Infantile cerebral palsy (ICP): symptoms, diagnosis and treatment. Cerebral palsy: causes and forms of cerebral palsy forms and types

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

Cerebral palsy - what is it?

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

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

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

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

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

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

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

Causes

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

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

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

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

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

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

Forms and their characteristics

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

Hyperkinetic (dyskinetic)

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

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

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

Ataxic (atonic-astatic)

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

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

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

Spastic tetraplegia (spastic tetraparesis)

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

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

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

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

Spastic diplegia (Little's disease)

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

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

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

Hemiplegic

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

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

mixed

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

unspecified

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

Symptoms and signs

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

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

However, they cannot be ignored.

Parents should be suspicious if:

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

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

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

Stages of the disease

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

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

Diagnostics

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

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

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

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

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

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

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

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

Treatment

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

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

Massage and Bobath Therapy

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

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

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

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

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

Food

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

There is no special diet for children with cerebral palsy. When prescribing nutrition, the doctor takes into account the development of sucking and swallowing reflexes, as well as the amount of food that the child “loses” in the process of eating - sheds, cannot swallow, burps.

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

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

Vojta therapy

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

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

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

Medicines

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

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

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

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

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

Other Methods

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

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

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

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

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

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

Methods with unproven effectiveness

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

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

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

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

Forecasts

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

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

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

Disability

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

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

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

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

Development features

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

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

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

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

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

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

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

Means of rehabilitation

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

All devices are divided into three large groups:

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

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

Hygiene

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

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

Mobility

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

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

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

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

Devices for the development of the child

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

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

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

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

simulators

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

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

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

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

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

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

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

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

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

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

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

Charitable foundations

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

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

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

Cerebral palsy is a group of diseases in which there is a violation of motor functions and posture. This is due to a brain injury or a violation of the formation of the brain. This disease is one of the most common causes of permanent disability in children. Cerebral palsy occurs in about 2 cases for every thousand people.

Cerebral palsy causes reflex movements that a person cannot control and thickening of a muscle that can affect part or all of the body. These impairments can range from moderate to severe. There may also be intellectual disability, convulsive seizures, impaired vision and hearing. Sometimes it is a difficult task for parents to accept the diagnosis of cerebral palsy.

Infantile cerebral palsy (CP)

Cerebral palsy (CP) is one of the most common diseases in children today. In Russia, according to official statistics alone, more than 120,000 people are diagnosed with cerebral palsy.

Where does this diagnosis come from? Inherited or acquired? A sentence for life or can everything be fixed? Why childish? After all, not only children suffer from it? And what is cerebral palsy anyway?

  Cerebral palsy is a disease of the central nervous system in which one (or several) parts of the brain are affected, resulting in non-progressive disorders of motor and muscle activity, coordination of movements, functions of vision, hearing, as well as speech and psyche. The cause of cerebral palsy is damage to the child's brain. The word "cerebral" (from the Latin word "cerebrum" - "brain") means "cerebral", and the word "paralysis" (from the Greek "paralysis" - "relaxation") defines insufficient (low) physical activity.

There is no clear and complete set of data on the causes of this disease. Cerebral palsy cannot be contracted and become ill.

The reasons

Cerebral palsy (CP) is the result of an injury or abnormal development of the brain. In many cases, the exact cause of cerebral palsy is not known. Damage or impaired brain development can occur during pregnancy, birth, and even during the first 2 to 3 years after birth.

Symptoms

Even when the disease is present at birth, the symptoms of cerebral palsy (CP) may not be noticed until the child is 1 to 3 years old. This is due to the growth of the child. Neither doctors nor parents may not pay attention to violations of the child's motor sphere until these violations become apparent. Children may retain the reflex movements of newborns without age-appropriate development of movement skills. And sometimes the first to pay attention to the underdevelopment of the child are nannies. If cerebral palsy has a severe form, then the symptoms of this disease are already found in the newborn. But the appearance of symptoms depends on the type of cerebral palsy.

The most common symptoms of severe cerebral palsy are

• Swallowing and sucking disorders
• Weak cry
• Seizures.
• Unusual postures of the child. The body can be very relaxed or very strong hyperextension with spread of the arms and legs. These postures are significantly different from those that occur with colic in newborns.

