy for children with cerebral palsy.
It is not necessary to contact a rehabilitation center to perform this complex with the baby, parents will be able to perform exercises to correct breathing at home.
All exercises are performed either lying on your back or standing.
We blow on a pen
The kid is explained how to take a deep breath and exhale through the nose and mouth. To develop interest in the exercise, it is recommended to exhale on some light thing (a piece of paper, a pen) or blow soap bubbles. 
Feel breathing
In this exercise, the baby will have to take a deep breath at the expense of 1,2,3 and a deep exhalation at the expense of 4,5,6. You can connect the finger technique and show the numbers on your fingers. To develop interest, the child can be asked to exhale into a basin of water.
We speak breathing
The kid learns to pronounce different sounds on the exhale 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 human facial expressions, and children with cerebral palsy are not always able to express certain feelings with facial expressions. It is important to teach the baby to show a smile or sadness. This is achieved by regular repetition and training. The specialist, by his own example, shows what a smile or sadness looks like, etc.
This section of exercise therapy is called psycho-gymnastics.
Emotions
The manifestation of emotions, as well as facial expressions, are no less important, and it is not so difficult to teach a child with a disease such as cerebral palsy to express surprise or suffering. 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 the baby to imagine that he was given a huge toy or to portray a baby elephant who found his mother.
- Aversion - the patient must reproduce the use of unpalatable porridge or bitter medicine.
- Fear - imagine a little mouse that saw a cat.
- Guilt - imagine that the baby 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 the fantasy and share it with the baby.
Position treatment
Therapeutic exercise 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 development 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 roller is applied under the neck, so as to tilt his 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 half-bent state. In this position, the baby should spend from an hour to two, depending on the patient and his condition.
Exercises in the pool with cerebral palsy
With regard to such summer look treatment, like classes in the 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 in its arsenal a huge number of special simulators, which facilitate classes for the most complicated cases and for all ages.
The benefits of water exercise are obvious. Even for a healthy person, a few minutes spent in swimming pool akin to a few hours of relaxing massage. The body not only feels the relaxation of all muscles, it is filled with energy.
Classes are best done in the morning, when the baby has recently woken up.
For children with hemiparesis or especially severe cases the use of a special Gross support simulator is shown, which can be read in more detail in this article.
In the pool, you can perform the following exercises:
Leg abduction
Starting 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 as much as possible to the sides (repeat up to ten times).
Abdominal exercises
Starting position - the patient is located on his stomach and holds his hands on the side (the instructor supports the patient under the stomach).
It is necessary to raise the left and right legs up (five times for each limb), spread the legs apart (up to ten times), bend the right and left leg in the knee at the chest (five times for each limb).
Bending the legs to the chest (option)
Back exercises
Starting position - the patient lies on his back and holds his hands on the side.
It is required to lift up two legs at the same time (up to ten times), spread the legs apart (up to ten times), perform the scissors exercise (up to ten times).
Sitting exercises
Starting position - in a semi-sitting state, you need to press your back against the side of the pool.
A bicycle exercise is performed (up to 1020 repetitions for each leg), raise the legs at an angle of 90 degrees and perform circular movements with them
Games
The central nervous system of a person is rather tender and capricious, like the mood of a sick child, so sometimes for productive activities it is required to bring elements of the game into them. For example, classes using a fitball (in a simple way, a special ball).
Ball training includes the following exercises:
ball riding
Starting position - the baby is located with his back to the ball.
It is required to support the patient's legs on the fitball and roll it back, and then return it to its original position.
lying on the ball
Starting position - the baby lies on the ball on his stomach
Holding the patient by the legs (hips), push the ball forward while keeping the baby astride it.
wiggle
Starting position - the child sits on the ball.
Swinging from side to side reduces muscle tone.
Fitball exercise options
Children with cerebral palsy also want to participate in various types sports. So, perhaps, holding competitions with them in such a sport as table tennis. It has been proven that patients with cerebral palsy are quite able to hold a racket and perform the movements necessary for this game. Moreover, the patient trains not only his muscles, but also adapts socially.
In addition to general strengthening exercises, increased attention should be paid to improving general 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 suffering for the patient and simplify his life. It is important to understand that the regularity of classes plays a huge role in exercise therapy.
