Classification of various forms and types of cerebral palsy and their characteristics. Signs and causes of cerebral palsy in a child, methods of treating infantile cerebral palsy Cerebral palsy is referred to as

Cerebral palsy (cerebral palsy)

The collective name "infantile cerebral palsy" (abbreviated as cerebral palsy) denotes not one pathology, but many disorders of the nervous system (NS), malformations that form during pregnancy, in the natal and postnatal periods, united by a single complex of symptoms.

Movement disorders in cerebral palsy, often combined with mental, speech, cognitive impairments, epilepsy, visual impairments, hearing impairments, etc., are secondary symptoms arising from developmental anomalies, trauma, and inflammatory pathologies of the brain. Although they are considered non-progressive, as a child with cerebral palsy grows and develops, objective clinical picture may improve or worsen, depending on:

• forms of cerebral palsy, the degree of damage to the central nervous system;
• adequately selected therapy for concomitant disorders;
• the success of the rehabilitation program for cerebral palsy;
• psychoemotional state of a particular patient with cerebral palsy;
• his social environment;
• joint efforts of parents, doctors, teachers and other caring people who, by the will of fate, are near, take part in habilitation, the fate of children with cerebral palsy in the first year of life and older.

Manifesting at an early age, childhood disease (cerebral palsy) will gradually develop into an adult over the years. Congenital or acquired in natal and postnatal periods, pathologies of the central nervous system accompany a person throughout his life. If the brain damage is insignificant, it was possible to diagnose cerebral palsy on time, start symptomatic treatment and rehabilitation for up to a year, continue them if necessary throughout life, there is a chance that in adulthood, motor, cognitive and other impairments will be minimal. Modern habilitation and rehabilitation programs for cerebral palsy make it possible to level pathological symptoms with mild degrees of damage.

Some adults who were once diagnosed with cerebral palsy are getting education, various professions, moving up the career ladder, and running at the Paralympic Games. Among them are artists and lawyers, musicians and teachers, journalists and programmers. The whole world knows the names of outstanding people who cannot be called "patients with cerebral palsy." Special people who, by the will of fate or nature, found themselves in a less advantageous position in comparison with the rest, ordinary people, were able to rise above the disease, defeat it, achieve much more in life than others.

Let's talk about some of them.

Cerebral palsy in women

Known not only on her home continent, but all over the world, the Australian prose writer, public figure, Anna MacDonald. She spent from 3 to 14 years in a closed institution, where they did not live in isolation from society, but there were people with disabilities with cerebral palsy and other serious illnesses. This dramatic stretch of fate became the theme of the acclaimed book Anna's Coming Out, and later the script for a feature film.

Similar, but not so dramatic, is the fate of the Russian scriptwriter Maria Batalova. She has also been struggling with the symptoms of cerebral palsy for many years, but she has always had relatives and people who love her by her side. The bright lines of her works for adults, wonderful stories for children are imbued with philanthropy. In 2008, her script for the film "House on the English Embankment" won the highest award at the Moscow Film Premiere Film Festival.

Anastasia Abroskina, a beautiful young mother and at the same time a successful model, has won six gold medals at the Russian Paralympic Equestrian Dressage Championships. Her illness, which had long since outgrown childhood (cerebral palsy, hyperkinetic form), could not break the will to win, destroy the thirst for life of an elegant, seemingly very fragile, but in fact, incredibly persistent, purposeful woman.

In the middle of the 15th century, the illegitimate son of notary Piero da Vinci, Leonardo, was born in Italy. The boy's right arm and right leg did not obey from birth, he had hemiplegic cerebral palsy. Therefore, when he grew up, he limped slightly when walking, and he learned to write, draw, etc. with his left hand. Thanks to his divine gift, numerous talents, the world cultural heritage was enriched with great canvases ("Annunciation", "Madonna with a Flower", etc.), sculptural works (unfortunately, lost), and he was also an architect, scientist, inventor.

Among our contemporaries who are diagnosed with cerebral palsy and world-famous are actors Sylvester Stallone, R.J. Mitt, Chris Foncesca.

In 2008, one of the sensations of the Paralympic Games in Beijing was the triumph of Russian athlete Dmitry Kokarev. The young swimmer brought our team one silver and three gold medals.

The pride of all Crimeans is their fellow countryman, a legendary man, Niyas Izmailov, a special child, a disabled person with cerebral palsy, who grew up and became the world champion among ordinary bodybuilders.

Children and cerebral palsy: from birth for many years

World medical statistics claim that today children with cerebral palsy (up to one year and older) are found in the population with a frequency of 0.1 to 0.7%. Moreover, boys are victims of pathology almost one and a half times more often than girls. For every 1000 citizens in different countries, there are, on average, 2 to 3 people with damage to the nervous system, which is called "childhood" (cerebral palsy), as it occurred during intrauterine development, in the natal or postnatal period. However, in some countries, children with cerebral palsy are much more common among the population.

For example, in the United States, the numbers are much higher, and they differ even for nearby states. For example, in 2002, statistics showed that children with cerebral palsy (1 year of age and older) per 1000 people occur with a frequency of:

• 3.3 - in Wisconsin;
• 3.7 - in the state of Alabama;
• 3.8 - in the state of Georgia.

On average, American scientists said that children with cerebral palsy (1 year and older) occur with a frequency of 3.3 patients per 1000 population.

• In Russia, according to Rosstat, in 2014 there were 32.1 small patients with cerebral palsy per 100,000 children per 100,000 children (from 1 year of age to 14 years).
• According to the estimates of the Ministry of Health in Russian Federation back in 2010 there were more than 71 thousand children with cerebral palsy (1 year - 14 years).

The forecast of experts from the World Health Organization is not very encouraging. Children with cerebral palsy are born more often. And in the coming years, the number of babies who have signs of cerebral palsy from birth will increase.

Despite the fact that the disease is childhood, cerebral palsy accompanies the patient from birth, relentlessly following him all his life. Therefore, the fight against the disease always continues.

If a baby has perinatal brain damage, cerebral palsy, the year (first from birth) can determine the whole future fate. After all, the objective clinical picture in the future will depend on how much:

• signs of cerebral palsy were quickly identified;
• the form and extent of damage to the nervous system are precisely determined;
• the selected symptomatic therapy is adequate;
• the rehabilitation and habilitation program of cerebral palsy is correctly drawn up.

Parents of children with various forms of cerebral palsy often regret the time, energy and money spent in vain on psychics, traditional healers, etc., in the first years after the birth of a baby. It is important that the confused, and sometimes morally crushed, changes that have taken place in their lives, with the birth of a special child, dads and mothers, are sent on the right path by specialists, doctors, psychologists. The road of habilitation and socialization is always very difficult, thorny for every family, which has children with special needs.

Therefore, it is better not to stray by roundabout paths, making your way by touch, experiencing alternative methods on your own son or daughter, expecting a miraculous healing and losing precious time, during which deformities, contractures have time to form, and other accompanying complications appear. And rely on the existing world experience in habilitation and treatment of cerebral palsy, enlist the support of specialists.

And the sooner parents stop looking into the past, looking for an answer to the question "why" is cerebral palsy sent, seeing the causes of the disease in the "evil eye" of ill-wishers or stirring up their own actions, they will understand that it is necessary to live in the present, the sooner they will understand how to live in future.

Helping the baby to fight for life, rejoicing in each, albeit tiny, completely invisible to others, but such a huge victory for the family, giving, without a trace, all his love and tenderness to the most defenseless, helpless of all people, mom and dad, grandparents, other relatives and strangers by blood, but the most humane people on this earth who become foster parents, guardians, educators for abandoned children with cerebral palsy, acquire a meaning of existence. They develop spiritually, gaining invaluable experience of compassion and mercy.

Special people or patients with cerebral palsy?

Parents, doctors, teachers and other people are products and part of society. The worldview and attitude of each individual towards disabled people are formed by virtue of public opinion and the position of the state.

The moral norms of the modern human population, which distinguish people from animals, differ significantly from those that existed at the dawn of human civilization. They have changed significantly during the evolution of society.

Weaker children have always come to the world, including those with cerebral palsy. However, in addition to natural selection, in old days people tried on the role of gods, deciding who has the right to life and who is not worthy. Infanticide, the killing of infants with signs of inferiority, has existed for millennia. Only in 374, for the first time in world history, a law was issued prohibiting the physical destruction of newborns with various pathologies. But only in the 9th century the Christian world began to equate infanticide with the usual murder of its own kind.

The spiritual life of Western European society and the entire world civilization has experienced great positive changes, thanks to the great figures of the Renaissance and humanist educators who fought for the rights of disabled people during the French Revolution. Thanks to them, society for the first time realized its responsibility for the disadvantaged, outcast, patients with cerebral palsy, etc.

