Therapeutic physical culture in cerebral palsy: the main sets of exercises. Exercise therapy for atonic-astatic form of cerebral palsy Gymnastics for adult patients with cerebral palsy

is a severe neurological disease that affects the brain. Pathology can occur during fetal development, during childbirth or after birth. In any case, the disease should be treated without fail so that the child's well-being can be improved and adapted to later life.

The sooner therapy begins, the easier it will be. At the same time, an integrated approach is used during treatment, that is, several methods are used at once, which are aimed at improving the well-being of the child.

An essential component of therapy is exercise therapy with cerebral palsy, because in this case the child will actively move and develop his body. It is important to choose the right exercises so that they do not lead to a negative result.

Cerebral palsy often occurs in childhood For example, in Russia there are approximately 6 sick children per 1000 healthy ones. At the same time, parents are often interested in the question of what exactly causes such a dangerous disease as.

After all, even when planning a pregnancy, people are worried about protecting the unborn child from the influence of negative factors. There are many reasons that lead to cerebral palsy, and it is important to understand them.

Provoking factors:

• Incorrect formation of the cerebral cortex. This can happen under the influence of various factors, in particular due to hypoxia. In this situation, oxygen starvation occurs, which is mainly observed during fetal development. Often it is associated with a problem pregnancy. Perhaps placental circulation is disturbed, late toxicosis is observed, or infectious diseases begin. As a result, under the influence of negative factors, the structures of the brain do not have the opportunity to fully develop.
• Chronic or acute illnesses of the mother. These include anemia, heart disease, and obesity. In addition, pregnancy can complicate diabetes and hypertension. In any case, it is important to take care of the treatment of diseases, as well as maintain your health in good condition. A woman can be recommended to visit a doctor without fail if she is carrying a child.
• Birth trauma that damages brain structures. They can appear in a situation where a woman has reduced labor activity. Also, a narrow pelvis, protracted or transient labor, and a long anhydrous period lead to them.
• The conflict of the Rh factor in the blood of mother and child. In this situation, the baby develops nuclear jaundice. This, in turn, can lead to cerebral palsy.
• Mistakes of medical personnel committed during childbirth. Because of them, children often suffer and acquire serious deviations in the state of health. It is important to contact good clinics if you want the birth to go without complications.
• Prematurity and underweight in the newborn. If possible, it is important to prevent childbirth from occurring prematurely.

If the disease could not be avoided, then it is important for parents to take care of the treatment. You should prepare for a long rehabilitation period, because without it it will not be possible to adapt the baby to the environment. In this case, it will be necessary to deal with both the physical condition of the minor and mental development. In all cases, doctors recommend doing exercise therapy for cerebral palsy, because gymnastics can achieve good results.

Parents should carefully supervise the exercise process and support the child. Naturally, the specific complex is determined depending on the age and condition of the patient.

Why physical activity is necessary

If a child is diagnosed with cerebral palsy, then it will be difficult for him to perform specific actions, while unwanted movements will be involuntarily carried out. That is why therapeutic exercises are required, because it helps to strengthen the body and teach a person to control his body. It is important to understand that patients with cerebral palsy are forced to constantly exercise. They are needed not only at an early stage, but throughout life.

By doing exercise it will be necessary to teach the minor household skills and abilities. He should consider serving himself as much as possible. In this case, it will be necessary to acquaint children with labor, this is a separate method of therapy.

In this case, it will be important to observe the specific principles of physiotherapy exercises:

• All exercises will need to be performed regularly, because it is extremely important that classes take place continuously. It should be understood that muscle memory quickly scores specific points. Therefore, they must be carried out systematically so that the best result can be achieved.
• Be sure to gradually increase the load. No need to immediately move from easy exercises to complex ones. Everything should happen gradually, because it is not easy for a child to cope with gymnastics.
• Individual approach. If the baby has cerebral palsy, then specific exercises should be selected individually. A group approach is excluded, because it is necessary to take into account the characteristics of the patient.

Naturally, when prescribing exercise therapy for cerebral palsy, it will be necessary to take into account the age of the child and the severity of the disease. If you choose the right treatment complex, then you will be able to achieve various goals. In particular, exercise will prevent the occurrence of adhesions between the nerve roots. They will strengthen the body and make the patient healthier.

It will also be possible to activate weakened muscles and eliminate the curvature of the spine. Another benefit of exercise is that it can improve blood circulation and also stimulate brain activity.

Directions of exercise therapy for cerebral palsy

Before moving on to exercises, it is important for parents to understand that physiotherapy exercises have several independent directions. However, they are not always related to gymnastics. Other therapeutic forms are also used, which are aimed at improving the well-being of the child.

The exercises of the following groups are distinguished for:

• support and improvement of motor function.
• joint strengthening.
• improve facial expressions and control over emotions.
• breathing correction.
• abdominal muscles.
• torso and neck area.

Directly medical complex may consist of the following aspects. Stretching for the child can be used, walking and control over body position can be used. By the way, quite often doctors recommend doing yoga, of course, with a focus on the patient's well-being.