Some problems associated with cerebral palsy become more apparent over time or develop as the child grows. They may include:

• Muscle wasting in injured arms or legs. Problems in the nervous system impair movement in the affected arms and legs, and muscle stiffness affects muscle growth.
• Pathological sensations and perception. Some patients with cerebral palsy are very sensitive to pain. Even normal daily activities, such as brushing your teeth, can be painful. Pathological sensations can also affect the ability to identify objects by touch (for example, to distinguish between a soft ball and a hard one).
• Skin irritation. Drooling, which is common, can irritate the skin around the mouth, chin, and chest.
• Problems with teeth. Children who have difficulty brushing their teeth are at risk for gum disease and tooth decay. Anti-seizure medications can also contribute to gum disease.
• Accidents. Falls and other accidents are risks associated with impaired coordination of movements, as well as in the presence of convulsive attacks.
• Infections and somatic diseases. Adults with cerebral palsy are at high risk for heart and lung diseases. For example, in severe cerebral palsy, there are problems with swallowing and when choking, part of the food enters the trachea, which contributes to lung diseases. (pneumonia)

All patients with cerebral palsy have certain problems with body movement and posture, but many babies do not show signs of cerebral palsy at birth, and sometimes only nannies or nurses are the first to pay attention to deviations in the child's movements that contradict age criteria. The signs of cerebral palsy may become more apparent as the child grows. Some developing disorders may not become apparent until after the child's first year. The brain injury that causes cerebral palsy does not show up for a long time, but the effects may appear, change, or become more severe as the child gets older.

Certain effects of cerebral palsy depend on its type and severity, the level of mental development and the presence of other complications and diseases.

1. The type of cerebral palsy determines the movement disorders in a child.

Most patients with cerebral palsy have spastic cerebral palsy. Its presence can affect both in all parts of the body, and in individual parts. For example, a child with spastic cerebral palsy may develop symptoms mainly in one leg or one half of the body. Most children usually try to adjust to motor impairments. Some patients can even live independently and work, needing only occasional assistance. In cases where there are disorders in both legs, patients require a wheelchair or other devices to compensate for motor functions.

Complete cerebral palsy causes the most severe problems. Severe spastic cerebral palsy and choreoathetoid cerebral palsy are types of complete paralysis. Many of these patients are unable to care for themselves due to both motor and intellectual impairments and require constant care. Complications such as seizures and other long-term physical effects of cerebral palsy are difficult to predict until a child is 1 to 3 years old. But sometimes such predictions are not possible until the child reaches school age, and in the process of learning, communicative intellectual and other abilities can be analyzed.

1. The severity of mental impairment, if any, is a strong indicator of daily functioning. Slightly more than half of patients who have cerebral palsy have some degree of intellectual disability. Children with spastic quadriplegia usually have severe mental impairments.
2. Other conditions, such as hearing impairment or problems, often occur with cerebral palsy. Sometimes these disorders are noted immediately; in other cases, they are not detected until the child is older.

In addition, just like people with normal physical development, people with cerebral palsy experience social and emotional problems during their lives. Since their physical defects exacerbate problems, patients with cerebral palsy need the attention and understanding of other people.

Most patients with cerebral palsy survive to adulthood, but their life expectancy is somewhat shorter. Much depends on how severe the form of cerebral palsy is and the presence of complications. Some patients with cerebral palsy even have the opportunity to work, especially with the development of computer technology, such opportunities have increased significantly.

Cerebral palsy is classified according to the type of body movement and postural problems.

Spastic (pyramidal) cerebral palsy

Spastic cerebral palsy is the most common type. A patient with spastic cerebral palsy develops muscle stiffness in parts of the body that are unable to relax. In damaged joints, contractures occur, and the range of motion in them is sharply limited. In addition, patients with spastic cerebral palsy have problems with coordination of movements, speech disorders and swallowing disorders.

There are four types of spastic cerebral palsy, grouped according to how many limbs are involved. Hemiplegia - one arm and one leg on one side of the body, or both legs (diplegia or paraplegia). They are the most common types of spastic cerebral palsy.

