Cerebral palsy is one of the most severe outcomes of a perinatal lesion. nervous system.

Cerebral palsy is the result of brain damage sustained during pregnancy, childbirth, and during the first 28 days of a baby's life. The disease is manifested by motor disorders, disorders of speech, mentality and perception of the surrounding world, which do not progress, but can only be partially corrected and restored.

For modern medicine, cerebral palsy is a complex, difficult-to-treat disease, despite its scientific and practical achievements.

The manifestations of cerebral palsy have been known for a long time, since 1843, when they were first described by Little. In those days it was called Little's disease. The modern name was proposed by Sigmund Freud, and it quite accurately characterizes the manifestations of the disease.

Factors contributing to the development of cerebral palsy

Impact on the fetus during pregnancy:

• the presence of serious illnesses in the mother that can adversely affect the development of the unborn child;
• complications during pregnancy;
• hypoxia, infections, toxins and other factors that can cause abnormal development of the child.

Factors affecting the baby at the time of childbirth:

• asphyxia that occurred during childbirth;
• birth injury.

Impact on the child in the neonatal period:

• various injuries;
• body poisoning;
• infections;
• lack of oxygen in the child's body.

Types of cerebral palsy

Forms of cerebral palsy according to clinical manifestations:

1. Double hemiplegia.
2. Spastic diplegia, which is also called Little's syndrome.
3. Hemiparetic or spastic hemiplegia.
4. Hyperkinetic.
5. Atonic-astatic.

According to the course of the disease:

1. Early stage. Develops in the first four months of life. It is characterized by a severe general condition of the baby, a disruption in the functioning of internal organs caused by a failure of nervous regulation (signals for action from the nervous system to organs), an increase, nystagmus (involuntary eye movement), convulsions and motor disorders.
2. Initial stage (chronically residual). Starts at 5 months and lasts until 4 years of age. It proceeds against the background of residual effects after the transferred pathology with the formation of persistent neurological disorders.
3. Late residual stage (final). The stage when incorrect motor stereotypes with contractures and deformities are finally formed.

According to the severity of the process

1. Easy degree. With this degree, independent movement and self-service skills are possible.
2. Average degree. Children require partial assistance with mobility and self-care.
3. Heavy. Children are completely dependent on the people around them.

There is another classification for assessing motor disorders that occur with cerebral palsy. This is an international classification of motor (movement) functions, a global standard used throughout the world to assess the level of motor impairment in children, taking into account their abilities and needs for devices that help them move around.

This classification includes 5 levels:

1. The child moves without assistance and has no restrictions.
2. Can move without assistance within the premises.
3. The child moves using assistive devices (walkers, crutches).
4. Moves in a wheelchair. Independent movements are limited.
5. Movement is severely restricted.

Children and teenagers of the second level cannot run and jump like children of the first level. They need special devices to help them get around when they go a long way, going outside (wheelchair, railing for going down or up stairs).

Children of the third level need special devices both for moving around the house and for moving along the street and in public places.

Level 4 children can sit up if supported and move around in an electronically controlled wheelchair.

Level 5 children cannot sit and move without assistance or special technology.

In addition to motor disorders, children with cerebral palsy in 90% of cases have changes in the structure of the brain.

There are two groups of changes.

1. Death and destruction of brain cells.
2. Violation, abnormal development of the brain.

For prognosis and drawing up a rehabilitation program, early detection of the disease is especially important. In most children with cerebral palsy, the diagnosis can be established already in the first year of life.

Early manifestations of cerebral palsy

The first signs that make it possible to suspect the development of cerebral palsy in a child can be seen even in the first year of life.

1. Slow development of the motor sphere, speech and psyche of the baby.
2. Delay or complete absence extinction of innate reflexes.
3. Developmental delay or complete absence of reflexes, which should be formed together with the motor development of the baby in the first year of life.
4. Impaired muscle tone.
5. Enhanced tendon reflexes.
6. The appearance of unnecessary involuntary movements and muscle contractions (synkinesias).
7. Formation of incorrect positions of the limbs.

In order to make a diagnosis as early as possible, a pediatrician and a neurologist must clearly know the sequence and be able to correctly assess the neuropsychic development of a baby in the first year of life.

This form accounts for 15-18% of all cases of cerebral palsy.

A common cause of development is birth trauma. The hemiparetic form often develops in full-term and post-term children.

The main manifestations of the hemiparetic form of cerebral palsy are given below.

1. Unevenly dilated lateral ventricles, cell atrophy of the cerebral hemispheres.
2. Spastic hemiparesis. Muscle tone and tendon reflexes are enhanced on one side only.
3. The arm suffers more than the leg.
4. The arm and leg on the affected side are shorter and thinner (thinner) than healthy ones.
5. Violation of gait, in which the leg on the side of the lesion, when moving a step, seems to describe a semicircle, at this time the diseased arm is bent at the elbow and pressed to the body. This gait is called the hemiparetic or Wernicke-Mann gait.
6. Curvature of the feet and contractures on the side of the lesion.
7. In 35% of patients, epilepsy (convulsive seizures) develops due to brain damage.

This form often develops as a result of brain damage with excess bilirubin, which is often formed during the Rh conflict between the blood of the mother and the fetus (the mother has a negative Rh, and the fetus has a positive one). In full-term babies, the brain is affected when the blood level reaches 428 µmol/l and above, in premature babies - 171 µmol/l and above.

Also, the cause of the development of this form can be hypoxia (prolonged lack of oxygen in the fetus) as a result of ischemia (impaired blood circulation in the brain).

The main manifestations of the hyperkinetic form of cerebral palsy are as follows.

1. Hyperkinesis or involuntary movements and positions of the body. Violation of muscle tone: increased or decreased tone in all muscles, or dystonia (different tone in different muscle groups).
2. At first, hyperkinesis occurs in the tongue at the age of 2-3 months, then appears on the face at 6-8 months, and after two years they are already well expressed. These children have chorea (the child appears to be grimacing and making faces) and athetosis or slow seizure. All these manifestations increase when the child is worried, and disappear during sleep.
3. The presence of pathological and high tendon reflexes.
4. Violation of the autonomic system, which is manifested by autonomic crises (incomprehensible, unreasonable attacks of panic and fear), fever.
5. Speech is impaired in 90% of patients. It is indistinct, illegible, inexpressive.
6. Hearing problems in the form of sensorineural hearing loss are observed in 30-80% of patients.

At an early age it is 10 - 12%, at an older age it occurs in 0.5 - 2%.

With this form, the frontal lobes, the cerebellum are affected.

The main manifestations of the atonic-astatic form of cerebral palsy are expressed in the symptoms indicated below.

1. Decreased muscle tone. Characterized by widespread from birth.
2. Impaired coordination of movements (ataxia), inability to determine the amplitude of movements (hypermetry), trembling of the limbs or tremor.
3. Disturbed balance.
4. Paresis.
5. The range of motion in the joints is increased, hyperextension is characteristic.
6. Tendon reflexes are increased.
7. Speech impairment is observed in 65-70% of patients.

double hemiplegia

This form is the most severe variant of cerebral palsy with a poor prognosis. With it, brain changes are pronounced, as are the main manifestations.

1. Pronounced tetraparesis: both arms and legs are affected, and the arms are more affected.
2. Severe, gross movement disorders. The child is not able to hold his head, fix his eyes, roll over, sit, arms and legs practically do not move.
3. Tendon and tonic reflexes are sharply increased, there is no protective reflex. The connection of the brain with the muscles of the pharynx, tongue, soft palate and vocal cords is disrupted, which is manifested by a violation of speech, swallowing and voice. All these are manifestations of the so-called bulbar pseudosyndrome. Also, patients are worried about constant salivation.
4. Mental development and intellect suffer. Children have moderate or severe mental retardation.
5. Speech is absent or significantly underdeveloped.

With cerebral palsy, in addition to motor disorders, complications associated with disruption of the work of other organs and systems quite often develop.

Complications of cerebral palsy

1) Orthopedic-surgical complications. These include disorders of the hip joints, curvature of the feet, forearms and knee joints.

2) The epileptic syndrome, manifested by various seizures, is especially often observed in the hemiparetic form.

An urgent problem for children with cerebral palsy is the presence of (convulsive seizures), which significantly complicate their already difficult life. Convulsions aggravate the course of cerebral palsy, there are certain difficulties with rehabilitation and, in addition, pose a danger to life. Among patients with cerebral palsy, there are various forms of epilepsy, both extremely severe and benign with a favorable prognosis.