Exercises for motor function

As the name implies, these exercise therapy exercises for cerebral palsy are used in order to maintain motor activity child. Parents can familiarize themselves with a specific set of exercises that will be used for patients.

Types of exercises:

• The doctor should stand in front of the patient, and then put his hands on his shoulders. In this case, the baby should sit on his heels. Now the child must try to kneel from the starting position.
• It is important that the baby learns to transfer weight from one lower limb to another. The doctor should support the baby by the armpits, while he is behind. The specialist is obliged to smoothly move the baby to the left, then to the right. This is necessary so that a person learns to transfer weight from one leg to another. When the transfer is made, it will be necessary to tear off one leg from the floor, while the arms are spread apart.

• The kid needs to learn to straighten his knees. The child will need to be in a sitting position, while he should be squatting. The specialist is obliged to put pressure on the child's knees with his hands, and then slowly tilt the patient's torso. At the same time, in this position, the knees should straighten on their own.
• Be sure to teach the child to stand up. Starting position - the baby must sit on a chair. In this case, the doctor must stand in front of the minor, while he needs to lightly step on the patient's feet. Naturally, this should not cause discomfort and pain. The child's hands should be raised up, the specialist should pull them slightly. In this case, there will be an independent rise from the chair.
• A child with cerebral palsy needs to train balance. He should stand, while one leg should be put forward a little. It is important that two adults are present during the exercise. One will face the baby, and the other will be behind him. In this case, it is necessary to alternately produce pushes, they are not made diagonally, but directly to the back and chest.

It will be extremely important to teach the baby to take the first steps. He will need to stand, after which the doctor will gently pull the patient by the hand. It needs to be pushed into different sides for him to take a step. It is also important to exercise pressure with the feet. The baby needs to lie down and bend his knees. The doctor should observe that the feet press on the floor surface. This will help increase your resilience.

Directly for the muscles of the body, it is useful to perform swaying. The baby will lie on his back, while the doctor fixes the body with both hands. After that, he will begin to perform shaking movements to the left, then to the right. After that, you need to use your head, turning it in different directions.

Specific exercises will be determined by a specialist, because he must take into account the individual characteristics of the child. Naturally, you will need to start with a simple one, and then gradually complicate all the actions. If the set of exercises is correctly selected, then the child's condition will gradually improve.

Cerebral palsy is one of the most severe forms of motor cerebral (brain) disorders in children, occurring for various reasons (there are up to 400 of them, which means that 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 "ripening" 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. Given that during the neonatal period, the child normally has increased muscle tone, determine the changes muscle tone it is possible, 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 make attempts 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 it on a flat and dense surface on the stomach and lift both legs with your right hand by about 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 pressed 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:

1. normalization of muscle tone so that the child can make arbitrary movements;
2. 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 of the muscles of the back, neck (forms the cervical bend and reveals violations 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 knees of the baby should be bent and as close as possible to the head along the midline of the body (with hip dysplasia and the “short neck” symptom, 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 lumbar curve 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. A child with normal muscle tone easily and happily 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 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 starting 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 the left foot on the floor on the right side of the 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. It is necessary to bend the hip 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 help 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, he performs 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 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. For improvement respiratory functions it is necessary to teach the child to exhale at different volumes, whistle the whistle, play the harmonica, 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, the following rules should be followed (treatment by position):

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.

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 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 in order 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 flexion legs in extended 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. Encourage the child to rise to a sitting position horizontal position allotted legs. 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 in 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 fix the weight (sandbag) in the middle third of 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.

Health is the most important, the most fragile, the most necessary value in the life of any person. The fact that not everyone is fully aware of the importance of a healthy body does not in any way detract from its importance. At the present time, people with good health and the absence of painful sensations and disease-causing conditions take this very lightly. It is not surprising: nothing hurts, nothing bothers - so there is nothing to think about. But this does not apply to those who were born already sick. This frivolity is not understood by those who were not allowed to enjoy health and full-fledged normal life. This does not apply to people with cerebral palsy.

The essence of the diagnosis of cerebral palsy

Cerebral palsy (ICP) is a chronic disease that does not belong to the progressive group, but requires constant and regular treatment due to pathologies of the brain, in its cortex or subcortical areas, trunk or capsules. This disease manifests itself mainly in the partial physical and intellectual-psychological insolvency of a person, as well as the inability to fully control his body. This failure is explained by the fact that the patient's brain does not send a signal to the muscles for motor activity, so he cannot control most of his movements. The reason for such a diagnosis is often abnormal intrauterine development, childbirth with complications, birth hypoxia or asphyxia, as well as endocrine or infectious diseases suffered by the mother of a sick baby during pregnancy. Children with cerebral palsy later begin to hold their heads, roll over from their backs to their stomachs, sit, walk. Very many of them cannot walk, already being at the stage of growing up.

But there is one positive moment in this whole sad story: cerebral palsy is not a sentence. There are a lot of various methods, therapeutic measures, various medical methods that contribute to the partial restoration of the child's health and bring it closer to normal life.

