Operating standard of acupoint therapy:
(1) Integral acupoints: including head and neck acupoints, trunk acupoints and limbs acupoints. * * * Treatment duration 10 minute.
1. Head and neck acupoints: click Baihui, Tang Yin, Sibai, Bai Yang, Sizhukong, Jingming, Xiang Ying, Li Anquan, Chengjiang, Tianzhu, Naofu, Fengfu, Fengchi, Lvgu, Danggen (Wugong, located at the root of earlobe), Wangu and Dazhui.
2. Trunk acupoints: Pressing Jianjing, Guanyuanshu and other acupoints, tapping the meridians along the direction of Du Meridian and Bladder Meridian, pressing Jiaji Acupoint and pressing the sacrospinous muscle have the functions of promoting blood circulation and dredging collaterals, which is of positive significance for strengthening the muscle strength of waist and back, improving sitting posture and adjusting balance.
3. Acupoint selection of limbs: Acupoints are selected along the Yin San Meridian and Sanyang Meridian of limbs, with emphasis on tapping the meridians and acupoints passing through spastic muscle groups. At the same time, it can stimulate acupoints such as knuckles (Wugong point), nail roots (Wugong point) and twelve wells with kneading method, which has the functions of promoting blood circulation, dredging collaterals, relieving spasm and calming wind.
(2) local acupuncture: including local acupuncture and orthopedic manipulation, * * * treatment time 10 ~ 20 minutes. It is mainly used to treat joint contracture (deformity) caused by muscle spasm.
1. The local acupoint selection is mainly to tap and press the acupoints of the affected muscles and joints, and pay attention to the starting and ending points of muscles, muscle abdomen, the transition between muscle abdomen and tendon, muscle septum and the direction and distribution area of peripheral nerves. The stimulation intensity can be slightly heavier, and the finger strength should be vertical and deep, depending on the patient's pain.
2. Bone-setting manipulation refers to the combination of pulling, poking and pushing intermittently at the same time of acupoint treatment. The traction method is to pull the contracture joint with reverse force, slowly pull the spasmodic muscles (muscle groups), and pay attention to the gentle action to prevent muscle reflex spasm. Pulling is a method of pulling the starting and ending points of muscles, muscle abdomen and the transition between muscle abdomen and tendon with fingers when muscles are relaxed and tightened. Tuina is a method of pushing along muscles and meridians. Demonstration of key points of orthopedic manipulation (taking the right side as an example);
(1) adduction contracture deformity of shoulder joint. Passively abduct shoulder joint, massage and stir pectoralis major and latissimus dorsi at the same time, and click deltoid.
(2) shoulder extension contracture deformity. Passive flexion and external rotation of shoulder joint, massage and pull up latissimus dorsi and teres major at the same time.
(3) elbow flexion contracture deformity. Passively straighten the elbow joint, toggle the biceps brachii and triceps brachii, and click the triceps brachii.
(4) Forearm pronation deformity. The doctor holds the child's right elbow with his left hand, buckles the curved pool with his thumb, holds the ulna and the distal end of the radius with his right hand, puts his thumb on the back of the radius, and exerts relative force with both hands, so that the child's right forearm is passively supinated. At the same time, the index finger, middle finger and ring finger of the left hand are clenched, pronator teres is moved, and the right hand is moved, and the anterior muscle is rotated appropriately.
(5) Wrist flexion contracture deformity. Passive wrist extension is corrected by traction.
(6) thumb adduction and flexion contracture deformity. The doctor grasps 2~4 fingers of the patient's right hand with his right hand, and grasps the thumb with his left hand, so that the thumb is passively straightened, abduction and dorsiflexion are performed, and wrist dorsiflexion and forearm supination are performed.
(7) finger flexion contracture deformity. The doctor grasps 2~4 fingers of the patient's right hand with his right hand, and grasps the left palm with his left hand, so that the fingers are passively straightened and overstretched.
(8) Hip adduction contracture deformity. Do frog test, the hip joint bends 90&; Ordm, the knees are passively separated, and the adductor muscle of the thigh is plucked.