3) Violations of the cognitive sphere. These include impaired memory, attention, intelligence and speech.

The main speech disorders in cerebral palsy are a violation of pronunciation or dysarthria, stuttering, lack of speech with preserved hearing and intelligence (alalia), delayed speech development. Motor and speech disorders are interrelated, so each form of the disease is characterized by specific speech disorders.

4) Violation of vision and hearing.

Treatment and rehabilitation of the consequences of cerebral palsy

Cerebral palsy is difficult to treat and the later the diagnosis is made, the less chances for recovery and correction of disorders. The most favorable range for complex treatment and correction is the age period from one month to three years, and it is very important to make a diagnosis and start treatment in this interval.

Treatment of cerebral palsy is a long process. The method of treatment is a group of doctors working together. The group includes a pediatric neurologist, a physiotherapy doctor, an orthopedist, a speech pathologist, a teacher-educator and a psychologist. When drawing up the methodology, the age of the child, the form and severity of the disease are taken into account. Each child with cerebral palsy requires an individual approach.

The main complex of rehabilitation treatment of cerebral palsy consists of three components.

1. Medical rehabilitation, which includes the prescription of drugs, physiotherapy exercises and massage, the use of special medical load suits and pneumosuits, physiotherapy, orthopedic and surgery, treatment with the use of orthoses - devices that help to make the correct movements in the joints.
2. Adaptations in the social environment. Teaches children to navigate, adapt and behave appropriately in society.
3. Psychological, pedagogical and speech therapy correction, which consists of classes with a psychologist, teacher, speech therapist, occupational therapy, teaching basic skills and family activities.

Of the methods of medical rehabilitation, kinesiotherapy or movement therapy, drugs and physiotherapy are most often used.

Kinesiotherapy

This is a method of correcting movement disorders and reducing or eliminating the consequences of a sedentary lifestyle.

Types of exercises used in kinesiotherapy.

1. Gymnastic. These are exercises that help develop muscle strength, restore joint mobility, and develop coordination of movements. They are divided into active and passive; static and dynamic.
2. Sports and applied. This type of exercise is used to restore complex motor skills.
3. Physiotherapy. Teaches voluntarily and dosed to strain and relax muscles, maintain balance, normalize muscle tone and help get rid of synkinesis, increase muscle strength and restore motor skills.
4. Mechanotherapy. Various exercises with the help of simulators and specially designed devices.

Massage

Massage normalizes body functions, improves blood and lymph circulation, and optimizes the processes of oxidation and recovery in muscles. In patients with cerebral palsy, various massage techniques are used. The best effect is observed after classical therapeutic massage, segmental massage and massage of the cervical-collar zone, circular trophic and acupressure massage, sedative and tonic massage, as well as massage carried out according to the Monakov system.

Dynamic proprioceptive correction (DPC)

The method is based on the use of a modified penguin space suit for the treatment of patients with cerebral palsy older than three years of age. For treatment, the Adele, Regent and Spiral medical load suits are used. The duration of the course is 10 - 20 days, the duration of one lesson is 1.5 hours a day. In general, it is necessary to conduct 3-4 courses per year.

The DPC method eliminates the pathological (wrong) position, improves the support of the vertical position and motor functions. DPC is contraindicated for up to three years in diseases of the spine, hip joints and during an exacerbation of diseases.

This required component rehabilitation treatment of cerebral palsy.

Several groups of drugs are used for treatment.

1. Neurotrophic and nootropic drugs (Cortexin, Pantogam, Phenibut, Picamilon).
2. Drugs that improve blood circulation and microcirculation of the brain (Actovegin, Trental).
3. Preparations that improve the metabolism in the nervous tissue, have a resolving effect and restore damaged cells (Lidase).
4. Drugs that reduce intracranial pressure (Diacarb).
5. Anticonvulsants (Depakin).
6. Drugs that normalize muscle tone (Mydocalm, Prozerin).
7. Vitamins of group B and Aevit.

Since 2004, in Russia, botulinum toxin A has been successfully used to treat spastic and distal forms of cerebral palsy, which relieves muscle spasticity and stiffness, increases movement in the joints and improves the mobility of the child, and also eliminates pain. In general, the use of botulinum toxin improves the quality of life of the patient, facilitates his care.

The effect of treatment with botulinum toxin is more pronounced at an early start. The most optimal for botulinum therapy is the age from 2 to 7 years.

Physiotherapy

The purpose of physiotherapy is to increase the efficiency of cells of the nervous and muscular systems not destroyed by damaging factors, to reduce pain and swelling.

Types of physiotherapy used for cerebral palsy:

• electrotherapy;

1. Electrophoresis with various drugs that decrease or increase muscle tone, depending on the situation.
2. Electrical stimulation of muscle groups. A relaxing or stimulating technique is used.
3. magnetic fields.

Electroprocedures are not prescribed for patients who have convulsions.

• thermal, warming procedures (applications of paraffin and ozocerite);
• mud therapy (wraps and mud baths);
• hydrotherapy (pools, pearl baths, water massage);
• acupuncture;
• treatment with natural factors. This is a spa treatment prescribed for children over three years of age, subject to 2 conditions: the absence of seizures and increased intracranial pressure.

Surgical treatment in patients with cerebral palsy is often used to eliminate contractures, curvature of the feet and upper limbs.

Neurosurgical treatment is usually used to correct spasticity or high tone in cerebral palsy.

Orthosis therapy

This is a treatment using special devices - orthoses, designed to give the correct position to the musculoskeletal system and correct disorders and curvatures. Splints and corsets are examples of orthoses.

An important component of the complex of rehabilitation of the consequences of cerebral palsy is psychological and pedagogical correction.

Basic principles of psychological and pedagogical correction.

1. Complex character, simultaneous correction of speech, mental and movement disorders.
2. Early start of correction.
3. Logically consistent principle of corrective work.
4. Individual approach to the personality of the child.
5. Observation and control of the dynamics of psychoverbal development.
6. Joint work and unity of the ongoing correction with the child and his immediate environment, that is, with the family.

Important importance in correctional work is given to sensory education, which develops a full perception of the child's surrounding reality. It develops all types of perception (visual, auditory, tactile-motor), forming in the child a complete picture of the properties of the things and objects around him.

The main tasks of speech therapists in working with children with cerebral palsy

1. Development of verbal communication and improvement of the intelligibility of spoken words.
2. Restoration of normal tone and movements of the speech apparatus.
3. The development of voice and speech breathing.
4. Synchronization of breath, voice and speech.
5. Correction of incorrect pronunciation.

Early diagnosis of cerebral palsy, adequate and timely medical and social rehabilitation and psychological and pedagogical correction significantly increase the effectiveness of the rehabilitation therapy complex. The result of this is a decrease in disability, successful social adaptation and improvement in the lives of patients with cerebral palsy.

Cerebral palsy is a group of diseases with obligatory damage to the central nervous system, dysfunction of the motor and muscle systems, impaired coordination of movement, speech, and intellectual retardation.

According to the classification used in the Russian Federation by K.A. Semenova, distinguish five forms of cerebral palsy based on clinical picture, which is largely due to which particular area of ​​the brain is damaged in the patient.

1. Spastic diplegia (Little's disease) is the most common form of cerebral palsy. In patients, the parts of the brain responsible for the motor activity of the limbs are affected, which leads to complete or partial paralysis of the legs (to a greater extent) and hands.

2. double diplegia characterized by severe damage to all parts of the brain, or only the cerebral hemispheres. Rigidity of the muscles of the limbs is observed, children cannot hold their heads, stand, sit.

3. Hyperkinetic form. With it, the subcortical structures are affected, which leads to hyperkinesis, that is, involuntary movements, which are especially enhanced by fatigue, excitement, and stress. This form of cerebral palsy in its pure form is relatively rare, more often in combination with spastic diplegia.

4. Atonic-asthenic form occurs when the cerebellum is damaged, characterized by paresis (decrease in muscle strength), low muscle tone. The patient suffers from coordination of movements and a sense of balance.

5. Hemiparetic form- the result of damage to one of the hemispheres of the brain with cortical and subcortical structures responsible for motor activity. One of the sides of the body suffers (hemiparesis of the extremities), cross in relation to the diseased hemisphere. In this case, the lesion is more severe in the upper limbs.