Timely appeal of the parents of a child with cerebral palsy to a neurologist for advice can contribute to their earlier intervention in the course of the disease process and the rehabilitation of the deplorable state of health of the baby through the implementation of certain procedures. Medicine that does not stand still offers all kinds of ways to improve the well-being of a child with this diagnosis in the form of massages, therapeutic gymnastics, classes on special simulators, physiotherapy, magnetotherapy, electroreflexotherapy, Bobath therapy, the Voight method, classes with speech therapists and psychologists, the use of auxiliary equipment. And cerebral palsy occupies not the last place in this chain.

Healing Fitness

It's no secret that sport is the key to a healthy body and healthy spirit. Sports give a person the opportunity to actively spend time on the move, develop all muscle groups, get a boost of energy and vigor, give their body aesthetically beautiful curves and shapes, keep themselves in a good mood and high spirits. You can endlessly list the benefits of playing sports, as well as name all kinds of sports activities. But a special place in this list should be given to physiotherapy exercises.

Exercise therapy is a complex of special therapeutic techniques with the use of physical exercises that help improve the condition and partially restore the health of patients and the disabled, as well as used as a prophylaxis against possible diseases. Physiotherapy itself is considered a medical discipline with pedagogical features, since it is not only the performance of isolated physical exercises, but also the education in the patient of self-confidence and confidence that success will come and health will return. It is not surprising that as one of the rehabilitation methods in the case of children with cerebral palsy, it is precisely the set of exercise therapy exercises for cerebral palsy that is used. After all, the parents of the unfortunate baby are ready to do any activity, to follow everything possible. gymnastic complexes and undergo all kinds of therapy just to ensure that their child at least partly feels the joy of a fulfilling life.

The value of therapeutic exercises for cerebral palsy

What is the peculiarity of the influence in cerebral palsy? Due to what comes the remission of individual muscle groups in the body of a child with cerebral palsy? And how does the complex of exercise therapy for cerebral palsy work? To answer these questions, you need to understand what are the goals, objectives and principles of the method of physical therapy, which helps to rehabilitate what the baby has lost in prenatal, birth or postpartum period health.

The main goal of exercise therapy in children with cerebral palsy is to develop the ability to voluntarily inhibit movements, as well as to reduce muscle hypertonicity, improve motor coordination, and increase amplitude movements in the joints. For children whose muscle activity is inhibited and does not allow them to function normally physically, this is a very important aspect of rehabilitation.

Tasks exercise therapy complex with cerebral palsy include several main areas:

• implementation of a restorative and health-improving effect on the body;
• help in restoring the health of the body;
• normalization of blood circulation and metabolism in the affected area;
• full or partial settlement of metabolic and neurovascular disorders;
• preventing the appearance of adhesions in the area between nearby tissues and nerve sheaths;
• replacement of already formed adhesions with the adaptability of tissues to such formations through special exercises;
• strengthening weak muscle tissue;
• development of coordination of movements;
• help in the fight against concomitant anomalies - curvature of the spine, impaired mobility, and so on.

And this list is not final. Methods of exercise therapy for cerebral palsy provide for the construction of a set of exercises on the principles of regularity, systematicity, continuity of classes, an individual approach to each patient, paying attention to his age and mental development, taking into account the severity and stage of the disease. All these aspects together predetermine a positive result from the procedures, which determines the importance of this kind of physical therapy for children with deviations of the nervous and mental systems.

Types of exercises

What are the main variations of exercise therapy exercises for cerebral palsy based on the course of rehabilitation of patients?

1. Fixed position - a model of therapeutic exercise based on the fixation of limbs in a special splint or splint.
2. Muscle stretching - involves swinging in all joints of the limbs with an amplitude of oscillations designed for a gradual increase.
3. Muscle relaxation - provides for alternate fixation of arms and legs to reduce the number of involuntary movements carried out by a sick child, as well as weakening the increased tone.
4. Walking - makes it possible to develop a motor apparatus for higher possibilities in movement.
5. Exercises with stimulation of muscle activity and muscle inhibition - are alternate flexion-extension of the joints with parallel muscle massage.
6. Climbing the surface with an incline - is carried out with an instructor and makes it possible to train, as far as possible, the press and leg muscles, keep balance and maintain balance.
7. Endurance exercises.

Exercise therapy for the activation of the motor apparatus

In the complex of exercise therapy exercises for children with cerebral palsy, priority exercises are provided for the most important area of ​​​​rehabilitation - the motor apparatus. Indeed, many children with cerebral palsy are not able to walk, they need help, they need to be taught this. In cases where the central or peripheral nervous system is damaged, there may be a problem with the movement of the upper or lower extremities. This problem is referred to in medicine as tetraparesis. In order to strengthen the motor and coordination skills of children with disabilities, as well as to increase their degree of control over their own actions, appropriate gymnastic exercises.