Humanity has gone through a huge evolution of spiritual growth over the past hundred years. And this process continues today, in front of each of us.

So in 2008, an event took place that in the long term should change the life of disabled people with cerebral palsy and other pathologies in Russia. Our country has signed the Convention on the Rights of Persons with Disabilities. The new international law was ratified by MPs in 2012. It is designed to help socialize people with disabilities, reduction of manifestations of discrimination against them by the state, officials, society.

The state turned its gaze towards special people. The media started talking about an accessible environment for people with disabilities, inclusion, equal opportunities. Many positive changes are taking place before our eyes. The mere fact that large and small people in wheelchairs with various orthopedic devices have appeared on the streets of Russian cities already suggests that the process has begun.

However, much remains to be changed. First of all, in the minds of each individual person. So that adults and children are not afraid of people with disabilities, including those with cerebral palsy, do not shy away from them in public places, do not humiliate or offend, voluntarily or involuntarily, do not ignore their difficulties. Society must understand that patients with cerebral palsy are ordinary people, only they have their own characteristics, like every person.

Special people have the same desires and dreams as ordinary people. Just to fulfill even the smallest of them, it is sometimes necessary to make incredible efforts. For example, to take a walk in the park on a fine day, learn to paint, or find a true friend.

Therefore, they need help, not only material, but physical, psychological. Not giving, but sincere participation of others. And yet - partnership, on an equal footing.

They are the same people, just stranded.

Several diseases at once, which are based on a developmental abnormality or damage to the brain during the intrauterine development of a child, at the time of childbirth or in the postnatal period, are called cerebral palsy.

In 1861, William Little, an orthopedic surgeon from England, first described the clinical picture of one of the varieties of cerebral palsy; he saw the causes of spastic diplegia in oxygen starvation at the time of childbirth. But he believed that it was not the brain that was affected, but the spinal cord. In honor of him, this form of cerebral palsy is sometimes called "Little's disease" today.

The term "cerebral palsy" itself was introduced into medical practice in 1893 by Sigmund Freud, at that time already a well-known psychoanalyst. In 1897, he first compiled a classification of children, listing the signs of cerebral palsy. Freud was the first to describe the development of cerebral palsy. Unlike Little, he saw differently the etiology and pathogenesis of cerebral palsy, the causes of pathology. According to Freud, not only the spinal cord, but primarily the brain suffered from cerebral palsy, he was looking for the causes of disorders not only in birth trauma and asphyxia. Freud believed that the development of cerebral palsy begins much earlier. He was the first to name the cause of cerebral palsy in the wrong intrauterine development of the child.

Signs and manifestations of cerebral palsy

Since 1980, according to the definition of experts of the World Health Organization, signs of cerebral palsy, as a group of pathological syndromes of the nervous system, are considered non-progressive motor and psycho-speech disorders. They are a consequence of brain damage in cerebral palsy, the causes of which lie in the postnatal, intrapartum and intrauterine periods of the child's development.

Throughout history, since the definition of the signs of cerebral palsy by William Little, there have been many attempts to classify and streamline the symptom complexes of the group of syndromes. However, according to some scientists, it was not possible to compile a single, clear concept of multifaceted pathology, forms of cerebral palsy.

In general, the severity of the condition of patients with cerebral palsy is assessed in accordance with three degrees of damage:

• easy - full socialization is possible with a given degree of damage in cerebral palsy, training, mastering not only self-service skills, but also professions, engaging in socially useful work, a full life;
• medium - partial socialization, self-service with the help of other people are possible;
• heavy - a person remains completely dependent on others, cannot serve himself without assistance.

Today in medical practice several classifications are used, including various forms of cerebral palsy.

In Russia, they often use the classification compiled in 1972 by Professor Ksenia Aleksandrovna Semyonova, who in our country was affectionately nicknamed "the grandmother of cerebral palsy." This classification combines the following forms:

• atonic-astatic;
• hyperkinetic;
• hemiparetic;
• spastic diplegia;
• double hemipletic;
• mixed.

In Europe, the following scheme is usually used clinical classification signs of cerebral palsy:

• ataxic paralysis;
• dyskinetic paralysis;
• spastic paralysis.

In this case, the dyskinetic form has two types of cerebral palsy, the symptoms of which differ from each other:

• choreoathetosis;
• dystonic.

The spastic form also has two options for the development of cerebral palsy:

• bilateral paralysis;
• unilateral paralysis.

Bilateral damage is divided into:

• quadriplegia;
• diplegia.

In international medical practice, the statistical classification ICD-10 has been adopted. According to her, all cerebral palsy (cerebral palsy) is divided into:

• spastic - G80.0;
• spastic diplegia - G80.1;
• infantile hemiplegia - G80.2;
• dyskinetic - G80.3;
• ataxic - G80.4;
• other types of cerebral palsy - G80.8;
• unspecified cerebral palsy - G80.9.

The development of a child with cerebral palsy goes through several stages.

The first of them is called "initial", it lasts from birth to six months.

If during it, as early as possible, the correct diagnosis of cerebral palsy is established, adequate therapy is prescribed, rehabilitation begins, there are much more chances to avoid unwanted complications and extreme disability.

The next stage, the initial residual, lasts from six months to 3 years.

At this time, the diagnosis of cerebral palsy has already been made, the degree of brain damage is clear and predictions have been made. But no modern classifications and predictions are able to accurately predict the compensatory capabilities of the brain of a particular child. Moreover, if they are multiplied by the persistence of the patient himself, the efforts of his relatives, doctors, everyone who participates in the rehabilitation program of cerebral palsy. It is during this period that the rehabilitation of cerebral palsy gives its first fruits. In addition, the correct strategy for dealing with the disease at the initial residual stage lays the foundation for the development of a child with cerebral palsy in the future.

At the age of 3, the residual stage starts.

Although organic lesions of the brain are irreversible, and the symptom complex in this period is finally formed and is considered non-progressive, classes with children with cerebral palsy cannot be stopped. Persistent and consistent habilitation, rehabilitation, training in cerebral palsy are of great importance at any age, for children and adults. If you carry out regular training and classes, cerebral palsy can be corrected. A clear proof of this is many adults and grown-up children who, thanks to training, habilitation and rehabilitation, were able to defeat cerebral palsy and live a full life.

At the end of the last millennium, Ukrainian scientists, Vladimir Ilyich Kozyavkin and Vladimir Oleksandrovich Padko, proposed a new rehabilitation classification of cerebral palsy, symptoms of motor and psycho-speech disorders were systematized for a unified assessment of the condition of patients at different stages of rehabilitation with cerebral palsy. It is based on the assessment of three main syndromes, which, in combination with an additional one, make it possible to diagnose cerebral palsy. These are syndromes:

• speech disorders;
• intellectual impairment;
• movement disorders.

Speech disorder syndrome can be characterized by:

• delayed speech development;
• sensory, motor, or mixed alalia;
• dislalia;
• ataxic, spastic, hyperkinetic or mixed dysarthria.

The syndrome of intellectual disabilities is defined as a mental retardation of two degrees:

• easy;
• pronounced.

The syndrome of movement disorders, at various stages of the development of cerebral palsy, is assessed based on:

• severity - plegia (complete absence) or paresis (limitation, weakness);
• prevalence - by the number of involved limbs;
• the nature of the violations - by the type of changes in muscle tone.

Based on the assessment of the syndrome of motor disorders, the following stages are distinguished, which the development of cerebral palsy goes through:

• stages of locomotion;
• phase of verticalization.

The stage of locomotion is subdivided into several segments, each of which is characterized by a certain way of movement in space:

• impossibility of movement in space;
• movement by turning the body;
• simple crawling (on bellies);
• spasmodic, non-alternating crawl;
• alternating, reciprocal, or alternating crawl;
• walking on your knees;
• walking in an upright position, with the help of special devices and devices;
• independent walking (pathological).

The verticalization phase also has several stages:

• lack of head control while lying down;
• having head control while lying down;
• the ability to sit independently;
• the skill of standing up with support;
• the ability to get up without support.

Assessment of the state at different stages of rehabilitation, taking into account the development of a child with cerebral palsy, allows us to trace the dynamics of neurological syndromes, to outline the immediate goals and prospects.

Each form of cerebral palsy has symptoms that distinguish it from others. The differences are due to the specific causes of cerebral palsy, the nature and extent of lesions of the nervous system. Therefore, even within the framework of the general form, children of the same age can have significant differences in development, even against the background of a single rehabilitation program.

Let us dwell, optionally, on the main forms and their features.

