Muscle spasm. Neurological pathologies and muscle spasticity

Muscle spasticity is defined as a state of increased muscle tone with increased tendon reflexes, often due to excessively rapid muscle stretch or movement. Properly performed exercises can alleviate these conditions.

1. Avoid positions that increase spasticity.
2. Do gymnastics that allows you to stretch your muscles as much as possible, but slowly.
3. Keep in mind that moving a muscle to a new position can lead to increased spasticity. If this happens, allow the muscles to relax for a few minutes.
4. During gymnastics, try to keep your head upright without tilting it to one side or the other.
5. If you are taking medication that reduces spasticity, do exercises no earlier than one hour after taking the medicine.
6. Doses of anti-spastic drugs should be adjusted regularly depending on the condition of your muscles.
7. The sudden appearance of spasticity can be triggered by various diseases, skin inflammations, and even uncomfortable shoes or clothes.

Usually in patients with multiple sclerosis, spasticity of the extensor or flexor muscles is observed. In the case of spasticity of the flexor muscles, the bent knees are directed pressed against each other. Sometimes the hips and knees are separated.

Spasticity of the extensor muscles is less common. In this case, the hips and knees are straight, the legs are very close together or crossed.

Know that if you decide to refrain from active exercise and prefer to do passive gymnastics, then you should choose those exercises that suit you with the type of spasticity that you suffer from. If you are prone to extensor spasticity, but prefer active gymnastics, refrain from those exercises that require straightening the legs and knees.
It is important to remember that in this section the recommended body positions are designed to reduce spasticity. If this does not help you, consult your doctor or physical therapist.

• Prone position on the stomach.

This position is good for patients suffering from spasticity of the muscles that flex the hips and knees. Remember not

It is necessary to wait a few minutes for the muscles to relax in this new position for them.

• Prostrated position lying on the side.

This position is suitable for those whose knees tend to roll inwards. Try placing a small pillow or towel between them. Remember that it takes some time for the muscles to adjust to the new position and relax.

• Side lying position.

This position will help patients who have spasticity of the extensor muscles of the thighs and lower leg at the same time. Lying on your side, bend the knee of the leg that is on top, and straighten the knee of the other leg. You can also place a pillow or towel between your legs.

• The position lying on the back.

If your hips and knees are outward due to spasticity in the supine position (frog pose), then by placing a pillow or a large towel under your thigh (all the way to the knee), roll it up so that your hips and knees align. The toes should be pointing up.

• Fixation of the ankle joints.

If you want your feet to be perpendicular to your shins, this is easy to do by placing your feet on a special shelf attached to the headboard. It can be easily made at home.

• Fixation of the shoulder joints.

About the project initiators

The mission to promote activities aimed at supporting patients with multiple sclerosis and their loved ones was undertaken by the Moscow Society of Multiple Sclerosis and the United Society of Multiple Sclerosis. The Moscow MS Society was founded in 1995 by people united by the desire to help patients with this incurable neurological disease in the fight against the disease and improve their living conditions and the lives of their loved ones. The task of consolidating the forces of people concerned about these problems in the regions of the Russian Federation is also dealt with by the United Society of Multiple Sclerosis.
The new edition of the book Therapeutic exercises for multiple sclerosis, which provides specific assistance to patients, is an initiative of the Moscow Society of Multiple Sclerosis and the United Society of Multiple Sclerosis.

Indications for the use of muscle relaxants are:

1. Painful muscle spasm associated with the pathology of the spine and the muscles themselves.

1. Painful muscle spasm associated with the pathology of the spine and the muscles themselves.

2. Muscle spasticity is a symptom that accompanies movement disorders in many neurological diseases.

Painful muscle spasm

Definition. Painful muscle spasm (BMS) is a tonic muscle tension that occurs in response to pain irritation. Each local pain stimulus causes a spinal sensorimotor reflex in the corresponding segment of the spinal cord, accompanied by activation of motor neurons, which, in turn, leads to spasm of the muscles innervated by these neurons. The physiological validity of muscle tension that follows any pain is the immobilization of the affected area of ​​the body, the creation of a muscular corset. However, the muscle spasm itself leads to increased stimulation of muscle pain receptors. A vicious circle arises according to the mechanism of self-reproduction: pain-muscle spasm-increased pain-painful muscle spasm. Presumably, trigger points are formed in the muscle containing multiple sensitization loci, consisting of one or more sensitized nerve endings. The doctor most often deals with BMS with back pain as part of degenerative-dystrophic lesions of the spine (reflex muscular-tonic syndromes) or myofascial syndromes. Myofascial pain syndromes, as a rule, are not associated with spinal pathology, but are a manifestation of primary dysfunction of myofascial tissues, but can develop against the background of reflex muscular-tonic vertebrogenic syndromes, complicating their course (Fig. 1).

Rice. 1. Painful muscle spasm (diagnosis and therapy algorithm)

The myofascial pattern of pain is characterized by regional pain that is fairly distant (“reflected”) from the spasmodic muscle. The spasmodic muscle itself, which is sharply painful on palpation, contains zones of even greater painful muscle compaction, where trigger points are localized. When you click on an active trigger point, a sharp pain appears at the point itself and at a distance - in the reflected zone.

BMS is a non-specific link in the formation of back pain, therefore, before proceeding with its correction, it is necessary to exclude a serious pathology, which can be clinically manifested only by pain and muscle spasm. It is necessary to be vigilant in relation to primary and metastatic tumors of the spine, spinal cord, internal organs, reflected pain in diseases of the internal organs, vertebral fractures, infectious diseases. The diagnostic and therapy algorithm is shown in Figure 1.

Treatment . The main task in the treatment of patients with acute pain is to reduce its intensity. With dorsalgia, for this purpose, symptomatic treatment is still most often used - non-steroidal anti-inflammatory drugs (NSAIDs) and physiotherapy.

However, there are theoretical prerequisites and practical evidence of the success of the complex treatment of dorsalgia with the inclusion of muscle relaxants in therapy . Addition of muscle relaxants to NSAIDs and physical therapy helps to reduce the duration of treatment and reduces the risk of side effects of NSAIDs by reducing the dosage of the latter in combination therapy . Recently, the range of application of Mydocalm has significantly expanded due to the successful use of BMS in therapy. The breadth of the etiological spectrum of clinical models of dorsalgia (osteochondrosis, spondylarthrosis, osteoporosis, osteoarthrosis), in which Mydocalm was used, demonstrates that its appointment is pathogenetically justified in the presence of BMS of various origins. The presence of the injectable form of the drug allows in the acute period to use the / m method of administration, and in subsequent periods - tablet forms. Despite significant differences in the doses used, the optimal dose is 450 mg of Mydocalm per day in three divided doses. The duration of treatment varies from 10 to 28 days (average 21 days). Mydocalm is well tolerated. Contraindications to its use are not specific and include only individual hypersensitivity to tolperisone (for the injection form, also to lidocaine).