(9) flexion contracture deformity of hip joint. Press the front of the knee in supine position, press the sacroiliac part in prone position, so that the hip joint is extended backward and the lower part of iliopsoas muscle is gently pushed.
(10) flexion contracture deformity of knee joint. Press the knee in supine position, press the sacroiliac joint and ankle joint in prone position, and straighten the knee joint.
(1 1) horseshoe foot deformity. Foot adjustment method: the patient lies on his back with the doctor standing on his right. First passively stretch the ankle joint, then pull out the triceps brachii of the calf, and then lay the right foot flat. The doctor holds the front foot with the palm of his right hand, presses the left palm down at the height of the arch of the foot, and pulls the right hand far away at the same time, and a sound can be heard.
(12) Ankle varus contracture deformity. The ankle joint is passively stretched and everted, and the posterior tibial muscle is pulled.
(3) Relaxation technique: fully relax and lightly stimulate muscles, including pushing, twisting and patting for 2 minutes.
(4) Treatment of special symptoms: For patients with drooling and speech disorder, press and massage points Chengjiang, Li Anquan and Xiang Ying 4 times each, with thumb and forefinger opposite, and massage the larynx, hyoid bone and small muscles above hyoid bone 15 times each. Add a vertical root point for drooling, and add a dumb door point for speaking badly.
(5) Balance muscle strength: In addition to the direct treatment of spasmodic muscles, we should also pay attention to the stimulation treatment of corresponding antagonistic muscle groups.
(6) Functional exercise: According to children's functional disorders, formulate relevant exercise methods for parents to master and cooperate with exercise. It is mainly to practice the functions of reaching out, taking things, taking things, eating, dressing, squeezing buttons and standing and walking with the heels of lower limbs straight.
(7) Application of external fixation: For joint contracture deformity caused by severe muscle spasm, such as severe horseshoe foot deformity and knee flexion contracture, plaster external fixation can be combined to help correct it.
(8) Key technical links
1, click:
(1) According to the affected limb, the principle of selecting points locally and along meridians is adopted.
(2) Acupoints are selected according to the motor area and sensory area corresponding to the head;
(3) Selecting points according to the trend of nerve trunk of limbs;
(4) Acupoint selection according to muscle trend;
(5) Acupoints around joints, near the starting and ending points of muscles, near the muscle abdomen and tendon migration are sensitive and can be used as key acupoints.
2. Operation:
(1) For contracture muscles (muscle groups), acupoint stimulation can be slightly heavier (that is, purging method), and finger force should be vertical and deep, depending on the patient's pain. At the same time, click on its antagonistic muscle group to combine strength with weakness, with light as the main factor and heavy as the auxiliary factor (that is, complement method).
(2) When taking local acupoints for spastic cerebral palsy, pulling, poking and pushing are combined intermittently.
(9) Notes
Comprehensive and meticulous examination, clear the involved muscle groups and their meridians that lead to dysfunction, and the operation should be targeted. The intensity of treatment should be moderate, and it should be mastered reasonably according to the size and operating position of the child. The operation should be gentle and rough, so as not to cause muscle, ligament or neurovascular injury, or even avulsion fracture or diaphysis fracture. Before treatment, doctors should cut off long nails to avoid skin injury.
(10) Possible accidents and solutions.
1, subcutaneous ecchymosis and muscle hematoma. If the patient is prone to bleeding, or the doctor acupuncture too hard, this kind of injury may occur, often more obvious the next day. Once it appears, the treatment should be stopped, and local treatment can be left untreated. If the doctor's acupuncture intensity is too strong, observe for a few days, and then continue treatment after the reaction subsides, but pay attention to control.
2, skin abrasions. If the doctor's nails are too long, it may hurt the skin. In addition, in the treatment, the child's restlessness is also the main cause of skin abrasions. Once it appears, the treatment should be stopped, and local debridement, dressing change or topical drugs should be done as appropriate according to the injury.
3. Muscle tear, ligament injury, avulsion fracture. If the orthopedic manipulation is too urgent and the amplitude is too large, it may cause muscle reflex spasm, leading to muscle tear, ligament injury and even avulsion fracture. Once it appears, the treatment should be stopped. If necessary, further film inspection and processing will be conducted.