The hyperkinetic, athetosis form (3.3% of patients) undergoes two phases of the formation of neurological syndromes - the hyperkinetic one replaces the dystonic one. Muscle tone is significantly different - from severe spasticity to hypotension-dystonia. As a rule, dyskinesias, ataxia, psychoverbal retardation are diagnosed. Despite rehabilitation, training and classes with children with cerebral palsy of this form, limb deformities and scoliosis form over time.

The atactic form (9.2% of patients) manifests itself as a “flaccid baby” syndrome in the first weeks after birth. With this form of cerebral palsy, the causes of pathological syndromes are hidden in lesions of the frontal lobes of the brain. The delay in motor development is combined with a decrease in muscle tone. With brisk tendon reflexes, the following are noted:

• intentional tremor upper limbs;
• ataxia of the trunk;
• dysmetria;
• discoordination.

Despite the efforts of rehabilitation, regular classes, with cerebral palsy of this form:

• great difficulties are observed, often the inability to verticalize the body, since the mechanism of postural control is disturbed;
• often develops astasia-abasia syndrome (inability to sit and stand);
• gross mental retardation is recorded.

Spastic forms (up to 75% of patients) are characterized by:

• increased muscle tone;
• an increase in tendon reflexes;
• clonuses;
• pathological reflexes of Rossolimo, Babinsky;
• suppression of surface reflexes;
• lack of muscle control;
• suppression of normal synkinesis;
• the formation of pathological friendly movements.

The clinical picture is different for different spastic forms of cerebral palsy.

Quadriplegia (tetraplegia) is characterized by a violation of the muscle tone of the whole body, more often the hands are more affected. If significant differences are recorded in the lesion, with a predominance in the upper extremities, we are talking about bilateral hemiplegia.

The signs of this spastic form are:

• lack of head control;
• impossibility of visual-spatial coordination;
• due to violations of the mechanisms of the formation of postural reflexes, there are big problems with the verticalization of the body;
• have difficulty swallowing;
• articulation is difficult;
• problems with speech;
• despite classes with children with cerebral palsy of this spastic form, as a rule, deformities of the limbs and spine, contractures develop;
• delays in psychoverbal development of various degrees.

Paraplegia is a predominant lesion of the lower extremities, in combination with preserved motor function of the hands, minor or moderate impairment of the functional capabilities of the upper extremities. With safe speech and perfect control of the head, despite training and classes, with cerebral palsy of this spastic form, a "ballerina's pose" is formed and there are:

• flexion contractures in knee joints;
• equino-varus or equino-valgus deformities of the feet;
• dislocation of the hip joints:
• hyperlordosis of the lumbar spine;
• kyphosis of the thoracic spine, etc.

Paraplegic patients have difficulty mastering skills:

• seating;
• standing;
• walk.

Hemiplegia is a spastic lesion on one side of the body, in which the hand is more affected. Noted:

• violation of the grasping function;
• extension with external rotation of the leg on the affected side;
• in addition to increased tone, there is an increase in tendon reflexes;
• even under the condition of systematic exercises, cerebral palsy of this form is complicated by the shortening of the affected limbs as the child grows;
• contractures of the shoulder, elbow joints, hand, thumb can form;
• contractures develop in the lower limb, horse foot;
• high risk of scoliosis.

The prognosis for consistent habilitation, regular sessions with children with cerebral palsy of this spastic form is more favorable in comparison with others. The success of social adaptation correlates with the syndromes of psycho-speech disorders and intellectual disabilities.

Cerebral Palsy Diagnosis: The Importance of Early Diagnosis

Rehabilitation of cerebral palsy is the more successful the earlier the correct diagnosis is made. An experienced pediatrician or neurologist may notice even minor neurological disorders in a newborn based on:

• careful inspection;
• reflex assessments;
• measuring visual acuity, hearing;
• determining the functionality of muscles.

To confirm or deny the fears of doctors, help high-tech modern methods surveys:

• magnetic resonance imaging;
• cT scan;
• electromyography;
• electroneurography;
• electroencephalography, etc.

Since the neurological symptom complex in cerebral palsy is accompanied by various disorders and pathologies, in addition to observation by a neuropathologist, patients need consultations:

• psychotherapists;
• epileptologists;
• speech therapists;
• otolaryngologists;
• oculists, etc.

Just like the forms of cerebral palsy, the causes of chronic symptom complexes of motor disorders are very diverse. Among the most common are called:

• premature birth of a small person into the world, prematurity (according to world statistics, about half of all episodes of cerebral palsy are associated with it);
• malformations of the central nervous system;
• brain damage as a result of hypoxia and ischemia;
• intrauterine viral infections, including herpes;
• postnatal infectious diseases;
• toxic lesions;
• rh-conflict between the blood of the mother and the fetus;
• cNS injuries during childbirth and in the postnatal period, etc.

Interesting statistics have been collected on the popular "Children-Angels" forum. Parents of children with cerebral palsy call today among the common causes of damage to the nervous system:

• incorrect delivery - 27.1%;
• premature pregnancy - 20.2%;
• errors in resuscitation and treatment - 11%;
• vaccination - 8%;
• diseases of the mother during pregnancy and taking medications - 6.6%;
• psychoemotional stress of expectant mothers - 5.7%, etc.

Complex treatment of cerebral palsy

When talking about treatment of cerebral palsy, means a complex of therapeutic and rehabilitation measures, which allows you to improve the clinical picture, reduce the severity of pathological symptoms.

Complex treatment of cerebral palsy may include:

• drug therapy;
• physiotherapy methods;
• rehabilitation measures;
• in some cases, surgical treatment is indicated.

Cerebral palsy is usually complicated by many other pathologies:

• epilepsy;
• scoliosis, arthritis and other diseases of the musculoskeletal system;
• hydrocephalus;
• atrophy of the optic nerve and other visual disturbances;
• disorders of coordination of movements;
• hearing impairment;
• psychoemotional disorders;
• behavioral disorders;
• speech disorders, etc.

The goal of symptomatic therapy is not the causes, but the complications of cerebral palsy

Medical treatment for cerebral palsy and non-drug therapy are usually designed to combat common complications. An integrated approach allows you to avoid undesirable scenarios for the development of pathology, to reduce the pathological symptoms of concomitant diseases.

So drug treatment allows:

• stop epileptic seizures;
• minimize metabolic disturbances as much as possible;
• remove muscle tone;
• reduce pain symptoms;
• stop panic attacks, etc.

Habilitation and rehabilitation of cerebral palsy is based on three main principles:

• early onset;
• a complex approach;
• duration.

The initial residual stage is the most promising for compensating for neurological deficits. It is between the ages of 6 months and 3 years that the most active response to rehabilitation programs is observed.

Individual rehabilitation programs for cerebral palsy

Comprehensive rehabilitation programs for small and mature patients with CNS lesions are made taking into account:

• forms of the disease;
• the extent of perinatal lesions;
• individual characteristics;
• concomitant diseases, etc.

Comprehensive rehabilitation for cerebral palsy may include:

• medical methods;
• methods of social and environmental adaptation;
• speech therapy classes;
• psychotherapy sessions;
• educational programs for patients with cerebral palsy, training, occupational therapy, etc.

Most patients with cerebral palsy need special devices, devices, orthopedic products that make life easier, make it possible to move in the space of special people. If a disability is established, for a person with cerebral palsy, during the examination by specialists of medical and social expertise, an individual rehabilitation program is drawn up, which may include various technical means or assistive devices.

They are conventionally divided into three groups:

• providing the ability to move in space (wheelchairs, walkers, verticalizers, seats);
• designed for the development of motor capabilities (verticalizers, bicycles, chairs, orthoses, tables, orthopedic shoes, etc.);
• facilitating patient hygiene (toilet chairs, bath seats, etc.).

Exercise therapy for cerebral palsy

Physiotherapy or kinesiotherapy for different formsah cerebral palsy can mitigate the negative effects of hypodynamia, forced movement deficit, and correct motor disorders.

Classes should be regular, systematic, throughout the life of a person with cerebral palsy. Types of fitness, alternation of exercises, loads are selected by kinesiotherapists, exercise therapy instructors, together with neuropathologists, pediatricians, psychotherapists and other specialists.

Specific fitness workouts for different forms and grades can include:

• remedial gymnastics;
• gymnastic exercises;
• sports and applied training;
• training on simulators, etc.

Massage for cerebral palsy helps:

• optimize blood circulation;
• improve lymph flow;
• normalize metabolic processes in muscle tissue;
• improve functionality different systems and organs.

In clinical practice, the following massage techniques are widely used in rehabilitation programs for children and adults with cerebral palsy:

• classic;
• segmental;
• point;
• sedative;
• tonic;
• monakov system.

Speech development

Many patients with cerebral palsy have speech impairments of varying degrees. Regular and consistent sessions with speech therapists help:

• normalize the tone of the muscles that provide articulation;
• improve the motor skills of the speech apparatus;
• to form correct speech breathing and synchronize it with articulation and voice;
• develop optimal sound, voice strength;
• smooth out phonetic defects, improve pronunciation;
• achieve intelligibility of speech;
• facilitate verbal communication, etc.