It must be emphasized that despite the fact that cerebral palsy is a group of specific diseases, it cannot be described by the word "syndrome", since this term, as a rule, denotes a set of symptoms of an unclear etiology that are often observed together. The root cause of cerebral palsy is clear - it is a lesion of the central nervous system. A movement disorder caused by other causes (for example, a spinal injury) in a healthy brain is not cerebral palsy.

Why does cerebral palsy occur?

The main cause of the disease is damage to the brain cells of a child as a result of oxygen starvation (hypoxia, asphyxia) or trauma (bruises, hemorrhages) in the prenatal or postnatal period. Such damage can occur as a result of maternal injuries during pregnancy and childbirth, circulatory disorders of the brain in the fetus, various infectious, genetic, endocrine, cardiovascular diseases of the mother, threats of abortion, complications during pregnancy, group or Rh incompatibility of the mother's blood and fetus, tight entanglement of the fetus with the umbilical cord, premature detachment of the placenta. After the birth of a baby, damage to the central nervous system can occur as a result of the following causes: severe infection (meningitis, encephalitis, acute herpes infection), poisoning (lead), head injuries, incidents leading to brain hypoxia (drowning, blockage of the airways by pieces of food, foreign items).

It should be noted that all risk factors are not absolute, and most of them can be prevented or minimized their harmful effects on the health of the child.

What are the symptoms and signs of cerebral palsy?

Symptoms of cerebral palsy can be detected immediately after the birth of a child, and may appear gradually in infancy. In the event that risk factors occurred during pregnancy and childbirth, the pediatrician, as a rule, closely monitors the child for possible symptoms of the disease and warns parents about what features should be noted in order to establish a diagnosis and begin rehabilitation as soon as possible. Parents should be familiar with the basic norms for the development of motor and play skills, speech development, and if the child is noticeably behind, inform the doctor about this. Parents and specialists should be alerted by such features of the baby's behavior as freezing in a certain position, performing involuntary movements, and lack of contact with the mother.

Pediatricians are not always in a hurry to diagnose cerebral palsy: the children's brain is very plastic and has huge compensatory capabilities that can completely neutralize the consequences of brain damage, so there are much fewer patients with cerebral palsy than children whose birth was accompanied by risk factors.

If a child over the age of one year does not sit, does not walk, does not speak, and also has various mental disorders, and experts confirm the stability of neurological symptoms, cerebral palsy is diagnosed.

Abroad, some experts believe that the final diagnosis should be made at the age of about three years, since earlier what looks like symptoms of cerebral palsy may later turn out to be the result of spasticity not associated with damage to the central nervous system, or clinical manifestation neoplasms in the brain or metabolic diseases. As a rule, all these diseases lead over time to a deterioration in the patient's condition, and the patient with cerebral palsy is stable, although the symptoms may vary somewhat.

This is not an easy situation, because, on the other hand, the sooner a child's rehabilitation begins, the greater the hope that he will be able to achieve relative physical independence if the brain damage is not very deep.

The main symptoms of cerebral palsy are motor activity disorders: spasticity (muscle stiffness), athetosis (hyperkinesis, slow tonic spasm of the muscles of the limbs, face, trunk), rigidity, ataxia (impaired coordination of movements), tremor of the limbs. The diagnosis may be accompanied by disorders of the organs of vision, hearing, changes in perception, orientation in space, impaired speech development, epilepsy, delayed mental and emotional development, learning problems, functional disorders gastrointestinal tract and urinary system.

Signs of a severe form of cerebral palsy in an infant may be a violation of swallowing and sucking, a weakened cry, convulsions. The attention of parents and specialists should be attracted by unusual postures of the child, for example, a very relaxed body, extended joints with a large spread of arms and legs.

Not always, however, problems are immediately obvious, they can appear as the baby grows. Damage to the parts of the brain causes a violation of the movement of certain muscles, which leads to their immobility and, following this, hypertrophy. As they grow and mature, problems of a sensory nature appear: the patient may not distinguish objects by touch (shape, texture), ordinary actions (for example, brushing teeth) can cause pain. Often with cerebral palsy, salivation is observed, in severe forms - problems with swallowing.

So, the diagnosis of cerebral palsy is made primarily on the basis of observing the child for some time, fixing the above symptoms. Sometimes a significant period of time passes between the first alarm bell and the final diagnosis.

Cerebral palsy

What is Cerebral Palsy -

Cerebral palsy- a term that unites a group of non-progressive brain diseases that have arisen as a result of underdevelopment or damage to brain structures in the antenatal, intranatal and early postnatal periods, characterized by movement disorders, postural, speech, and mental disorders.

The frequency of cerebral palsy is 1.7-3.3 per 1000 children and 1.7-5.9 per 1000 births.

What provokes / Causes of Cerebral Palsy:

Factors that determine structural and functional changes in the brain, in 80% of cases, act in the process of intrauterine development of the fetus, in 20% - postnatally. Among the pathogenic factors that damage the brain in utero, the leading role belongs to infections (influenza, rubella, toxoplasmosis), somatic and endogenous diseases of the mother ( birth defects heart disease, chronic lung disease, diabetes, hypo- and hyperthyroidism, etc.), immunological incompatibility of the blood of the mother and fetus (according to the Rh factor, the ABO system and other antigens), occupational hazards, alcoholism. Of the factors causing brain damage during childbirth, birth trauma, birth asphyxia, and encephalitis in the early postpartum period are of primary importance.

Pathogenesis (what happens?) during Cerebral Palsy:

Changes in the nervous system are associated with hypoxia and metabolic disorders, which have a direct and indirect (through products of impaired metabolism) effect on the development and function of the brain.

Pathomorphology. The variety of harmful factors and different periods of their action determine the variability in the severity of structural defects in the brain. In 30% of children with cerebral palsy, brain anomalies are found - micropolygyria, pachygyria, porencephaly, agenesis of the corpus callosum, which are the result of brain damage at an early stage of ontogenesis. Microscopic examination reveals glial proliferation and neuronal degeneration. In some cases, gross focal defects are found - atrophic lobar sclerosis, atrophy of the cells of the basal ganglia and thalamus, pituitary gland, cerebellum. Atrophic lobar sclerosis is manifested by massive localized atrophy of the frontal lobe, underdevelopment of the cerebral cortex, midbrain. The defeat of the basal ganglia and the thalamus is characterized by the growth of myelin fibers with an annular arrangement around the vessels. Usually these changes occur with kernicterus. In the cerebellum, insufficient myelination of pathways and changes in neurons are found.

Symptoms of Cerebral Palsy:

Depending on the characteristics of motor, mental and speech disorders, five forms are distinguished:

1. spastic diplegia;
2. double hemiplegia;
3. hyperkinetic form;
4. atonic-astatic form;
5. hemiplegic, or hemiparalytic, form.

There are three stages of the course of the disease:

1. early;
2. initial chronically residual;
3. final residual.

In the final stage, the I degree is determined, at which children master the skills of self-service, and the II degree is incurable, with a profound mental and motor impairment.

Spastic diplegia (Little's disease). The most common form of cerebral palsy. Characteristic features are spastic tetraplegia (diplegia) or tetraparesis with predominant localization in the legs, mental and speech disorders. Most clearly spastic diplegia manifests itself by the end of the first year of life. In children, the formation of static and locomotor functions, straightening reflexes of the body, is delayed. Muscle tone was significantly increased in all limbs. The increase in tone is especially pronounced in the flexor muscle groups of the arms, as well as the extensor and adductor muscles of the legs. Due to the increase in muscle tone, the active movements of the child are limited, and a forced position of the limbs occurs. In the prone position, the arms are brought to the body, bent at the elbow joints, the legs are extended, unbent at the hip and ankle joints, brought to each other, sometimes crossed. When you try to put the child on his feet, he rests on his socks, while his legs cross. Movements in the proximal muscle groups are difficult, but in the distal ones they are preserved. Increased muscle tone with age contributes to stiffness, contractures in large joints. The constant tension of the calcaneal (Achilles) tendon and the reinforced support on the toes lead to gross deformities of the feet.