• In the starting position, sitting on his heels, the baby tries to kneel under the influence of the movements of the instructor (or parent), who takes the child by the shoulders, holding him parallel in the hip part.
• Sitting on his knees, under the influence of the movements of an adult who holds him in the axillary zone, the child begins to move from side to side in order to be able to transfer his body weight on one leg. At the same time, the baby tries to tear off the second leg from the support itself, spreading its arms to the sides.
• Turning to face a small patient with cerebral palsy sitting on a chair, the exercise therapy instructor in the person of a specialist or a parent fixes his legs on the floor with his own and gently takes him by the handles. At the same time, the hands are pulled forward and up to give the child the opportunity to learn to stand up on his own.
• In the initial standing position, the child’s legs are placed with their feet to each other in one line one by one, with the adult’s hands, light pushes are made first in the back, then in the chest - this is how the baby develops the concept of maintaining balance.
• In a similar starting position, you need to try to swing the child to the sides so that he tries to take a step on his own.

Such exercise therapy exercises for children with cerebral palsy can increase the baby's motor activity and give him a chance to learn to walk.

Exercise therapy for the study of joints

It is equally important to teach the child to control his movements and strengthen his joints. The peculiarity of this moment lies in the fact that children with cerebral palsy are characterized by pain in the joints, convulsive pain and related pathologies. To develop the joints of the limbs, you need to pay attention to a number of exercise therapy exercises aimed at strengthening them in cerebral palsy.

• The starting position of the child is lying on his back. One leg unbends and is fixed by an adult under its own weight of the body or under the support of the arm, and the second gradually bends at the knee. At the same time, the thigh, if possible, is pressed against the stomach, after which it is smoothly retracted back to its original position.
• The starting position of the baby is lying on its side. The knee is kept bent, the thigh is alternately retracted, then returned to its original position.
• The primary position of the body is standing facing the table right next to it. It is necessary to lean the stomach against it so that the legs hang freely, after which alternately straighten them, straightening the knees, then return them to a suspended state.
• Lying on his back, the child, with the help of an adult, bends the leg at the knee, after which, if possible, straightens it as evenly as possible.
• Having put a child with cerebral palsy on his stomach, an adult or instructor places a roller under his chest, after which, holding the baby by the hands, lifts upper part his torso, abruptly and springily making movements up and down.
• The starting position of the baby is lying on his back. The arms are bent at the elbow so that the face remains motionless and turned to the side. After that, the adult helps to bend the child's limb, turning his head in the other direction.

Exercise therapy for stretching

A set of exercise therapy exercises for children with cerebral palsy for stretching also helps to increase flexibility. It allows you to reduce the severity of the pathological condition of the back and spine, improves the condition of the affected spinal cord, as well as its nerve endings. Moreover, this kind of exercise therapy for children with cerebral palsy allows you to strengthen the muscles of the limbs, which, of course, affects more confident movements of the arms and legs.

• The child must be seated in the starting position on the floor so that the legs are straightened, and the torso, along with them, creates a right angle and is perpendicular to the floor. Exhaling, the baby should try to bend down so that he can reach his toes with his fingers. At the same time, the assistance of an exercise therapy instructor for children with cerebral palsy in this exercise lies in the fact that it helps to lower the body even lower, making gentle pressure on the back so that the child’s forehead also touches the legs.
• Being in the prone position, the child stretches his arms along the body. Then he turns his hands to the floor and focuses on them. Gradually resting on his hands and raising his chest above the floor level, the baby trains the stretching of the biceps muscles, imitating push-ups of a healthy person. An adult should ensure that the child does not throw back his head, and that his breathing is calm, even.
• Next exercise resembles a press of the lower press with throwing back the legs in the complex of exercises for a healthy person. Starting position - a child with cerebral palsy lies on his back, arms extended along the body. On the count of “one”, he slowly and smoothly raises his straight legs above his head and brings them up behind his head, touching the floor above his crown with his toes and not bending them at the knees, on the count of “two” he returns them just as slowly to their original position. Throughout the exercise, the adult controls the process and makes sure that the hands do not come off the floor.
• Starting position - sitting on the floor with legs apart. The first movement is the bending of the right leg so that its heel touches the inner thigh of the left leg, the second movement is the approach of the foot of the left leg to the knee joint of the right leg. After carrying out these manipulations, the movement of the right hand to the left knee is carried out in a girth with the support of the left leg, and the movement of the left hand moves it to the opposite side of the waist behind the back. The adult turns the child's head to the left and tilts it so that the chin touches the left shoulder. In this case, the right knee constantly remains in a position pressed to the floor.

Such a set of exercise therapy exercises for children with cerebral palsy, when performed regularly every day, contributes to a significant improvement in the condition of a small patient. Such therapeutic exercises are especially effective in the case when it is carried out at an early stage of growing up a child. And the sooner, the better.

Exercise therapy for relaxation

It is noteworthy that exercises in exercise therapy for cerebral palsy in adults, as well as in children, contribute to the rehabilitation process. But in adults, this happens much more slowly than in children, since the children's body is much more malleable. Therefore, it is impossible to delay with exercise therapy for cerebral palsy in children.