• Monoplegia: Only one arm or leg is impaired.
• Quadriplegia: Both arms and both legs are involved. Usually in such cases it happens, and damage to the brain stem and, accordingly, this is manifested by swallowing disorders. Newborns with quadriplegia may have problems with sucking, swallowing, weak crying, the body may be cottony or vice versa tense. Often, when in contact with a child, hypertonicity of the body appears. The child may sleep a lot and not show interest in the environment.
• Triplegia: Either both arms and one leg or both legs and one arm are called.

Non-spastic (extrapyramidal) cerebral palsy

Nonspastic forms of cerebral palsy include dyskinetic cerebral palsy (subdivided into athetoid and dystonic forms) and ataxic cerebral palsy.

• Dyskinetic cerebral palsy is associated with muscle tone that ranges from moderate to severe. In some cases, there are uncontrollable jerky twitches or involuntary slow movements. These movements most often involve the muscles of the face and neck, arms, legs, and sometimes the lower back. The athetoid type (hyperkinetic) type of cerebral palsy is characterized by relaxed muscles during sleep with slight twitches and grimaces. When the muscles of the face and mouth are involved, there may be disturbances in the process of eating, salivation, choking on food (water) and the appearance of inadequate facial expressions.
• Ataxic cerebral palsy is the rarest type of cerebral palsy and affects the entire body. Pathological movements occur in the torso, arms, legs.

Ataxic cerebral palsy is manifested by the following problems:

• Body imbalance
• Violation of precise movements. For example, the patient is unable to place their hand on the desired object or perform even simple movements (for example, bring the cup exactly to the mouth). Often only one hand is able to reach the object; the other hand may tremble from trying to move that object. The patient is often unable to fasten clothing, write, or use scissors.
• Movement coordination. A person with ataxic cerebral palsy may walk with too large steps or legs wide apart.
• Mixed cerebral palsy
• Some children have symptoms of more than one type of cerebral palsy. For example, spastic legs (symptoms of spastic cerebral palsy related to diplegia) and problems with facial muscle control (symptoms of dyskinetic CP).
• Total (complete) cerebral palsy of the body affects the entire body to one degree or another. Complications of cerebral palsy and other health problems are most likely to develop when the whole body is involved rather than isolated parts.

There are several forms of this disease. Basically, spastic diplegia, double hemiplegia, hyperkinetic, atonic-ataxic and hemiplegic forms are diagnosed.

Spastic diplegia or Little's disease

This is the most common (40% of all cases of cerebral palsy) form of the disease, clearly manifested by the end of the first year of life. It occurs mainly in premature babies. They develop spastic tetraparesis (paresis of the arms and legs), and the paresis of the legs is more pronounced. In such children, the legs and arms are in a forced position due to the constant tone of both the flexor and extensor muscles. The arms are pressed to the body and bent at the elbows, and the legs are unnaturally straightened and pressed against each other or even crossed. Feet often deform during growth.

Also, these children often have speech and hearing impairments. Their intelligence and memory are reduced, it is difficult for them to concentrate on any activity.

Seizures are less common than in other types of cerebral palsy.

double hemiplegia

This is one of the most severe forms of the disease. It is diagnosed in 2% of cases. It occurs due to prolonged prenatal hypoxia, in which the brain is damaged. The disease manifests itself in the first months of a child's life. With this form, paresis of the arms and legs is observed with a predominant lesion of the arms and an uneven lesion of the sides of the body. At the same time, the arms are bent at the elbows and pressed to the body, the legs are bent at the knees and hip joints, but can also be unbent.

The speech of such children is slurred, poorly understood. They speak in a nasal way, either too quickly and loudly, or too slowly and quietly. They have a very small vocabulary.

The intelligence and memory of such children are reduced. Children are often euphoric or apathetic.

With this form of cerebral palsy, convulsions are also possible, and the more often and stronger they are, the worse the prognosis of the disease.

This form of cerebral palsy, which occurs in 10% of cases, is characterized by involuntary movements and speech disorders. The disease manifests itself at the end of the first - beginning of the second year of a child's life. Arms and legs, facial muscles, neck can move involuntarily, and movements are intensified during experiences.

Such children begin to speak late, their speech is slow, slurred, monotonous, articulation is impaired.