In order for a patient with cerebral palsy to adequately perceive the world around, objects, people, to form an idea of \u200b\u200btheir shapes, sizes, position in space, smells, taste characteristics, etc., it is necessary to form a full-fledged perception of information by his senses. The importance of sensory education (correction) is that it allows you to:

• develop tactile-motor, auditory, visual and other types of sensory perception;
• generate sensory samples of shapes, colors, sizes, etc .;
• improve cognitive abilities;
• correct speech disorders, enrich vocabulary.

Animal therapy

For the rehabilitation of children with cerebral palsy, classes with animals are successfully used:

• dolphin therapy;
• canistherapy;
• hippotherapy, etc.

In the process of communicating with smaller brothers, the child receives not only positive emotions, vivid impressions, which in themselves are an excellent medicine. During training with horses, dogs, dolphins in children with various forms of cerebral palsy:

• motor capabilities expand;
• new skills and abilities appear;
• muscle tone is normalized;
• the range of motion increases;
• reduced hyperkinesis;
• coordination improves;
• speech skills are improved;
• fears and consequences of stress go away;
• decrease in psychological and behavioral disorders etc.

Classes in creativity with cerebral palsy, training in drawing, modeling, applied arts:

• enrich the spiritual world of kids and adults;
• are great sensory training;
• develop fine motor skills;
• contribute to the correction of psycho-emotional disorders;
• form figurative thinking;
• improve the ability to concentrate;
• help get rid of behavioral disorders.

Little artists, sculptors, craftsmen see the fruits of their labor, get satisfaction from creativity, joy from communication with beauty, gain confidence in their own capabilities. Many children find their favorite hobby, and for some, the hobby for needlework and drawing develops into the main business of their whole life.

Habilitation for cerebral palsy and socialization of disabled people

Today the term “habilitation” is often used for children with cerebral palsy. It is more accurate, since it reflects the fact that, in contrast to, the complex of medical and pedagogical measures is aimed not at restoring the lost skills and abilities (motor, speech, cognitive), but at their acquisition, for the first time. Habilitation serves the socialization of children with various forms of cerebral palsy. In the process of training and learning, the child masters:

• movement;
• self-service skills;
• labor activity;
• speech;
• sensory perception etc.

The ultimate goal of habilitation, which, unfortunately, is not always achievable due to the degree and scale of damage to the nervous system, is the integration of patients with cerebral palsy into society.

Persistence in achieving the goal, daily work can change a lot in the life of a child with cerebral palsy. Unlike ordinary children, their development is hampered by labyrinth and cervical tonic reflexes. Pathologies of vision, hearing, psycho-speech disorders, difficulties with spatial analysis and synthesis, which are associated with movement disorders, complicate learning. But thanks to the joint efforts of the patient himself, relatives, doctors, teachers, speech therapists, today it is possible to change the lives of many people with cerebral palsy. Those who, while remaining in social isolation, without having the opportunity to get habilitation, education, used to become helpless people with severe disabilities, today they often gain independence, master professions, create their own families.

Special child and regular school

Until recently, the education of children with cerebral palsy in our country, with the exception of isolated cases, was carried out in specialized boarding schools. Children with special needs who cannot attend a regular school continue to receive education in correctional educational institutions.

But today the right to inclusive education is enshrined in the strategic National Doctrine of the Russian Federation. Therefore, a child with motor and psycho-speech disorders, with limited ideas about the world around him, can receive an inclusive education, study in a regular, general education school.

The element of competition, the desire to be equal among equals is a great stimulus for learning. Daily activities, homework, allow you to expand your horizons, improve thinking, memory and other cognitive abilities. In addition, getting the first experience of independent life outside the home, communicating with peers, teachers, the child expands the boundaries of the spiritual world, learns to exist in society, interact with other members of the team.

And this is a great experience not only for a special boy or girl, but also for quite ordinary children. Along with mathematics, languages, biology and other sciences, they have the opportunity to receive a free lesson in kindness, mercy, compassion, and mutual assistance. Provided that adults, teachers, psychologists, who must provide support for a child with cerebral palsy in a regular school, will help them understand what is "good" and what is "bad", will show an example of philanthropy.

If for some objective reason a child with cerebral palsy cannot attend general education or correctional institutions, today there is the possibility of home schooling.

During individual home lessons, the teacher can devote his attention and time entirely to one student. The child feels protected, which means he is more calm at home, so it is easier for him to concentrate on the learning process.

However, being homeschooled, he will be deprived of the opportunity to communicate with peers, life in a team, independence in decision-making, etc.

Therefore, if the child's condition, the form of the disease and the degree of injury allow him to receive an inclusive education, parents and other adults should do everything possible for his successful integration into the children's team.

Most diseases in children are accompanied by difficulties in the diagnosis process. The symptoms of pathology are not always obvious, and the child is often unable to correctly describe his feelings. An example is cerebral palsy, the causes of which and symptoms can be multifaceted.

What is Cerebral Palsy?

Many have heard about this disease, but not everyone knows what cerebral palsy is in children, how it manifests itself and why it occurs. Cerebral palsy (CP) is a complex of motor and motor function disorders resulting from damage to the central nervous system. The term was first used in 1889 by the Canadian physician William Osler.

Research conducted over many decades has shown that the disease is complex. The defeat of the brain leads to the emergence of progressive disorders of motor activity, coordination of movements, affects the visual apparatus, hearing organs. In children with cerebral palsy, speech is often impaired, memory suffers.

Cerebral palsy - causes

Studies have shown that in most cases of infantile cerebral palsy, the causes of its occurrence are continuously associated with violations during gestation. According to statistics, 70–90% of cases of cerebral palsy are recorded during pregnancy.

Among the main reasons for the formation of pathology:

• dysgenesis of the brain;
• chronic fetal hypoxia;
• hypoxia;
• intrauterine infections (toxoplasmosis, rubella, herpes);
• mother and fetus;
• head trauma during childbirth;
• toxic lesions of the brain.

Forms of cerebral palsy

Depending on which area of \u200b\u200bthe brain is affected, a specific picture of cerebral palsy develops. Sometimes the symptoms are mild, but in severe cases, they are extremely serious. Depending on this, it is customary to distinguish the following forms of cerebral palsy:

1. Spastic diplegia (40% of cases). It is characterized by a lesion of the area of \u200b\u200bthe brain responsible for the motor activity of the limbs.
2. Double hemiplegia - due to damage to the two hemispheres of the brain, which causes muscle rigidity. Children are unable to hold their heads, sit poorly, cannot stand and move poorly.
3. Hemiparetic form - accompanied by damage to one hemisphere of the brain. Causes hemiparesis of the extremities on one side of the body.
4. Hyperkinetic form. Damage to the subcortical structures is observed, which causes hyperkinesis - involuntary movements of the limbs. Often combined with spastic diplegia
5. Atonic-astatic form - is a consequence of the defeat of the cerebellum. It manifests itself in a violation of coordination of movements, a violation of the sense of balance with muscle atony.

Cerebral Palsy - Causes of Pregnancy

Cerebral palsy in most cases occurs during pregnancy. It is difficult to determine possible abnormalities in the fetus at the same time at the embryonic stage. Analyzing cases of cerebral palsy in newborns, doctors have formed a list of reasons, the appearance of which is a threat of pathology:

1. Infectious processes in the body of the expectant mother. The development of infections such as toxoplasmosis, rubella, herpesvirus, several times increases the likelihood of a future baby developing pathology.
2. Genetic mutations in the fetus. According to the results of the studies conducted, up to 14% of cases of cerebral palsy are provoked by a violation of the gene apparatus.
3. Chronic fetal hypoxia. Insufficient supply of negative oxygen to the body of the future baby affects the work of the brain and central nervous system.
4. Congenital malformations brain.

Separately, doctors identify a group of factors, the appearance of which increases the risks of cerebral palsy:

• prematurity;
• low birth weight;
• the presence of hyperthyroidism in a pregnant woman;
• the development of bleeding in the later stages;
• severe toxicosis;
• fetoplacental insufficiency;
• multiple pregnancy.

Causes of cerebral palsy during childbirth

As shown by medical observations, the causes of cerebral palsy in children are often directly related to the process of childbirth. They can be connected both with the mechanism of childbirth itself, and with the incorrect provision of obstetric benefits.

As a result, cerebral palsy develops, the reasons for which are as follows:

• prolonged, protracted labor;
• premature rupture of amniotic fluid;
• incorrect insertion of the head into the small pelvis;
• placenta previa;
• against the background of entanglement with the umbilical cord;
• breech presentation.