Spasticity

Definition. Spasticity (a special, persistent pathological increase in muscle tone) is one of the components of pyramidal (central) paresis, which, according to modern classification, is referred to as upper motor neuron syndrome (SVM). SVM includes muscle weakness, loss of dexterity, increased muscle tone, muscle spasms, and increased tendon reflexes. The upper motor neuron syndrome is one of the most common neurological syndromes that are chronic. The most common causes of SVM are cerebral stroke, craniocerebral and spinal injuries, perinatal encephalopathy (cerebral palsy) and multiple sclerosis. . Once having arisen, SVM leads to a disability of the patient, expressed in varying degrees, and most often persists throughout life.

Diagnostics . Spasticity is detected in the study of passive movements in the limb, as an increased resistance (contraction) of the muscle in response to its rapid stretching. The predominant increase in tone is observed in the anti-gravity muscles: arm flexors (shoulder adduction, flexion at the elbow and wrist joints) and leg extensors (hip adduction, extension at the knee joint and plantar flexion at the ankle joint). After identifying the patient's spasticity, it is necessary to determine the degree of its severity and, accordingly, the contribution to the violation of motor functions. Some degree of spasticity, especially in the leg, may be beneficial to the patient, as it enables the patient to use the leg as a support when walking. However, severe spasticity levels the remaining muscle strength, contributes to the development of contracture and deformity of the limb, the appearance of painful flexor spasms.

Treatment . Of all the manifestations of chronic SVM, spasticity, muscle spasms and, to a much lesser extent, the strength and dexterity of voluntary movements are best corrected. The effectiveness of treatment is largely determined by the timing of the disease and the degree of paresis. Early antispastic therapy prevents the development of many problems, including the development of contractures that can occur if spasticity persists. Conducting antispastic therapy must be combined with physiotherapy and therapeutic exercises, since these methods do not replace one another. At the same time, antispastic therapy facilitates therapeutic exercises and enhances the overall rehabilitation effect. As a general rule, antispastic treatment should be continued for years. The algorithm for the diagnosis and treatment of spasticity is shown in Figure 2.

Rice. 2. Spasticity (diagnosis and therapy algorithm)

Spasticity is due to a combination of various pathophysiological disorders, so antispastic drugs should not be extremely selective. Most muscle relaxants actively used in clinical practice mainly inhibit polysynaptic and, to a lesser extent, monosynaptic reflexes in the spinal cord. Muscle relaxants are tolperisone (Mydocalm) . The mechanism of action of Mydocalm is multifaceted. Its muscle relaxant effect is achieved by suppressing the activity of the caudal part of the reticular formation of the trunk and inhibition of mono- and polysynaptic reflexes in the spinal cord. The effectiveness and safety of Mydocalm have been proven by long-term successful use in clinical practice.

When using Mydocalm in the therapeutic range from 150 to 450 mg per day, a decrease in spasticity is achieved on average after a month and persists for several years.

Spasticity is a neuromuscular disorder characterized by an increased tonic stretch reflex with excessive ligament convulsions resulting from excitation of the stretch reflex. (Visually similar to convulsions).

The causes of spasticity can be various diseases and injuries. Let's consider the most common ones. These are such as disabled children suffering from cerebral palsy, multiple sclerosis, trauma to any part of the spine, skull brain injury (TBI), various tumors in the brain or spine, Tai-Saha disease, Rett syndrome, Batten's disease and a number of other very unpleasant diseases. ( I’ll add my own here - Strümpel’s syndrome)

What is spasticity.

Spasticity is spastic muscle contraction.

"Spasticity is a state of increased muscle tone, in which the limb resists the performance of passive movements. The maximum of this resistance occurs at the beginning of the movement, and the movement itself is performed only when significant pressure is applied to the limb. Spasticity is one of the symptoms of damage to the corticospinal tracts of the brain or spinal cord Usually spasticity of the affected limb is also accompanied by its weakness " (http://gufo.me/)

That is, there is an accumulation of energy in the muscles, and the connection with the brain is poor or non-existent. Muscles do not perceive brain commands correctly and contract arbitrarily and at different times. It can work at any time and without warning. As if spending the accumulated energy.

If a person is motionless for a long time (2 hours or more), spasticity increases in people with disabilities. That is, if you have worked out well, you will notice a significant decrease in the activity of spasms in the muscles. Massage also helps to relieve spasticity, but, unfortunately, only temporarily (however, massage improves blood circulation in spasmodic muscles).Spasticity can also be removed with various drugs (for example, baclofen, sirdalud, etc.), but, of course, only with a doctor's prescription. Ina must forget that we treat one thing, we cripple another.

Pills relieve spasticity, of course, but there is a big load on the liver, kidneys, and if you have tolerable spasticity, try to give up the pills. Better work out a little. Plus, if you stop using pills or drugs that relieve spasticity, spasticity increases many times, at least at first, and then eventually normalizes to its normal state. Alcohol also relieves spasticity, but in the morning it becomes 2-4 times stronger. Surgery can also relieve spasticity, but not for all types of diseases that cause spasticity.

Spasticity can be conditionally divided into several groups. The first is weak spasticity, the second is moderate and the third is strong. That is, with the first two, you don’t feel much discomfort and you can do without pills, and limit yourself only to sports. But the third group with severe spasticity has more problems, for example, with a strong attack, they can simply be thrown out of the wheelchair due to muscle spasm or twist their legs and arms.

(for me, due to severe spasticity, it turned out to be impossible to get into the stroller, she finally put me to bed). In such cases, of course, you can not do without pills.

But we must not forget that with injuries and diseases, each patient has his own spasticity. Some are stronger, some are weaker.

Spasticity, of course, interferes with the disabled, but on the other hand, it does not allow the muscles to atrophy and keeps them in constant tone. (this is acceptable if spasticity is moderate).

Based on materials

P.S. The text in italics was added by me.

A large family and the adoption of a disabled child with a rare disease
... I answered: - No. When she realized that it was for a long time, or rather, forever, she somehow calmed down. When we picked her up, her foot was so cramped that we couldn't put on her size 30 boots, even though she has a size 22 foot. And suddenly, two months later, when I was collecting her for school, the shoes fit perfectly. Later, the doctor explained to me that the child relaxed and the spasticity was gone. In addition, in the orphanage they told me that Tanya goes under herself all her life. After we arrived home, she told me: - Mom! Come here, look! - Are you going to the toilet? - Of course! It was a joke! Later we abandoned the catheter, and now we are on the way to ensure that the child does not use diapers at all. That is, about...
...— Aren't you afraid that Tanya has already formed internal conflicts that will be extremely difficult to resolve? One of the most positive qualities in Tanya's character is that she is incredibly positive. And she is also a leader. She once told me that she was born to win. As you know, sport relieves anxiety, blocks the mechanisms triggered by anxiety in childhood. Now I want to cure her back and play sports with her. I think she can swim - incredibly strong hands. This is first. And secondly, I have an inexhaustible resource of love and tenderness inside me. She gets a lot of love. It heals many wounds. - Did you send the girl to a regular school? - Yes! Here Nick Vuychich studied at ...

Discussion

I'm so glad that Tanya found a family, I'm just glad to tears. I really wanted to take her away, but there is already a very difficult adopted child in the house, who pulls all the resources on himself, so I did not dare. It is a great happiness to know that the girl is still lucky, her mother was found, who loves her and treats her.
And about PR, children are really different. My adaptation of two foster children lasted less than a year, then they became ordinary children, quite ordinary, from whom it is a pleasure. But the other two are horror and a nightmare, 4 years have passed - like in the sand (((. How lucky ...