Intellect rarely suffers in this form. Often such children successfully graduate not only from school, but also from a higher educational institution.

Convulsions in the hyperkinetic form are rare.

Atonic-astatic form

In children suffering from this form of cerebral palsy, the muscles are relaxed, and hypotension is observed from birth. This form is observed in 15% of children with cerebral palsy. They begin to sit, stand and walk late. Their coordination is disturbed, and there is often a tremor (trembling of the hands, feet, head).

Intelligence in this form suffers slightly.

Hemiplegic form

With this form, which occurs in 32% of cases, the child has unilateral paresis, that is, one arm and one leg on one side of the body are affected, and the arm suffers more. This form is often diagnosed already at birth. Speech impairment is characteristic of this form - the child cannot pronounce words normally. Intelligence, memory and attention are reduced. In 40-50% of cases, convulsions are recorded, and the more often they occur, the worse the prognosis of the disease. There is also a mixed form (1% of cases), in which various forms of the disease are combined.

There are three stages of cerebral palsy:

• early;
• initial chronically residual;
• final residual.

In the final stage, there are two degrees - I, in which the child masters self-care skills, and II, in which this is impossible due to severe mental and motor disorders.

Diagnostics

Symptoms of cerebral palsy may not be present or detected at birth. Therefore, the attending physician observing the newborn needs to carefully monitor the child so as not to miss the symptoms. Nevertheless, it is not worth overdiagnosing cerebral palsy, since many motor disorders in children of this age are transient. Often the diagnosis can be made only a few years after the birth of the child, when it is possible to notice movement disorders. Diagnosis of cerebral palsy is based on monitoring the physical development of the child with the presence of various deviations in physical and intellectual development, analysis data and instrumental research methods such as MRI.

How to diagnose cerebral palsy in newborns: symptoms

If the baby sharply pulls up the legs or, on the contrary, stretches them at the moment when he is taken under the tummy, there is no lower thoracic and lumbar lordosis (bend) in his spine, the folds on the buttocks are weakly expressed and at the same time asymmetrical, the heels are pulled up, then parents should suspect the development of cerebral palsy.

The final diagnosis is established as a result of observing how the child develops. As a rule, in children with a disturbing obstetric history, control over the sequence of formation of reactions, the dynamics of general development and the state of muscle tone is carried out. If there are noticeable deviations or obvious symptoms of cerebral palsy, then an additional consultation with a psychoneurologist is required.

How cerebral palsy manifests itself in children under one year old

If the child was born prematurely or had a low body weight, if pregnancy or childbirth had any complications, parents should be extremely attentive to the baby's condition so as not to miss the warning signs of developing paralysis.

True, the symptoms of cerebral palsy up to a year are not very noticeable, they become expressive only at an older age, but still some of them should alert parents:

• the newborn has difficulty sucking and swallowing food;
• at the age of one month, he does not blink in response to a loud sound;
• at 4 months does not turn his head in the direction of the sound, does not reach for the toy;
• if the baby freezes in any position or he has repetitive movements (for example, nodding his head), this may be a sign of cerebral palsy in newborns;
• the symptoms of the pathology are also expressed in the fact that the mother can hardly spread the legs of the newborn or turn his head in the other direction;
• the child lies in obviously uncomfortable positions;
• The baby does not like being turned over on his tummy.

True, parents need to remember that the severity of symptoms will greatly depend on how deeply the baby's brain is affected. And in the future, they can manifest as a slight clumsiness when walking, as well as severe paresis and mental retardation.

How does cerebral palsy manifest itself in children at 6 months?

With cerebral palsy, symptoms at 6 months are more pronounced than in the infant period.

So, if the unconditioned reflexes characteristic of newborns have not disappeared in a baby before the age of six months - palmo-oral (when pressing on the palm, the baby opens his mouth and tilts his head), automatic walking (raised by the armpits, the baby puts bent legs on a full foot, imitating walking) is a warning sign. But parents should pay attention to such deviations:

• periodically, the baby has convulsions, which can be disguised as pathological voluntary movements (the so-called hyperkinesis);
• the child later than his peers begins to crawl and walk;
• symptoms of cerebral palsy are also manifested in the fact that the baby often uses one side of the body (pronounced right-handedness or left-handedness may indicate muscle weakness or their increased tone on the opposite side), and his movements look awkward (uncoordinated, jerky);
• the baby has strabismus, as well as hypertonicity or lack of tone in the muscles;
• a baby at 7 months is not able to sit on its own;
• trying to bring something to his mouth, he turns his head away;
• at the age of one, the child does not speak, walks with difficulty, leaning on his fingers, or does not walk at all.