Based on the fact that a frequent symptom of cerebral palsy is severe muscle hypertonicity, medicine provides special exercises to relax them.

• In order for the arms and legs of a sick child to rest, he needs to lie on his back on the floor, after which the limbs on one side should be fixed in a stationary state, while using weighting agents that can be built from sandbags.
• The free arm on the other side of the body should be bent by the child at the elbow, while his forearm helps him hold the adult conducting therapeutic exercises. The arm remains in this position until a decrease in muscle tone is felt. After that, the adult helps the child shake the hand, periodically bending it, rotating it and moving it from side to side.
• The same must be done with the leg. While the fixed limbs of one side touch the child's stomach, the adult helps him hold his shins and move his legs in the hip joint so as to be able to make circular movements to stretch the muscles of the leg. Accordingly, the legs alternate alternately.

Exercise therapy for breathing

The exercise therapy exercise system for cerebral palsy provides for a remission process only if they are performed regularly. The schedule of the training program should include activities in the patient's leisure time daily, day after day. Only regular gymnastics and constant exercises can return the physiology of a sick child to a more or less acceptable form. Therefore, it is impossible to neglect the daily frequency of complex therapy for cerebral palsy.

Among other things, exercise therapy for cerebral palsy also provides for the ability to breathe correctly.

• The adult shows the child how to take the correct deep breath in and out through both the mouth and the nose. To do this, you can use auxiliary equipment in the form of balls, rubber toys, soap bubbles.
• The instructor pronounces vowel sounds, either lowering or raising the volume of his voice. The child must repeat after him. You can alternate this exercise with singing or playing the brass.
• The standard exercise to restore the respiratory process is to raise the arms above the head and fill the lungs with air when inhaling full chest, as well as lowering the hands on the exhale. You can complicate the exercise by using part of the exhalation with the patient's head immersed in water.

Many schemes of work in exercise therapy with cerebral palsy were developed by medical workers of various institutions of a corresponding nature throughout the Russian Federation. One of these can be considered the Samara Rehabilitation child Center"Duckling". Here, children with various diseases, including cerebral palsy, are received. So, an exercise therapy coach and a child with cerebral palsy in Samara can perfectly find a common language for spending time together in one of the two pools, for therapeutic massage, physical therapy, hydromassage, phytoaromatherapy, educational games on the water.

Exercise therapy in game exercises

As mentioned earlier, the training program for children with cerebral palsy should include the work of an adult with a child every day, all seven days a week. But in addition to this, it is necessary to take into account the rationality of the applied loads, because the child must also rest. The calculation of the loads taken as a basis in the exercise therapy complex for children with cerebral palsy should be based on the age factor, body weight and height of the sick child. In addition, it is necessary to take into account the degree of the affected psyche and physiology, because cerebral palsy itself includes a huge number of varieties with varying degrees of severity. The more neglected the case, the more frequent and assertive the training should be, but they should be performed with the utmost care and only with a representative of medicine. At the same time, massage in exercise therapy for cerebral palsy is also suitable for some of the children, and for some water procedures- everything here is very individual, depending on the specific case of the course of the disease.

Many children like the game method of working with instructors. in exercise therapy for cerebral palsy provide not only the effectiveness and efficiency of the process, but also allow you to interest the child and give him the opportunity to relax. In this case, specific auxiliary equipment can be used in the form of devices supporting the patient on his feet, all kinds of fitballs, soft modules, pillows and other equipment. What games can be included here?

• "Destruction of the tower" - the game provides for a heap of soft game devices and circles one on top of the other in imitation of building a tower structure. At the same time, an adult can help a child build such a building, and he must destroy it himself - this is the main goal of the game, to learn how to make efforts in order to break through the "cushion" defense of an illusory tower.
• "Get out of the rubble" - such game exercise also involves the use of effort by the child, only now not in a running "attack on the tower", but in a lying position with heaps of pillows. The goal of the child is to get out of the simulated blockages.
• "Jackknife" - good game for stretching and flexibility of a child with cerebral palsy. Its essence lies in the fact that the child plays the role of a folded knife when he takes the position of an “embryo” on the floor and wraps his arms around his legs bent at the knees. On the count of “one”, the knife opens - the child stretches his legs and arms as far apart as possible and remains lying on his side until the count of “two” does not need to return to its original position. The exercise is done in moderate pace.
• "Sausage" is a humorous game with the initial position lying on your back on the floor. An adult in the face of a parent or instructor takes the crumbs by the ankles, gently turning him by the legs, as if by levers, now in one direction, then in the other. At the same time, the pace gradually increases.

Many different game procedures and exercises of physical therapy can be cited as an example - they are all aimed at only one result. This result is a partial recovery of the baby. Partially because the defeat of human health with cerebral palsy occurs not only in terms of physical disorders, but also psychological. And it is, alas, impossible to influence human psychology with therapeutic exercises to the extent that the body requires it.