The structure of the nervous system. Where did the brain damage occur?

I am pleased to announce that TONUS-CLUB®, as part of a charitable project, provides exercise equipment for children with cerebral palsy. In September, TONUS-CLUB® provided 3 more exercise machines for children living in St. Petersburg. New project participants aged three to five years will be able to undergo a rehabilitation course on a simulator in comfortable home conditions for children. You can still find detailed information about the project and leave an application for participation on the official website of the network of sports and recreation...

Discussion

Hello! We have 2 children with cerebral palsy in our family. Can we participate in the promotion for a free simulator? Barnaul

The first partner in Uzbekistan received the TONUS-CLUB® franchise for free!
Already in August, the opening of the first club of the network of women's clubs TONUS-CLUB in Tashkent will take place!
The largest Russian franchisor has developed a special offer for potential partners to support the development of small businesses in the regions of Russia. The TONUS-CLUB® company provides 3 franchises free of charge in regions that are investment-attractive and priority for network development.

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Therapeutic massage strengthens stretched back muscles and eliminates hypertonicity of shortened muscles, reducing pain; with lordosis and kyphosis, massage helps to strengthen the muscular corset of the back and correct unnatural deflections of the spinal column, relieve tension, muscle pain and muscle spasms. with bruises and sprains (muscles and ligaments of the ankle and knee joint), massage helps to restore impaired motor functions as quickly as possible, reduces pain, and promotes the resorption of hemorrhages in the injured area. In case of injuries, massage is combined with therapeutic rubbing and thermal procedures (paraffin, water and dry air ...

Discussion

massage for children is a great thing. but only a professional should do it, and only gymnastics for moms. There will be more benefits

massage is a great thing, it's not just pleasant with useful, but a powerful healing effect on the body, it's not for nothing that it has existed for several thousand years, I myself am a massage therapist with 19 years of experience and I am very glad that I can help people in this way, write in a personal, maybe someone then you need me, I'm at your service

At the first sign of unpleasant uterine tension, these measures must be taken!
... Isn't this the best preparation for childbirth? Use relaxing scents. In order not to be caught off guard by sudden tension, carry an amulet or aroma medallion with you with one of the relaxing aromas. From among the well-known relaxants, choose those that are pleasant to you. Delicate jasmine aroma relieves stress, helps the body to mobilize hidden reserves. Slightly tart and sweet smell of lotus not only soothes, but also relieves fatigue. This fragrance is commonly used in various spiritual practices. Mirra is a mild antidepressant that helps to cope with stress and insomnia. Sweet, "candy" rose relieves nervous tension, fights stress and panic attacks.

If the physiological curves of the spine are the norm, then their modifications as a result of any circumstances (including as a result of insufficient mobility) are already a disease.
...Other authors give large numbers, arguing that the cause of the curvature is unknown in 40 and even more percent of cases. Throughout these 37 years, I have been watching patients with scoliosis. Of course, in some cases, the reasons for its appearance are obvious: trauma, a consequence of surgery, cerebral palsy, when scoliosis develops due to spasticity of the muscle tone of one side and the other, subluxation or dislocation of the hip, and so on. And yet, in the vast majority of cases, we have to deal with scoliosis, which is inherited. In 92% of cases, along with the child, postural disorders are necessarily traced in the parents - in the father or mother. Optionally, scoliosis will develop ...

Discussion

Before, when I read articles, forum posts about back pain, I never thought that it was really terribly painful and scary. One morning I got up to collect the children in the kindergarten, in the kitchen, when I was preparing tea, I felt a sharp and very strong prick in my heart (as I thought at first). Between the shoulder blades as if pincers squeezed. I can’t breathe, I can’t move, I have a panic - I can’t even call someone. Luckily, a few minutes later my husband came into the kitchen and helped me to the couch. I started to get hysterical, I was afraid of what would happen to me next .... Naturally, I couldn’t take the children to the kindergarten ... my husband also urgently needs to go to work .... Fortunately, my children are smart, and until dinner they quietly played and had a bite of cookies themselves. By lunchtime, I was somehow able to stir up, and the first thing I called the clinic, they told me that they couldn’t help me, the neurologist would not be there until the end of the week ... I decided to go to the MED4YOU clinic, which had already been repeatedly checked. Qualified doctors immediately helped me, the pain went away. They prescribed a complex treatment as part of manual therapy, acupuncture (reflexology), biopuncture (microinjections), provided a very good discount on all procedures!!! Manual therapy sessions were conducted by Igor Nikolayevich Yarukhin, a real doctor, an excellent specialist. I go to this clinic many times for various reasons, and I am always greeted with warmth and care. Only in this clinic, unlike the others, they do not try to rob the client and extract all the money from him, as others do. The doctors of this clinic primarily care about the health of the patient. Prices, it is worth noting, are very democratic! In addition, they provide very good discounts for different categories. Now there is a 50% discount on ALL PROCEDURES in honor of the 13th anniversary of the clinic, if paid on November 3 and 4. Agree, decent enough discounts! At MED4YOU, they will always help you solve your health problems, while not pulling all the money out of you. Although what to tell, once you apply and you will see everything for yourself!

It has not been specifically said - on which side the muscles are spasmodic, and on which side they are weakened. This is actually a very important question and not as obvious as it seems at first glance.

Good evening! Mothers of children with cerebral palsy who did the operation according to the Uzelbat method? Where did they do it? Physician name? What are the results? Thank you all.

Discussion

Doctor Chereshnev, she is satisfied with the result - she lowered her heel, Now she walks a lot with support, It began to work out a little with walkers, before the operation there was not even a question of walking - she twisted her leg like that, it seemed - it would break. Before the operation, she told the doctor - it’s better not to hold out than to overtighten, so as not to over-relax the muscles. There are 7 notches in total: 3 on the leg, 5 on the arm. It seems to me that it is very important to make notches taking into account the motor abilities of the child - we decided only when the daughter herself began to try to get up on her feet, and spasticity interfered. Decide for yourself specifically what result you expect and talk to your doctor about it. For example, we also wanted to make notches on the other leg, but I refused.

We went to Tula in 2006 for a consultation. very well received, examined for a long time, told us a lot about what could happen to the child after the operation, BUT they said that perhaps in our case there would be a deterioration. we didn’t have surgery and only in 2008 did we find out that our muscles had nothing to do with it, it was all about the bones. We have scoleosis since birth, 2-3 degrees, the right hand does not work, the hands do not have a full range of motion. bones are spliced. If not far from Tula, try to go and consult.

Muscle clamps and blocks. Elimination of voice clips, chest belt, diaphragm clips and waist.
... Sit on the floor, legs slightly bent at the knees and slightly apart. Place your palms on the back of your head. Tilt your torso to the left, trying to get your elbow as close to the floor as possible (ideal if it touches the floor). Stay in this position for a while. Then slowly straighten up and repeat the same to the right side. Despite the fact that these exercises help to remove the clamps around the waist, they are not enough to release the “clusters” of fear impulses. Fear can only be released through the release of blocked anger. The work of unlocking the emotion of anger, the most condemned in society, is of particular concern to many people. What if she breaks out in an uncontrolled flow? What if the consequences are many times worse than emotional distress and depression? In fact...

