Nursing Methods for CP

The second problem is psychological -  a problem of behaviour of parents. They constantly should be ready to work, search for experts, to listen to these experts at all times  - even conflicting opinions, to compare these opinions, to show persistence and to trust in success. And, last, the third problem (we shall name it dependence somatics illnesses from the condition of the psyche) is a problem of development of the child for normal movements, overcoming the constraints of its body.

Here again the rehabilitation therapist's work is not only with the child, but also with the parents and dealing with their moods, from their belief that recovery of the child is extremely important to them. The nurse's role as a rehabilitation therapist for children's cerebral palsy, as the actual direction of modern nursing procedures, is based on the general principles of physical therapy, corresponding to the International norms of nursing procedures.

These principles are stated, in particular, in the classical work of Virginia Henderson "Main Principles of Nursing Procedures", published in 1996. It presents the International advice of nurses and is translated into more than on 20 languages. The basis of the theory of Virginia Henderson presents is the concept about the vital needs of the patient; an overall aim of all nursing procedures is their improvement. Realizing vital needs of the patient with children's cerebral palsy. The nurse helps to solve this designated problem. "... The help, rendered to the patient via the nurse, should promote discovering quickly how to give the patient independence" (from an article: Virginia Henderson and Her Theory of Nursing Procedures. — G.M.Perfileva, M.Kirkevod // Honey. The help. — 1998. — 1. — With. 13—17.

In the basic modern standard for the Russian public health services, for the model of development and procedures for children's cerebral palsy, the three following premises are presented:

1.)  Chidren's cerebral palsy has functional characteristics for the brain - there are no gross damages to the structures of the brain. The role of hypoxia as a factor in occurrences of children's cerebral palsy was discussed in detail by us in a previous publication (Nursing Procedures for Rehabilitation Therapy for Children, Suffering from Children's Cerebral Paralysis // the Medical Nurse. — 2002. — 3. — With. 18—19). Here, I only shall list the topics: first, is a pregnancy trauma, hypoxia of the brain, a Rhesus factor causing premature pregnancy. This does not cause rough, irreversible organic defects of the brain, but, they nevertheless are capable of causing the expressed functional impairments that cause children's cerebral palsy.

2. Children's cerebral palsy is depicted by the expressed impairments of the locomotive apparatus, in particular spastic paresis and hyper-kinetic disorders. As writes L.O.Badaljan in monographs "Children's Neurology" (М.: ЕДпрессинформ, 2001. — With. 345—346): « more often forms of children's cerebral palsy on which the foreground of the muscular hypertension acts -  both arms, and legs. So in essence these forms of children's cerebral paralyses will cause th child to suffer from quadraparesis. Under the neurological characteristic of quadraparesis it is difficult to pin-point the central, spastic paralyses because the system is effected not only in a pyramidal tract, but also in the extra-pyramidal tract, as it is marked by discoordination pertaining to motor activity from the brain stem and the impellent centers.

Depending on the prevailing impairments of the arms and legs, right or left sides, distinguishes separate clinical variants whose names do not always correspond to classical eurologic terminology (for example, диплегия, double rемиплегия), but were fixed historically ». From frequent variants of the clinical picture of children's cerebral palsy, on L.O.Badaljanu, frustration of coordination concern for hyperkinetic syndrome; there is a hypotonic form — a so-called атонически-astatic syndrome less often. The semiology appears so diverse, that it is difficult to determine any concrete diagnosis.

Pertinently to result brief classification of different displays of the most frequent forms of children's cerebral palsy as on rehabilitation of some of them and the practical actions discussed further are directed. Spastic диплегия (syndrome Литтла) — it is the most frequent вcтречающаяся the form of a cerebral paralysis for which infringement of movements in the top and bottom finitenesses is characteristic, and legs are more amazed.

Spastic гемиплегия it is characterized by impellent infringements mainly on one party. The leg at spastic гемиплегии is amazed мень-
ше, than a hand. The muscular tone in a hand above, at the senior children a hand sometimes is in position « hands акушера ». Double гемиплегия it is characterized by infringement of movements of all finitenesses, and hands are amazed more, than legs. A áÔ«¡¿þÑ߬¿-astatic syndrome — "languid" form ДЦП; in a clinical picture on the foreground выступа- ет the expressed muscular hypotonia.

The hyperkinetic form is characterized by primary defeat of structures стриопалидарной systems. A muscular tone изменчив, it is frequent колеблется between a hypotonia and нормотонией; are observed пере- межающиеся spasms, attacks of increase of the muscular tone, caused by a changing activity of tonic reflexes on a background of a hypotonia. For мозжечковой forms are typical infringements коор-динации in a combination to spastic paralyses, a атонически-astatic syndrome.

3. To the additional infringements often meeting at ДЦП and demanding special actions sisterly патронирования, carry infringements of touch communications with world around: decrease Visual acuities, sensory acuities, partial loss of flavouring, tactile sensitivity, partial losses of speech function. In practice of rehabilitation it is necessary more often
To deal double гемиплегией or тетрапарезом and spastic гемиплегией.