Tendon and periosteal reflexes on the arms and especially the legs are increased, evoked from the extended reflexogenic zone. Possible clonuses of the feet, kneecaps, pathological flexion (Rossolimo, Mendel - Bekhterev, Zhukovsky) and extensor (Babinsky, Oppenheim, Schaeffer, Gordon) reflexes. Spastic diplegia is combined with hyperkinesis, mainly of the athetoid and choreoathetoid type, synkinesis. Hyperkinesis in the hands and mimic muscles of the face prevail over hyperkinesis in the legs. Athetoid hyperkinesis dominates in the fingers, hands, facial muscles, choreic - in the proximal limbs. Hyperkinesias increase with excitement and weaken in sleep, at rest. The severity of hyperkinesis directly correlates with the severity of damage to the nervous system.

The development of speech in children with spastic diplegia is delayed. Speech disorders are manifested by dysarthria, alalia. Hyperkinesis of the articulatory and respiratory muscles makes speech blurred, jerky. Intelligence in most cases is reduced. Children have difficulty concentrating on classes, quickly exhausted, distracted. As a rule, they cannot organize the game on their own, they do not control themselves. Memory is reduced. Convulsive paroxysms in spastic diplegia are less common than in other forms of cerebral palsy.

In the first months of life, generalized paroxysms often occur, then their nature varies. The presence of seizures worsens the prognosis.

Double hemiplegia. The most severe form of cerebral palsy. Characteristic features are spastic tetraplegia or tetraparesis with predominant localization in the hands and uneven damage to the sides, pronounced mental and speech disorders. The disease manifests itself in the first months of life. In the position of the child on the back, the limitation of his activity attracts attention. Due to the high muscle tone in the limbs, the arms are bent at the elbow joints, brought to the body, the legs are bent at the hip and knee joints, or, conversely, unbent. Static and locomotor functions are not formed in children with double hemiplegia. They do not master the skills of sitting, independent walking. Severe movement disorders are combined with early joint contractures and bone deformities.

Tendon reflexes are very high. Pathological carpal and foot reflexes are revealed. The symptom complex of pseudobulbar paralysis is often expressed, which causes difficulty in eating, dysfunction of the articulatory apparatus.

Speech disorders in double hemiplegia are manifested by a delay in speech development, a small vocabulary, pseudobulbar dysarthria. Speech is usually slurred, nasal, poorly understood, and incorrect pronunciation of sounds is often noted. Changed the pace of speech. Words and sounds are pronounced either excessively loudly, quickly, or weakly, slowly.

Intelligence is greatly reduced. Thinking is slow, inert, memory is weakened. Disinhibition, euphoria, apathetic-abulic disorders are often observed, convulsive seizures are noted. As with spastic diplegia, they affect the prognosis of the disease.

hyperkinetic form. Involuntary athetoid movements, impaired muscle tone, and speech disorders are characteristic. Involuntary violent movements in severe cases appear in infancy, but in most children with moderate damage to the nervous system, hyperkinesis occurs at the end of the 1st - beginning of the 2nd year of life. Hyperkinesias are localized in the distal extremities, mimic muscles of the face, muscles of the trunk, neck. In severe forms, involuntary movements are slow, observed mainly in the hands and feet; in relatively mild forms, they develop quickly, suddenly, cover the muscles of the neck, shoulders, trunk, such as torsion spasm. Emotional experiences intensify movements, and physiological peace, calm environment weaken involuntary movements.

Muscle tone during the first year of life changes periodically. Its rapid polar changes in a short period are typical (intermittent spasms, dystonia). In children of the 1st month of life, muscular hypotension is observed. From the 2nd month of life, dystonic attacks are noted, during which there is a sudden increase in muscle tone. changing to a decline. Tendon reflexes are normal or elevated. Speech disorders are manifested by a delay in the formation of speech, impaired articulation, and speech tempo. As a rule, speech in the hyperkinetic form of cerebral palsy is slow, monotonous, slurred, sometimes it represents a set of sounds that are difficult to distinguish. The intellect may suffer slightly. Convulsive paroxysms are rare.

Atonic-astatic form. Characteristic features are cerebellar disorders. From birth, generalized muscular hypotonia is observed. The formation of static and locomotor functions is delayed. Children with a significant delay in comparison with the physiological norm begin to sit down, stand, walk. In a vertical position, due to muscle hypotension, hyperextension in the knee joints is observed. Tendon and periosteal reflexes may be preserved, which distinguishes this form from spinal amyotrophies. Disturbances in coordination and statics of movements become noticeable with the development of voluntary movements. Intentional tremor, dysmetria, ataxia are typical. Intelligence suffers slightly. In some cases, children with atonic-astatic form have moderate hyperkinesis and signs of pyramidal insufficiency.

Hemiplegic form. Characteristic features are unilateral paresis of the arm and leg of the central type, mainly expressed in the arm, convulsive paroxysms, mental and speech disorders. In severe cases, the hemiplegic form is diagnosed from birth. Signs of motor insufficiency of the affected limbs are detected by limiting the volume of spontaneous active movements. Hemiparesis in the extremities is combined with damage to the central type VII and XII pairs of cranial nerves. Muscle tone in the first 2-3 months. life is reduced. The increase in muscle tone occurs slowly. It becomes pronounced by 1-1.5 years of age, when the child begins to walk. An increase in muscle tone in the arm flexors and leg extensors determines the classic Wernicke-Mann pose.

Tendon and periosteal reflexes are usually high on both sides, but higher on the side of the lesion. On the side of hemiparesis, pathological hand and foot reflexes are also detected. Sensitive violations of the conduction type are rarely observed. Speech disorders are manifested by pseudobulbar dysarthria. Intelligence and memory are usually reduced. Attention is unstable, children are quickly depleted. Mental activity is reduced. Convulsions are usually generalized, rarely partial, occur in 40-50% of cases. They affect the mental development and prognosis of the disease.

Diagnosis of Infantile cerebral palsy:

The diagnosis of cerebral palsy is made on the basis of a family history and clinical examination. In the first months of life, cerebral palsy can be suspected in the absence or delay of the main unconditioned reflexes, later - with the appearance of mesencephalic postural adjusting reflexes, asymmetry of muscle tone, its deviation from the physiological norm (muscle hypotension or moderate hypertension), limitation of the volume of spontaneous movements, asymmetry in movements, tremor of the fingers, athetoid hyperkinesis. These signs and a burdened history of pregnancy (infection, intoxication, Rhesus conflict between mother and fetus) are risk factors for the development of cerebral palsy, which serves as the basis for monitoring the child. The final diagnosis is formed after a year, when motor, speech and mental disorders become distinct.

Differentiate cerebral palsy should be from hereditary diseases, chromosomal syndromes, tumors of the nervous system, neuroinfections. In differential diagnosis, it is necessary to take into account data from a genealogical history, information about the course of pregnancy, the age of patients, clinical symptoms (the nature of movement disorders and changes in muscle tone), the effectiveness of therapy, and course features.

Most forms of hereditary degenerative diseases are characterized by a burdened family history (the presence of relatives in the family suffering from a similar disease), polysystemic damage to the nervous system and internal organs, and a progressive course. Patients with chromosomal syndromes have a characteristic appearance, there are multiple malformations. Brain tumors, as a rule, are combined with general cerebral and focal symptoms, their course is progressive.

Current and forecast. The course of cerebral palsy is usually regressive, with gradual improvement. An exception is cases with convulsions. The prognosis is determined by the degree of brain damage. In children with cerebral palsy resulting from the action of a damaging factor in early dates pregnancy, there are deeper disturbances in the nervous system and the prognosis is serious.

Treatment for Cerebral Palsy:

It should be early, individual, complex, staged, long-term. Early treatment of cerebral palsy provides for the timely creation of a basis for the development of normal reactions of posture, rotation, balance reactions, adequate stimulation of the sensory and motor activity of the child. An individual approach to treatment involves taking into account the nature and degree of damage to the nervous and neuromuscular systems, as well as the general somatic condition of the child.

Comprehensive treatment includes orthopedic measures, physiotherapy, physiotherapy exercises, massage, classes with a speech therapist, drug therapy, and, if necessary, surgical treatment of contractures. (In Little's disease, in some cases, there are indications for surgery on the roots of the cauda equina.)

Drug therapy is prescribed to stimulate the brain and improve its metabolism, correct violations of muscle tone, metabolic processes in muscle tissue, reduce intracranial pressure, neuro-reflex excitability. Improving the mental development of children is achieved by the appointment of glutamic acid, cerebrolysin, aminalon, pyriditol (encephabol). Vitamin B12 and pyrogenal also stimulate and improve metabolism.