Diagnosis of cerebral palsy includes:

• Gathering information about the child's medical history, including details about the pregnancy. Quite often, the presence of a developmental delay is reported by the parents themselves or it is detected during professional examinations in children's institutions.
• A physical examination is necessary to look for signs of cerebral palsy. During a physical examination, the doctor evaluates how long the reflexes of newborns in a child last compared to normal periods. In addition, an assessment of muscle function, posture, hearing function, vision is performed.
• Tests to detect a latent form of the disease. Developmental questionnaires and other tests help determine the extent of developmental delays.
• Magnetic resonance imaging (MRI) of the head, which may be done to identify abnormalities in the brain.

The combination of these diagnostic approaches allows you to make a diagnosis.

If the diagnosis is unclear, additional tests may be ordered to assess the state of the brain and to rule out possible other diseases. Analyzes may include:

• Additional questionnaires.
• Computed tomography (CT) of the head.
• Ultrasound examination of the brain.

Evaluation and control of cerebral palsy
After cerebral palsy is diagnosed, the child must be further examined and other diseases that may be simultaneously with cerebral palsy should be identified.

• Other developmental delays in addition to those already identified. Developing abilities should be assessed periodically to see if new symptoms appear, such as speech delay, as the child's nervous system is in continuous development.
• Intellectual lag can be detected through certain tests.
• Convulsive episodes. Electroencephalography (EEG) is used to detect abnormal activity in the brain if the child has a history of seizures.
• Problems with feeding and swallowing.
• Vision or hearing problems.
• Behavior problems.

Most often, a doctor can predict many of the long-term physical aspects of cerebral palsy when a child is 1 to 3 years old. But sometimes such predictions are not possible until the child reaches school age, when deviations can be detected in the course of learning and development of communication capabilities.

Some children need to be retested which may include:

• X-rays to look for dislocations (subluxations) of the hip. Children with cerebral palsy usually have several X-rays between the ages of 2 and 5 years. In addition, x-rays may be ordered if there is pain in the hips or if there are signs of hip dislocation. It is also possible to prescribe an x-ray of the spine to detect deformities in the spine.
• Gait analysis, which helps to identify violations and adjust treatment tactics.

Additional examination methods are prescribed if necessary and if there are indications.

Treatment

Cerebral palsy is an incurable disease. But a variety of treatments help patients with cerebral palsy minimize motor and other impairments and thus improve their quality of life. Brain injury or other factors leading to cerebral palsy do not progress, but new symptoms may appear or progress as the child grows and develops.

Initial (initial) treatment

exercise therapy is an important part of treatment that begins shortly after a child is diagnosed and often continues throughout his or her life. This type of treatment may also be given before a diagnosis is made, depending on the child's symptoms.

Despite the fact that cerebral palsy cannot be completely cured, it must be treated to make life easier for the child.

Treatment of this disease comprehensive, includes:

• massage to normalize muscle tone;
• therapeutic exercises to develop movements and improve coordination (should be done constantly);
• physiotherapy(electrophoresis, myostimulation) only if there are no seizures;
• electroreflexotherapy to restore the activity of motor neurons of the cerebral cortex, resulting in reduced muscle tone, improved coordination, speech, improved diction;
• load suits for correcting posture and body movements, as well as for stimulating the central nervous system;
• therapy with animals hippotherapy , canistherapy ;
• work with a speech therapist;
• development of motor skills of the child;
• prescribing drugs that improve brain function
• classes on special simulators such as loktomat.

If necessary, surgical intervention is performed - tendon-muscle plastic, elimination of contractures, myotomy (incision or division of the muscle).

It is possible that after some time a method of treatment with stem cells will appear, but so far there are no scientifically proven methods of treating this disease with their use.

