30% to 50% of cases of childhood acute hemiplegia have no identifiable cause, known as idiopathic childhood acute hemiplegia. The remaining cases can be attributed to underlying diseases and are referred to as symptomatic (secondary) childhood acute hemiplegia. Secondary childhood acute hemiplegia is commonly associated with infections, immune disorders, cranial vascular malformations, cranial trauma, heart diseases, blood disorders, and metabolic disorders. These conditions can cause occlusive cerebrovascular lesions, leading to hemiplegia.
Traditional Chinese medicine believes that tuina massage has a certain effect in treating childhood hemiplegia.
Traditional Chinese Medicine Tuina Treatment for Childhood Hemiplegia
Main Acupoints
Qihai, Guanyuan, Baihui, Bladder meridian of Foot Taiyang, Du meridian, Weizhong, Yanglingquan, etc.
Procedure
300 times of tonifying Spleen meridian, 300 times of tonifying Kidney meridian, 100 times of kneading Zhongwan, 5 minutes of abdominal rubbing, 100 times of pressing and kneading Zusanli, 100 times of pressing and kneading Baihui, 3 rounds of pressing and kneading the back shu points of the first side of the Bladder meridian, 5 rounds of rubbing the spine, 3 rounds of pinching the spine, rubbing the Du meridian and the first side of the Bladder meridian until the skin turns red.
For the upper limbs, knead Jianzhen, Quchi, and Hegu each for 1 minute, and repeat for 3 times.
For the lower limbs, knead Huanqiu, Chengfu, Weizhong, and Yanglingquan each for 1 minute, tap and pluck the inguinal region and the acupoints of the Bladder meridian of Foot Taiyang, shake the hip joint for 1 minute, passively flex and extend the ankle joint for 10 times, and repeat for 3 times of Achilles tendon plucking.
The child should undergo tuina treatment once a day, and observe the effectiveness after 30 sessions, which is considered as one course of treatment. After 6 courses of treatment, evaluate the therapeutic effect.
The above is a traditional Chinese medicine tuina technique for treating childhood hemiplegia. Although tuina massage cannot cure childhood hemiplegia completely, it can still have a certain effect in treating this acute condition with an unknown cause.
Nursing Measures
1. Safety Nursing
Assign a dedicated caregiver, provide meticulous care in daily life, promptly secure bed rails to prevent falls and injuries. If a hot water bag is needed due to the reduced movement and sensation in the affected limb, the temperature of the hot water bag should not be too high to avoid burns. Maintain unobstructed airways.
2. Dietary Nursing
Ensure sufficient calorie intake by developing a dietary plan based on the child's energy needs. Provide a light, high-protein, low-fat, low-cholesterol, and vitamin-rich diet, with small, frequent meals, and pay attention to food combinations to increase the child's appetite. For those who frequently vomit and cannot eat, observe their vomiting condition and temporarily withhold food when vomiting occurs. Provide intravenous fluid therapy to maintain fluid and electrolyte balance. For those with swallowing difficulties, early nasogastric feeding should be initiated to prevent suffocation.
3. Prevention of Complications
Long-term bed rest and difficulty in turning over can easily lead to aspiration pneumonia and pressure ulcers in bony prominences. Therefore, the child should be turned over every 1 to 2 hours. When turning over, avoid dragging or pulling on the bed to prevent skin abrasions. Check the areas prone to pressure ulcers, such as the sacrococcygeal region, hips, shoulders, elbows, outer ankle, and heel, during each turning. Choose appropriate mattresses, such as sponge or air mattresses. For a few children with urinary and fecal incontinence, keep the skin and bedding dry. Give the child a warm water sponge bath, back rub, and local massage regularly to promote blood circulation. After washing, apply zinc oxide powder to the back and sacrococcygeal region. Clean the external genitalia daily to prevent urinary tract infections.