The role of physical therapy cannot be underestimated in the prevention of many diseases. Separately, it does not have a healing effect. However, in combination with medication and massage, it gives excellent results. Exercise therapy is an integral part of the life of children with cerebral palsy.

During the rehabilitation period for cerebral palsy, special attention is paid to the therapeutic and physical exercise complex. This load successfully helps:

• develop immediacy and ease of inhibition of movements;
• reduces hypertonicity of muscle tissue;
• positively affects the coordination of movements;
• improves joint mobility;
• acquire the necessary skills in everyday life;
• beneficial effect on the possibility of self-service.

Important! It is necessary to start exercises for children with cerebral palsy in early age. Exercise therapy contributes not only to the development of muscles and mobility, but also makes the brain of a sick child more plastic. Reduces the risk of severe mental retardation.

There are no general contraindications to exercise therapy for children with cerebral palsy. There are personal prohibitions on specific exercises, but they can only be clarified with the attending physician. However, it is worth noting that physiotherapy exercises include many different complexes, you can always choose the right one.

Exercise complexes

The exercise program for children with cerebral palsy, of course, should include the following types of loads:

1. Complex for stretching muscles. To prevent teratogenesis, it is necessary to develop muscle mobility. This will help relieve tension and increase the area of ​​​​movement.
2. Exercises to maintain the sensitivity of muscle tissue and its development. This helps to regulate the strength of interaction with specific muscles, allowing you to perform everyday rituals in everyday life.
3. Load to improve the response of nerve endings. It has a positive effect on the functionality of the nervous tissue.
4. Program for improving antagonistic muscles.
5. A complex aimed at developing endurance, stamina, discipline of the body.
6. Exercises that help to consolidate normal walking, correcting gait.
7. Loads to maintain balance. Training of the vestibular apparatus.

Important! Should be treated with special attention and concentration to a set of classes carried out at home! All potential exercise programs must be approved by a physician. Thoroughly study the technique of performing each exercise.

Exercise rules

First of all, it is necessary to follow the basic rules regarding the set of exercise therapy exercises for children with cerebral palsy:

• classes should be regular;
• approach - individual to each child;
• it is necessary to observe the systematic study, without interrupting them;
• the increase in loads should occur gradually and strictly under the supervision of a doctor;
• when prescribing the complex, the severity of the pathology and the mental development of the patient must be taken into account.

Attention! The technique for performing exercise therapy for cerebral palsy in children on video can be found here. However, you do not need to blindly follow the recommendations in such collections. Each child is individual. No one, except parents and a doctor, can determine whether a particular technique is suitable for an exceptional baby.

The role of massage in medical medicine

Massage serves as an auxiliary, but very important element in case of cerebral palsy deviations. It normalizes blood circulation, improves metabolism, has a beneficial effect on muscle tissue, relieves spasms.

There are three main types of massage for cerebral palsy:

• classical,
• segmental and
• point.

After familiarizing yourself with each method in detail, parents can do massage on their own at home. There are also special courses.

It is worth noting that massage for a child with cerebral palsy should be started as soon as an accurate diagnosis is revealed.

It is possible to determine the degree and nature of the disease at about 2 months of age.

Classical massage is aimed at relieving spasm from tense muscles and toning weakened ones. It helps to change the child's distorted postures. Movement during the procedure should be smooth, slow. The skin should not move with the hand.

The following methods of stimulation are used:

• continuous stroking - warms up and relaxes the muscles;
• felting - used to influence large groups muscles;
• skating - ideal for influencing the hip and shoulder joints;
• deep intermittent stroking - suitable for maintaining tone in muscle tissues;
• trituration outer part palms - ribbed surface helps to stimulate large muscles (buttocks, back, thigh);
• slight tingling, tingling.

Auxiliary simulators

For additional trainers early development, which are desirable to have at home, include:

1. A rug with an uneven surface, covered with small bumps. It is necessary to teach the child to walk on it with bare feet. Emphasis is best placed on the heels. It is there that the largest number of nerve endings are concentrated. Also, the undoubted advantage of the procedure is the normalization of blood circulation. To create more interest in this activity in a child, it is recommended to color the rug, apply interesting applications, patterns. Such a decision will contribute to intellectual development.
2. Special expander. Now there are enough similar simulators for the development of grasping reflexes. But before, beautiful rag bags with cereals (buckwheat, rice) were used. This tool also eliminates spasticity of the fingers.
3. Walkers or jumpers. Care must be taken when choosing this simulator. It is advisable to select special ones - for children suffering from cerebral palsy. They have a unique orthopedic insert, have the function of attaching to a vertical surface. However, the opinions of doctors about the need to use walkers differ greatly. It is recommended that parents study all the reviews and, after consulting with a specialist, make a decision.

Swimming pool for children with cerebral palsy

Water for children has always been a source of joy, fun, carelessness. Children with cerebral palsy are, of course, no exception.