Complex orthotics in the rehabilitation of patients with cerebral palsy

Characteristic signs of cerebral palsy are a violation of motor activity with the subsequent development of vicious attitudes, and later contractures and deformities of large joints of the limbs and spine, so timely and adequate orthotics is an important, if not a determining condition for the successful rehabilitation of patients with cerebral palsy.

When prescribing rehabilitation measures, it should be borne in mind that in its development, a sick child must consistently go through all the stages inherent in a healthy child, namely: sit (with and without support on hands), get up and sit down, stand with support, and only after that walk: first with support, and then without it.

It is unacceptable to skip any of these stages, as well as to carry out rehabilitation activities without orthopedic support. This leads to an increase in orthopedic deformities, the patient develops a stable vicious posture and a stereotype of movement, which contributes to the development of concomitant orthopedic pathologies.

At the same time, orthotics at all stages of the patient's development not only protects him from the formation or progression of vicious attitudes and ensures the safety of large joints, but also contributes to a faster and better passage of the current stage.

It should be noted that the upper limbs, which, as a rule, receive little attention during rehabilitation, also play an important role in the life support of the patient, since they perform supporting and balancing functions. Therefore, orthotics of the upper extremities are no less important than orthoses of the lower and spine.

When prescribing orthopedic products, it should be borne in mind that the orthopedic product shown must perform the task. In particular, the S.W.A.S.H. cannot be used for walking. this design does not allow you to do it correctly and without harm to the hip joints. Also, for walking, you should not use devices for the lower limb with locking hinges in the hip and knee joints at the same time. The use of various load devices without orthotics of large joints is also unacceptable, because. in this case, a muscular frame occurs with vicious joints, which further exacerbates orthopedic pathologies.

Dynamic orthotics

This type of orthotics is used when it is necessary to replace the function of damaged muscles, tendons and nerves of the limbs.

A dynamic orthosis is made for a specific patient, is a removable device and allows you to minimize the consequences of injuries / operations / diseases associated with impaired movement in the limbs, and also, in some cases, has a therapeutic effect.

Medications can help manage some of the symptoms of cerebral palsy and prevent complications. For example, antispasmodics and muscle relaxants help relax spasmodic (spastic) muscles and increase range of motion. Anticholinergics help improve limb movement or reduce salivation. Other drugs may be used as symptomatic treatment (eg, anticonvulsants, if seizures are present)

Permanent treatment

Permanent treatment for cerebral palsy (CP) focuses on continuing and adjusting existing treatments and adding new treatments as needed. Permanent treatment for cerebral palsy may include:

• Exercise therapy that can help a child become as mobile as possible. It may also help prevent the need for surgery. If the child underwent surgical treatment, then intensive exercise therapy may be necessary for 6 or more months. Drug treatment should be constantly monitored in order to avoid possible side effects of drugs.
• Orthopedic surgery (for muscles, tendons, and joints) or dorsal rhizotomy (excision of the nerves of injured limbs), if there are severe problems with bones and muscles, ligaments, and tendons.
• Special orthopedic devices (braces, splints, orthoses).
• Behavioral therapy, in which the psychologist helps the child find ways to communicate with peers, is also part of the treatment.
• Massage, manual therapy can also be used in the treatment of both the main symptoms of cerebral palsy and complications associated with impaired movement biomechanics.
• Social adaptation. Modern technologies (computers) have made it possible to employ many patients with the consequences of cerebral palsy.

Prevention

The cause of cerebral palsy (CP) is often unknown. But certain risk factors have been identified and proven to be associated with the incidence of cerebral palsy. Some of these risk factors can be avoided. Fulfilling certain conditions during pregnancy helps reduce the risk of brain damage in the fetus. These recommendations include:

• Complete nutrition.
• Do not smoke.
• Do not come into contact with toxic substances
• See your doctor regularly.

• Minimize injury from accidents
• Determine neonatal jaundice
• Do not use substances containing heavy metals (lead)
• Isolate the child from patients with infectious diseases (especially meningitis)
• Promptly immunize your child.

What parents need to know

Parents should be very attentive to the condition of their child, so as not to miss the signs of cerebral palsy in newborns. The symptoms of this pathology should be taken into account especially if there are grounds for alarm in the form of a problematic pregnancy, childbirth, or diseases suffered by the mother.