Cerebral Palsy is not a sentence! Treatment of cerebral palsy, elimination of spasticity, muscle and joint contractures, restoration of correct voluntary movements only by natural, biomechanical methods (without medications and surgical interventions) P.s. A new problem has come to the fore in the form of an orthopedic diagnosis: contractures of the adductor muscles of the hip joints. I climb walls out of despair and hopelessness. Help with advice, please.

Discussion

we have been practicing this technique for almost a year, we are a year and a half, spastic tetraparesis with a predominant lesion of the arms, epilepsy, etc.
earlier he could not tear his head off the ground while lying on his back - now he makes such attempts, from a semi-horizontal position he generally makes a jerk and sits down (he sits for a few seconds)
before he could not lie on his stomach, strong spasticity in his hands interfered (arms did not bend at the elbows) - now they bend, lie on his stomach, sometimes leans on his forearms, tries to crawl, sometimes turns over from his back to his stomach
before, I didn’t notice my hands at all - now, of course, I don’t take anything in my hands, but if you put a toy in your hand, then the movement of the hand is badly poor, but it controls (brings it closer, looks at it) and many other positive little things, but we don’t take the recommended 3 hours in a day.
This method is very suitable for especially very heavy children, I communicate with mothers of many children abroad, very good results, even children who were fed only through a tube in the stomach now go from a spoon, those who ate from a nipple until 6 years old themselves manage with a spoon and fork. and helps to completely change the structure of the child's body (and children with cerebral palsy differ from healthy ones already outwardly). The method is very soft, at first we did the exercises while the child was sleeping.
you just need to have the patience to do the exercises, there is no violence against the child there, and this is completely different than with the older Bloom.

tell me how to deal with spasticity? were at the neurologist, she said that we had spasticity ...

Discussion

Sveta, below was the topic of "stretching", there is a very competent link given, just against spasticity. Only work and stretch marks are effective against spasticity, IMHO. Vojta is a very good method for teaching movements to make the child move, but it doesn’t suit everyone: (We still couldn’t do it - the child yelled like a beluga, then turned away from me - he was offended, closed in on himself, so there was more harm than good .

It depends on what the doctor meant by spasticity - increased muscle tone, increased tendon or tonic reflexes, hyperkinesis.
If the muscle tone is increased, then the movements are constrained, the amplitude is reduced, with passive movements resistance is well felt.
Reflexes are checked by a doctor with a hammer and when changing the position of the body and limbs.
Hyperkinesis is myoclonus, and various obsessive movements, and spasms of individual muscles, which are replaced by hypotension and vice versa.
Muscle tone and tonic reflexes are corrected by massage / exercise therapy / various methods, reflex tone is treated comprehensively, hyperkinesis is difficult to correct.

Need info on where to get botox. A friend with a daughter (2 years old) comes from Chechnya in December to Skvortsov for the 4th time, it’s completely useless, but she hopes, because he was given the term for the appearance of the result, a year from the moment of treatment. The next step is Botox. They say it effectively relieves spasticity. Who came across, tell me where in Moscow it is possible to do the procedure. Thanks in advance

Discussion

In the Research Institute of Pediatrics on the Korovenskoe highway. There they will inject and plaster.

We are not in Moscow, but I will insert "five kopecks". Better let them look for where they inject Dysport. It has a slightly different composition - more suitable for skeletal muscles. Removes spasticity well. We got hooked up recently.
By the way, you can search for rehabilitation centers. We just did it in the rehabilitation center. Children's orthopedists also probably prick ...

Today the local pediatrician came to see us about ARVI. And let's give advice on rehabilitation :) Here, he says, is a wonderful center - specialized hospital No. 32 on Aviamotornaya in Moscow. Just for children with different forms of cerebral palsy due to perinatal lesions of the central nervous system. I got scared. We don't have paralysis, we were tested! We have developmental delay! We already once tried to "confused" and almost started to treat the wrong thing. Moreover, I know that epilepsy can also occur with cerebral palsy - but the methods used for ...

Discussion

It seems to me that many in the diagnosis of cerebral palsy are confused by the word paralysis, an immobilized recumbent person immediately appears, or vice versa "twisted into a ram's horn." but, as they explained to me, we are talking primarily about motor problems to one degree or another - and there does not have to be spasticity, etc. here. if the child is elementary as we are at 9 months old, does not hold his head, does not sit, etc. he is given cerebral palsy. "according to the instructions" up to 18 months this is called a delay in motor development, and then cerebral palsy. the fact is that whatever one may say, but there are norms of development - when a person should sit, crawl, stand, walk. and these norms are not just for nothing, but because then it becomes more and more difficult and problematic for a person to master all these things ... I think that even if you take an absolutely healthy child and immobilize him with diapers for a year, then he will also be diagnosed with cerebral palsy and it will be very difficult for him to learn do everything that he should be able to do by age.
and there are no other methods of rehabilitation for cerebral palsy except for massage and gymnastics. we also have epi, and also a delay (read dsp) and we also suffer from the fact that we CAN'T DO ANYTHING ....

And in cerebral palsy there is a form with muscle atony, not only with spasticity. Also, the hyperkinetic form is not always accompanied by spasticity, or rather, there is a variable spasticity.
Until the age of two, we hung like a trough, there was no spasticity at all, we didn’t arch, we slept relaxed. So what. We still have neurologists disagreeing: - spastic-hyperkinetic form or cerebellar lesion of the GM.
contracts per year? It's funny, they are formed over the years, I have not yet seen a single child in a year with contractures, even with the incredible strength of spasticity.
The concept of pure cerebral palsy, well, I don’t know. Do not forget that cerebral palsy is a drain hole of diagnoses.
And at the age of 60, cerebral palsy is called a stroke, does it make you feel better?
And the methods are yes - any treatment of neurology is stimulation, and with epi it is categorically contraindicated.
But a relaxing massage can just be shown. There is cortexin = nootropic used in epi.
You have a developmental delay, PTCNS - well, almost all cerebral palsy patients had such diagnoses.
Are you afraid of the very word? Well, it doesn't make us all happy.

By the way, I draw your attention to the Morozov hospital does not specialize in cerebral palsy.

My son (1 year old) has cerebral palsy. There are a lot of problems (we don’t hold our heads, we don’t sit, we don’t crawl, etc.), but we are slowly fighting, working. Recently, more and more worried about spasticity in the hands - the hands are strongly twisted, bent inward. The masseuse says: "constantly correct the handle, return it to the physiological position, teach the correct grip." I correct, put objects into the handle, fix the correct grip, but .... the baby resists, cries, does not want to hold the object, throws it. BUT...

Discussion

Wrote to the podnik mail

Girls, as I understand it, you all went through similar problems, you give sensible advice, if you can share more developments (on large motor skills, for example (how to teach your head to hold, sit, crawl). Doctors are silent like partisans, they only shrug their hands, all that is really " works” I learn either from a masseuse or from mothers who have already put their children on their feet.