Water procedures are carried out no more than half an hour. Do not overwork the muscles. It is better to practice regularly, patiently achieving results, than at one time, which will not bring success. Classes must be performed gradually, in complexes:

1. The first 2-3 classes are held on land by the pool, without contact with water. It is necessary to explain to the child how to move correctly in the water. It should, through gymnastics, teach the patient to move his arms and legs correctly.
2. The first time you dive into the water, you need to be alert. Children with cerebral palsy are easily frightened and may not understand contact with water. The child will need additional support, both physical and moral. However, it should be noted that children get used to swimming very quickly.
3. Next, attention is paid to warming up the hands. The movements of the upper limbs during swimming help to strengthen the cervical vertebrae. It is necessary to show the child how to move his hands correctly. The first swings must be smooth, slow. Muscles have to get used to the changes. On next lessons start spinning faster.
4. Later give credit to the movement of the feet. Due to the incorrect development of the musculoskeletal locomotive apparatus in children with cerebral palsy, it is necessary to correct this in the pool. in a good way serve jumping in the water. For their implementation, it is recommended to hold the baby by the hands.

On this moment the field of rehabilitation and prevention for children with cerebral palsy is widely developing different ages. Programs successfully help to function normally in society and everyday life. The main thing is not to "start" with treatment, follow all the doctor's instructions and be patient.

Cerebral palsy is a pathology that consists in paralysis of the central nervous system, which arose due to the defeat of several or one part of the human brain. The disease can begin to form even while the fetus is in the womb, immediately after childbirth, or for a short time after that. In order to prevent the continuation of the development of pathology, various methods and therapies are used, among which games for children with cerebral palsy are very effective way.

What is LFC

Exercise therapy is physiotherapy exercises, which is aimed at restoring the functions of the human body. Special exercises for children with cerebral palsy contribute to the inhibition of paralysis of the central nervous system. A set of physical therapy exercises will allow children to gradually regain control over their movements, significantly improve coordination, as well as the frequency of movements of the limbs.

The main tasks and goals of the exercise therapy program are aimed at teaching a sick child with cerebral palsy ordinary everyday skills that will make their life easier. Also, a set of exercises will allow sick children to learn simple labor activities, and to carry out self-service without outside help (nannies, parents, and others).
As a result of the exercise therapy complex, new skills are gradually developed, movements become more accurate and correct.

Parents should know that a course of exercise therapy should be prescribed immediately after the discovery of a pathology in a child. With a gradual complication of physical activity, therapy should be started immediately to avoid transition to a more severe form. Exercise therapy is also prescribed for children who do not have physical abnormalities, but there are prerequisites for this or a predisposition (for example, heredity).
The methodology for restoring the physical activity of disabled children is based on several principles:

• patients do not have long breaks between performing special exercises;
• therapy takes place regularly and systematically;
• needs to be gradually increased physical activity to strengthen muscle tissue and tendons;
• individual appointment of preventive exercises that are focused only on one patient with certain physical abnormalities;
• the age of the child is taken into account when prescribing a course of exercise therapy, psychological condition patient and stage of pathology.

Correctional and educational work is very important for children, which is aimed at compensating for all impaired functions of the body. In this regard, doctors strongly recommend conducting exercise therapy from the very early years. It is important to remember that the sooner prevention begins, the better it is for the young organism. At an early age, children are more amenable to correcting the musculoskeletal system.

Types of exercises

Since the mobile exercise therapy complex for a child with cerebral palsy must be selected individually, depending on the manifestation of the pathology, doctors may prescribe different types therapeutic exercises. For the treatment of the disease, classes can be aimed at stimulating the musculoskeletal system in the form of special gymnastics or swimming in the pool.

Disabled people are prescribed exercises for stretching ligaments, to relax muscle tissues and joints. Classes with children will be held in a sitting position and lying down. It should also be said that patients with cerebral palsy are more willing to undergo therapy if it is in the form of a role-playing game or with toys.

Classes to stimulate the motor apparatus are aimed at developing and strengthening motor ability child with cerebral palsy. First of all, the child should sit on his heels so that the foot is completely on the floor. Then mom or dad should stand in front of him, put his arms on his shoulders, fixing the patient in the pelvic area. After that, you need to start gradually tilting him so that he gets on his knees.

When the patient kneels, he must be supported in the armpit area in order to move him in different directions. After a while, you need to loosen the support so that the child gradually gets used to transferring the center of mass of his body from one leg to the other on his own. When the center of gravity shifts to the left leg, the right one should be torn off the floor. Over time, you need to start spreading your arms to the sides, training to keep your balance.

Then you can put the baby on a chair, standing in front of him. With your feet, you need to fix the legs of the patient near the floor, taking him by the hands. Then you need to pull them towards you and up. This exercise will allow you to learn to stand up without assistance. Another exercise from the exercise therapy complex should help a child with a disturbed musculoskeletal system to keep balance correctly. To do this, you need to become so that his one foot is in front of the other, but on the same line. It is necessary to alternately push the baby in the back and chest so that he feels how the mass of his body is distributed in this position.