If you start treating a baby before the age of three, then cerebral palsy in 75% of cases is reversible. But with older children, recovery is highly dependent on the state of mental development of the child.

Cerebral palsy does not tend to progress, therefore, in the case when the pathology has affected only the patient's motor system, and there are no organic damages in the brain, good results can be achieved.

Attention! the information on the site is not a medical diagnosis, or a guide to action and is for informational purposes only.

Cerebral palsy (CP) is a collective term for a group of neurological diseases that cause impaired motor function and coordination.

Cerebral palsy occurs due to damage to the area of ​​\u200b\u200bthe brain responsible for muscle activity. The cause of the disease may be a violation of the development of the brain or its trauma before, during or shortly after childbirth.

The cause of cerebral palsy in most cases is laid during the intrauterine development of the baby and is associated with diseases of a pregnant woman, pregnancy pathology or mutations. And in rare cases - with problems in childbirth and injuries received after birth.

According to statistics, the main cause of disability in children is damage to the nervous system (47.9%), and cerebral palsy is the most common pathology in this group. Approximately 1 out of 400-500 people in Russia has cerebral palsy.

As a rule, the symptoms of cerebral palsy appear during the first three years of a child's life.

The initial stage of cerebral palsy appears immediately after birth. Changes in the behavior of the child are associated with a violation of the signal from the damaged parts of the brain. The movements of the baby are constrained due to constant muscle tension or, on the contrary, muscle weakness, lethargy. The child may shudder periodically, convulsions, trembling in the body are possible. Parents can pay attention to the fact that the baby cannot fix his eyes, sucks badly. All these changes often occur against the background of a difficult general condition of the child: problems with breathing, heartbeat, intracranial pressure, etc.

Early residual stage of cerebral palsy starts at 2-4 months of age. In parallel with the growing up of the child, disorders are manifested, determined by the place and volume of brain damage. There is a developmental delay, such children begin to sit, crawl, walk, talk late, stiffness and unnatural movements of the damaged part of the body become clearly visible. For example, a child can perform all movements with only one hand, and press the other to the body, walk on toes, and so on.

Late residual stage of cerebral palsy occurs in older children. There are no new symptoms. Due to the lack of full-fledged movements, the development of irreversible body deformities, muscle atrophy, and the formation of a specific gait are observed.

There are various methods of treatment that can reduce the manifestations of cerebral palsy and increase the independence of the child. These include physical therapy, occupational therapy, and medications to relieve muscle tension and spasms. In some cases, surgery may be required.

Symptoms of cerebral palsy in a child

As a rule, the symptoms of cerebral palsy appear during the first three years of life. A child with cerebral palsy may be slower to reach important developmental milestones such as crawling, walking and talking.

There are four main forms of cerebral palsy:

• Spastic. This is the most common form of the disease. With her, the muscles are in constant tension, so the child does not succeed in fast and accurate movements. The arms are bent at the elbows, the legs are often brought together or crossed, which makes it difficult to swaddle the baby. The degree of cerebral palsy damage can be different - from severe paralysis to slight awkwardness in movements, which are noticeable only when performing complex manipulations.
• Dyskinetic. It can be manifested by both tension and flaccidity of the muscles. As a rule, newborn children with dyskinetic form of cerebral palsy behave sluggishly, almost do not move. At the age of 2-3 months, attacks of a sudden increase in muscle tone (sharp muscle tension) appear in response to strong emotions, loud sounds, bright lights. After 1–1.5 years, hyperkinesis appears - slow worm-like movements of the arms and legs (athetosis), fast and jerky movements (choreic cerebral palsy) or contractions of the muscles of the body, which lead to its rotation, head turns and other changes in posture (torsion movements). Hyperkinesias usually do not appear at rest and disappear when the child is sleeping. Children with this form of cerebral palsy often have a decrease in hearing and speech, as well as difficulty with eating. At the same time, mental development suffers less frequently than in other forms of the disease.
• Ataxic. With this form of cerebral palsy, balance and coordination disorders come to the fore, because of which movements become convulsive and awkward. Children start standing and walking at the age of 1.5–2 years, but these functions have to be brought to automatism for a long time. Tremors (involuntary trembling) of the hands and head may also be observed. Possible decrease in intelligence.
• Mixed. With it, patients have signs of more than one of the forms of cerebral palsy described above.