Prevention of Cerebral Palsy:

Which doctors should you contact if you have Cerebral Palsy:

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What is cerebral palsy - damage to one or more parts of the brain, either in the process of intrauterine development, or during (or immediately after) childbirth.

cerebral palsy - cerebral palsy

T The term "cerebral palsy" is used to characterize a group of chronic conditions in which motor and muscle activity is affected with impaired coordination of movements.

Cerebral palsy- damage to one or more parts of the brain, either in the process of intrauterine development, or during (or immediately after) childbirth, or in infancy / infancy. This usually occurs during a complicated pregnancy, which is a harbinger of preterm labor.

The word "cerebral" means "cerebral" (from the Latin word "cerebrum" - "brain"), and the word "paralysis" (from the Greek "paralysis" - "relaxation") defines insufficient (low) physical activity.

By itself, cerebral palsy does not progress, because. does not relapse. However, in the course of treatment, the patient's condition may improve, worsen, or remain unchanged.

Cerebral paralysis is not a hereditary disease. They never get infected or sick. Although cerebral palsy is not curable (not “curable” in the conventional sense), constant training and therapy can improve the condition and minimize the effects of the disease.

How was cerebral palsy diagnosed?

IN In 1860, the English surgeon William Little first published the results of his observations on children who, after suffering a birth injury, developed paralysis of the limbs. The condition of the crumbs did not improve or worsen as they grew: there were problems with the grasping reflex, crawling and walking.

Signs of similar lesions have long been called “ Little's disease', and now they are known as ' spastic diplegia". Little suggested that these lesions were caused (by hypoxia) at birth.

However, in 1897, the famous psychiatrist Sigmund Freud, noting that children with cerebral palsy often suffered from mental retardation, visual impairment and epileptic seizures, suggested that the causes of cerebral palsy are rooted in the pathology of the development of the infant's brain in the womb.

Despite Freud's assumption, until the 1960s of the last century, it was widely believed among doctors and scientists that complications during childbirth were the main ones.

True, in 1980, after analyzing data from national studies on more than 35,000 cases of newborns with signs of cerebral palsy, scientists were amazed: complications due to birth trauma were less than 10% ...

In most cases, the causes of cerebral palsy have not been identified. Since then, extensive studies of the perinatal period have begun, i.e. from the 28th week of intrauterine life of the fetus to the 7th day of the life of the newborn.

What types of cerebral palsy exist?

ABOUT The answer to the question of what types of infantile paralysis distinguishes modern medicine is of interest to all parents. There are several classifications of types of cerebral palsy, but I will focus on the classification proposed by Professor K. A. Semenova.

Depending on the area of ​​brain damage and the characteristic manifestations of the disease, Semenova distinguishes the following forms of cerebral palsy:

1. Spastic diplegia. The most common form of cerebral palsy. In the general statistics of such babies - 40-80%. Damage to the parts of the brain responsible for the motor activity of the limbs is observed, which, in turn, leads to complete or partial paralysis of the legs (to a greater extent) and hands.

2. Double hemiplegia. This form of cerebral palsy is expressed by the most severe manifestations. The cerebral hemispheres or the entire organ are affected. Rigidity of the muscles of the limbs is clinically observed, children cannot hold their heads, stand, sit.

3. Hemiparetic form. Unlike other types of cerebral palsy, this form of the disease is characterized by damage to one of the cerebral hemispheres with cortical and subcortical structures responsible for motor activity. The right or left side of the body suffers (hemiparesis of the extremities), crossed in relation to the diseased hemisphere.

4. Hyperkinetic form(up to 25% of patients). Subcortical structures are affected. It is expressed in hyperkinesis - involuntary movements, an increase in symptoms with fatigue, excitement is characteristic. This type of cerebral palsy in its pure form is relatively rare, more often in combination with spastic diplegia.

5. Atonic-astatic form occurs with damage to the cerebellum. Most of all, coordination of movements and a sense of balance suffer, muscle atony is observed.

Consequences of cerebral palsy

Characteristic features of cerebral palsy are impaired motor activity. The muscular sphere is especially affected, which worsens coordination of movements.

Depending on the degree and location of areas of brain damage, one or more types of muscle pathology may occur - muscle tension or spasticity; muscle paresis, involuntary movements; gait and mobility impairment.

Also, with all types of cerebral palsy in children, the following pathological phenomena may occur:

• abnormal sensation and perception;
• decreased vision, hearing;
• deterioration of speech;
• epilepsy;
• impaired mental function.

Other problems are also possible: difficulty in eating, weakening the control of urination and bowel function, breathing problems due to violation of body position, bedsores. Training is not easy either.

In order to help the child, first you need to identify and only then develop a plan of action.

I hope you have found the answer to the question of what types of cerebral palsy exist. You can also search the Web for other common classifications of forms of cerebral palsy, and not just for Semenova.

Cerebral palsy is one of the most difficult diagnoses that parents of a baby can hear from doctors. If you want to understand what this disease is, what are the symptoms and treatment, check out this article.

Cerebral palsy - what is it?

Cerebral palsy is not a specific disease with specific symptoms. This is a whole group of pathologies of the motor system, which became possible due to serious disorders in the central nervous system. Problems with the musculoskeletal system cannot be considered primary, they always follow brain lesions.

Anomalies in the cerebral cortex, subcortex, capsules and brain stem most often occur even during the period of intrauterine development of the baby. The exact causes that eventually lead to cerebral palsy in newborns are still being investigated by scientists. However, doctors (despite a lot of hypotheses) seriously consider two periods when global changes in the brain can lead to severe pathology - the period of pregnancy and the period immediately before, during and immediately after childbirth.

Cerebral palsy does not progress, the stage of the lesion and limitation of motor functions do not change. As the child grows, some disorders become more noticeable, so people mistakenly believe that cerebral palsy can develop and become more complicated.

The group of diseases is quite common - based on statistics, it can be noted that out of a thousand children, two are born with one form or another of cerebral palsy. Boys are almost one and a half times more likely to get sick than girls. In half of the cases, in addition to impaired motor functions, various mental and intellectual disorders are observed.

Pathology was noticed in the 19th century. Then the British surgeon John Little took up the study of birth injuries. It took him exactly 30 years to formulate and present to the public the idea that the oxygen deficiency that the fetus experiences at the time of its birth can result in paresis of the limbs.

At the end of the 19th century, the Canadian doctor Osler came to the conclusion that cerebral disorders are still associated with the hemispheres of the brain, and not with the spinal cord, as the Briton Little had argued before him. However, Osler's arguments were not too convincing to medicine, and Little's theory was officially supported for a very long time, and birth trauma and acute asphyxia were called as starting mechanisms for cerebral palsy.

The term "cerebral palsy" was introduced by the famous doctor Freud, who was a neurologist and studied the problem in his own practice. He formulated intrauterine damage to the child's brain as the main cause of the pathology. He was also the first to classify different forms this disease.

Causes

Modern doctors believe that cerebral palsy cannot be considered a hereditary disease. Damage to the motor apparatus and problems with mental development become possible in case of improper development of the baby's brain during the mother's pregnancy, as well as banal underdevelopment of the brain.

If a child was born much earlier than the due date, then the risk of cerebral palsy is several times higher. This is confirmed by practice - many children with disorders of the musculoskeletal system and an established diagnosis of cerebral palsy were born severely premature.

However, prematurity itself is not terrible, it only creates the prerequisites for the development of disorders.

The likelihood of cerebral palsy is usually influenced by other factors that, in combination with premature birth, lead to the disease:

• "mistakes" during the appearance and development of brain structures (first trimester of pregnancy);
• chronic oxygen starvation of the fetus, prolonged hypoxia;
• intrauterine infections that the baby suffered while still in the womb, most often caused by herpes viruses;
• a severe form of Rh-conflict between the mother and fetus (occurs when the mother is negative Rh and the child is positive Rh), as well as severe hemolytic disease of the child immediately after birth;
• brain injury during childbirth and immediately after them;
• infection of the brain immediately after birth;
• toxic effects on the brain of a child with salts of heavy metals, poisons - both during pregnancy and immediately after birth.

