Therapeutic physical education for children with cerebral palsy. An effective exercise therapy complex for children with cerebral palsy

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 the real cause is unknown) during pregnancy and childbirth. Cerebral palsy is, first of all, impaired muscle tone and improper coordination of movements, and this is a disability. And, unfortunately, this disease is becoming more and more common. It occurs in children from 3 months to 3 years (untreated children with this pathology very rarely live longer than 3 years). However, if the disease is detected in a timely manner and treatment is started without delay, then the child has the opportunity to socially adapt in the future (have a job and a family). The good news is that cerebral palsy does not progress, and as the child grows, the symptoms of the disease may decrease.

Treatment of cerebral palsy is complex, long-term and is aimed at teaching movement and restoring impaired functions, which is achieved through the tireless (selfless!) work of parents. According to statistics, significant improvement is observed in 25% of patients, and some mitigation of defects is observed in 50%; 25% of children do not have any positive dynamics.

The difficulty of treatment is that medications can accelerate the “maturation” process nerve fibers, normalize muscle tone, but do not in any way affect muscle and joint contractures, which do not allow the child to gain experience of normal postures and movements. Daily physical therapy and massage can help the baby develop normally. In any case, coming to terms with disability is not the solution to this problem. Starting physical therapy at any age brings positive changes: the child’s emotional state improves, muscle contractures decrease (or disappear).

The form of the disease must be determined by a pediatric neurologist. There are several classifications, and parents can familiarize themselves with them. According to L. O. Badalyan, cerebral palsy manifests itself in a spastic form, in the form of hemiplegia, diplegia, bilateral hemiplegia, in dystonic or hypotonic forms.

According to A.Yu. Ratner, cerebral palsy is divided into spastic tetraparesis (double hemiplegia), spastic hemiparesis (both forms are accompanied by epilepsy), cerebellar syndrome ( muscle hypotonia), hyperkinesis (violent movements that interfere with walking).

According to K. A. Semenova, spastic diplegia, double hemiplegia, hyperkinetic form of cerebral palsy, atonic-astatic syndrome, hemiparetic form of pathology are determined.

There is also a rudimentary version of cerebral palsy: minimal brain dysfunction - neurological disorders in the form of lethargy, fatigue, excitability, restlessness, tics, headaches, and at an older age, disorders manifest themselves in low performance at school due to difficulties in learning new things. Such children have difficulties in communication and sleep disturbances.

1) acute period, or early stage (7-14 days, up to 2-3 months), when the disease manifests itself in the form of syndromes:

a) cerebrovascular accident syndrome - there are groans, convulsions, sudden agitation of the child with a piercing cry, breathing problems;

b) syndrome of increased intracranial pressure (hydrocephalic-hypertensive) - the fontanel is tense or bulging, the size of the head quickly increases, there may be convulsions;

c) convulsive syndrome - convulsions occur several times a day;

d) syndrome of inhibition of unconditioned (innate) reflexes - grasping, automatic gait, etc. Incorrect attitudes of the torso and limbs are formed;

e) diencephalic syndrome - there is a slight increase in weight, growth retardation, sleep disturbance, and temperature;

2) recovery period:

a) early recovery period (initial chronic-residual stage) - begins after the subsidence of acute manifestations of cerebral hemorrhage. According to various authors, this period lasts from 2 to 5 months. It is at this time that the doctor can determine the form of cerebral palsy. More often it is mixed and includes various movement disorders; b) late recovery period - lasts up to 1-2 years;

3) the period of residual phenomena, or the final residual stage, begins at 2 years of age and continues throughout the entire period of childhood and adolescence. Children 4-7 years old with intact intelligence attend speech therapy groups kindergartens (motor disorders combined with speech disorders). Exercise therapy classes with a methodologist are held every other day; on all other days, the child studies with his parents. A two-year-old child with cerebral palsy can be in motion for up to 2.5 hours a day, for 3-7 years old - up to 6 hours.

The task of parents and the pediatrician is to identify the symptoms of the disease as early as possible, and for this there are special tests. Considering that during the newborn period a child normally has increased muscle tone, changes in muscle tone can be determined by indirect signs only from the end of the first month: with increased tone, the child does not attempt to raise his head from a position on his stomach and place it in the midline.

To check the muscle tone and symmetry of a child’s body from 2 months: place him on a flat and firm surface on his 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 movement along the spine is smooth (straight), then the child’s muscle tone is normal. If muscle tone and body asymmetry are disturbed, your hand will SHARPLY change direction along its path; at this moment the child’s body will bend to the side (and not down); at the same time, you will clearly feel the tension of the muscles under your hand; The baby's legs will be bent at the knee and hip joints.

At the same age, a child may notice a tilting of the head and tension in the back of the head. When supported under the armpits, he does not rest on his full foot, but on the tips of his toes (“on tiptoes”).

In healthy children, innate reflexes begin to disappear from 3 months. If grasping, searching reflexes, and the automatic gait reflex do not disappear after 4 months, but even intensify, then there is a high probability of increased muscle tone. In the prone position, such a child bends his arms and legs and raises his pelvis.

A newborn baby normally makes rhythmic, automatic movements. If the baby lies motionless, the arms are clenched into fists, brought to the body, thumb squeezed inward, and the legs are crossed, this is very similar to spastic paresis of the upper and lower limbs.

If movements are made, but the child is flaccid, “spread out”, the palm is extended, the hand hangs down, and the legs are in the “frog” position, then flaccid paresis of the limbs can be suspected.

How else can you suspect something is wrong? If for 1-3 months the baby’s negative emotions predominate (frequent crying) and there is no “booming,” then you should bring this to the attention of your pediatrician.

Remember: hypertonicity of the muscles of the upper extremities disappears by 2.5 months, in the lower extremities - by 4 months. Only a doctor can distinguish normality from pathology.

Tests that only a doctor should do, but which are useful for parents to know about.

In the supine position:

1) the doctor places his hand under the child’s head and tries to bend it. Normally, the head bends easily, but with cerebral palsy the head presses on the arm;

2) the doctor takes the baby by the hands and pulls him towards himself. Normally, the child bends his head and tries to sit up. With cerebral palsy, the head is thrown back;

3) the child’s arms are raised up parallel to the head (taken to the sides, crossed). With cerebral palsy, the child resists these movements;

4) the doctor straightens the child’s legs, grabs them under the knees and bends them towards the stomach. With cerebral palsy, resistance to this movement is determined.

In the prone position:

1) the doctor grabs the child’s hand and tries to place his hands on both sides of the head (takes his hands out from under chest). With cerebral palsy, resistance is felt;

2) the doctor puts his hand under the baby’s chin and tries to lift his head. With cerebral palsy, the chin presses on the doctor’s hand. Normally, by the age of 5 months, the baby independently raises his head in a position on his stomach, while leaning on his hands.

The adult spine resembles a spring with several bends (lordosis) - cervical and lumbar. They allow you to maintain a vertical body position. A newborn does not have these bends, i.e. his spine is almost straight. The cervical curve (lordosis) appears at 2.5 months, which allows the child to hold his head in an upright position. In the spastic form of cerebral palsy, the neck seems to be inserted into the shoulders—a “short neck,” and the formation of cervical lordosis is delayed.

Lumbar lordosis should be formed at 6 months, after which the baby begins to sit independently. If the lumbar curve is insufficient, then the torso tilts forward, which disrupts balance (support on the legs). Excessive lumbar curve (hyperlordosis) leads to stiffness (contracture) of the hip joints (one or both), which causes the gait to change greatly: oscillatory movements appear when walking (from side to side or back and forth).

With cerebral palsy (increased back muscle tone), a newborn can hold his head from a position on his stomach earlier than 2 months. To understand this, you need to put the child on his back and try to lift him by the arms (test 2) - the head will hang.

Tests to determine correct lumbar lordosis

1. Starting position - lying on your back. Pull the child's knee towards the chest. If the other leg rises at this time so that it cannot be pressed down, this is evidence that the hip flexors are shortened.