Maybe the participants of this conference will be able to explain to me why atony turns into spasticity??? Well, some kind of horror, you study, study with her for 1.5-2 hours a day, well, finally, she turned over, began to turn over often in all directions, and bam, all in one day! He lies flat on his stomach and can’t even raise his head well (it’s already been more than 2 weeks), the arms are in fists, pressed to the body, he presses his legs to himself, well, what the hell? (sorry for my English)! Is it possible to somehow influence this? Or...

Discussion

Nadya, what form of cerebral palsy was given to your daughter initially? In general, the form of cerebral palsy can change, but for some reason, no one can answer! A friend of mine has a son, everyone diagnosed cerebral palsy with spastic diplegia, now they have a mixed form of cerebral palsy, atony in the hands, spasticity in the leg. No one can really say anything either! Well, it seems to me that it is easier to deal with spasticity than with atony (IMHO). Spasticity can be "removed" in many ways and even with medication, but pumping up muscles with atony is very difficult, although everything is very individual. It is good to remove spasticity with stretch marks, exercises on the ball, medocalm helped us well (from medications). If you believe the specialized literature, then the spastic form of cerebral palsy is more promising in terms of prognosis and rehabilitation ...

hello girls! I am writing for the first time, the Kid is two and a half years old. Cerebral palsy spastic tetraparesis strong spasticity in the jaw removed 9 teeth from severe spasms, there was no other way out. The mouth almost does not open, eats poorly, swallows, very strong salivation. Maybe someone similar problem please help with advice what to do?

Discussion

Alena, we have spastic tetraparesis. True, apparently not as strong as yours. However, we still have some very serious problems, because of which I was forced to feed the child through a tube. I think in your case - this is the way out. I learned on my own, without doctors or nurses. Once I was shown by a nurse in the hospital, I specifically went to show her how to do it, well, the trouble is the beginning ...

Girls, tell me, please. My cub is 3 g, he started walking a little from 2.5. There is progress, the gait, of course, is typical for cerebral palsy - lameness and the leg turns out, but I'm more worried about extreme instability and lack of coordination. I remember adult patients - the gait is completely uneven, but they walk quite steadily, do not sway and do not lose their balance. Does this mean that this stability is acquired with age, or is it necessary to do something specially for this?

Discussion

We had cerebral palsy of the atonic-astatic type, but we almost completely rehabilitated the child from THIS problem. Massage + exercise therapy - daily for 3 hours - from 2.5 months to 2 years. After that, it helped us very well: 1. independent walking on sand and pebbles - for hours on the sea on loose soil (several years daily), 2. independent walking on the grass, 3. ladder-ladder for 5 steps - a million approaches daily, 4. daily thousands of people walking up the stairs from the 1st to the 3rd floor and back, 5. walking along the curb, first by 1 hand, then without support, 6. long and tedious work on balance, the vestibular apparatus, and last but most importantly - DO NOT BE SORRY! They abandoned the stroller at the age of 2, and everywhere they scrabbled on their own, with snot, tears, but on their own. It is better to rest, pick up, but not put in a stroller. What we have now, at the age of 9.5: gait without features, independent walking up and down the stairs, if you bark, then moves away from the railing and walks up the stairs with variable steps on her own, runs, jumps, stands on 1 leg, learns to ride on 2 - a wheeled bike. Dz removed.

It is imperative to do it, otherwise, with age, such a pathological gait only takes root and it becomes almost impossible to fight it. There is a special device in the form of ropes along a special path, on which the skills of proper walking are developed. We also walk barefoot along the prickly path, the instructor raises the knee high in the bend, then correctly puts his foot on the path, so we stomp forward and always back. This is only a small fraction of what I know as my kinder grows, but I can say for sure that it’s too early for you to stop and you need to contact the instructors for help so that you don’t leave a trace of your problems later.

Features of personality formation in children with cerebral palsy: mental infantilism, mental retardation

Discussion

A good combination of theoretical foundations with accessible language. this is important for parents. You can add more practical recommendations.

THIS ARTICLE ANSWERED MY QUESTIONS THE CHILD AFTER TREATMENT "froze" PARENTS DESPERATED YES THIS IS UNDERSTANDING. Thanks

Very often, parents ask a simple question: does a child need a massage under the age of one? And if so, which one? After all, it is obvious that there can be no universal complex for all babies in the world. Let's try to figure it out.

Discussion

Dear Gavrilova Elena! Maybe I will disappoint you, but cerebral palsy is NOT TREATED! And what doctors call "the threat of cerebral palsy" can be renamed into "suspicion of cerebral palsy." Cerebral palsy is a consequence of irreversible changes in the brain, not in the muscles. Our son is 1.2 years old, we have been treated since birth: massages, gymnastics, baths, swimming, medicines. Three courses at the Kozyavkin clinic. We were diagnosed with cerebral palsy at 8 months. Before that - a syndrome of motor disorders. We are fighting, and if cerebral palsy were curable, the baby would probably already be healthy

I live far away from doctors who can consult. Here I am interested in such a question, what is torticollis? my son always tilts his head to the left. so I don’t know if it’s torticollis or it’s just convenient for him, but if I myself lay down or turn his head, he doesn’t cry.
many thanks to everyone who answers

girls about our grandfather domovskogo massage therapist! she considered that we had hyperkinesis on all four, we had dystonia. who knows what it is plz tell me! I also met with our doctor. he gave her advice. it turned out that our doctor is almost a god.......... :) according to her, although when she didn’t see him, she was very surprised that someone would give her recommendations, and then seeing his hands jogged! In general, we have a cool healer! :) this makes me happy! So about...

Discussion

You are lucky with a specialist, if she really knows all the techniques.
I am very interested in styling for dampening reflexes! Tell!!!

muscular dystonia - a type of cerebral palsy - is spasticity, and the opposite form of dystonia. That is, the muscles, on the contrary, are over-relaxed. So, what was your diagnosis in general? Do you have hyperkinesis or not? And they also say that Vojta cannot be combined with massage. And styling is the most ordinary, we also use such (in other words, splints, splints ...) And they are definitely needed.

The thread was created to discuss this article. From the moment the abbreviation of cerebral palsy appears in the child’s medical record, his loved ones do not leave the feeling of fear, grief and doom, because in their understanding such a diagnosis means helplessness and isolation from a normal, full-fledged life. Article author: Natalia Talanova

Discussion

The main thing is that parents do not forget to praise him even for the slightest manifestation of activity and in no case show their displeasure - even if the traces of the "violent activity" of the little owner will have to be eliminated for several hours. This is the case when the patience and a certain dedication of adults benefit the child. For example, self-dressing helps to strengthen the muscles of the hands, develop coordination of movements and orientation in space, and even allows you to enrich your active vocabulary. First, let the baby dress a doll or a teddy bear for a walk and at the same time explain to his mother what he is doing and how. The task of an adult is to encourage the child to speak not only in one-two-syllable sentences, but also in full expanded phrases. Over time, his speech will change ...