4. Prevention of Muscular Contracture and Joint Deformity
(1) Elevate the affected limb. Use a support or other device to elevate the forearm when sitting, and elevate the affected lower limb by 10 to 20 cm when lying down to reduce the effects of gravity and promote venous blood return.
(2) Maintain the affected limb in a functional position: To prevent adduction contracture of the upper limb, place a pillow under the child's armpit; to prevent foot drop, provide splint fixation or have the child wear high-top tennis shoes to provide support to the foot and ankle joint. During the fixation period, observe the peripheral circulation of the limb.
(3) Initiate passive exercises for the affected limb as early as possible. Perform passive exercises (massage) for each joint 2 to 3 times a day, with at least 5 movements in each direction. The movements should be gentle to avoid pain and tissue damage.
(4) Once the function slightly recovers, encourage early active exercises. Start with individual joint movements and gradually progress to multi-joint movements. During active movements, try to involve the affected limb. When performing sitting, standing, and walking training, parents should stand on the affected side to assist the child in sitting up, standing, and walking, and encourage the child to raise the affected limb as much as possible.
(5) Functional exercises during hemiplegia can also be supplemented with simple medical gymnastics. Medical rehabilitation equipment such as walking aids, foot pedals, and resistance exercisers can also be used. Acupuncture, tuina massage, massage, and physical therapy instruments for neuromuscular treatment can also be used.
5. Psychological Nursing
Children with childhood hemiplegia and their parents may experience various psychological issues such as pessimism, sadness, anxiety, and fear due to slow recovery and limited mobility. Therefore, when caring for these children, it is important to show empathy and patience, respect, care, and attention to both the child and the parents, and help them gather the courage to face life, actively cooperate with treatment, and engage in self-exercises.
6. Observation of Medical Condition
(1) Monitor vital signs and observe changes in respiration, blood pressure, pupil size, and consciousness to detect changes in intracranial pressure and herniation in a timely manner.
(2) Observe for irritability, headache, vomiting, and seizures, and pay attention to changes in muscle strength, muscle tone, and pathological reflexes in the paralyzed limb.
(3) Examine the skin, especially in bony prominences. Pay attention to urinary and fecal incontinence, facial paralysis, and swallowing difficulties.
7. Medication Administration
(1) For children with severe cerebral edema or increased intracranial pressure during the acute phase, rapid infusion of mannitol and the use of dexamethasone can be used for emergency treatment. Monitor the therapeutic effects and side effects of medications.
(2) Low molecular weight dextran can improve microcirculation, increase cerebral blood flow, and reduce sequelae, but it should be avoided in cases of increased intracranial pressure and bleeding.
(3) The use of anticoagulants should be carefully selected based on indications and should not be used in children with bleeding tendencies, intracranial hemorrhage, or decreased platelet count. Monitor for signs of bleeding. Before using thrombolytic agents such as ancrod, perform a skin allergy test, and only use if the test is negative.
(4) Avoid intravenous and intramuscular injections in the affected limb as much as possible.
8. Health Education
(1) Explain the condition and treatment and nursing methods to the child and parents according to their understanding, encourage their active participation, and encourage them to participate in the development of nursing plans and rehabilitation programs.
(2) Guide and encourage the child and parents to perform limb massages, passive exercises, active exercises, daily living skills training, speech rehabilitation training, and skin care to prevent and reduce the occurrence of sequelae. However, do not rush the nursing process to avoid accidental injuries. Children with hemiplegia have limited mobility, so education on safety knowledge should be provided to prevent falls and injuries.
(3) For children with cerebral hemorrhage, avoid vigorous exercise, maintain emotional stability, ensure sufficient sleep time, maintain regular bowel movements, pay attention to keeping warm, prevent colds, and avoid severe coughing. Be gentle when turning over.
(4) For children with cyanotic congenital heart disease who develop hemiplegia due to cerebral embolism, prevent thrombus formation. In summer, pay attention to drinking plenty of water and adequate fluid replacement, and monitor fluid intake and output to correct dehydration in a timely manner.