2. Starting position - lying on your stomach. Bring the child's heel to the buttock. If the rectus femoris muscle is shortened, this cannot be done.

The main goals of exercise therapy for cerebral palsy are:

1. normalization of muscle tone so that the child can make voluntary movements;
2. age-appropriate motor skills training; strengthening the sense of posture, training the vestibular apparatus.

It should be remembered that any intense (careless) impact can lead to an increase in muscle tone (pain increases muscle tone). Exercise therapy should be started as soon as the symptoms of increased intracranial pressure subside and the convulsions stop.

Exercises to normalize increased muscle tone

Exercise 1. Designed to identify and eliminate asymmetry of the torso, increased tone of the muscles of the back, the back of the head (forms the cervical curve and reveals disorders in the hip joints).

Performed no earlier than 2 months of age (during the formation of cervical lordosis). If there are indications of injury in cervical spine spine, then the exercise is performed only after the therapeutic massage procedure.

The starting position of the child is lying on his back. The instructor brings the child into a flexion position (“fetal position”): arms are crossed on the chest, legs bent at the knees lead to the stomach and the head is bent towards the chest.

The baby’s knees should be bent and as close as possible to the head along the midline of the body (with hip dysplasia and the “short neck” symptom, this cannot be done, and the child performs an easy version of the exercise). Hold the child in this position for several seconds, making rocking movements.

The flexion position is natural for a healthy child and does not cause difficulties in its implementation. If a child has increased tone (rigidity) of the muscles of the back and neck, he will cry. Under no circumstances should you bend your child with great force!

With hip dysplasia, the baby will “slip” out of the instructor’s hands, trying to free himself and tilt in a different direction.

The exercise helps after 14 days for 5-8 month old children with increased muscle tone in the neck and back, who cannot hold their head up, roll over and sit down.

Exercise 2. Designed to identify and eliminate increased tone of the thigh muscles, formation lumbar curve spine. It is recommended for children who, when performing an automatic gait, rely not on the entire foot, but on the toes. It is performed no earlier than 6 months of age (at the beginning of the formation of lumbar lordosis) after consultation with an orthopedic doctor. The exercise promotes internal rotation of the hip, and therefore, before performing it, you need to make sure that the child does not have (if the spine is eliminated) dysplasia or subluxation of the hip joint.

Starting position - the child sits between the heels with legs bent at the knees, feet shoulder-width apart, turned upward. The instructor tilts the child back so that the head, shoulders, and back touch the surface of the table.

The instructor's right hand pulls the head and shoulders down, and the left hand fixes the knees. A child with normal muscle tone easily and happily remains in this position.

If the thigh muscles are tense, the child will try to free himself from the position that causes discomfort as soon as possible and sharply 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 is normalized), and then sit down independently (the exercise forms lumbar lordosis).

Exercises to develop motor skills

Exercise 1. The starting position of the child is sitting on his heels. Stand in front of the child, put his hands on your shoulders and, fixing him in the pelvic area, encourage him to kneel.

Exercise 2. The starting position of the child is kneeling. Supporting the child under the arms, move him from side to side so that he learns to independently transfer his body weight to one leg, lift the other leg from the support and spread his arms.

Exercise 3. The starting position of the child is squatting. Stand behind the child, pressing on your knees. Move the child's body forward, straightening his knees.

Exercise 4. The starting position of the child is sitting on a chair. Stand facing the child, use your legs to fix his legs to the floor, and take his hands. Pull your arms forward and up, encouraging you to stand up on your own.

Exercise 5. The starting position of the child is standing, one leg in front of the other. Alternately push the child in the back area, then in the chest area so as to teach him to maintain balance.

Exercise 6. The starting position of the child is standing. Take the child by the hand, pull and push in different directions, encouraging him to take a step.

Exercise 7. The starting position of the child is lying on his back. Press your feet onto a solid support (the exercise improves your ability to support yourself).

Exercises for joints

Exercise 1. The starting position of the child is lying on his back. Keep one leg of the child in an extension position, gradually bend the other at the hip and knee joints. If possible, bring the thigh to the stomach, and then slowly abduct it.

Exercise 2. Starting position - lying on your side. Slowly abduct the hip with the knee bent.

Exercise 3. Starting position - lying on your stomach on the edge of the table so that your legs hang down. Gradually straighten your limbs.

Exercise 4. Starting position - lying on your back. Bend your knee, then straighten it as far as possible.

Exercise 5. The starting position of the child is lying on his stomach, with a cushion placed under his chest. Raise the child by the outstretched arms, making springy extension movements of the upper body with light jerks.

Exercise 6. The starting position of the child is lying on his back. Bend the child's arm so that his face is turned towards the arm being bent. After this, bend the arm with the head positioned in the opposite direction.

Exercises for abdominal muscles

Exercise 1. Starting position - the child sits on the mother's lap. Press the baby's back to your chest and tilt with him (so that the baby feels confident). Secure the baby's legs and pelvis so that he can lift himself. If getting up is difficult, the mother should help him get up.

Exercise 2. The starting position of the child is lying on his back, arms pressed to the body.

With the help of a swinging movement of the leg, he should try to turn from his back to his stomach and back without using his hands.

Exercise 3. Starting position - lying on your back. Inhale and exhale with the abdomen drawn in as you exhale.

Stretching exercises

Exercise 1. Starting position - sitting on the floor. Stretch your legs forward so that your body is at a right angle. Extend your arms in front of you (parallel to the support), inhale. As you exhale, bend your body forward so that your palms touch your toes. Tilt your torso more and more until your forehead touches your legs.

The exercise eliminates stiffness in the back muscles, making the spine flexible, improving blood circulation and the function of the spinal nerves.

Exercise 2. Starting position - lying on your stomach, arms along your body. Leaning on your palms, slowly lift your chest up (the body from the waist to the feet should be in contact with the support). At the same time, the head is thrown back, legs and feet are together. slow and deep.

Throughout the entire spine, the tone of muscles and ligaments increases, and the function of nerve trunks and blood vessels improves.

Exercise 3. Starting position - lying on your back, legs together. Raise your legs straight above your head, do not bend your knees, and keep your hands on the floor. Try to touch the floor above your head with your fingertips. Slowly return to the starting position.

Exercise is beneficial 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 right leg so that your heel touches the opposite thigh. Place your left foot on the floor on the right side of your right knee, move your right hand around your left knee and hold the foot of your left leg with it. Place your left hand behind your back to the right side of your waist as far as possible, turn your head to the left and tilt it so that your chin touches your left shoulder, while your right knee should not leave the floor.

The exercise corrects back defects along its entire length. Children can perform the exercise with the help of adults who help them maintain the position they have taken.

Treatment by position

In the initial stage of cerebral palsy, treatment with positioning (laying) is carried out after a relaxing massage and relaxation exercises.

In order to give the body a physiologically correct (symmetrical) position, special rollers with sand and tires with soft inner lining are used. The child can remain in such positions for 2 hours, then rest for 1-2 hours, and the splints are applied again.

At older ages, a position with maximum approximation of muscle attachment points is used.

Pose lying on your back: place a bolster (pillow) under your head so that your head is almost lowered to your chest. Bend your arms at the elbows or cross them over your chest. The hip and knee joints should be bent (place a bolster under the knees), the angle of flexion is selected individually. Place your feet on a support, spread your hips freely.

The pose allows you to inhibit hyperkinesis and reduces the influence of the cervical-tonic asymmetric reflex.

Exercises to relax the muscles of the upper limb

Exercise 1. Starting position - lying on your back, your head is located strictly along the midline, your arm and leg on one side are fixed with sandbags. The free arm is bent at the elbow, the forearm is fixed by the instructor (mother). The instructor (mother) holds the child’s hand until the increased tone (hypertonicity) of the muscles subsides, after which he shakes the child’s hand, alternating with passive movements in wrist joint(flexion, extension, abduction, adduction, rotation).