Discussion

Good afternoon! A lot of people are concerned about cerebral palsy. I'm not sure that most people know that in Israel there is a specialized center for children with congenital diseases, including cerebral palsy - Beit Easy Shapira. This center is the only one of its kind in Israel, operating for more than 30 years and is a leader at the national level and beyond. They accept foreign children. You can send the documentation to the email and get the necessary information: [email protected]

I ask experienced parents and people with cerebral palsy to help with advice. A 19-year-old girl with the consequences of cerebral palsy - tetraparesis, spasticity, normal intelligence, speaks well, her hands work - she is engaged in beads, sits, does not walk. An orphan, from the age of 1.5 in boarding schools, among psychochronics, was never rehabilitated. The regional hospital offers to perform an operation - to dissect the tendons. They say I won't walk, but it will be better, Then 2 months in a cast, then you can go to a rehabilitation center. And our opinion - first in the center. What do you recommend?

With the search in general nightmarish problems. I can't find anything. I put "Elena (exnezareg)" in the name of the author, change the date to two years ago, remove these "90 days", choose. conf - as a result, nothing was found. How to look, search and read what has already been accumulated???

I couldn’t come to Charkovsky, now he’s coming to me himself, "- approximately this feeling was born when I learned about the seminar in Kaluga. The two-day seminar, which included a lecture at the Kaluga Pedagogical University and a six-hour non-stop aqua training, was organized at the initiative of the regional center Experts Dmitry Utenkov and Larisa Mitrofanova have long been looking for a radical way to help children with cerebral palsy, but even in the process of preparation this seminar went beyond the originally outlined framework: there were much more interested people. - Marina, let's meet in the pool on Friday before the lecture Take your younger children, Igor Borisovich will show you some exercises so that on Saturday you can demonstrate them to other parents, &md...

Discussion

Hello people, I share the trouble, because it could save someone's life.
My friend is an athlete, a champion of Russia in mountaineering, a skydiver, his girlfriend is a pro-level yogi and a woman. Two years of trying to have a child ended successfully, she became pregnant.

Two months before the birth, the guys went to Thailand, Chiang Mai, the Tao Garden center to a fairly well-known spiritual midwife, Marina Dadasheva-Draun, the best student of Igor Charkovsky, about whom they had previously read a lot of good reviews on the Internet. Qigong, yoga, breathing practices, a swimming pool, cycling - a serious preparation offered by a midwife, in general, I liked it.

But Marina herself, in the course of communication in Thailand, made an ambiguous impression on both, urging them to constantly invest in “spiritual” obstetrics before giving birth, going to a restaurant with her, giving gifts and much more (this is in addition to paying for childbirth). Her strained relations with many local residents, the constant fear of deportation (Marina Dadasheva conducts her activities against the laws of Thailand), as well as the exaltation of her merits, that is, the complete lack of professional modesty, were also alarming.

After several conflict situations with Marina Dadasheva, the guys had the idea to leave her, but there were no options for retreat in the ninth month. The woman in labor was opposed to Thai hospitals, where it is very difficult to give birth naturally, and yet Marina's vast experience bribed.

Now to the point and briefly. The birth lasted more than two days, the water broke almost immediately, but Marina assured that this was not the first such case and she knew what to do. When the birth took place, the child was born entwined with the umbilical cord, weighing 2300, without signs of life. Marina Dadasheva carried out resuscitation with him and the baby began to breathe and even began to suckle at the breast. He died 5 hours later.

Now the opinion of professionals with no less experience than Marina: do not do an ultrasound before childbirth (Marina categorically insists and urges women in labor not to have an ultrasound during pregnancy) and do not call an ambulance after birth for such a baby, leave him without monitoring, therapy and resuscitation equipment is deliberately depriving the baby of a great chance of survival. And Marina Dadasheva knew this for sure, she simply could not help but know.

While the guys were in shock after the incredible physical and mental overstrain and grief, Marina demanded to pay the full amount for the birth, this is $ 2,500, and quickly leave her house. When she got what she wanted, she stopped talking. Draw your own conclusions.

Girls, help with advice, is it worth it to go for treatment using the Skvortsov method. Respond who was treated., Were there any results? We ourselves are from the Altai Territory and therefore it is very far to go. I called the clinic and they promised a 90% positive result, is that true? Sincerely, Marina K.

Discussion

I can’t calculate the percentages, but it helped us a lot and I know many who helped with severe forms of cerebral palsy without convulsions.
We injected 6 times in Moscow with Skvortsov, and then another 7 times in the local center, our doctor, who was officially trained by Skvortsov, injected. The spasticity was removed in all muscles, except for the ankles. On the ankles, then Ulzibat was still done anyway.
But we could see from the first time that it helps. That's why we went. The procedure is not easy, the mother is on valerian, the child is on fenozepam at first, when he grows up, he is also on valerian (during the procedures, of course).
The smaller the child, the better the results. We injected for the first time in a year and ten. In the last - in 7 or 8 years. I do not remember exactly. And then there was obvious progress without drugs.

At first I was apprehensive about this procedure. But we decided to take one course, then another - in the end five.
This happened between one and two children's years.
Immediately the results were not visible, as promised. But analyzing later the development of the child, they noted that the child spoke and went precisely during this period. This was the leap in his development. Whether it is connected with obkalyvaniye - can be and yes. If there was a child older, then I would not have gone for it - only to injure the already shaky psyche. And at the age of a year - in my opinion, I got more, because when I left the small office, I forgot everything and no longer cried. That alone calmed me down a bit. After and still does not remember these procedures and rather does not remember.

Please, who has experience of taking sirdalud, share!!! What doses, from what age? In our city, doctors do not use this, at best they have heard about it.

Discussion

I read your discussion about sirdalud. We did not take it constantly, but during massage courses as follows: before the massage, paraffin applications were made against the background of sirdalud (0.002), 1/3 tablets a day, 2-3 weeks (the dose is designed for a one-year-old child). After the first 2-3 doses of the drug, lethargy and lethargy disappeared, just the baby was calmer and softer during the massage. Such an appointment was made in the Evpatoria clinical sanatorium of the Moscow Region. And as for salt baths, I have doubts - "hotter water" leads to even more pronounced spasticity (max t37), and the load on the heart is large.

We drank, we drink and, probably, we will drink Sirdalud for a long time - we have a very high spasticity. The medicine is good - the only medicine that really removed our spasticity. Mydocalm was too weak for us, more precisely, up to 8 months - still nothing, and then they connected Sirdalud. We drank at first 1/8, 3 times a day, when we were little. Then after a year and a half - 1/4 3 times a day. Now we take a whole pill. True, now I don’t constantly give it to her, but as soon as spasticity increases, I give it for three or four days, then I reduce the dose and reduce it to nothing. It is impossible to cancel abruptly - the tone will soar through the roof. Only gradually. It is also desirable to introduce gradually - it is necessary to choose the dose in such a way that the child does not cut off immediately, as from anesthesia. We gave in the morning, before daytime and before nighttime sleep. Before bedtime - the largest dose. Now I give her this way - in the morning 1/2, otherwise she will be sluggish, before daytime sleep - a pill, before nighttime - a pill. I've been giving it for three days - after a year-long break. Spasticity increased sharply (there was a jump in growth) - there was nowhere to go, I had to give it again.
Yet. Sirdalud suited us well in combination with vertical coniferous-salt baths. But they are better to do in the afternoon, before daytime sleep. After them - stretching and sleep. Then Yanka woke up soft-soft!