Is cerebral palsy inherited?

Cerebral palsy, the causes of which are often difficult to determine, is not hereditary disease... This means that the presence of cerebral palsy in the family does not mean the development of the disease in subsequent generations. Studies and statistics prove that even in the presence of one child with pathology, the likelihood of having a second and subsequent ones with cerebral palsy does not exceed 1%. The cases when patients with this disease have brothers and sisters with the same pathology are small and do not depend on the genetic factor.

Cerebral palsy - symptoms

Signs of cerebral palsy, the symptoms of this disease can have a different nature and severity. This makes it difficult to diagnose the disease in newborns when the clinical picture appears months after birth. In most cases, parents and doctors begin to suspect a disease when a child, at the age of 5-6 months, does not crawl, does not sit well, does not turn over. In most cases, babies with pathology retain the reflexes of infants longer.

The muscular system in such children has insufficient or increased tone. As a result of such changes, the baby's limbs assume pathological positions. In 30% of cases, cerebral palsy is accompanied by the development of seizures. However, in some cases, these symptoms may be absent.

You can assume the presence of cerebral palsy if:

• the baby does not blink at sharp, loud sounds;
• at 4 months, the baby does not turn his head to the source of the sound, does not reach for the toy;
• at 7 months, the child is unable to sit without support;
• at 1 year he does not utter a word, performs actions with only one hand, does not attempt to walk, squint is observed.

Cerebral palsy degree

After the diagnosis of cerebral palsy is made, the causes of the disease have been established, doctors determine the degree of pathology. When characterizing cerebral palsy in children, neurologists often distinguish different levels of the disease. Neurologists use the GMFCS International Patient Motor Function Classification Scale. It can be used to describe the nature of disorders in a child over 2 years old. At the same time, the general functional activity of the child in the environment familiar to him is assessed.

Depending on the results obtained, the following levels or degrees of cerebral palsy are distinguished:

• 1st level - the child moves independently without restrictions, there are difficulties when performing complex motor skills;
• 2nd level - the patient is able to walk, but there are limitations;
• Level 3 - movement is possible only with the use of additional devices (cane, walker) on flat surfaces;
• 4th level - children are able to sit independently, but cannot walk;
• 5 level of violations - the most severe: the child is completely unable to walk without additional help.

Cerebral palsy - treatment

Cerebral palsy is difficult to treat. It is impossible to completely exclude the disease, therefore, therapeutic measures are aimed at alleviating the well-being of the child, restoring motor activity. Rehabilitation takes years, and the character treatment measures is completely determined by the general condition of the child and the presence of concomitant pathologies. However, the diagnosis of cerebral palsy is not a sentence.

Much attention, while treating cerebral palsy, is paid to physiotherapy. Massage, medical gymnastics are designed to improve the work of the musculoskeletal system, coordination of movements. For a tangible effect, regular such procedures are required throughout the patient's life.

In the absence of seizures, apply:

• myostimulation;
• electrophoresis;
• electroreflexotherapy.

Consequences of cerebral palsy

Cerebral palsy in children is almost always accompanied by impaired motor activity, impaired coordination of movements. Depending on which parts of the brain are damaged, one or several forms of muscle pathology are observed: tension, spasticity.

Infantile cerebral palsy is the most serious illness affecting a child's life. This neurological disease, associated with brain damage, develops into a disability of the baby. But with timely and correct treatment, the disease stops progressing, some symptoms disappear.

The most common causes of the development of cerebral palsy include the following manifestations:

• (lack of oxygen during the carrying of the child by the mother);
• Infections during gestation;
• Disruptions in the formation of brain structures;
• Conflict of the Rh factor between mother and baby;
• Brain trauma during gestation and childbirth;
• Toxic poisoning;
• Disorders during childbirth.

The onset of symptoms of cerebral palsy in newborns is often not associated with any one cause, but are caused by a complex of factors, and finding out the exact cause is not always possible.

The most common factor in the manifestation of cerebral palsy is hypoxia, accompanied by early placental abruption and abnormal fetal position. This is followed by the conflict between the Rh factor and infection, and a genetic predisposition on the part of one of the parents.

It is customary to group the causes of cerebral palsy by their main factors:

• Genetic. Damage to the parents' chromosomes stimulates the onset of cerebral palsy in their child.
• Hypoxia. Lack of oxygen supply to the fetus, both during pregnancy and at the time of delivery.
• Infections. Patients with meningitis, encephalitis, arachnoiditis before the age of one year increase the risk of cerebral palsy, especially in severe forms.
• Poisoning. Damage to the body of a pregnant woman or baby with toxic poisons or drugs leads to illness. Harmful production, contact with toxic substances, potent medications - sources of risk for a woman in position.
• Physical. Various radiations and electromagnetic fields cause damage to the child in the prenatal period, radiation is also among the same sources of risk.
• Mechanical. The child receives mechanical damage during childbirth - these are birth trauma.

The most accurate determination of the cause of cerebral palsy will help identify the main pain points and prescribe the appropriate treatment.

Forms

There are forms of cerebral palsy according to the generally accepted system.

Spastic tetraplegia

The cause of the manifestation of spastic tetraplegia is oxygen starvation of the fetus during the prenatal period or at the time of childbirth. Due to hypoxia, neurons in the baby's brain die off, and the nervous tissue loses the necessary characteristics. Brain lesions reveal such signs of cerebral palsy in a child as strabismus, speech impairment, hearing and visual impairment up to blindness, mental impairment and developmental delay are possible.

With an unexpressed violation of the activity of the hands, a patient with cerebral palsy with spastic syndromes can find his place in society, doing feasible work.

Diskinetic

The dyskinetic form is also called the hyperkinetic form of cerebral palsy. The causes of this symptom are the transfer of hemolytic disease to the newborn. With a dyskinetic form, the following symptoms of the disease are observed:

• Uncontrolled movements of not only limbs, but also any part of the body;
• Frequent convulsions and paralysis are possible;
• The vocal cords are affected by paresis, which leads to problems with sound production;
• Posture is impaired.

The development of children with cerebral palsy of the dyskinetic type can take place in general institutions, since this form of cerebral palsy does not affect mental abilities. The intellectual capabilities of children allow them to enter universities and successfully receive a diploma, continuing their activities in work teams.

Ataxic

In the ataxic form, a decrease in muscle tone is observed, tendon reflexes are actively manifested, and violations of the speech apparatus may occur. This type of cerebral palsy occurs with hypoxia and damage (most often when injured) of the frontal lobes of the brain. The symptoms of cerebral palsy in ataxic form are as follows:

• Reduced muscle tone;
• Trembling of hands and feet is observed;
• Mental retardation;
• Speech disorders.

Mixed

Damage to the structures of the infant's brain occurs as a result of a complex of the above forms in various combinations.

Symptoms

Cerebral palsy symptoms can appear immediately after birth or in the first months of life. Parents and doctors should be attentive to absolute reflexes and, when their manifestation fades, urgently carry out a complete diagnosis.

It is important to monitor the timeliness of the development of playing skills, the development of speech, the lack of contact with the mother can be a signal of alarm.

Cerebral palsy is not the main diagnosis in case of developmental disorder of a child under one year old, but if the child after this period cannot sit, does not show speech skills, shows mental disorders, then the likelihood of diagnosing this disease increases.

Symptoms of cerebral palsy include visual and hearing impairment, epileptic seizures, developmental delays and problems with the urinary system.

Treatment

Treatment of cerebral palsy is prescribed by a neurologist after identifying the causes of the disease and making a diagnosis. When diagnosing, electroencephalography and electroneuromyography are performed to study in more detail the work of the child's brain and muscles. According to the data obtained, the treatment process is immediately started in order to avoid more severe consequences, and as a maximum - to get rid of the disease itself.

Drugs

For the relief of seizures and epileptic seizures, drugs of the anticonvulsant type are prescribed, to improve blood circulation - nootropic medicines, in the case of muscle hypertonia - muscle relaxants. When pain symptoms appear, antispasmodics are prescribed.

In the most serious cases of brain damage, surgery is prescribed.

Massage

Massage for cerebral palsy is used when the child reaches the age of 1.5 months. The massage should only be trusted by an experienced specialist who can assess muscle tone. All types of massage are used: classic, segmental, acupressure, according to Manakov.

Parents should not independently perform these procedures, since only a specialist can correctly calculate the required load and frequency of sessions.

Exercises

Examples of workouts and exercises to develop muscle groups and joints:

Development of motor skills

• The kid is squatting, the adult is also squatting in front of the child. Holding the baby by the belt and putting his hands on his shoulders, the adult pushes the baby to make such a movement that the baby will kneel;
• From the position of the child on his knees, holding his armpits, the adult tilts him to the right and left;
• Holding the child, it is necessary to give him the opportunity to stand on one or the other leg.