With the help of acupressure, carried out in parallel, you can stimulate active flexion and extension of the hand.

At the end of the exercise, the forearm and hand are shaken and placed in the middle position with fixation with shreds or rollers with sand.

Exercise 2. Starting position - lying on your stomach, head in the middle position, arms extended to the sides, forearms lowered from the couch, a pillow placed under the body, legs and pelvis fixed. The instructor (mother) holds the child’s shoulder until involuntary movements disappear (weaken), then swings and shakes the forearm, performs passive flexion and extension in elbow joint. Stimulates active movements in the child’s elbow joint with massage techniques, swings the forearm again and finally fixes the arm in the middle position.

Exercises for the lower extremities

Exercise 1. Starting position - lying on your back, head in the middle position, arms fixed, legs bent so that they touch the stomach. The instructor (mother), holding the shins in the upper third of the front surface, performs abductions in the hip joints. Then, fixing one leg, he carries out circular movements with leg extension (for each leg).

Exercise 2. Starting position - lying on your stomach. The instructor (mother) fixes the child’s pelvis with one hand, and with the other, supports the leg by the lower third of the thigh. The pelvis is fixed using sandbags. The instructor (mother) supports the leg by the lower third of the thigh with one hand, and with the other hand performs a stimulating massage to contract the gluteus maximus muscle. At the end of the exercise, the child’s foot should “fall” onto a soft support.

At the next stage, the instructor performs passive extensions in hip joint, after which the child holds the leg independently for a certain count. Then the leg falls freely onto a soft support.

Exercises for the muscles of the trunk and neck

Exercise 1. Starting position - lying on your back, head in the middle position. The instructor (mother), holding the child's torso on both sides, gently rocks the body from side to side, making sure that the child does not offer resistance. Then the instructor (mother), holding the child's head, rocks it freely, alternating rocking with head turns (without resistance).

Exercise 2. Starting position - lying on the right (left) side, the right (left) hand is under the head, the left (right) is along the body. The instructor (mother) gently pushes the child so that he falls on his back or stomach. The child must maintain the starting position when pushing, relaxing the muscles and falling only at the instructor’s signal.

Exercise 3. Starting position - sitting in a chair, hands on the armrests, head lowered to the chest. The instructor (mother) performs passive bending, turning the head, flexion-extension (without resistance from the child). The child must fix his head during passive movements, then actively relax the muscles so that the head “falls” on the chest.

Exercises to correct breathing

The starting position when performing any exercise is lying on your back, with a gradual transition to a sitting and standing position.

Exercise 1. The child needs to be shown how to take a deep breath and exhale deeply through the nose and mouth, and then invite him to exhale onto thin paper (a feather, a flag), or his palm. You can blow up toys and blow bubbles.

Exercise 2. For improvement respiratory functions you need to teach the child to pronounce at different volumes while exhaling, whistle, play the harmonica, sing.

Exercise 3. Inhale to the count of “one, two, three,” while raising your arms up, and exhale to the count of “four, five, six,” lowering your arms down. Exhale into the water, lowering your head into the bath with.

Facial exercises

The problem of recognizing (identifying) feelings is relevant not only for children with cerebral palsy. In other words, this is not even a “children’s” problem at all - not every adult can answer the question: “How do you feel now?” Not to mention the fact that the ability to respond to certain negative emotions in a form that is safe for yourself and others is the key to not only peace of mind, but also physical health.

Teach the child to imitate various emotional states in order to distinguish them later in everyday life, and with the help facial muscles to discharge these emotions is the task of psycho-gymnastics.

Expressing emotions

Interest, attention: show the child how a dog sniffs, how a fox eavesdrops, how a commander studies a map. Ask him to repeat the sketches.

Surprise: make your eyes round.

Joy, pleasure: ask the child to show how a kitten behaves when petted; ask to smile; imagine that Carlson arrived (Santa Claus came) and brought delicious candies (toys).

Suffering: show the child how his stomach hurts; how he cries infant; how cold it can be in the cold. Ask him to repeat the sketches.

Disgust: Ask your child to imagine drinking salty soda water.

Anger: ask the child to show how angry grandma (mom, dad, grandpa) is.

Fear: ask the child to imagine how the little fox lost his home.

Guilt and shame: ask the child to remember how he lost his mother’s (grandmother’s, grandfather’s, father’s) favorite thing; To apologize.

Exercise therapy for congenital hip dislocation

In children, dislocation of the hip joint can be acquired (during childbirth) or congenital (due to proper development hip joint, which is called dysplasia).

Congenital hip dislocation is currently the most common malformation and occurs in at least 2 out of 1000 newborns, with girls 5 times more likely than boys. In addition, it was noted that in girls the left hip joint is predominantly affected.

So, the main cause of congenital dislocation of the hip joint is its dysplasia (underdevelopment), which can occur for several reasons. Firstly, there are anatomical predisposing factors: the joint capsule can be thin, and the ligaments that strengthen the joint are not sufficiently developed. Secondly, the glenoid cavity (it has its own name - the acetabulum) is shallow immediately after birth. Thirdly, the head of the femur of a newborn consists not of bone, but of cartilage, and is smaller than normal in size and has a short neck. Therefore, 2/3 of its surface can be outside the acetabulum.

Under unfavorable conditions (including poor care of the newborn), the hip joint becomes unstable, and the femoral head moves upward and posteriorly.

Hip dislocation is easy to identify and treat only in a newborn child, and therefore the earlier this pathology is diagnosed, the more effective the treatment will be. Usually, during the first examination of a newborn, the pediatrician performs the following test (symptom of “slipping” or “clicking”): pulls the legs of the child lying on his back together, bends them at the knees, presses them to the tummy, and then spreads them apart. When the hip is dislocated, a characteristic click is heard. It should be remembered that the severity of the “clicking” symptom decreases already on the 3-7th day of life, and instead, movements in the joint are limited.

Other signs of a hip dislocation include:

1) asymmetrical skin folds in the buttocks (in the position on the stomach) and on the inner thighs (front and back);

2) symptom of “abduction limitation” - difficult passive abduction of the legs bent at a right angle at the hip and knee joints (it is difficult to separate the legs when the child is lying on his back);

3) symptom of “reduction and dislocation”;

4) atrophy (underdevelopment) gluteal muscles;

5) there may be an excessive range of motion in the joint (hypermobility);

6) external rotation of the hip on the side of the dislocation. If congenital dislocation of the hip was not treated before the age of 1 year (or the treatment was ineffective), then the baby will not be able to start walking in time. By the age of 3, such a child has a clearly visible shortening of one limb and a smoothly waddling gait (“duck-like”); only surgery can help him at this age.

Treatment of congenital dislocation of the hip begins in the maternity hospital (immediately after the disease is detected): up to 3 months, wide swaddling of the child is indicated, in which the hips do not close, but remain apart. To do this, place a diaper folded in four between the hips, bent at the joints and abducted. By the way, such swaddling is not only a method of treatment, but also the prevention of hip dislocation. It is not for nothing that, for example, in Africa, from birth a child is carried tied to his back, while his legs are always spread apart!

At 2-3 months, a child with suspected congenital dislocation of the hip should have an x-ray of the hip joints. After consultation with an orthopedic doctor, the diagnosis is either confirmed or removed.

When treating a dislocation, you should adhere to the following rules (treatment by position):

1) when the child is positioned on his stomach, make sure that the feet are outside the mattress, otherwise the spasm of the adductor muscles of the thigh intensifies;

2) as soon as the child begins to sit (from 6 months), he should be seated on his knees with his legs apart, facing himself, holding the back with both hands;

3) when a child is held in his arms while standing, his legs should cover the adult’s torso.