However, it is not always possible to establish the true cause of the onset of a child's illness. If only because there is no way to understand at what stage of development of the embryo and fetus that total “mistake” occurred, as well as to prove that brain damage is the result of a conflict of Rh factors. Some children with cerebral palsy have not one, but several reasons for the development of the disease.

Forms and their characteristics

Since cerebral palsy is a group of disorders, there is a fairly detailed classification of the forms of each type of lesion. Each form of cerebral palsy has certain signs and manifestations:

Hyperkinetic (dyskinetic)

This form is most often diagnosed in children who suffer an attack of antibodies associated with Rh conflict in utero. When they are born, the development of hemolytic disease of the newborn (HDN) plays a role, its nuclear icteric form is especially dangerous. This affects the subcortex of the brain, as well as auditory analyzers.

The child suffers from a hearing impairment, he has uncontrollable twitching of the eyes. He makes involuntary movements. Increased muscle tone. Paralysis and paresis are able to develop, but are not considered mandatory. Children with this type of cerebral palsy are quite poorly oriented in the surrounding space, they have difficulties with intentional actions of the limbs - for example, it is difficult for a child to pick up one or another object.

With all this, the intellect suffers to a lesser extent than with some other types of cerebral palsy. Such children (with due efforts on the part of parents and teachers) are perfectly socialized, they are able to study at school, many then manage to enter a university, get a profession and find a job.

Ataxic (atonic-astatic)

This type of cerebral palsy is associated with damage to the cerebellum, the frontal lobes of the brain, and the pathway between the cerebellum and the frontal lobe. Such damage is most often the result of chronic severe fetal hypoxia, an anomaly in the development of these brain structures. Birth trauma to the frontal lobes is often cited as a likely cause.

With this form, the child's muscle tone is reduced. When moving, the muscles do not coordinate with each other, so the child is not able to make purposeful movements. It is practically impossible to maintain balance due to reduced muscle tone. There may be trembling (tremor) of the limbs.

Such children are most prone to epileptic seizures. At an early age there are problems with the development of vision and speech. With proper care, systematic studies, adequate therapy, children with an athanic-astatic form of cerebral palsy can demonstrate certain low intellectual abilities that allow them to only slightly master the basics of speech and realize what is happening. In more than half of the cases, speech remains undeveloped, and the children themselves do not show any interest in this world.

Spastic tetraplegia (spastic tetraparesis)

This is the most severe form of cerebral palsy. It occurs due to damage to the brain stem, both hemispheres or the cervical spine. The most likely causes are intrauterine hypoxia of the fetus, mechanical asphyxia when the neck is wrapped around the umbilical cord, hemorrhage in the brain (when affected by toxins, for example, or when the brain is infected). Often, a birth injury is considered as the cause, in which the patient suffered cervical region spine.

With this form of cerebral palsy, the motor activity of all four limbs (both arms and legs) is disturbed - approximately to the same extent. Since the arms and legs cannot move, their inevitable and irreversible deformation begins.

The child experiences muscle and joint pain, he may have difficulty breathing. More than half of children with such cerebral palsy have impaired activity of the cranial nerves, resulting in strabismus, blindness, and hearing impairment. In 30% of cases, microcephaly is noted - a significant decrease in the volume of the brain and cranium. More than half of patients with this form suffer from epilepsy.

Unfortunately, such children cannot serve themselves. There are also big problems with learning, since the intellect and psyche suffer to a large extent, and the child not only does not have the opportunity to take something with his hands, he does not have a banal motivation to take something or do something.

Spastic diplegia (Little's disease)

This is the most common form of cerebral palsy, it is diagnosed in three out of four sick children. With an illness, some parts of the white matter of the brain are usually affected.

Spastic lesions are bilateral, but the legs are more affected than the arms and face. The spine is deformed very quickly, the mobility of the joints is limited. Muscles contract uncontrollably.

The intellect, mental development and development of speech suffer quite pronouncedly. However, this form of the disease is subject to correction, and a child with Little's disease can be socialized - however, the treatment will be long and almost permanent.

Hemiplegic

This is a unilateral spastic lesion that most commonly affects the arm rather than the leg. This condition becomes possible as a result of hemorrhage in one hemisphere of the brain.

The socialization of such children is possible if their intellectual capabilities are sufficiently large. Such babies develop with a large lag behind their peers. They are characterized by a delay in mental and mental development, problems with speech. Sometimes epileptic seizures occur.

mixed

With this form of pathology, brain dysfunction can be observed in a variety of structures and areas, so the likelihood of a combination of disorders of the motor apparatus is quite real. Most often, a combination of a spastic form and a dyskinetic form is detected.

unspecified

This form of the disease is spoken of if the lesions are so extensive that it is not possible to establish the specific parts of the brain in which the anomaly occurred (malformation or traumatic impact).

Symptoms and signs

It is not always possible to see the first signs of cerebral palsy in an infant even in the maternity hospital, although serious brain disorders are noticeable from the first hours of a child's life. Less severe conditions are sometimes diagnosed somewhat later. This is due to the fact that as the nervous system grows, the connections in it become more complicated, violations of the motor and muscular apparatus become apparent.

There are alarming symptoms that should make parents wary and see a doctor. These symptoms are not always signs of cerebral palsy, quite often they indicate neurological disorders that are not related to cerebral palsy in any way.

However, they cannot be ignored.

Parents should be suspicious if:

• the child does not fix his head well, cannot hold it even at 3 months;
• the muscles of the crumbs are weak, which is why the limbs look like "noodles";
• the child does not roll over on his side, does not crawl, cannot fix his eyes on the toy and does not take toys in his hands, even if he is already 6-7 months old;
• unconditioned reflexes, with which every child is born (and which should normally disappear by six months), continue to persist after 6 months;
• the limbs are spastically tense and do not relax, sometimes spasms occur in “attacks”;
• the child has convulsions;
• visual impairment, hearing impairment;
• chaotic movements of the limbs, uncontrolled and random (this symptom cannot be assessed in newborns and children in the first month of life, since for them such movements are a variant of the norm).

The most difficult to determine the signs of cerebral palsy in children under the age of 5 months. This task is difficult even for an experienced doctor. He may suspect a pathology, but he has no right to confirm it until the child is 1 year old. For one or more symptoms from the above list, it is impossible to suspect cerebral palsy, as well as mistakenly take the symptoms of some similar diseases for cerebral palsy.

Parents should be very careful, because if the treatment of some forms of pathology is started early, before the age of 3, then the results will be excellent, and the child will be able to lead a completely fulfilling life.

Stages of the disease

In medicine, there are three stages of the disease. The first (early) begins at about the age of 3-5 months, the initial stage is called a disease detected at the age of six months to 3 years, the late stage is said if the child is already 3 years old.

The smaller the stage, the more favorable the prognosis for a cure. Even if the child cannot be completely cured, it is quite possible to minimize the negative manifestations. The child's brain (even those affected by trauma or malformations) has a high ability to compensate, and this can and should be used to correct disorders.

Diagnostics

Quite often, genetic diseases are mistaken for cerebral palsy, which are completely independent diseases, as a result of which children are given a diagnosis that does not correspond to reality. Modern medicine is very developed, but the symptoms associated with brain pathology are still not well understood.

It is usually possible to determine the disease closer to 1 year. If a child at this age does not sit, does not crawl, shows other progressive signs of disorders of the nervous system, then the doctor prescribes an MRI.

Magnetic resonance imaging is the only more or less reliable study that allows you to judge the presence of cerebral palsy - and even establish its presumptive form.

For small children, the procedure is carried out under general anesthesia, since in the capsule for taking pictures you have to lie still and for a long time. Children can't do that.

With genuine cerebral palsy, layered MRI images show atrophy of the cortical and subcortical zones of the brain, a decrease in the density of white matter. To distinguish cerebral palsy from a huge list of genetic syndromes and conditions similar in manifestation, a child may be assigned an MRI of the spinal cord.

If the child has convulsions, the doctor prescribes electroencephalography. Ultrasound of the brain is relevant only for newborns, this technique is sometimes used in maternity hospitals if there is a suspicion of cerebral palsy.

The reason for an ultrasound examination may be factors such as prematurity and low birth weight of the child, the established fact of intrauterine infection, the use of special forceps by obstetricians during childbirth, hemolytic disease, a low Apgar score of the newborn (if the child "scored" at birth no more than 5 points) .