Also, for this, you can put it in front of you, and, taking your hand, push and pull in different directions so that the patient takes a step on his own. This will allow him to independently find a fulcrum. To develop support, you need to lie on your back, and then press on a solid surface with your feet. Such classes are very effective if they are carried out regularly, without violating the schedule.

Video "Exercises for the spine"

For stretching

To improve stretching of the limbs and increase flexibility, you need to regularly carry out special exercises. The patient should sit on the floor, legs straight out in front of him so that his body is located at an angle of 90 degrees. Next, the child should begin to stretch his arms in front of him, breathing in. When inhaling, he should bend the body, trying to reach the tips of his toes with his palms. If initially this cannot be done, then you need to gradually increase the load, tilting the patient to the legs.

Over time, the load can be increased so that he gets his forehead to his feet. Also, the baby can lie on his stomach, put his hands along his body. The patient should raise his chest, resting his palms on the floor. It is important that his head is thrown as far back as possible, slowly inhaling the air. In the starting position (on the back), you need to put your legs together. It is necessary to raise the outstretched legs above the head, keeping the body in a supine position. The knees should not be bent and the hands should be kept on the floor. Ideally, you need to reach with the tips of your toes to the floor behind your head.

Another exercise will improve stretching. To do this, sit on the floor, bend your right leg so that the heel of the foot reaches inside left thigh. The left foot should reach the right knee. right hand you need to translate around the left knee, holding the left foot. Next, you need to bring the left handle behind your back from the opposite side at the waist, and turn your head to the left, tilting it so that your chin reaches your left shoulder. It is important that the right knee does not come off the floor.

Such developing gymnastics is aimed at correcting defects in the back and spine. This technique also improves spinal cord and nerve endings muscle tissues legs and arms.

For relaxation

To relax upper limbs, it is necessary to put the patient on his back, and then secure the leg and arm on one side with a load (for example, sandbags). The free arm should be bent at the elbow, and the parents will fix the forearm. So you need to hold the patient until the muscles relax. You can shake the brushes, bend and rotate them.

To relax lower limbs you need to fix your hands, and bring your legs to your stomach. One of the parents will hold the shaft, moving the hip joint to the sides. Further, fixing one leg, a circular movement of the other limb is made, gradually unbending it. Such gymnastics relieves tension from the muscles, giving the opportunity to weaken the tone. This is very important, since in pathology they can involuntarily contract or be in tension.

For joints

Exercise therapy to strengthen the joints is very important for the recovery of a child with cerebral palsy. Most of the exercises from the complex are carried out in the prone position. When the patient lies on his back, his one leg should be kept unbent, and the other should be slowly bent at the knee joint. If at an early age he has good flexibility in the body, then, if possible, bending the leg, you need to bring the thigh to the stomach, and then take it away.

Next, the patient should lie on his side, and gradually raise the thigh up. The knees and legs should be in a bent position. Ligaments cannot be overstretched.
The next exercise - the child lies on his stomach (best on a hard table), so that his feet hang down behind the tabletop. Then parents should help to slowly unbend and bend his limbs.

Lying on your back, you need to bend your knees alternately and unbend them as much as possible.
When the child lies on his stomach, a special roller should be placed under his chest. It will be necessary to lift it on outstretched arms, making springy movements with gradual soft jerks. Such exercises allow you to strengthen the joints of the upper body.

The child can lie on his back. Then his arm must be bent so that the patient's face is turned in the appropriate direction. Then the procedure is repeated, turning the head to the other side.

Among the more mobile exercises of therapeutic gymnastics, there are those that are carried out in the pool or using role-playing games. When using various toys during exercise therapy or role-playing games, children are more willing to do gymnastics. Toys allow you to create interest around a given activity without feeling uncomfortable. Role-playing games with various toys are closely intertwined with the main brain activity of the child. The process itself is important.

Role-playing game can be safely called effective way therapy, as it improves the imagination of children, shows imagination. Role-playing games develop memory well, allow you to think in a simulated situation.
Role-playing games for young children are an inspiration. The use of toys in story games will stimulate the brain, increasing its activity. In story games, it is best to include life situations in a simplified form so that it is easy for children to perceive information.

Even without story games, individual toys that are dear to a child can have a very strong effect. Toys usually evoke a range of emotions that a sick child experiences. And it also affects the way his brain works. Thus, toys can have a positive effect on the psyche, even without using them in a role-playing game.

Pool exercise works well for those who can walk on their own, but deviations can be seen. With such therapy, the patient will learn to swim in the pool, as well as strengthen his health. Classes in the pool should be conducted by a specialized instructor who knows the methods of treating cerebral palsy and correcting the musculoskeletal system in young children.

Water helps to relax the body, tones the muscles, and energizes. This therapy is called hydrokinesitherapy. Very often, children with a pronounced sign of cerebral palsy have a problem with their emotional state. For this, there are also separate psycho-gymnastic exercises that an adult should help to carry out.

Video "A set of exercise therapy exercises for children with cerebral palsy"

This video guide will help you create a rehabilitation program for children with cerebral palsy. Visual and easy-to-perform exercises will help you cure your child.