For orthopedic treatment, special devices are used: up to 3 months, Pavlik stirrups, after 3 months - CITO, Vilensky splints, from 6 months - Volkov, Polonsky splints. Exercise therapy for congenital hip dislocation is carried out as prescribed by an orthopedic doctor. All conservative treatment methods are aimed at gradually and gently restoring the shape of the joint. This is achieved by long-term fixation in a position that is therapeutic (corrective). Exercise therapy for hip dysplasia not only helps to form the joint, but is also the only means of developing a child’s motor skills.

Therapeutic exercises help eliminate stiffness (contracture) of the thigh muscles (adductor muscles), strengthen the muscles that move the joint, and also correct the position of the joints (valgus), which develops after the use of orthopedic splints.

Exercise therapy for children of the first year of life is carried out 3-5 times a day for 5-10 minutes together with massage.

Therapeutic exercises for children in the first 6 months of life

With congenital hip dislocation, the muscles surrounding the hip joint are particularly affected. Scientists have proven that the electrical excitability of these muscles is reduced. This is especially true for the adductor muscles, hip flexors, and gluteal muscles, in which contractures form. Treatment requires systematic stretching exercises, massage and thermal treatments.

Exercise 1. Traction along the longitudinal axis of the limb. Starting position - lying on your stomach. With one hand the instructor (mother) fixes the child’s shoulders, with the other he pulls the leg towards himself (there may be a click). The procedure is repeated once every 3-4 days.

Exercise 2. Abduction of straight legs to the sides. Starting position - lying on your back. Holding the child's shins in the lower third, spread the straight legs to the sides. Repeat 6-8 times.

Exercise 3. Circular movements with legs. Starting position - lying on your back.

Bend the child's legs at the knee and hip joints, holding the legs by the shins. Make 5-

Exercise 4. Retraction of bent legs to the sides. Starting position - lying on your back.

Bend the child's legs at the knees and hip joints and gently spread the hips to the sides. Grasp the child’s thigh with your palm so that the thumb lies on the inner surface of the thigh, 2-3 cm below the inguinal fold (7th point). Using the pads of the second and third fingers, touch the skin at the projection site of the hip joint to feel the depression.

In this place (projection of the entrance of the femoral head into the acetabulum), apply gentle pressure. Relax the adductor muscle with acupressure vibration massage of the 7th point area and lightly shaking the thigh.

Exercise 5. Lowering straight legs to the sides. Starting position - lying on your back.

Bend the child's straightened legs at the hip joints and make several abductions to the sides.

Exercise 6. Alternating flexion legs in a spread position. Starting position: lying on your back. Bend your legs at the hip and knee joints, gently spread your hips to the sides. Alternately bend and straighten the child's legs. Repeat 4-6 times.

Exercise 7. Internal rotation of the hip. Starting position - lying on your back. With your left hand, fix the child’s left hip joint, with the bent hand of your right hand, covering the knee, gently rotate the thigh inward, while simultaneously pressing on the knee and moving the shin outward. Repeat 4-6 times for each leg.

Exercise 8. Leg bending. Starting position - lying on your stomach. Place the palm of your left hand on the child’s right buttock, with your right hand, grabbing the shin, bend the leg at the knee and hip joints. Repeat 4-6 times for each leg.

Therapeutic exercises for children in the second half of life (with the splint removed)

Exercise 1. Starting position - lying on your back, legs straight to the sides. Encourage the child to rise to a sitting position horizontal position abducted legs. Repeat 4-5 times.

Exercise 2. Starting position - sitting, legs extended to the sides. Leave the baby in this position for 2-3 minutes, then let the child lie on his back on his own. Repeat 4-5 times.

As soon as the child begins to sit independently, the highchair should be modified (changed) so that the baby can sit in it with his hips wide apart. To do this, an insert measuring 12-15 cm is attached to the front edge of the seat. In baby walkers, a spacer cushion is installed opposite the child’s crotch measuring 15x10x3 cm. Recommended toys: horse (seat with hips wide apart), tricycle with a wide saddle (no pedals).

An approximate set of special exercises for preschool children with congenital hip dislocation

For children 5-6 years old, to consolidate the results of conservative treatment (or for follow-up treatment), exercise therapy is carried out 3 times a week for 20 minutes.

Exercise 1. Starting position - sitting on a chair. Alternately bend and straighten your feet. Repeat 4-6 times.

Exercise 2. Starting position - lying on your back. Alternately bend and straighten your legs at the knee and hip joints. Repeat 6-8 times for each leg.

Exercise 3. Starting position - standing with support on the crossbar. Abduct and adduct the straight leg without support on the floor, pull the toe towards you with the foot in a vertical position. Repeat 4-6 times with each leg.

Exercise 4. Starting position - standing, arms down along the body. Raise your arms up through your sides, reach for your arms, lower your arms, return to the starting position. Repeat 3-4 times.

Exercise 5. Hang the ball at a height of 0.5 m. Kick the ball 4-6 times with each foot.

Exercise 6. Starting position - sitting on a chair, legs bent, feet on the floor. Smoothly spread your hips to the sides and just as slowly return to the starting position. Repeat 4-6 times.

Exercise 7. Starting position - lying on your stomach. Tighten and relax the muscles of the buttocks 6-8 times.

Exercise 8. Starting position - lying on your stomach. Lightly tap your heels on your buttocks 4-6 times.

Exercise 9. Starting position - standing on all fours. Withdraw bent leg to the side. Repeat 3-4 times with each leg.

Exercise 10. Hit a ball suspended at a height of 0.5 m with your heel 4-6 times with each foot.

If conservative treatment methods are ineffective, arthrotomy with arthroplasty is performed. In the period before the operation (1.5-3 months), general strengthening and toning exercises are carried out, the skill of voluntary muscle relaxation is trained (which is necessary for skeletal traction when the femoral head is high).

On the second day after surgery, therapeutic exercises are prescribed to strengthen the gluteal muscles and increase mobility in the hip joint. The plaster cast is removed 1 month after surgery.

Approximate complex special exercises in the postoperative period

Exercise 1. Starting position - lying on your stomach, legs extended. Alternately bend and straighten your legs knee joint. Repeat 8-10 times for each leg.

Exercise 2. Starting position - lying on your stomach, legs extended. Alternately raise straight legs up. Repeat 8-10 times for each leg.

Exercise 3. Starting position - lying on your stomach, legs extended. At the same time, raise your straight legs up. Repeat 6-8 times.

Exercise 4. Starting position - lying on your healthy side. Abduct the leg bent at the knee. Repeat 5-6 times for each leg.

Exercise 5. Starting position - lying on your healthy side. Move your straight leg to the side. Repeat 5-6 times for each leg.

Exercise 6. Starting position - lying on your stomach, on your leg (on the side of the operated joint), and attach a weight (a bag of sand) to the area of ​​the middle third of the lower leg. Extend your straight leg with weights upward. Repeat 3-5 times for each leg.

Exercise 7. Starting position - lying on your healthy side. Move the straight leg with the weight to the side. Repeat 3-5 times for each leg.