At a very early stage after birth, symptoms of very severe forms of cerebral palsy can be visually visible. At the same time, it is also important to distinguish them and separate them from other similar pathologies. The alarming symptoms of a newborn include a sluggish sucking reflex, the absence of spontaneous limb movements, and hydrocephalus.

Treatment

Treatment does not aim to restore the functioning of the affected parts of the brain, since this is almost impossible. Therapy is aimed at enabling the child to acquire skills and abilities that will help him become a member of society, get an education, serve himself independently.

Not every form of cerebral palsy is subject to such correction, since the severity of brain damage in them is different. But in most cases, doctors and parents, through joint efforts, still manage to help the child, especially if the treatment began in a timely manner, until the baby is 3 years old. The following options can be distinguished:

Massage and Bobath Therapy

Motor functions are restored sequentially, for this, therapeutic massage and Bobath therapy are used. This method was founded by a British couple, therapists Berta and Carl Bobath. They proposed to influence not only the damaged limbs, but also the child's psyche. In a complex psychophysical impact gives excellent results.

Such therapy allows the child to develop over time not only the ability to move, but also to do it completely consciously. Bobath therapy is contraindicated only for children with epilepsy and convulsive syndrome. For everyone else, this method is recommended.

The exercise therapy specialist selects an individual program for each baby, since Bobath therapy, in principle, does not provide for a single approach and a specific scheme. Depending on how and how the limbs are affected, at the first stage, the doctor does everything to ensure that the body “forgets” the wrong position. For this, relaxing technologies and exercises, massaging are used.

At the second stage, the specialist makes the correct physiological movements with the child’s limbs so that the body “remembers” them. At the third stage, the child begins to be motivated (in a playful or other form) to independently perform those very “correct” movements.

Bobath therapy allows the child to go through all the natural stages of development, albeit later, - standing on all fours, crawling, sitting, grasping with hands, resting on legs. With due diligence in classes, parents and doctors achieve excellent results - the “correct” positions are perceived by the child’s body as familiar and become an unconditioned reflex.

Nutrition

Proper nutrition is very important for a child with cerebral palsy, since many babies with this diagnosis have concomitant pathologies of the internal organs and oral cavity. The digestive system is the most commonly affected.

special diet for children with cerebral palsy does not exist. When prescribing nutrition, the doctor takes into account the development of sucking and swallowing reflexes, as well as the amount of food that the child “loses” in the process of eating - sheds, cannot swallow, burps.

From the diet of children with this diagnosis, coffee and carbonated drinks, smoked fish and sausage, canned food and pickled foods, as well as spicy and salty dishes are completely eliminated.

Formulas are encouraged (regardless of age) as they provide a more balanced diet. If the child refuses to eat or cannot do so due to the lack of a swallowing reflex, a special probe can be installed for him.

Vojta therapy

The method, which bears the name of its creator - the Czech doctor Vojt. It is based on the formation in children of motor skills characteristic of their age. For this, the exercises are based on two starting skills - crawling and turning. Both in a healthy child are formed at the level of reflexes.

In a child with lesions of motor skills and the central nervous system, they have to be formed "manually" so that later they become a habit and give rise to new movements - sitting, standing and walking.

The Vojta therapist can teach the technique to parents. All exercises are carried out independently, at home. The clinical effectiveness of this type of impact (as well as Bobot therapy) has not been proven to date, but this does not prevent medical statistics from being regularly updated with positive numbers of improved conditions in children with cerebral palsy.

Medicines

There is no special bet on pills and injections, since there is no such medication that would help cure cerebral palsy completely. However, some drugs significantly alleviate the condition of the child and help him to actively rehabilitate. Not every baby with such a pathology needs their use, the expediency of using drugs is determined by the attending physician.

Often prescribed to reduce muscle tone Baclofen, "Tolperison". Reduce muscle spasticity and botulinum toxin preparations - "Botox", "Xeomin". After the introduction of "Botox" into a spasmodic muscle, visible muscle relaxation appears already on the 5-6th day.

This action sometimes lasts from several months to a year, after which the tone usually returns. But the motor skills acquired during this time are preserved, so botulinum toxins are included in the Russian standard for the treatment of cerebral palsy - as a means of complex therapy.

With epileptic seizures, the child is prescribed anticonvulsant drugs, to improve cerebral circulation, nootropic drugs are sometimes prescribed.

Some disorders in cerebral palsy are quite successfully corrected surgically. Tense ligaments and tendons are operated on, muscle-tendon plasty is performed, surgeons are excellent at eliminating ossification and limited movement of the joints, which accompany some forms of the disease.

Other Methods

Very good results are shown by the treatment of children with cerebral palsy with the help of pets. Animal therapy (this is the international name of the method, not always used in Russia) allows the child to socialize faster, stimulates intellectual and mental functions. Most often, parents of a child with such a diagnosis are advised to get a dog or cat. At the same time, the child should communicate and be close to his pet as often as possible.

Hippotherapy - treatment with the help of horses - has also become very widespread. In many Russian cities there are clubs and centers where kids with cerebral disorders go in for horseback riding under the supervision of experienced hippotherapists.

While riding in the saddle, all muscle groups are involved in a person, and attempts to maintain balance are reflexive, that is, a signal from the brain to set the muscles in motion is not at all necessary. During classes, children develop useful motor skills.

The beneficial impulses that a horse sends to its rider while walking are a natural massage. During the procedure, the child is placed in the saddle, pulled along the horse's spine, seated, trying to load all the "problem" parts of the body and limbs.

Emotionally, children perceive a live horse much better, emotional contact is exactly the factor that allows you to form motivation in a child with cerebral palsy.

If parents and children do not have the opportunity to communicate live with such animals, then a hippo simulator will come to the rescue, on which all movements are monotonous, the same.

Methods with unproven effectiveness

Quite often, children are prescribed vascular drugs "Cerebrolysin", "Actovegin" and others, classed as nootropics. Although their use is widespread, it raises great doubts, since clinical trials have not shown a significant change in the condition of children with cerebral palsy after a course of treatment with nootropic drugs.

Quite often on the Internet, parents who are constantly looking for new methods and ways to defeat a terrible disease stumble upon modern homeopathic remedies, which promise "improvement of brain activity". None of these funds currently have official approval from the Ministry of Health, their effectiveness has not been proven.

Treatment of cerebral palsy stem cells- another commercial and very profitable step for manufacturers of drugs with unproven action. Clinical trials have shown that stem cells cannot restore movement disorders, since they do not have any effect on the connection between the psyche and motor skills.

Experts believe there is little benefit in cerebral palsy and from manual therapy. No one detracts from its significance, with a number of other pathologies during the recovery period after injuries, the technique gives positive results. However, it is in children with cerebral palsy that its use is inappropriate.

Forecasts

With the modern level of medicine, the diagnosis of cerebral palsy is not a sentence. Certain forms of the disease lend themselves to complex therapy, which includes the use of medications, massage, rehabilitation techniques, and work with a psychologist and a correctional teacher. Even some 50-60 years ago, children with cerebral palsy rarely lived to adulthood. Now life expectancy has changed in a big way.

On average, during treatment good care a child with cerebral palsy today lives to be 40-50 years old, and some have managed to overcome the retirement age. It is rather difficult to answer the question of how long they live with such a diagnosis, because much depends on the degree and severity of the disease, its form and the characteristics of the course in a particular child.

A person with cerebral palsy is prone to premature aging, his actual age is always lower than his biological age, because deformed joints and muscles wear out faster, creating the prerequisites for early aging.

Disability

Disability in children with cerebral palsy is issued based on the form and severity of the course of the disease. Children can count on the status of a “child with a disability”, and after they come of age, they can receive the first, second or third group of disability.

To obtain a disability, the child will have to undergo a medical and social examination, which should establish:

• form and degree of cerebral palsy;
• the nature of the lesion of the motor function (on one or both sides, whether there are skills in holding objects, leaning on the legs);
• the severity and nature of speech disorders;
• the severity and degree of mental damage and mental retardation;
• the presence of epileptic seizures;
• the presence, as well as the degree of hearing loss, vision.

Children with severe disabilities are usually given the category of "disabled child", which, before the age of 18, needs to be re-confirmed. The parents of such a child will be able to count on receiving the rehabilitation means necessary for the child and visiting a sanatorium at the expense of the federal budget.