Development of joint functions

• From a supine position, keeping one leg in a straight position, the other should be bent towards the tummy and returned back, changing legs;
• From a supine position, raise and lower the legs alternately, bending them at the knees.

Development of abdominal muscles

• From a position, sitting on a chair, the child should be helped to bend forward, he should perform extension to the initial position independently;
• From a sitting position on the floor, the child should reach to the toes. An adult helps;
• From a lying position, the child raises his legs and throws them over his head, with the help of an adult.

Removal of hypertonicity

• Develop the baby's hand by moving it in different directions, shake the handle slightly at short intervals, relaxing the muscles.

Leg muscle training

• From a supine position, an adult helps the baby to flex and extend the hip joint.

Exercises in water will help relieve muscle tension and tone them up. A kid bathing in a central pool or even a bathtub becomes much more energetic, better fights stress and depression. Finding a sick child in a dolphinarium has an amazing effect and helps to greatly advance the healing process.

Child development

You can overcome the symptoms of cerebral palsy by additional development of the child with the help of game manipulations. Fine motor skills, involved in playing with pyramids and cubes, rolling the ball, holding and releasing objects, affects the development of both the mental abilities of the baby and his speech apparatus.

As a result of these activities, the child learns to memorize various objects faster, which leads to more intensive development and smoothing, or complete disappearance of the symptoms of cerebral palsy.

Prevention

You can prevent the occurrence of cerebral palsy in an infant by following certain rules:

• Pregnancy should be planned;
• The expectant mother should stop smoking and drinking alcohol;
• Need to organize proper nutrition during pregnancy and breastfeeding;
• Immediately treat all types of infectious and viral lesions of the body;
• Establish regular monitoring of the hemoglobin level in the blood of a pregnant woman;
• Childbirth should only take place in a clinic;
• Viral and infectious diseases in the infant should be avoided.

Cerebral Palsy (infantile cerebral palsy) is the name of a whole group of neurological disorders that occur as a result of damage to brain structures in a child during pregnancy and in the first weeks of life. An obligatory clinical component is movement disorders, in addition to which there are often speech and mental disorders, epileptic seizures and disorders of the emotional-volitional sphere. Cerebral palsy is not progressive, but its symptoms often remain with a person for life and cause disability. From this article you will learn about the causes, clinical manifestations and methods of treating cerebral palsy.

In infantile cerebral palsy, there is always a structural and morphological lesion of the brain, that is, a clear anatomical basis of clinical symptoms. Such a zone arises as a result of the action of some causal factor and does not apply to other parts of the brain (therefore, in the case of cerebral palsy, they speak of the non-progressive nature of the course). Since a certain function is assigned to each area of \u200b\u200bthe brain, this function is lost with cerebral palsy.

Despite modern achievements in the field of medicine, the prevalence of cerebral palsy remains high and amounts to 1.5-5.9 per 1000 newborns. The incidence of cerebral palsy among boys is slightly higher than among girls. The ratio is 1.33: 1.

Cerebral Palsy Causes

At the heart of any case of cerebral palsy is the pathology of neurons, when they have structural disorders that are incompatible with normal functioning.

Cerebral palsy can be caused by unfavorable factors in various periods of brain formation - from the very first day of pregnancy, during all 38-40 weeks of pregnancy and the first weeks of life, when the child's brain is very vulnerable. According to statistics, in 80% of cases, the cause acted in the prenatal period and during childbirth, the remaining 20% \u200b\u200boccur in the postpartum period.

So what can cause cerebral palsy? Most frequent reasons are:

• violation of the development of brain structures (as a result of genetic disorders transmitted from generation to generation, spontaneous gene mutations);
• lack of oxygen (hypoxia of the brain): acute (asphyxia during childbirth, premature placental abruption, rapid labor, entanglement with the umbilical cord) or chronic (insufficient blood flow in the vessels of the placenta due to placental insufficiency);
• infectious diseases transferred intrauterinely and in the first months of life (intrauterine infections, especially the TORCH group, meningoencephalitis, arachnoiditis);
• toxic effects on the child (alcohol, smoking, drugs, potent drugs, occupational hazards, radiation);
• mechanical trauma (intracranial injury during childbirth);
• incompatibility of the mother and the fetus for various reasons (Rh-conflict, blood type conflict with the development of hemolytic disease);
• chronic diseases of the mother (diabetes mellitus, bronchial asthma, heart defects).

Children born prematurely are at particular risk. Among them, the prevalence of cerebral palsy is significantly higher compared to full-term children. Also, the risk is higher in children with a birth weight of less than 2000, in children from multiple pregnancies (twins, triplets).

None of the above reasons are 100% true. This means that, for example, the presence of diabetes in a pregnant woman or a previous flu will not necessarily lead to the development of cerebral palsy in a child. In this case, the risk of having a child with cerebral palsy is higher than that of a healthy woman, but nothing more. Of course, a combination of several factors significantly increases the risk of pathology. In each individual case with cerebral palsy, it is rarely possible to detect the presence of only one weighty cause; more often, several factors are found in the history.

Based on the stated main causes of cerebral palsy, the following prevention of this condition is recommended: planning a pregnancy with the remediation of chronic foci of infection, competent management of pregnancy with careful and timely examination, and, if necessary, treatment, individual tactics of delivery. The listed factors are the most effective measures for the prevention of cerebral palsy.

Symptoms

For children with cerebral palsy, delayed motor development is characteristic.

The symptoms of cerebral palsy are mainly movement disorders. Moreover, the type of such violations and the severity differ depending on the age of the child. In this regard, it is customary to distinguish the following stages of the disease:

• early - up to 5 months of life;
• initial residual - from 6 months to 3 years;
• late residual - after 3 years.

In the early stage, the diagnosis is rarely made, because there are very few motor skills as such at this age. But, nevertheless, there are certain signs that may be the first symptoms:

• delayed motor development: there are average periods for the appearance of certain skills (the ability to hold the head, roll over from abdomen to back, purposefully reach for a toy, sit, crawl, walk). The lack of these skills in the appropriate time period should alert the doctor;
• children have unconditioned reflexes that fade away by a certain age. The existence of these reflexes after reaching this age is a sign of pathology. For example, the grasping reflex (pressing on the child's palm with a finger causes the seizure of this finger, squeezing the palm) normally does not occur after 4-5 months. If it is still detected, this is a reason for a more thorough examination;
• violation of muscle tone: increased or decreased tone can be determined by a neurologist during examination. Changes in muscle tone can result in excessive, aimless, sudden or slow, worm-like movements in the limbs;
• the predominant use of one limb for the implementation of actions. For example, a child normally reaches for a toy with both hands with equal eagerness. Moreover, this does not depend on whether the child will be right-handed or left-handed in the future. If he constantly uses only one hand, this should be alarming.

Children who, during a routine examination by a doctor, have revealed any even minor violations, should be examined every 2-3 weeks. During repeated examinations, attention is paid to the dynamism of the identified changes (whether violations persist, increase or decrease), whether all motor skills are formed with a delay, or the delay in one of them was a variant of individual development.

Most of the symptoms of cerebral palsy appear in the initial residual period, that is, after six months of life. These symptoms include disorders of movement and muscle tone, speech, mental development, hearing and vision, swallowing, urination and defecation, the formation of contractures and skeletal deformities, convulsions. Which symptoms will come to the fore depends on clinical form diseases. Let's take a look at the existing clinical forms of cerebral palsy.

There are 4 forms in total:

• spastic (spastic diplegia, spastic tetraplegia (double hemiplegia), hemiplegia);
• dyskinetic (hyperkinetic);
• ataxic (atonic-astatic);
• mixed.

Spastic form

This is the most common form. The main signs are a violation of muscle strength and tone in the limbs. Depending on the number of involved limbs, it is divided into several subtypes.

Spastic diplegia (Little's disease)- characterized by the defeat of all four limbs, with the greatest severity of the process in the legs, mental, mental and speech disorders. Symptoms manifest themselves most clearly by the end of the first year of life. Muscle tone is increased in all limbs, but more in the legs (mainly in the flexors of the arms and extensors of the legs). This leads to limitation of movements, to the formation of a forced position of the limbs. When trying to get up, the legs do not rest their entire foot on the surface, but stand on their toes, sometimes they cross. Constant muscle tension over time leads to the formation of contractures, as a result of which the joints change their configuration. This makes voluntary movements even more difficult. The calcaneal tendon is shortened, the feet are deformed.

Tendon reflexes increase, pathological foot and hand signs are revealed (Babinsky, Gordon, Zhukovsky and others).