This set of exercises was given by Lena (Ex-unregistered) at the “Other Children” conference on 7ya, she literally put her daughter on her feet.
Perhaps many are already doing such exercises, but for some it will be something new, so, I quote Lena verbatim:
Indeed, it would probably be easier to post these exercises here rather than send them personally to everyone. I would like to write a little more about the treatment. We were diagnosed early, within a month. At the clinic, the neurologist saw nothing. But we had a double intestinal infection from the maternity hospital - staphylococcus and E. coli. We were sent for a month's consultation to the Institute of Children's Infections, and there we found a wonderful doctor. He literally turned the child over in his hands for 5 minutes and said that first of all we would go to their chief neurologist. And half an hour later I came out with my hair standing on end... So we started studying right away. We were treated at Hospital No. 25 on Gavrskaya. Of course, it was scary to go to bed with such a little one, but the fear of the diagnosis was overwhelming. I believe that we have very qualified specialists in this hospital in St. Petersburg. ICP was treated at Raufhus by neurosurgery, since there was a terrible relapse at 2 years old; at first we were told that there was a “massive process” - this is how they delicately called a brain tumor. Speech therapy techniques were also given to us by a speech therapist at Hospital No. 25; between courses we studied at home all the time. When the girl started talking at 2 years old, it became clear that she had a very bad memory. Poems were taught every day. I also re-read a bunch of books on defectology and I liked the idea that when dealing with PMMR you need to be proactive. They were so ahead that she went to school at the age of 6 straight into 2nd grade. True, later this turned out to have many disadvantages and we regretted it. The diagnosis was removed when we were 4.5 years old; the residual diagnosis was MCD in the form of left-sided hemisyndrome. This was also dealt with with a massage. Yes, I did massage myself from the age of 2, completed special courses with an emphasis on this pathology, and until I was 2 years old we had a very good masseuse. She showed me acupressure, and during exercise therapy I myself removed spasticity - we had spasticity against the background of the atonic-astatic form in individual muscles. As I understand from a lot of literature I have read, the most important (and difficult) thing with cerebral palsy is to achieve the correct development and change of reflexes. You can normalize the tone, but if the tonic reflexes do not fade and the adjustment reflexes develop, motor skills will still not develop. I send the exercises in the form in which I have already sent them to other parents; it takes too long to retype them. Courage and success to everyone. Don’t go to healers, it’s just a waste of money and time. And by the way, Orthodox Church this condemns...Everything doesn’t go through at once, I send it in pieces.
Complex for extinguishing tonic reflexes.
The labyrinthine tonic reflex (LTR) manifests itself in two positions - on the back and on the stomach. On the back, LTR is manifested by an increase in tone in all extensor muscles of the body. This leads to
the spine and legs are straightened, the tone in the adductor and inward rotating muscles of the thighs reflexively increases. The arms can be abducted or bent and brought towards the body. The child cannot raise his head, move his shoulders forward, and subsequently he cannot roll over and sit down. To eliminate this reflex good result gives "fetal position".
1. Using constant light shaking, the patient’s limbs are grouped into a position of maximum flexion, the head is brought to the chest in the middle position, the arms are bent on the chest, and the legs are either brought to the stomach, or, with high tone of the adductor muscles, slightly spread. This position helps to stretch previously shortened muscles, and additional constant rocking in this position helps to relax and normalize muscle tone.
2. On big ball. The child lies with his stomach on the ball, his arms are extended along the ball, his legs are extended along the ball and spread apart. Swinging on the ball back and forth, from side to side.

Continuation:
On the abdomen, LTR is manifested by tension in the flexor muscles of the body. The head and arms are bent towards the chest, and the legs are brought towards the stomach. The child cannot raise his head, straighten his arms, or straighten his torso. This deprives him of the opportunity to lean, rise, and then sit down and stand up.
3. On the ball. The child lies on his back, legs extended along the ball (hold with hand). The head is thrown back, the arms are relaxed and thrown back behind the head. Rolling the ball back and forth.
Tonic cervical symmetrical (TSC) - when tilting the head forward and down
muscle tone increases - upper flexors and lower extensors
limbs. The child cannot alternately bend and straighten his legs, cannot move his head in isolation, without causing cooperative movements of the limbs.
4. To slow down the TSR in the initial position on the stomach, with a pillow placed under the chest, the child is held in the middle position and passively straightening the arms resting on the palm.
5. In the starting position, lying on your back. The legs are spread as far apart as possible and
turned outward and resting on the hips of the practitioner, performing passive sittings.
6. Starting position on all fours with a ball or roller under the chest. If the child has pronounced plantar flexion of the feet, they should be lowered beyond the edge of the support. The head is flexed passively, keeping the arms straight and legs bent.
7. In the starting position on all fours with a ball or roller under the chest with straightened legs and bent arms at the elbow joints, passive extension of the head and retention of bent arms and straightened legs are carried out.
The tonic cervical asymmetric reflex depends on rotational movements in the cervical spine. Rotation of the head to the side increases the tone of the extensors of the limbs on the side where the face is turned and the tone of the flexors on the side where the back of the head is turned. It is extinguished by the development of an asymmetrical righting reflex.
8. The child stands on the table with his back to the instructor so that the heel hangs down. One leg is bent at the knee and held in this position by the instructor. Then the child is tilted down with a sharp turn of the body by the arm of the same name as the leg. The child reflexively makes a reverse turn of the body and, straightening his leg, rises.
9. The child lies on his back. Following the passive turn of the child's head, his shoulders and torso are slowly turned in the same direction.
10. Lying on his back. Following the passive rotation of the lower limbs and pelvis, the shoulders are slowly turned in the same direction.
11. The child hangs face down from the table at waist level. Holding the pelvis, first give the body the following position: the head is raised, the child is looking forward and upward, the body is bent upward in an arc (“fish”). The arms can first be brought towards the body, and as you master this pose, ensure that they are extended forward or spread out to the sides. Raising the head is achieved, I stimulate neck muscles and rectus dorsi muscles (along the spine).
12. The child is hanging from the table bottom bodies. The head is raised (as in the previous exercise), the hands rest on the table at shoulder level. Before performing the exercise, relax your legs. They stimulate the abdominal and back muscles, giving the back half of the body an upward curved position (“fish with legs”). At first, these movements are performed by the instructor for the child; gradually, you need to achieve independent holding of the pose when giving the child the starting position.
Continuation:
13. "Fish on its side." The child hangs sideways over the edge of the table. Arms are extended forward, try to (first passively, then actively) raise the head up, while the upper leg should also rise up.
14. The same on the ball when rocking back and forth and from side to side.
15. The same when soaring (the child is held in the air by the waist). They move on to this exercise after mastering the previous ones.
Moro reflex, Babinski reflex and Perez-Galant reflex are extinguished
With exercises of the complex aimed at developing motor skills, thermal procedures also help well. We made azokerite (medicinal mud) at home. The oral reflex gradually goes away on its own; I observed it in one child until he was 6 years old.
Complex for the development of motor skills.
With spastic tetraplegia, it is very important to relieve tone constantly,
It would be good for you to find a massage therapist who knows acupressure so that he can show you the main points for relieving tone. Then, in the process of studying with
As a child, you could relieve spasticity yourself. Points can be
ask the massage therapist to mark, for example, with brilliant green, until you yourself
learn to find them. Gentle shaking also relieves tone well.
like vibration, with arms and legs. During classes, you need to pay attention
so that the limbs, especially the hands, are not clamped, but open.
You can shake and stroke your hands to achieve their relaxation and
openness. For classes you need to purchase several inflatable balls
appropriate size (will be clear from the description of the exercises).
Exercises on the ball are very important - they allow you to develop support in
limbs and train the ability to maintain balance, without it
the child will not sit down and will not master the position on all fours, and this is the basis
development of further motor skills. You don’t need to walk yet, since you have
stepping over. We didn’t have a stepover until a year ago.
For classes you need a large table, it would be good to cover it for a while
doing something prickly, so that when developing support, she gets irritated
skin on the palms and soles. Classes start and end
training in the fetal position (you know?).
So, exercises to teach movements.
1. Training turns from a supine position. Bend the child's left leg at the knee, press the foot with one hand to the table so that the child feels support on this leg. Pressing the foot with the elbow, hand
take the left hand, force the child to bend the hand at the elbow, press
his hand to the table at waist level. This creates a support for
movements. In this case, you use one hand. Take with your other hand
the child’s right hand and make him reach with this hand to his elbow
left hand. Grasping your right hand with your other hand, quickly grab the
right foot and stretch it towards the table next to the left foot resting on
table. Thus, the right arm and leg do almost simultaneously
cross motion, and the child turns over onto his stomach. The description makes it seem difficult, but you'll get the hang of it quickly. In the same way, train turning to the right, relying on your right arm and leg. If during an exercise the child “squeezes”, you need to achieve relaxation; the feet and hands should be open with full support.
2. Training turns from a prone position. Leaning on the arm bent at the elbow, stretch back with the leg of the same side, at the same time
the opposite handle stretches forward, further behind the head to
the opposite side in a cross motion, and the leg of the same side bends at the knee and makes a pushing motion from the table with the foot. After several repetitions of these exercises, it is useful to do a cycle of turns from your back to your stomach and vice versa several times.
Continuation:
3. Squat training. Lying on his back, bend both arms at the elbows and press them to the table at waist level so that the child feels supported by his arms. Pressing one hand to the table, reach with the other hand to the knee on the opposite side, while the child should sit down, and immediately rest the hand that was reaching for the knee with the hand on the table at the level of this knee. That is, the child makes a cross movement with his hand and sits down with a turn. Repeat the same with the extremities of the other side. My girl mastered normal sitting down after all the movements, and sat down in her own way from a position on all fours. However, it is very important exercise. It allows the child to master the transition to a position on all fours.
4. Support training on the hands. The child lies on his stomach on the ball
so that his arms and legs hang freely behind and in front of the ball.
Hold the child on the ball with your left hand by the back. Let yours down
right hand under the child's arms. With your left hand, swing the ball forward
At the same time, with your right hand, you seem to knock the child’s arms forward, so
so that when the child's head goes down, she throws her arms forward and
leaned on her hands. This is a very important exercise to practice.
support. Normal children, if you take them and tilt them upside down,
reflexively throw their arms forward in front of their head. Those with cerebral palsy have this
there is no movement.
5. Development of foot support. Also lying on the ball, with your right hand
swing the ball back (that is, the tilt goes towards your feet), and with your left hand
ensure that the child leans on his legs (press his feet,
fix them, move your leg on the table so that the child
a support stereotype was formed).
6. On the same ball. The exercise is aimed at training the ability to hold
equilibrium. Without this, the child will not sit down. We did it not on the table, but
on the floor. Place the child on top of the ball so that at any time
Losing her balance, she could lean against your knees. Brush
Take her hand with one hand, reach down and lean on the ball. The ball tilts in the same direction. At the same time, take the child’s head with your other hand and tilt it towards the shoulder of the opposite side. That is, the hand goes down with support on the ball, and the head tilts in the opposite direction. Do the same in the opposite direction.
7. Training the same movement on a table. The child sits with his legs dangling
down. Hold your shoulders with one hand and tilt your body to the side,
with the other hand you push out her handle and get her to lean on it
on the table.
8. On a smaller ball - balance training by supporting your feet.
The child sits on the ball, legs wide apart along the ball. With one hand, hold the child on the ball by the shoulders, at the same time tilt the ball forward, while with the other hand you take the leg and fix the foot on the table so that the child leans on this leg. Repeat with the other leg.
9. Training to move to a position on all fours. The child lies on
table on your stomach. Place one hand under her straightened arms,
force them to bend at the elbows and achieve support on the hands. With your second hand, alternately bend your knees so that she stands on her knees.
10. Crawling training. On a small ball. The child lies on the ball
stomach, hands and knees should rest against the table (fix
hands, fidget on the table, make sure the child is resting his hands).
Your right hand is extended between the ball and the child's hands. Moving
alternately with your elbow and palm, force the child to step over
the table with your hands. At the same time, move the ball forward along the table with your left hand. Thus, the child seems to crawl in his arms.
Continuation:
11. The same with the movement of the legs. Hold the child with your right hand
ball, simultaneously moving the ball forward (sleight of hand!), and with your left hand
move her legs bent at the knees. You need to feel that
the child rests his knees on the table.
12. Another exercise for hand support. The child lies on your
left arm bent at the elbow over the table so that her arms hang down
forward. Place your right hand under her arms resting on the table
(open palms!) and, as in exercise 10, alternately moving your elbow and hand, make her move her hands along the table. Your left hand is moving above the table at this time. Those. the child seems to be walking in his arms
table. This is a very difficult exercise for a methodologist, but it is done well
dads.
13. Training leg movements when crawling. The child is kneeling on the table. Your right hand is brought under her armpits, as if hanging on your hand. With your left hand, alternately move the child’s knees along the table, while simultaneously moving your right hand with the child forward.
14. Full workout resting on the hands and feet on the ball. The child is lying
on the ball with your stomach. Swinging the ball back and forth with one hand, with the other hand
at the same time, alternately force her to lean on her hands, then
on the feet.
15. Formation of an extensor position for the lower extremities.
The child lies on the table, legs apart and turned out as far as possible
outward and rest your feet on your thighs. Take the child by the hands and
sit down with your hands resting on the table.
16. Formation of the extension position of the arms. On the ball
on your stomach, bend your head down, keeping your arms straight
position, and legs bent at the knees.
17. The development of stepping is our own invention. We put the child on our own feet and, holding him by the armpits, walk around the room.
From our experience, I realized that when you perform some movement for a child 10,000 times, the necessary chain of signals arises in his brain and suddenly he begins to do it himself. It is better to exercise before meals. They also taught us in the hospital that even an immobile child needs space; when he sees around him not a bed, but a whole room, the motivation to move arises more easily. Therefore, we kept the child directly on the floor outside of sleep, and we ourselves entered this room, taking off our slippers at the threshold. I know from literature (and we used this) that it is easiest to focus your gaze on yellow objects. We wish everyone good luck in treatment and lots and lots of patience.