Development features

In infants, cerebral palsy has almost no clear manifestations (in any case, up to 3-4 months). After that, the baby begins to rapidly lag behind in development from his healthy peers.

Children with cerebral palsy have difficulty with coordinated movements. As they get older, the child will try to avoid them. If at the same time intellectual abilities are preserved, then the kids grow “slow”, they do everything very slowly, leisurely.

Children with a light children with cerebral palsy are rarely aggressive and angry. On the contrary, they have an incredible attachment to their parents or guardians. She can reach panic if the baby is afraid to be alone.

Some forms of cerebral palsy “deform” the personality so much that the child can become withdrawn, embittered, aggressive (for no apparent reason). However, it would be wrong to attribute everything only to the form of the disease. Parents play a very important role in shaping the character of a child. If they are positive, good-natured, encourage the achievements of the child, then the likelihood of getting an aggressive child is minimized.

At the physical level, in children with cerebral palsy, the lack of understanding of what the correct position of the body in space should be comes first. Since an erroneous signal comes from the affected brain, the muscles receive it incorrectly, hence the inability to do something consciously and spontaneous movements.

Reflexes (Moro, grasping and others), which are characteristic of all newborns, disappear in order to give way to new skills. In children with cerebral palsy, these innate reflexes often persist, and this makes it difficult to learn new movements.

Many children with cerebral palsy are characterized by insufficient body weight, minimal subcutaneous fat, and weak (often blackened and crooked) teeth. Individual features of development are determined by a single factor - the preservation of intellectual potential. If it is, then a lot can be adjusted and corrected.

Means of rehabilitation

Special funds that make life easier for a child with cerebral palsy can be obtained from the federal budget. True, this is only possible if the doctor has entered their exact list in the rehabilitation card, and the ITU commission, when confirming disability, has recorded a list of necessary funds for rehabilitation.

All devices are divided into three large groups:

• hygienic devices;
• devices that make it possible to move;
• devices for the development of the child, training and medical procedures.

In addition, the child may need special furniture adapted for babies with cerebral palsy, as well as shoes and dishes.

Hygiene

These facilities include toilet chairs and bathing chairs. In order not to carry the child to the toilet (especially if he is already large and heavy), a toilet chair is used, which consists of a chair equipped with a removable sanitary tank. The chair also has wide, comfortable straps for secure fixation of the child.

The bathing chair has an aluminum frame and a seat made of waterproof material. On it, parents will be able to place the child comfortably and calmly bathe him. The tilt adjustment allows you to change the angle to change the position of the body, and the seat belts securely hold the child in the bath.

Mobility

A child who cannot move independently needs a wheelchair, and more than one. Wheelchairs are used to move around the house, and strollers are used for walking. Walking option (for example, "Stingray") is lighter, sometimes equipped with a removable table. Very good options manufacturers of electric wheelchairs offer, but their price is quite high.

If a child has learned to walk, but cannot (or cannot always) keep his balance, he needs a walker. A well-fitted walker can also help in the process of learning to walk. In addition, they train coordination of movements. Usually walkers look like a frame with four wheels and a safety device. The wheels cannot roll back, this completely eliminates tipping.

A more complex version of the walker is the parapodium. This is a dynamic stander that will allow the child not only to stand, but also to exercise on the simulator at the same time. In such an orthosis, the child will be able to move independently. However, the parapodium is suitable only for children who have retained their intellectual functions, for everyone else it is better to use a regular static stand.

The verticalizers fix the child in the region of the popliteal space, as well as the feet, on the hips and on the belt. It can lean slightly forward. If the model is equipped with a table, then the child will even be able to play there.

Devices for the development of the child

Such devices include special furniture, tables and chairs, some verticalizers, langets, a bicycle, exercise equipment and complex orthopedic shoes. All furniture is equipped with body position regulators, seat belts. It can be one item (chair or table) or a whole set, where each element is combined and combined with another.

A special bicycle for children with cerebral palsy is not only a toy, but also a means of active rehabilitation. It has a special (unusual for most people) design. It is always three-wheeled, and its steering wheel is not connected to the pedals. Therefore, turning the steering wheel in the wrong direction does not lead to turning the wheels in a given direction.

Such a bike is equipped with mounts for the hands, legs and feet, as well as a cane that allows parents to push the device with the child forward if the child cannot pedal on his own.

Using a bicycle allows you to prepare your child well for learning to walk, trains leg muscles, alternating movements.

simulators

The modern medical industry has stepped far ahead, and children with cerebral palsy today have access not only to the most familiar exercise bikes, but also to real exoskeletons that will take over all the “work” of the muscles. In this case, the child will make movements together with the exoskeleton, due to which the reflex correct movement will begin to form.

The most popular in Russia is the so-called Adele costume. This is a whole system of support and load flexible elements. Classes in such a suit allow the child to correct posture, the position of the limbs, which ultimately has a good effect on other body functions. The kid begins to speak better, draw, it is easier for him to coordinate his own movements.

Adele's costume is very reminiscent of the outfit of a volunteer cosmonaut from a science fiction film, but this should not be scary. The average course of treatment in such an outfit is about a month. In this case, the child (from 3 years old) will have to walk, bend and unbend, squat (if possible) in this suit for 3-4 hours a day.

After such courses, which can be taken on the basis of a rehabilitation center, children feel more confident, they are easier to control own hands and legs, their arches are strengthened, a wider step appears, they master new skills. Doctors say that the risk of developing "fossil" joints is reduced several times.

For home use the most common treadmill, ellipsoid, as well as expensive (but very useful and effective) Motomed and Lokomat exoskeletons are well suited.

And at home, in a rehabilitation center, you can use the Gross simulator. It is very easy to fix it in the country, and in the apartment, and on the street, and even in the pool, so that the child can practice in the water. The simulator is a movable block with a stretched cable, elastic rods, hand rings, for which the child will hold on. Insurance and a special lever-carbine mechanism are provided.

Classes on such a simple simulator (according to the Ministry of Health) give amazing results - every fifth baby with cerebral palsy develops the skills of independent movement with legs, about a third of children with this diagnosis, after systematic classes, were able to attend specialized schools and study.

In half of the cases, speech development improves. More than half of the children have significantly improved coordination of movements, 70% of the children have the prerequisites for acquiring new skills - they were able to learn to sit, stand up, and take their first steps.

To fix the joints in the correct position, orthoses, splints and splints are often used. The most popular manufacturing companies - Swash And Gait Corrector.

Children from 1 year old can play with special toys for "special" babies, they include sets for fine motor skills with small movable and securely fastened parts. The production of special toys for the medical rehabilitation of such children is carried out in St. Petersburg, they are produced under the brand name "Tana-SPb". Unfortunately, the cost of the sets is quite high. Full set costs about 40 thousand rubles, but it is possible to buy one or two toys from the set (1500-2000 rubles each).

These motor toys are also great for children with severe mental retardation, they stimulate not only motor skills, but also many other functions of the child's body.

Charitable foundations

Parents should not be left alone with a serious illness of the child. Many rehabilitation means cannot be purchased at the expense of the budget, and incomes do not allow them to be bought on their own. In this case, charitable foundations created to help children with cerebral palsy will help. No one will ask parents for any “entry fees”, it is enough to send letters to the foundations describing the problem, confirming the diagnosis, and wait for the necessary support.

If you do not know where to turn, here are just a few organizations operating throughout Russia and well-established in helping children with cerebral palsy:

• Charitable Foundation "Children of cerebral palsy" (Tatarstan, Naberezhnye Chelny, Syuyumbike st., 28). The fund has been operating since 2004.
• "Rusfond" (Moscow, PO box 110 "Rusfond"). The fund has been operating throughout the country since 1998.
• Charitable Foundation "Creation" (Moscow, Magnitogorskaya st., 9, office 620). Since 2001, the Foundation has been working with children who are undergoing treatment and rehabilitation with cerebral palsy in clinics across the country.
• Spread Your Wings Charitable Foundation (Moscow, Bolshoy Kharitonevsky lane, 24, building 11, office 22). The Foundation has been operating since 2000 and provides support to disabled children.
• Kindness Foundation (Moscow, Skatertny lane, 8/1, building 1, office 3). She has been working only with children with cerebral palsy since 2008.
• Charitable Foundation "Children of Russia" (Ekaterinburg, 8 March st., 37, office 406). Helping children with cerebral and other disorders of the central nervous system since 1999.