The appearance of involuntary movements (hyperkinesis) in the limbs is possible, and more often they develop in the muscles of the face and hands. Sometimes this causes a negative reaction from others, because, for example, hyperkinesis in the facial area can look like grimacing, teasing. Hyperkinesis increases with excitement, decreases in sleep.

Speech disorders are expressed in blurredness, indistinctness, speech therapy defects. Moreover, with age, this does not go away without appropriate treatment.

Mental and mental problems are manifested by impaired concentration, poor memory, emotional instability. Usually, mental disorders are not pronounced. Therefore, with good functioning of the upper limbs, such people fully adapt in society, acquire a profession and serve themselves.

Spastic tetraplegia or double hemiplegia characterized by uniform damage to all four limbs or more pronounced disturbance of movements in the hands. This is the most severe form of cerebral palsy, because, as a rule, it is accompanied by severe mental, mental, speech disorders, convulsive syndrome. Mental disorders reach the degree of oligophrenia, speech can generally have the form of inarticulate mooing. Along with this, visual impairment due to atrophy of the optic nerves (which cannot be corrected by wearing glasses or lenses), strabismus, hearing impairment are observed. Symptoms in this form of the disease are noticeable already in the first months of life. Tendon reflexes are very high, and there are many pathological signs from the feet and hands. Such children cannot sit, much less walk. Severe movement disorders lead to early formation of contractures of many joints, spinal deformities. Patients require constant, lifelong outside care.

Hemiplegia means that the patient has muscle weakness on one side - left or right. That is, paresis captures the arm and leg of the same name, and it is often more pronounced in the hand than in the leg. Children with this form learn to sit and walk, master self-care skills, but much later than their peers. From birth, the lag of the affected limbs from the healthy ones is noticeable. When the child is already walking, a characteristic posture catches the eye - the affected arm is bent and pressed to the body (the hand of the begging), and the leg is straightened and does not bend when moving. In addition to movement disorders in hemiplegia, convulsive seizures, moderate or minor mental impairments are found. If seizures occur frequently, they can cause a significant decrease in intelligence.

Diskinetic (hyperkinetic) form

It is characterized by the presence of involuntary movements - hyperkinesis. Usually these symptoms appear after a year. The movements can be very diverse: worm-like movements in the fingers, swinging and imitation of throws with hands, twisting the body around its axis, grimacing. An involuntary contraction of the muscles in the larynx can lead to uncontrollable sounds and cries. With emotional overstrain, hyperkinesis intensifies, and disappears at rest and sleep.

Hyperkinesis is accompanied by a decrease in muscle tone. Periodically there are episodes of a sudden increase in tone, in children of the first months of life, this is called dystonic attacks.

There is a delay in the formation of motor skills: holding the head, turning, sitting, crawling, walking become possible later than in peers. However, such children eventually acquire self-care skills and do not need outside help.

With a dyskinetic form, speech may be impaired. Usually, words are pronounced slowly, not quite clearly, with a violation of articulation.

Intellect practically does not suffer.

Ataxic form

This form occurs with a predominant lesion of the connections of the cerebellum or frontal lobes. Muscle tone is reduced from birth. All motor skills are formed with a significant delay. Coordination and accuracy of movements are impaired. The gait is staggering, attempts to take anything end up missing and missed. Trembling in the limbs is possible. Sometimes hyperkinesis occurs with this form. Mental abilities may not be impaired, but may reach varying degrees of oligophrenia.

Mixed form

This form is diagnosed when there are symptoms characteristic of two or more clinical forms (described above).

Treatment

Physical therapy is an important component of the treatment of cerebral palsy.

Cerebral palsy treatment is a complex and very lengthy process. The effect depends on the severity of the damage to the nervous system (the clinical form of the disease), the period of diagnosis of the disease, the complexity of treatment methods, the persistence and perseverance of the parents of the sick child.

In cerebral palsy, the main role is given to non-drug treatment methods, which are based on the establishment of a muscle stereotype, correct posture by stimulating the remaining intact neural structures of the brain.

The state of cerebral palsy itself is not curable, that is, it is impossible to restore destroyed neurons today. But it is possible to "teach" the remaining intact neurons to function in such a way that a person can live in society fully, without feeling his inferiority.

Among all the methods of treatment, the following should be noted:

• massage;
• physiotherapy;
• Voight therapy, Bobath therapy;
• the use of load (training) suits - "Adeli", "Gravistat" and others;
• classes with a speech therapist and a psychologist;
• drug treatment;
• operative orthopedic assistance;
• symptomatic neurosurgical intervention.

You can learn about massage methods, peculiarities of its use for cerebral palsy from the article of the same name.

Remedial gymnastics is used both independently and in combination with Voight and Bobath therapy. Exercise therapy complexes are developed individually, aimed at relieving muscle tension, teaching coordination and maintaining balance, eliminating muscle weakness. The condition for achieving the effect is the regularity and systematicity of classes.

Voight and Bobath therapy are also types remedial gymnastics... At the origins of these techniques lies the stimulation of movements based on the existing innate reflexes. That is, learning new motor skills occurs thanks to the reflexes that a given patient has. The goal of therapy is to bring the patient's motor activity as close to normal as possible, to form a motor stereotype, even if based on pathological reflexes.

The use of training suits "Adeli", "Gravistat" allows you to eliminate the vicious positions of various parts of the body, to normalize muscle tone by stretching the muscles. The limbs and torso, with the help of braces, shock absorbers, special clothing, are given the correct body position, in which the child stays for some time and even performs separate movements. Treatment is carried out in courses, gradually increasing the time spent in the suit.

Classes with a speech therapist and a psychologist allow you to correct communication with others, socially adapt the child, and expand the sphere of his life.

Of the medications, the main focus is on the use of drugs that reduce muscle tone - Baclofen, Midocalm, Sirdalud. For the same purpose, botulinum toxin (Botox, Dysport) injections into the muscles are used.

It is possible to use drugs that improve the metabolism of the brain and its blood circulation, but some doctors are skeptical about such measures, not seeing the results of such treatment.

Operative orthopedic assistance consists in eliminating deformities of the limbs and joints in order to facilitate movement and self-care. For example, the Achilles tendon plasty contributes to the correct support of the foot.

Neurosurgical intervention involves the elimination of pathological impulses in the brain, which underlies spasticity and hyperkinesis. Operations consist either in the destruction of individual brain structures (responsible for the production of "incorrect" signals), or in the implantation of devices that suppress pathological impulses.

A special role in the treatment of cerebral palsy is played by the use of auxiliary devices (technical means of rehabilitation), which not only make the patient's life as easy as possible, but also exercise the muscles. Such means include wheelchairs, walkers, verticalizers (a device for giving the body an upright position), bath chairs, toilet chairs, special bicycles and exercise machines for patients with cerebral palsy, orthoses, splints for giving the correct position of the joints, and much more.

Most of the methods are applied in both special medical institutions for patients with cerebral palsy, and at home. Sanatorium treatment has a beneficial effect. Special sanatoriums, focused on patients with cerebral palsy, are equipped with a large number of necessary devices and allow for a complex effect on the pathological process. The combination of physiotherapeutic techniques with massage, exercise therapy, water procedures has a tangible healing effect.

Of the unconventional methods of treatment for patients with cerebral palsy, animal therapy is used - treatment with the help of animals. Horses and dolphins are often used for this purpose.

The effectiveness of stem cell treatment for cerebral palsy is currently not proven.

Cerebral palsy is a complex of various neurological symptoms, at the head of which are movement disorders. May be accompanied by mental and speech disorders. It can be very difficult, but this is not always a sentence. The complex application of various methods of treatment contributes to the formation of motor skills, the patient's adaptation to existence in society, provides an opportunity for training and the acquisition of professional skills, and therefore makes life full.

TVC, the program "Doctors" on the topic "Cerebral palsy: about symptoms and prevention"

Cerebral palsy is not considered an independent disease.

This term is used to refer to a whole complex of motor disorders that arise as a result of intrauterine brain damage.

Pathology is congenital in nature, its first signs can be seen already in children of the first days of life... The most complete and detailed clinical picture is manifested in children infancy, that is, until the child reaches 1 year. We will talk about what cerebral palsy in children is in the article.

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Concept and characteristics

Cerebral Palsy (infantile cerebral palsy) is a pathology that occurs as a result of damage to the areas of the brain responsible for child's physical activity.

The disease develops in the prenatal period, when the brain is just forming.

During the first years after the birth of a child, in the presence of certain negative reasons, the disease progresses, acquiring more and more new manifestations.

However, as the baby grows up, the development of pathology stops, that is, the brain damage is not aggravated. Movement disorders amenable to partial correction.

Brain damage can manifest itself in 2 variants:

• nerve cells of an initially healthy brain undergo pathological changes;
• the structure of the organ itself is disrupted.