Infantile paralysis of the central nervous system or cerebral palsy is formed against the background of damage various departments brain and causes disorder motor functions The child has. Atonic astatic form Cerebral palsy is considered to be the most severe type of the disease. Today there are no doctors effective means for the treatment of serious disorders in the functioning of children, but some techniques can reduce negative manifestations. These include medicinal ones.

The importance of exercise therapy for cerebral palsy

1. A child goes down into the pool and grabs the side with his hands. The legs are alternately pulled back (5 times each). Then the legs are spread to the sides 10 times.
2. Turning over with his back to the side, the baby clings to it with his hands, lifts his legs up and spreads them to the sides. Do this 10 times.
3. Having laid the patient with his back on the water, you need to let him grab the side. The mother places her hands under the baby's back. Begin by lifting both legs up (10 times), spreading them to the sides (10 times), crossing the legs (“scissors” 10 times).
4. Turn the patient over onto his stomach, let him hold the side with his hands, and you support him by the stomach. Do alternating leg lifts 5 times, then sideways 10 times, and bending the knees of each limb 5 times.
5. With your child's back against the pool, ask him to take a sitting position. Then he must spin the “bicycle” with his legs in the water.

Additional simulators

To harmonize the intellectual and physical development of children with cerebral palsy, it is necessary to use, which you can buy or make with your own hands. A lumpy mat is perfect for therapeutic massage and physical exercise and will improve blood circulation in the limbs. Mats are sold in specialized pharmacies different sizes: separately for the foot, for the entire body. The rug can be placed near the baby's crib so that he can walk on it in the morning.

To eliminate spasticity of the fingers, which is often observed in patients with cerebral palsy, sew a bag and fill it with cereal (rice, buckwheat). This homemade expander will prepare your hands for grasping and manipulating objects. This way you will get a wonderful one. Exercises with jumpers and walkers are also useful for the baby’s limbs.

Note!

You should not buy plastic walkers for a patient with cerebral palsy; they are unstable and can harm the child.

Brain diseases that develop in children require patience and perseverance from parents so that the child’s life is happy and fulfilling. Of course, a complete cure is out of the question, but exercise therapy complexes that are created for such children can achieve a lot. They raise physical abilities children and make life easier for parents. Training programs are compiled individually, but with regular implementation they ensure common success for everyone.

Video - Unusual exercise for children with cerebral palsy

People have not yet found a treatment that can restore the damaged brain. However, if you work according to a scientifically based program, then the nervous system, which is in an intact state, can perform all its functions, and also take on some of the functions of the damaged areas. Programs for physical education play a leading role in the comprehensive rehabilitation of children with cerebral palsy. One of the main elements of almost any treatment program is therapeutic Physical Culture(physical therapy), and other types of therapy based on movement - kinesitherapy, Bobath therapy, Vojta therapy and others.

As a term, exercise therapy refers to a branch of medicine that studies the treatment and prevention of diseases using physical education methods. In addition, exercise therapy is an independent scientific discipline, officially recognized in many countries of the world, including Russia.

On the other hand, it is a medical procedure that is used for restorative rehabilitation and treatment of sick and disabled people, as well as the prevention of various diseases. The main means of exercise therapy is exercise stress in different forms.

The main therapeutic method of exercise therapy is therapeutic exercises - physical exercise, individually selected for each specific case. For children, play forms of exercises are most often used, for example, using a ball. This helps stimulate the child's interest and direct his desire to motor activity in the right direction.

​ History of therapeutic physical culture​​​​

In ancient China, even in ancient times - several thousand years BC, physical exercise was used to improve health. In those days, there were medical gymnastics schools, where they taught therapeutic gymnastics and massage, and used them in the process of treating patients. In Chinese medical and gymnastic schools, diseases of the heart, lungs, curvature of the spine, bone fractures and dislocations were treated. In the VI century. n. e. For the first time in the world, a state medical institute was created in China, where therapeutic massage and gymnastics were already taught as a compulsory discipline. Since then, various gymnastics adapted for individual health activities, in various combinations, are widely used in Chinese sanatoriums and rest homes as the main form of exercise therapy.

The famous ancient Chinese physician Hua Tuo, who lived in the second century AD, the founder of Chinese hygienic gymnastics, argued: “The body requires exercise, but not to the point of exhaustion, for exercise is intended to eliminate bad spirits from the body, promote blood circulation and prevent illnesses.” “If the door handle moves frequently, it will not rust. Likewise, if a person moves a lot, he doesn’t get sick.” Two thousand years have passed since the life of the doctor, but the principle of Chinese physical culture is still the same - the search for health in physical activity: from morning exercises to martial art.

Exercise therapy for cerebral palsy

Therapeutic physical education is one of the most effective and popular means of rehabilitation of children with cerebral palsy of various forms. The main goals of exercise therapy for cerebral palsy are: reducing muscle hypertonicity, improving coordination, increasing the range of motion in joints, training weakened muscles, and consolidating correct motor stereotypes.

When doing exercise therapy, it is necessary to take into account an important circumstance - children with cerebral palsy, as a rule, get tired much faster than their healthy peers. Therefore, it is important to alternate exercises with high and low loads, and give a short rest after the procedure. It is not forbidden to send your child for a massage after exercise therapy, or do it yourself. In general, a combination of several procedures (read: types of therapeutic effects) can significantly increase the overall effectiveness of rehabilitation.

Speaking about the features of exercise therapy for cerebral palsy, it is important to follow the following conditions:

• Use an individual approach

• Maintain consistency and systematicity

• Gradually and measuredly increase the load

Physical activity during exercise therapy classes is calculated taking into account the individual capabilities and characteristics of the child. Over time, as the musculoskeletal system develops, it should increase.

If a patient has a hyperkinetic form of cerebral palsy, then...

In this case, physical therapy aims to achieve normalization of the patient’s postures and movements, improve coordination of movements, inhibit hyperkinesis, and also provide training in everyday skills.

In the atonic-astatic form of cerebral palsy...

With double hemiplegia...

Must be given Special attention exercises in which the hand works are exercises for extending the hand, grasping small objects, and also exercises with abduction of the lower extremities. Moreover, easier conditions are created for performing these exercises.

As for spastic diplegia, then...

For this disease, coordination and balance exercises, relaxation exercises, and positional treatment are widely used. Teaching patients to walk is of no small importance.

If a child is given a neurological diagnosis of cerebral palsy, it is extremely important to begin correctional and educational work as early as possible. This is due to the peculiarities of physical development - the high plasticity of the child’s brain, and its ability to compensate for impaired and lost functions. It is important to understand that neurological problems and delays in physical development body, also entail a significant delay in the psychomotor development of the child. It must be remembered that physical therapy alone is unable to cope with such a serious illness as cerebral palsy. Rehabilitation work with children with cerebral palsy must be comprehensive; limiting oneself to one procedure or one course of treatment per year will be ineffective. Every parent of a special child must be aware of the need for ongoing comprehensive treatment.

It is important to know that in case of a hyperkinetic form of cerebral palsy, when doing exercise therapy, it is necessary to avoid some restrictions, namely: limit exercise on exercise machines, exercises with dumbbells and other heavy objects, as well as jumping exercises, running short distances. All these exercises help to further increase muscle tone, so they must be approached with caution. In general, it must be said that sick children should not exercise on exercise equipment. As the child ages, the formation of contractures increases and muscle tone increases. And training on exercise machines leads to even greater contractures, muscles become clogged, and coordination of movements is impaired. There is also an increase in muscle spasticity, and this often contributes to the appearance of pain; the muscles cannot be relaxed. Considering all these factors, it is better for children with cerebral palsy to refrain from exercising on exercise equipment. Children with cerebral palsy are contraindicated for exercising on most sports equipment, except those that have been specially designed for these purposes. These include, for example, a hippo simulator or a Motomed simulator.

​ Children and teenagers around school age with cerebral palsy, doing physical therapy, they train certain work skills and self-care skills. Many parents do not realize the importance of teaching their child to take care of himself first.

Exercise therapy for various diseases and paralysis nervous system sets itself the following tasks:

• Providing a healing and restorative effect on the body
• Improving blood circulation and metabolic processes in problem areas
• Improvement and stimulation of metabolic processes in the body
• Combating the formation of adhesions between nerve sheaths and surrounding tissues
• Strengthening weakened muscles, increasing range of motion and amplitude, restoring coordination of movements
• Combating related problems and disorders of cerebral palsy - spinal curvature, spasticity and many others.

The purpose of the exercises is to relieve muscle tension, expand the range of motion and develop the musculoskeletal system.

Exercises to develop muscle sensitivity; to generate force that makes it possible to regulate a certain area of ​​the muscle.

Exercises to improve functional status nerve tissue through training the sensitivity of the nerves.

Endurance exercises, to maintain the efficiency of organ functioning.

Relaxation training, to eliminate spasms, tension and cramps.

Resistance exercises: Gradually increasing resistance training to develop muscle strength.

At the First Step medical center, you can sign up for physical therapy classes with more than 5 different specialists, and also choose a Russian or Chinese instructor.

Each instructor has extensive experience working with children and his own profile - some have received additional training in Vojta therapy, others in Bobath therapy or in other areas. Regardless of their specialization, they all get along well with children and know their job very well.

Signing up for exercise therapy in Kazan is very simple - just contact the First Step medical center. To do this, call us toll-free at 8-800-500-54-86, or request a call back. In addition, our online consultant can answer all your questions.

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The congenital disease cerebral palsy is a paralysis of the central nervous system that can occur in a child due to damage to certain parts of the brain. Impaired motor functions may begin to progress in the prenatal or childbirth period, as well as in the first days of life. With cerebral palsy, spastic syndrome is often encountered - a painful increase in muscle tone and tendon reflexes. You can reduce the negative consequences of the disorder at home with the help of gymnastic exercises recommended for cerebral palsy.

Therapeutic effect of exercise

Therapeutic physical education (PT) helps you learn to control your body. While doing special therapeutic exercises for children with cerebral palsy, it is possible to improve coordination, inhibition processes, and motor amplitude. The technique is an integral part of an integral complex aimed at reducing the manifestations of the disease caused by cerebral disorders.

Therapeutic effects of exercise therapy on the body:

1. Strengthens the tissues and organs of the child's body.
2. Activates weakened muscles.
3. Improves posture.
4. Normalizes metabolism.
5. Improves the functioning of the brain and circulatory system.
6. Promotes overall health.

With regular training, you can achieve the following results:

• developing the child’s necessary basic skills;
• mastering simple work activities;
• servicing yourself without outside help.