Hello! God help! I re-read the entire conference and collected all the information about all the places and doctors mentioned here. And one of the locals turned to some folk healers (I mean all sorts of bioenergetics, cosmoenergetics, etc.) who promise results for children with cerebral palsy. I rummaged around on the Internet, there are even those whose results are confirmed by clinical studies and observations by neuropathologists from well-known hospitals and who have licenses and permissions for this ...

Discussion

You will rush from side to side, it is unlikely that you will get the desired result. My advice is to throw all the fucking drugs, because they are of no use to the brain (if you need a more convincing explanation, then find my earlier messages in the conf) If you want results, then only Vojta or Bobat, depending on the severity of the disease.

Konstantin, you would have written on top there, otherwise you are not visible here, we had herpes, in the early stages of pregnancy but MRI is normal, but there is cerebral palsy, we generally began to hold our heads almost a year but turned over from 8 months, in general we have development after the intensive year began, but we also want to see healers, I know we have a woman Zina in Andrusovo in Krmyu, so she has a turn to sign up until December, we were with her at 9 months, but then they refused to treat her, they were afraid to stop drinking medicine! but in vain! and there is also in the white pier, so we called the White pier and said that cerebral palsy told us to come, so we’ll also go on the third Monday of December, but there are many such cases, I know about how a granny cured an eppy in a child in two doses, and There were three exclamation marks on the card about Eppie! and two doses and no more seizures.

Muscle tone disorders in children. tone diagnosis. Massage

Hello girls! Tell us what exercises you do with kids with cerebral palsy. In general, girls, write what you do for the child, how you do it, what programs anyone has to deal with cerebral palsy. For example, I move my son's arms to the music every day, make him lie on his stomach, baths with salt and aromatic oil 1-2 per week, pool on Fridays, massage, speech therapist, Chinese needles. Mine is only 9 months old, but he has severe spasticity, quadriplegia. I just need ideas...

Discussion

Girls, I read the archive of your messages for 3 years and realized that there is nothing to do abroad with problem children. But I got upset.
Eric is really very bad for me ... He died 4 times for 4-5 minutes, was born bloodless, completely white, his hemoglobin level was 27. Several times they did a blood transfusion, all the organs refused to work, there were clonic convulsions. The head grows very slowly. for almost 10 months, and the circumference is only 41cm. The tone is the strongest - do not bend, do not unbend the arms. legs, and that's it. Prefers the right side. Tried to correct it several times, that is, turn the head over to the opposite side. so yelling that the neighbors called the police to find out what was going on. They thought I was killing him here. He also has a very high-pitched cry. he seems to have calmed down a little because of Sabril (vaigabatrin). Breast sucking is one name ... Sponges will stretch out with a tube, and you must definitely put the nipple in his mouth, he can’t look for it himself. .
It looks like she poured out her soul.

I would like to learn more from Katya or from others about paraffin applications. About how you can wean it from the right side. Please help with advice.

My problem with Eric is a bit similar to that of Nadia (nadine) from Peter. Nadia, if you are reading, please write to me how you are coping with your child. We have West syndrome.

It occurs as a result of lesions in the upper motor neurons, which leads to the elimination of the inhibitory effect on both alpha motor neurons (alpha spasticity) and gamma motor neurons (intrafusal fibers) (gamma spasticity). As a result, an unsuppressable reflex arc arises between alpha motor neurons and nerve fibers of the type I from muscle spindles, which leads the muscles into a hypertonic state with clonus, and sometimes with involuntary movements. Possible etiologies: damage to the cerebellum (eg, stroke) or SM (spasticity is an expected consequence of trauma to the SC above the spinal conus), MS, congenital anomalies (eg, cerebral palsy, spinal dysraphism).

Clinical manifestations

Increased resistance to passive movements, hyperactive muscle stretch reflexes, simultaneous stimulation of antagonist muscle groups. May occur spontaneously or in response to min stimulation. Characteristic postures are crossed legs and excessively bent hips. It may be painful, it may interfere with the patient sitting in a wheelchair, lying in bed, riding specially adapted devices, sleeping, etc. It can also lead to the formation of bedsores. The spasmodic bladder has a small capacity and can be emptied involuntarily.

Spasticity may be exacerbated by the same stimuli that enhance autonomic hyperreflexia.

With an injury to the spinal cord, the onset of spasticity can be delayed from several days to months (this latent period is called " spinal shock”, during which muscle tone and reflexes are reduced). Manifestations of spasticity after a period of spinal shock begin with increased flexion synergistic activity for 3-6 months, with a more gradual increase in extensor synergy, which eventually becomes predominant in most cases.

Some "positive" moments of moderate spasticity:

1. maintains muscle tone and therefore muscle volume: maintains the position of the patient's body while sitting in a wheelchair, helps prevent pressure ulcers over bony prominences

2. muscle contractions help prevent deep vein thrombosis

3. may be useful when using a corset

Classification of spasticity

The examination of the patient should be carried out in a supine position in a relaxed state. The Ashworth scale is used to clinically assess the severity of spasticity (see. tab. 12-1). There are numerous attempts to quantify spasticity based on electrodiagnostics, the most reliable being the measurement of the H-reflex.

Tab. 12-1. Ashworth scale

Treatment

Depends on the degree of useful functions (or potential functions) present in the area above and below the spasticity. With complete SC involvement, there are usually few functions, while significant functions may be preserved in MS patients.

Medical treatment

1. “prevention”: measures to reduce the effect of precipitating factors (exercise therapy to reduce joint damage, good skin and bladder care, etc.).

2. prolonged stretching (more than normal range of motion): not only prevents joint and muscle contractures, but also alleviates spasticity

3. oral drugs: several drugs have a good effect without a pronounced undesirable PD

A.diazepam(Valium a MN . Most effective in patients with complete damage to the spinal cord.L : Start with 2 mg PO 2-3 r/d, increase by 2 mg every 3 d up to 20 mg 3 r/d. PD: may have a sedative effect, weakness, decreased vitality (the severity of most of these symptoms can be reduced by gradually increasing the dose). Abrupt discontinuation may lead to depression, seizures, withdrawal syndrome

b.baclofen(Lioresal ®): activates GABA A receptors, increases presynaptic inhibitiona MN and reduces pain sensitivity. May be most effective in patients with CM injury (complete or partial).L : Start with 5 mg PO 2-3 r/d, increase by 5 mg every 3 d up to 20 mg 4 r/d. PD: sedative effect, lowers the threshold of convulsive readiness. Discontinuation of the drug should be gradual (sudden discontinuation may cause seizures, reversal of spasticity or hallucinations)

C.dantrolene(Dantrium ®): reduces the polarization caused by the entry of Ca ++ ions into the sarcoplasmic reticulum of skeletal muscles; acts on all skeletal muscles (without any predominant action on the spasmodic reflex arc).L : Start with 25 mg PO 1 r/d, increase every 4-7 d first 2 r/d, then 3 r/d, then 4 r/d, then 25 mg every day up to≈ 100 mg 4 r / d (it may take 1 week to show the effect at the new level of saturation). PD: muscle weakness (may lead to inability to move), sedation, idiosyncratic hepatitis (may be fatal; more common in patients receiving >300 mg/d for >2 months), often preceded by loss of appetite, abdominal pain, T /R. The drug should be discontinued after≈ 45 d if there is no desired effect. It is necessary to monitor liver tests (ALT and AST)

D.progabid: activates GABA A and GABA B receptors. Effective in patients with severe flexor spasms

E.Other drugs may theoretically be useful, but they are not used for any practical reason (eg, phenothiazines reduce gamma spasticity, but only in high doses of PO or parenterally; clonidine; Darvon ; tetrahydrocannabinal, etc.)