These forms ДЦП badly give in to treatment as are characterized by so high pressure of muscles of finitenesses, that, as a rule, the child cannot be put on a stomach, to plant or Even распрямить its hand. At rehabilitation of children with these forms ДЦП it is necessary to develop the certain program sisterly патронирования which includes as actually rehabilitation of children, and psychological work with parents. Personal experience testifies, that parents not always understand all importance and the responsibility of that help which they can and should render the expert-реабилитологу

So, and to the child. The most important problem of rehabilitation at указан- ных forms of children's cerebral palsy — decrease in a high muscular tone. Many try to solve this problem, "breaking" hands and legs of the child. Our way of normalization of a muscular tone essentially differs from described in the literature. First, it is known, that tonic лабиринтный a reflex at children with children;s cerebral palsy, shown high Muscular tone, development physiological static and локомоторных skills brakes. Therefore we begin consecutive work on elimination of a high muscular tone as soon as possible — in the first 5 years of a life of the patient. Secondly, results of biophysical modelling of muscular activity establish following dependence:

Than with smaller force influence on Muscle, it is capable to answer those greater amplitude of a stretching influence, it is the extremely important for knowing at treatment спазмированной muscles. Our experience shows, that спазмированная the muscle as a result of repeating weak handling influences becomes more pliable to the subsequent similar воздей- ствиям. Usually we apply following rehabilitation actions:

1. In the beginning we spend superficial massage for a relaxation of fabrics (a lung поглаживание heads, backs and the amazed finitenesses of the child).

2. For each muscle with the expressed high tone We diagnose presence of the response to power influence, Which is expressed in occurrence of sharp mechanical resistance at the certain size of influence and тактильно is felt реабилитологом. We accept the established size of power influence for the top limit of influence.

3. Further, during carrying out actually manipulations, we carry out repeated, casual in a direction power influences, on size not surpassing before the established top limit. It is important, that alternation of these influences was not natural, they should be chaotic, i.e. разнонаправленными. Power influences consist in extension and-or twisting of muscles, bending and-or разгибании, Assignment and-or reduction of the top or bottom finitenesses, their rotation. Extension it is carried out with a speed of 0,4-0,6 mm/with, and rotation, bending-разгибание, assignment-reduction — with a speed 0,5—1,0 úÓáñ./with. Manipulations it is spent with muscles of the top humeral belt, a neck, the top and bottom finitenesses.

4. Duration of sessions — 90—120 mines, serially on each amazed muscle it is influenced during 3—5 minutes of Procedure are accompanied релаксирующим by music underneath. Practice testifies that, using the described procedures, it is possible to achieve decrease in a muscular tone and expressiveness of the generated pathological installations, so-called false brain patterns which are peculiar to patients ДЦП in the age of till 5 years. In the first 5 years of a life pathological processes in a brain обратимы, that does perspective rehabilitation of children of this age group.

On our supervision, carrying out of manipulations in the described mode promotes destruction generated in a brain of the child of installations on pathological poses, to formation new, correct, installations and healthy brain patterns.

As an example we shall result the concrete case record.

The patient, 4 years. The diagnosis: children;s cerebral palsy, double гемиплегия, impellent impairments in all finitenesses, and hands and legs are effected equally. The child because of a high tone of all groups сгибателей does not keep a pose laying on a stomach with the extended legs, does not hold a head in a prone position on a stomach. Active movements are absent in all groups of muscles of hands and legs. Because of a high tone аддукторов legs constantly keep « перекрест », hands are constantly pressed to a breast, a brush of hands Are sharply bent.

Treatment by the described way — 2 rates of manipulations, everyone on 10 sessions is lead. Duration of each session — 90—120 minutes Influence carried out on 3—5 mines serially on each amazed muscle. Results of treatment: спастика аддукторов it is partially eliminated, restriction in passive movement Hands it is removed, reduction of hands a breast is eliminated completely. Hands freely settle down along a trunk, passively rise upwards without refusal and in the parties; movements of fingers of hands are partially restored. The child keeps a pose laying on a stomach during 15—20 mines, laying on a stomach keep a head during 10—5 mines, passively deduces hands forward. The positive result is kept during 12 мес supervision.

Way of restoration normal muscular Tone at children in the age of till 5 years with spastic form children's cerebral palsy has passed examination of the State agency under patents, it is recognized by a new method of treatment and it is supported by the patent of the Russian Federation 2214209 from 29.07.2002.

Thus, the methods of rehabilitation therapy and the massage for children's cerebral palsy represents practical realization of socially meaningful problems of nursing procedures. Development of the program Nursing Rehabilitation therapy for Children's Cerebral Palsy and the organization of its practical implementation should and can be carried out within the limits of the general concept of nursing and medical aid. The way of restoration of a normal muscular tone at children in the age of till 5 years with the spastic form children's cerebral palsy, developed and applied by the author, with advantage is used in practice.
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