Need to start carrying out exercise therapy as early as possible, in the first days of life, gradually complicating the classes. Moreover, physical education must be carried out if the newborn has no symptoms of cerebral palsy, but is predisposed to its development.

Basic principles of the technique

1. At the core physical therapy there are a number of basic principles:
2. Classes are held regularly, without absences or long breaks.
3. Gradual increase in physical activity.
4. Individual approach.
5. Conducting classes taking into account the stage of the disease, age, and mental state.

Along with exercise therapy, correctional and educational measures must be carried out to compensate for functional impairments.

Types of exercises and features of classes

Any health-improving exercises should be selected taking into account the needs of each individual patient. However, each exercise program includes the following types of exercises:

• relaxing;
• helping to improve dynamics;
• stimulating motor activity;
• performed lying down;
• performed while sitting;
• having a gaming orientation.

If gait is difficult, or the patient is unable to walk, the exercise should be carried out near bars or rigid support. On next stage The lesson continues near the wall. In order for the center of gravity to be equally distributed on both sides of the body, actions are performed first with some limbs, for example, the right arm or leg, then with others. The weaker side is given a greater load. Squats should not be performed deeply; most often they are performed only at a distance from the knee to the foot (half squat).

Exercises for the development of the musculoskeletal system

If the central or peripheral nervous system is damaged, a disturbance in the movement of the upper or lower extremities may occur - tetraparesis. Relevant gymnastic exercises it is possible to strengthen the motor skills of disabled children and increase the level of control over their actions.

Exercises that improve motor activity:

1. Starting position - sitting on your heels. The adult conducting physical therapy puts his palms on his shoulders, then holds the child in the hip area, gradually pushing him to kneel.
2. At first, the child sits on his lap. Holding it in axillary area, you should start moving from side to side so that he learns to independently transfer his body weight to one leg. He tries to lift his other leg from the fulcrum and spread his arms to the sides.
3. You need to turn to face the child sitting on the chair. An adult fixes his legs on the floor with his own and takes him by the hands. The arms are extended forward and upward, so the patient with cerebral palsy will learn to stand up on their own.
4. Starting position - standing, feet placed in one line (one after another). You need to take turns lightly pushing the little patient in the back, then in the chest. Such actions will teach him to maintain balance.
5. Starting position - standing. Holding the child by the hand, you need to rock him different sides so that he can try to step on his own.

Lie on your back with a wall or other support nearby. We must try to press our feet onto a hard surface, training our ability to stand firmly on the ground.

Exercises to strengthen joints

With cerebral palsy, various joint pathologies, cramps and joint pain are common. Exercises necessary for their development:

1. The exercise is performed lying down. One leg needs to be straightened and fixed, the other gradually bent at the knee. If possible, the thigh should be pressed to the stomach, then pulled back.
2. While on your side and keeping your knee bent, you need to slowly begin to abduct your hip.
3. You need to lean your stomach against the table so that your legs can hang freely, then gradually straighten them.
4. The starting position is on your back. First you need to bend your knee, then straighten it as far as possible.
5. The starting position is lying on your stomach, with a cushion placed under your chest. Holding the patient's hands, you need to lift top part body, making slightly jerky springy movements.
6. The arm of a child lying on his back must be bent so that his face remains turned in the same direction. Then the limb bends when turning the head in the other direction.

Strengthening your abdominal muscles

As part of exercise therapy, classes are conducted that develop and strengthen a group of muscles located in the abdominal cavity:

1. The child needs to be placed on his knees, pressing his back to your chest, and then you need to bend down with him. In the next step, the legs and pelvic area of ​​the small patient are fixed so that he can rise on his own.
2. Starting position - lying on your back, arms pressed to your body. Making swinging movements and not helping yourself with your hands, you should try to roll onto your stomach and back.
3. Lying on your back, inhale and exhale, drawing in your stomach as you exhale.

Improved stretching

Activities that increase stretching and flexibility help achieve the following results:

• the severity of pathologies of the back and spine decreases;
• the condition of the spinal cord and spinal nerve endings improves;
• the muscles of the limbs are strengthened.

Sitting on the floor, you need to straighten your legs, while your body should form a right angle with them. While inhaling, you should extend your arms in front of you. As you exhale, try to bend down to reach your toes with your hands. An adult can help by lowering the body even further so that the forehead also touches the legs.

Starting position - on your stomach, arms extended along the body. The emphasis is placed on the palms, with a gradual rise of the chest. It is important to ensure that your head is thrown back and your breathing is even.

Lying on your back, your legs, without bending at the knees, are connected and raised above your head. You should try to reach the floor above the top of your head with your toes. Hands should not be lifted off the floor.

From a sitting position on the floor, bend your right leg so that your heel reaches your left thigh. The left foot should be on the right side of the other knee joint.

The right hand is moved around the left knee, it needs to hold the left leg. After performing these actions, the left hand is removed behind the back to the other side of the waist. At the same time, the head is turned to the left side, a tilt is made to touch the chin to the left shoulder. The right knee remains pressed to the floor.

Relaxation exercises

There are exercises for the upper and lower extremities:

1. To give you a rest upper limbs, you need to lie down, then fix your head, arm and leg on one side using weights, for example, sandbags.
2. The free arm is bent at the elbow joint, the forearm is held by the adult conducting the gymnastics. The hand must be fixed until the muscle tone decreases, after which the hand is shaken, then it must be alternately bent, rotated and moved to the side.
3. In the lying position, the fixed arms and legs are in contact with the stomach. An adult holds his shins, abducting his legs at the hip joint. After fixing one leg, you should make circular movements, trying to pull the leg. Legs need to be alternated.

Breathing exercises

All actions must be performed lying on your back, sitting down some time later, then moving to a standing position. Gymnastics that correct breathing:

1. The child needs to be shown how to take a deep breath and exhale through the nose and mouth. You can inflate balls, rubber toys, soap bubbles.
2. Different vowel sounds are pronounced at different volumes. You can alternate with singing and playing wind instruments.
3. On the count of one, raise your arms up and inhale; on the count of two, extend your arms down and exhale. The exercise will be more difficult if, as you exhale, your head plunges into the water.

Game exercises

Such elements of exercise therapy help maintain interest in the activity, while at the same time promoting relaxation. Game elements Exercise therapy:

Destroyer of towers. For this game, special soft modules or ordinary pillows can be used. If a child is able to build a tower, he does it himself; if not, adults help him. The main task is to destroy the tower.

Get out quickly. You'll need pillows again. This time the child lies on a gymnastics mat, the adult puts about 6 pillows on it and explains that on the count of three he needs to free himself.

Folding knife. Starting position - fetal position. The command is given: “the knife opens”: at the same time you need to pull your arms up and your legs down, remaining on your side. The action is performed at a measured pace. Then the “knife” must be folded. Slowly, the arms are pulled up to the chest, and the legs are pulled up to the stomach. The “knife” is complicated. The exercise is repeated three times on each side.

Sausage. The starting position is lying on your back. The adult carefully grabs the baby's ankles and begins to slowly turn the child in different directions. Gradually the pace accelerates.

Lion on the hunt. Good for group classes. Children sit on their heels with emphasis on their knees around a large soft module (you can purchase a special one or use gymnastic mats as an “island”). An adult tells a short story about a lion: “Once upon a time there lived a lion. He was brave and dexterous, and he also liked hunting. He waited in ambush for prey so that no one could see him (children should, without straining, group themselves with their heads on their palms pressed to their knees). Then he quietly crept (they show how a lion sharpens its claws and stretches its back) and jumped (they rise on their hands, helping themselves with their legs, and fall onto a soft surface).”

It is impossible to say in advance exactly when improvements will occur. Much depends on the degree of damage and how severe the spastic syndrome is. To achieve a significant reduction in the manifestations of cerebral palsy, exercise therapy with such children needs to be done regularly, gradually and listening to the personal needs of each of them.