Cerebral Palsy - English

NURSING TECHNIQUES FOR CHILDREN,

 SUFFERING WITH

 CHILDREN'S CEREBRAL PARALYSIS.

Our purpose is the development of therapy and uniquely individual programs of non medical rehabilitation for sick children with cerebral palsy and the development of recommendations for their parents. This has been an ongoing problem for modern medicine.

Let's consider emotional questions. In the text books it is specified that during the progress of a child's cerebral paralysis, there is neural damage to the brain as a result of birth trauma, hypoxia or the Rhesus factor-disruption of pregnancy, which the clinical diagnosis is called, as a rule, spastic hypoxia. Clinical inspection of such children often does not reveal gross organic defects of the fabrics of the brain. Signs of hydrocephaly or insignificant cyst variations, which result in formation around a zone of pathological damage, are pronounced.

The analysis of the diagnosis, mentioned above, and a clinical picture of observation, is childrens cerebral palsy because the lack of gross organic defects of fabrics of the brain does not lend itself to non medicinal methods of treatment applied in therapy for childrens cerebral palsy. As medical methods of treatment do not solve problems of normalization of blood flow in the central nervous system, neurological activization of exchange processes in muscles and fabrics, and the most important cause,, activization of exchange processes in damaged neurons, thus causing them to awaken from a condition of "hibernation", i.e. a condition of functional cessation.

As of today, nursing procedures for the general complex of medical procedures applied during treatment of patients with childrens cerebral palsy, presents the problem of normalization of all neurological exchange processes. Powerful, and it is frequently the most meaningful of results, is a contribution attained by use of massage and medical gymnastics. Regular application of massage and medical gymnastics stimulate metabolic processes, improves conductivity of nerve fibers, creates optimum conditions for sufferers, (but not for victims of hypoxia) by preparing conditions for transmitting signals from the periphery of the brain to the center and back of the brain.

The most important in an expertly designed nursing procedure is a choice of a techniques for the individual sick child. For each child, one of the main criteria defining a component of treatment is the development of a strictly individual program of nursing procedures -  in other words individual, non medicinal rehabilitation.

Author N.A.Abrashina quoted above offers the recommendations for newborns for whom disease at an early age is certain. Our practice suggests to use these recommendations and for children of advanced age, namely, from one to five years old, probably will bring significant corrective improvements to the functions of an body damaged by illness.

Understanding the necessity to use feedback, for gradual restoration of the damaged areas of the brain, is the first main task for rehabilitation of sick children with cerebral paly. Facing the rehabilitation therapist is a challenge, not only a choice of an individual medical treatment complex for the given child, but also a choice of auxiliary means of treatment, such as every possible orthopedic stacking, the adaptation for giving to a body various orthopedic correction positions which, with certain exercises, allow generation of correct body poses so, through a feedback from the periphery to the center of the brain allow messages to be sent to the brain - a signal about correct position of a body in space. This problem is solved by means of massage and medical gymnastics in individual employment of orthopedic treatment for the sick child.

Second, not less important, is the problem of rehabilitation of the sick child concerning the development of concrete rehabilitation exercises and training of parents to assist with these exercises, encouraging belief for the parents in necessity of consecutive, persevering and persistent participation together with the nurse/therapist in the program of the developed recommendations for correction of the impaired functions. The results of this work comes not quickly. The expert should be not only assured of the correctness of the developed regimine of treatments, but also should be able to convince, at times, despaired parents of obligatory daily, persevering consecutive work with the child.

Let's look at some examples.

The child, is a boy four years old, with a very strongly pronounced muscular tonus. When he is In a position on his back he cannot lift his head, extend hands forward,  or bring them to his mouth. When he lays on his stomach, he cannot lift and straighten his head, and turn it aside, or free his hands and lean on them. All this is accompanied by strong spastic movements and the absence of impellent skills. For this boy the specified diagnosis is tetraparesis  - attacking both his arms and legs.

After four years the child has received many sessions of massage, but visible results have not been achieved. The child and parents desire to find all possible ways for his rehabilitation.

Let's describe process of work for the nurse/therapist with a mother, with a direction of correction for one of the impaired functions, in the form of typical dialogue of the nurse with the parent which often arises during rehabilitation work.

Day 1.

Nurse: For 20 minutes a day, with gradual increase in duration of time he should lay on his stomach..

Mother: He cannot -  he cries all of the time and refuses to lay on his stomach.

Nurse: Using a system of platens which I shall provide you, he can lay on his stomach, and you try something to borrow it at this time. Also, I shall show you a system of active points on the cervicothoracic area of a backbone which stimulate raising of his head while laying on his stomach. You should stimulate these points at regular times during the day with your hand.

Day 2..

Nurse: What is the amount of time he laid on a stomach?

Mother: He has lain only 5 minutes, and then he  begins to cry strongly and his grandmother has taken him into her arms. Further he refused the to do the required exercises.

Nurse: You have arranged the platens about which I spoke to you during  the last session?

Mother: I did not have time.

Nurse: it is extremely important for your child to lay on his stomach. The brain practically does not recognize this position, therefore it is necessary to put enormous efforts so that the brain either has remembered or has learned anew this position. Stimulation of active points which I have shown you last time, will help you.

Day 3

Nurse: What is the time laid on a stomach?

Mother: I worked all day, and his grandmother has not told me.

Nurse: He will never hold a head upright if we shall not generate the necessary adjusting reflex for the head, and it is possible after repeated recurrence of the same positions.

Child O. - a little girl 4.5 years old. The diagnosis at receipt on rehabilitation: Williams's complicated hypertensive syndrome.

The specified diagnosis: Williams's syndrome, the essential function which is a  tremor of hands and the heads, arising at excitation, gait on "tiptoes".

Approximately 400 sessions of massage were lperformed.  Parents find result insufficient.

It is established: the orthopedic footwear was not applied, bandaging stops in fixed extension position was not used.

Recommendations for the rehabilitation therapist:

1. Necessity of use of orthopedic footwear with rigid fixing stops in extension position for development of new installation of a brain on correct natural position stops.

2. Carrying out the exercises improving a support on all to stop,

3. Explanations to the parents about the necessity for the home exercises so that vast improvement for the arms and legs will be realized - and the work of the therapist will be more effective.

Typical repeated dialogue from the rehabilitation therapist with mother, as repitition is necessary for the child's exercises.

As a result of joint with parents of rehabilitation actions at the child the steady positive result has been reached. In a month of regular employment the girl began to lean steadily on all to stop.

Child D. - a little girl  3 years old - the diagnosis at beginning of rehabilitation: was circulatory hypoxia - n encephalopathy, cerebral palsy, the hyperkinetic form. At the moment of the reference essential impairment of functions is revealed: the girl is not able to move independently and  all over the body there are chaotic movements of hands, legs, and head.

As a result of the lead fivefold rate of medical massage, on 20 sessions each rate, the child has started to hold a steady vertical pose, the confident walking is restored, the child to carry out there were confidently various game manipulations.

These significant results have been reached owing to persistent work of parents together with nurse

Conclusions:

1. It is necessary to obtain the earliest diagnostics;

2. Duly development of professional, strictly individual program of nursing rehabilitation methods provides achievement in a short times period of positive effect for correction of one or several impaired functions;

3. The important components of a medical treatment program - development of the qualified recommendations for parents, training for realization of these recommendations and regular implimentation, and their persevering execution..

The list of the quoted literature: