First, the development of rheumatic movement is backward, and the active rheumatic movement is reduced.
The backward development of rheumatism is manifested in two aspects: coarse rheumatism and/or fine rheumatism. There are many indicators to judge whether the development of rheumatic sports is backward, and each movement has different performances in different years (months), but we should master some main indicators skillfully in clinical application. Normal children can look up in 3 months; 4 ~ 5 months old, can reach out and touch things actively, can hold his hands on his chest, and can play with his hands in front of him when he is quiet; At 6 ~ 7 months, he will sit alone on the hard bed without falling, and he will climb at 8 ~ 10 months, and the upper limbs or lower limbs will move alternately when climbing; 1 year old can be independent; I can walk when I am 1 ~ 1 years old and a half. Children with cerebral palsy generally can't reach the level of normal children at the above age.
Children with cerebral palsy often show reduced movements, poor sucking ability and poor foraging response in neonatal period. Normal 3-month-old children often have kicking and pedaling-like movements in supine position, and they kick alternately. Kicking abortion in children with cerebral palsy is obviously reduced, and there are few alternating movements. The upper limb activity consultation of children with normal 4 ~ 5 months is very flexible, and the upper limb activity consultation of children with cerebral palsy is also reduced. Normal children do not form right-handedness or left-handedness within the age of l, while spastic cerebral palsy hemiplegia is characterized by often holding or touching things with only one hand, and the activity consultation of the other hand is reduced, and the hand often clenches fists.
Second, abnormal muscle tone
Muscle tension is the tension of a muscle doctor in a quiet state. Through passive flexion, extension, pronation and supination of limbs, we can understand their muscle tension. Infants can hold their forearms and shake hands with antibiotics, and understand the muscle tension of upper limbs according to the consulting scope of hand activities. Measure the muscle tension of lower limbs, or hold the calf and swing its foot, and judge its tension according to the consulting range of foot activity. When the tension is low, the hand and foot shake is large, and when the tension is high, the activity consultation is small.
It can also be judged according to the consulting scope of joint activities. If the consultation range of passive rheumatic joint activities is large, it means that the muscle tension is low and the consultation range of joint activities is small, which means that the muscle tension is high. Knowing the consultation range of upper limb shoulder joint activities can look up the information "scarf sign", observe the relationship between elbow joint and trunk midline, and know the lower limb muscle tension can look up the information abduction angle, orbital angle, heel touch ear test and foot dorsiflexion angle.
When checking the information muscle tension, you can know it through the "traction test". This information is easy to grasp. Hold the child's hand, pull it from supine position to sitting position, observe the drooping of the head and understand the tension of the neck and back muscles.
The development process of muscle tension shows that the muscle tension of flexor muscles increases in neonatal period, and gradually decreases and tends to be normal with the increase of month age. Therefore, for some less severe spastic cerebral palsy, the increase of muscle tension is not obvious within 6 months, which sometimes leads to the difficulty in diagnosing the activity. However, some children with severe spastic cerebral palsy can still show increased muscle tone within 6 months.
The increase of muscle tension in spastic cerebral palsy is a "knife-folding", but it should be noted that if the limbs are repeatedly flexed and stretched when searching for information, the feeling of "knife-folding" will gradually become less obvious. The type of hand and foot peristalsis often does not increase muscle tension within the age of L, but appears with age, often in the shape of "gear" or "lead tube". Tonic type is characterized by increased muscle tension of "lead tube". * * * Dystonia type does not increase muscle tone, while hypotonia type is characterized by low muscle tone, increased consultation range of joint activities, but active or hyperactive tendon reflex.
Check the data, muscle tension should pay attention to parenting. Some older children with a long course of disease have limited joint activity consultation because of joint contracture. Don't mistake it for increased muscle tension.
Third, abnormal posture.