Surgery

It is used in cases refractory to medical treatment, or when the PD of drugs becomes difficult to tolerate. Usually, these are either orthopedic [eg, transection of the calcaneal or hamstrings (tenotomies)] or N/C (eg, nerve blocks, neurectomy, myelotomy, etc.) interventions.

1. non-destructive procedures

A.intrathecal administration of baclofen

b.intrathecal morphine (may develop tolerance and dependence)

C.electrical stimulation with epidural electrodes placed percutaneously

2. damaging procedures with preservation mobility

1. blockade of the motor zone (intramuscular neurolysis with phenol): sensitivity and existing motor functions are preserved. Especially effective in patients with incomplete myelopathy;
2. Nerve blockade with phenol: similar to blockade of the motor zone, but used in cases where spasticity is more pronounced and complete blockade of the muscle is required. Open blockade with phenol, unlike percutaneous blockade, is performed when the nerve is mixed and sensitivity is required (also helps to reduce post-blockade dysesthesia)
3. selective neurectomy

1. sciatic nerve neurectomy: can be done by radiofrequency destruction

2. obturator neurectomy: useful for severe spasticity of the adductors of the thigh, resulting in crossing of the legs and the expenditure of additional energy during movement

3. pudendal neurectomy: useful in cases where excessive detrusor dyssenergy interferes with recovery of bladder function

1. percutaneous radiofrequency foraminal rhizotomy: small unmyelinated sensitivities are more sensitive to radiofrequency exposure than thick myelinated A-amotor fibres. Methodology: start from spine S 1 and move to the T12 spine on one side, then repeat the same procedure on the other side. At each level: verify the position of the needle by 0.1-0.5 V stimulation and control movements in the corresponding myotome (needle tip should be extradural; subarachnoid position should be avoided). On spine S 1 exposed to a temperature of 70-80C° for 2 minutes, and on the roots L 5-T 12 70 ° C for 2 minutes (to preserve motor function). If symptoms recur, you can repeat the procedure with a temperature of 90° C for 2 min
2. myelotomy

1. Bischof myelotomy: separation of the anterior and posterior horns by a lateral incision, leads to a break in the reflex arc. Has no effect ona spasticity

2. median "T" myelotomy: leads to a break between the sensory and motor parts of the reflex arc without disrupting the connections of the cortico-spinal tracts with the motor neurons of the anterior horns. Slightly higher risk of movement disorders. Methodology: T12 laminectomy- L 1. Mobilize the posterior median longitudinal vein and dissect the SM along the midline from the level of T12 to the level S 1 (starting with a depth of 3 mm, ending with a depth of 4 mm). Saving a level S2-S 4 allows you to save the reflex pathways for the bladder. Unilateral continuation to the spinal cone reduces spasticity of the bladder and increases its capacity until the onset of the emptying reflex

1. selective dorsal rhizotomy: the use of i / o EMG and electrophysiological stimulation to eliminate sensitive roots in "disabling spasticity" (with preservation of roots that provide "useful spasticity"). The intersection of the afferent branch of the pathological reflex arc. May be temporary, but usually persists for≈ 5 years. Does not affectaspasticity. Children with cerebral palsy who are able to move have an improvement in gait, and those who are unable to move, despite the improvement, remain immobilized after surgery
2. stereotaxic thalamotomy or dentatotomy: may be useful in cerebral palsy. Used for unilateral dystonia. With bilateral dystonia, bilateral thalamotomy threatens the patient's speech. Effective only for dystonia distal shoulders or hips. Should not be performed in case of rapid progression of symptoms

3. damaging procedures that lead to impaired ability to move(in case of complete damage to the spinal cord, non-destructive interventions are not indicated at all, since there are no motor functions, the recovery of which can be expected). Used in the absence of effect from percutaneous rhizotomy and "T" myelotomy.

A.intrathecal administration of 6 ml of 10% phenol solution (by weight) in glycerol with 4 ml of iohexol ( Omnipaque ® 300) for a final concentration of 6% phenol and≈ 120 mg iodine/ml. Injected with LP in the interval L 2-3 in the position of the patient on the side on the more sore side under the control of fluoroscopy until the cuffs of the roots are filled T12- S 1 (without affecting the roots S 2-4 to preserve bladder function). The patient remains in this position for 20-30 minutes, and then moves into a sitting position for 4 hours (the use of absolute alcohol gives a more permanent blockade, but it is hypobaric harder to control)

b.selective anterior rhizotomy: results in flaccid paralysis with denervation muscular atrophy

C.neurectomy, often in combination with tenotomy

D.intramuscular neurolysis by phenol injections

E.cordectomy: a more radical intervention, used in patients who have not been helped by any other measures. It leads to flaccid paralysis with the loss of those positive moments that a slight spasticity gives these patients. In this case, control of the bladder passes from the upper motor neuron to the lower motor neuron. Effective for progressive deficits caused by syringomyelia and spasticity, but of little help with “phantom” leg pain

F.cordotomy: rarely used

Intrathecal administration of baclofen

The criteria for selecting patients from work are given in tab. 12-2.

Tab. 12-2. Criteria for selecting patients for a baclofen pump

* this study used programmable intrathecal pumps

trial dose: use increasing doses of baclofen 50, 75 and then 100 µg, which is administered by LA or through a temporary catheter. Doses of baclofen are randomly interspersed with placebo administration. When the effect is achieved, the dose increase is stopped. After 0.5, 1, 2, 4, 8, and 24 hours after injection, the following parameters are assessed: pulse, respiratory rate, blood pressure, muscle tone (Ashworth scale), reflexes, voluntary muscle movements, PD (any, including seizures) . Pump implantation is indicated if there is a decrease in muscle tone of 2 points on the Ashworth scale and a decrease in muscle tone score for ≥4 hours after a bolus of active drug without intolerable PD.

Alternatively, inject 25 g i/t in the operating room and if the patient improves, implant a subcutaneous pump.

Pump types: among the available systems, we note Synchromed issued by the company Medtronic, Inc., Minneapolis, MN.

Complications: Complications related to the implanted system itself, see tab. 12-3. The frequency of most of them≈ 1%, except for catheter-related problems, the frequency of which was≈ 30%.

Tab. 12-3. Complications *

* complications associated with the implanted system itself, which required a second intervention

Greenberg. Neurosurgery