The manifestations of cerebral palsy are very diverse, in some children the motor activity of the legs is disturbed (the most frequent variant of the development of events), in others - in the hands, in others, coordination of movements suffers.

Such differences depend on what kind of brain damage occurs, and in what period of time they occurred (under the influence of negative factors, the part of the brain that was actively formed at the time of occurrence of unfavorable conditions).

Causes of occurrence

Why was the child born with cerebral palsy? Root cause- disruption of the brain, in particular, of its departments responsible for the ability to move.

A variety of adverse factors that arise both in the prenatal period and at the time of birth and in the first months of a baby's life can lead to such a defeat.

Intrauterine factors	Reasons at the time of birth	Causes in the first months of life
Long-term and intense toxicosis. Premature aging and placental abruption. The threat of termination of pregnancy. Kidney disease of the expectant mother. Fetal trauma during the intrauterine period of development. Oxygen deficiency. Fetoplacental insufficiency. Infectious and viral diseases during pregnancy.	A narrow pelvis of a woman. When passing through the birth canal, a child often receives serious injuries. Weakening of labor. Premature birth of a child. Large fetal weight. Rapid labor activity. Breech presentation at the time of delivery.	Disruption of the respiratory system, leading to hypoxia of the newborn. The ingress of amniotic fluid into the oral and nasal cavity of the child, which also contributes to the development of suffocation. - pathology arising from the Rh-conflict, accompanied by an increased rate of decay of erythrocytes.

How is it developing?

In children born ahead of schedule, the immaturity of the brain and its structures is noted.

This can lead to abnormal development of the organ, and, as a consequence, the occurrence of cerebral palsy.

Oxygen starvation in the prenatal period it contributes to the occurrence of brain damage, however, if there are no other abnormalities in the development of the child, this phenomenon does not have any visible effect (provided that the oxygen deficiency was insignificant).

If the child is light at birth, its organs, including the brain, are not fully formed, during hypoxia, some areas of the brain die off, and hollow areas appear in their place.

Accordingly, the functionality of the organ is impaired, which leads to impaired motor activity of the body.

Classification of pathology

There are several types of cerebral palsy, which differ from each other in their characteristic features, set of features.

The form	Features:
Spastic diplegia	This form is most common. It occurs due to damage to the areas of the brain that are responsible for the motor activity of the limbs. In children, in the first months after birth, there is partial or complete paralysis of the legs or arms.
Atonic-astatic	Pathology arises as a result of abnormal development or damage to the cerebellum. The child is unstable, his coordination of movements is impaired, and a decreased tone of muscle tissue is also noted.
Hemiparetic	The subcortical and cortical areas of one of the cerebral hemispheres are affected. In this case, movement disorders are noted only on one side.
Double hemiplegia	Damage occurs in both hemispheres of the brain at once. This form is considered the most dangerous, as it often leads to complete paralysis.
Hyperkinetic	It is caused by lesions of the subcortical areas of the brain. Often develops against the background of a spastic form. A child suffering from this type of cerebral palsy is inclined to make uncontrolled body movements. Often this manifestation intensifies in those moments when the baby is overexcited, nervous, worried.

Depending on the age of the child it is customary to highlight the early form(the first signs appear immediately after birth and up to 6 months of age), initial residual (6-24 months), late residual (over 2 years).

By severity, there are:

1. Easya form in which slight deviations in motor activity are observed. At the same time, the child is able to do without the help of strangers, can dress independently, eat, play, attend children's educational institutions.
2. Averageform when the baby needs outside help in the implementation of complex tasks. Nevertheless, such a kid can attend educational institutions and study successfully.
3. Severea form in which the child cannot do without help, because in this case he is not able to perform even the simplest actions.

Disease satellites

Cerebral palsy in a child can manifest itself not only in a violation of motor function, or its complete absence. Availability and other unpleasant moments, such as:

• involuntary convulsions;
• (the formation of pathological fluid in the brain area);
• decreased vision and hearing;
• (difficulty in pronouncing sounds, lack of speech, stuttering);
• difficulties in teaching writing, counting, reading;
• behavioral disorders, emotional disorders.

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Symptoms and signs

A child with cerebral palsy has the following symptoms:

Complications and consequences

DPC leads to the development of such serious complications as:

1. Musculoskeletal disorders (pathological flexion of the arms, which in severe cases can provoke dislocation of the joints, deformity of the foot, when the baby moves only on toes, curvature of the spine and persistent disturbance of posture, as a result of which the child's body loses its symmetry).
2. Speech disorders until it is completely absent.
3. Delays in mental development, problems with adaptation in the team.

Diagnostics

After the baby is born, the child is examined by a doctor without fail. This allows you to identify pathology at an early stage of its development and start treatment as soon as possible. Children who have increased risk of developing cerebral palsy.

These are premature babies with low birth weight, suffering from congenital anomalies in the development of internal organs, born as a result of difficult childbirth, having a low score by Apgar criterion.

The doctor carefully examines the child, checking the severity of congenital reflexes, muscle tone.

Upon detection of certain deviations, appoint hardware research:

• Ultrasound of the brain;
• CT, MRI.

Differential

Cerebral palsy in the first days of a child's life can manifest itself in the form of signs characteristic of other diseases, the treatment of which is carried out using fundamentally different methods and means.

That is why differential diagnostics is of particular importance. It is important to distinguish cerebral palsy from such ailments as metabolic disorders of amino acids, mucopolysaccharidosis, neurofibromatosis, hypothyroidism.

Treatment and rehabilitation objectives

Correctly selected therapy is aimed at solving the following tasks:

1. The need to encourage the little patient to develop the skills of movement, self-care, movement of arms and legs;
2. Prevention of the development of contractures (flexion of the limbs), posture disorders;
3. Creation of the necessary conditions for the mental development of the child, the acquisition of speech, writing and social skills.

A therapy that allows partially restore motor activity, should be comprehensive, including various methods of treatment and correction. The choice of this or that method is made by the doctor.

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Medication

The child is prescribed anticonvulsantsdrugs (Valparin, Epilim), if convulsions occur, as well as drugs that help eliminate muscle spasms (Diazepam).

Using nootropicsand other drugs to improve brain activity in cerebral palsy does not give any results, since the brain damage in this case is irreversible.

Self-medication with such means can only harm the child... All medications used for therapeutic purposes should only be prescribed by the attending physician.

Massage and exercise therapy

Massage and special exercises to promote strengthening muscle tone, restoring posture, preventing spinal curvature, the child needs to do throughout his life.

At first, a specialist should work with the baby, since the complex of massage movements and strengthening exercises is developed individually for each child suffering from cerebral palsy.

Correction of pathological posture

Changes in the child's body with cerebral palsy lead to disorders of the musculoskeletal system, as a result of which the body is unable to assume a physiological position.

In this case incorrect postures are formedthat need correction. Otherwise, it is possible to develop a persistent violation of posture, the formation of contractures. Various medical devices are used for correction, such as splints, splints, bandages.

Surgical correction of contractures

Contracture- persistent flexion of the limbs formed as a result of an incorrect position of the body.

This pathology needs correction, otherwise even more serious consequences may develop, such as significant deformation of the joint, its dislocation.

For correction use 2 types of surgical intervention: the Achilles tendon or muscle tissue in the lumbar region can be surgically affected.

Other ways

Depending on what manifestations of cerebral palsy are observed in a child, other methods can be used for more successful treatment, such as:

1. Physiotherapy, helps to relax muscles, eliminate painful spasms.
2. Classes with speech therapistallow you to eliminate (or reduce) speech disorders.
3. Socializationchild (communication with peers) will help him quickly adapt in a team.
4. Communication with animals(horses, dolphins) allows you to normalize the emotional state of the child, improve his physical activity.

Rehabilitation centers

Name	Address
	electrostal, st. Tevosyan, 27
Re-center	City of Samara Novo-Vokzalny blind alley 21 "A"
Sail of hope	voronezh, st. Plekhanovskaya, 10-a
	st. Petersburg, Pushkin, Parkovaya st. house 64-68
Rehabilitation center	moscow st. Lodochnaya, 15, building 2
SPC Solntsevo	moscow Solntsevo, st. Aviators, 38
Center for Curative Pedagogy	moscow Builders, 17b
Center for Speech Pathology	moscow, Solntsevo, st. Aviators, 38; Nikoloyamskaya, 20

Cerebral palsy is a disease manifested in very young children... Numerous reasons lead to its development, which can have a negative effect both in the prenatal period of fetal development, and after the birth of the baby.

Symptoms of pathology are very diverse, damage affects not only motor function. The disease negatively affects the emotional, intellectual, mental development child. Therefore, the ailment must be identified as early as possible and treated.

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We kindly ask you not to self-medicate. Make an appointment with a doctor!