The severity of symptoms can vary greatly from person to person. In some, the symptoms are expressed in a mild form, while in others the disease turns into invalids.

Cerebral palsy can also affect different parts of the body. In some, the right or left side of the body is affected, in others, the legs are primarily affected, and in others, both legs and arms. Depending on which part of the brain is damaged, cerebral palsy can be accompanied by a violation of not only motor, but also other body functions. Therefore, children with cerebral palsy may experience the following symptoms:

• recurring seizures or seizures (epilepsy);
• salivation and difficulty swallowing (dysphagia);
• gastroesophageal reflux disease (GERD);
• skeletal abnormalities or abnormalities, especially hip dislocation or spinal curvature (scoliosis);
• problems with bladder control (urinary incontinence);
• speech disorder (dysarthria);
• visual impairment;
• difficulties with learning (although mental abilities are often not impaired).

Causes of cerebral palsy

In the recent past, doctors believed that the cause of cerebral palsy was damage to the brain during childbirth due to a temporary lack of oxygen (hypoxia). However, in the 1980s a large study was conducted, during which it was proved that hypoxia during childbirth causes cerebral palsy in no more than 10% of cases. Also, sometimes brain damage can occur during the first few months of a child's life. This condition can be caused by an infectious disease (such as meningitis), very low blood sugar, a severe head injury, or a stroke.

Much more often, the disease develops due to brain damage that occurs even before the birth of the child. Researchers believe that damage to the brain of a child in the womb, leading to cerebral palsy, occurs for three main reasons.

Reason number 1 - periventricular leukomalacia. This is a lesion of the white matter of the brain. White matter is a set of nerve fibers that connect the nerve cells responsible for mental activity with the rest of the body. When white matter is damaged, the connection between the brain and organs and parts of the body is disrupted.

It is believed that the defeat leads to a reduction in the volume of blood flowing to the head of the fetus, or a lack of oxygen. In the future, this is fraught with serious consequences for the child's muscular system, since the white matter is responsible, among other things, for the transmission of signals from the brain to the muscles of the body.

The exact cause of periventricular leukomalacia is unclear. But it is believed that risk factors can be:

• very low maternal blood pressure - for example, due to a caesarean section;
• premature birth, especially before the 32nd week of pregnancy.

Reason number 2 - a violation of the development of the brain. Any damage to the brain can disrupt the transmission of signals from nerve cells to muscles and other parts of the body, and therefore can cause cerebral palsy in children.

The following factors can affect the development of the brain:

• changes (mutations) in genes that affect the development of the brain;
• an infectious disease suffered by a woman during pregnancy;
• fetal head injury.

Reason number 3 - intracranial hemorrhage and stroke. Intracranial hemorrhage is bleeding in the brain. This is potentially dangerous, because with a lack of blood, parts of the brain can die, and the accumulation of blood itself can damage surrounding tissues. Usually, intracranial hemorrhage occurs in premature babies, but it can also happen after a stroke in a child in the womb.

Factors that increase the risk of stroke in the fetus:

• initial weakness or pathology of the blood vessels of the fetus or maternal placenta;
• maternal high blood pressure;
• an infectious disease in a woman during pregnancy, especially chlamydia, trichomoniasis and other sexually transmitted diseases.

Diagnosis of cerebral palsy

If you notice signs of cerebral palsy in a child, contact your pediatrician. If a disease is suspected, he will write out a referral for a consultation to, who will check the baby's reflexes, his posture, muscle tone and movements. If the diagnosis is confirmed, you will undergo an additional examination by an orthopedist, who will prescribe treatment and develop a habilitation program (adaptation to life). Depending on the age of the child, they may also be referred to a psychologist for an assessment of intellectual development.

To exclude similar diseases and confirm the diagnosis of cerebral palsy, the doctor may prescribe an additional examination, for example:

• magnetic resonance imaging (MRI) - creating a detailed image of the brain using magnetic fields and radio waves;
• ultrasound (ultrasound) - creating an image of brain tissue using sound waves;
• computed tomography (CT) - the creation of a series of X-ray images that are collected by a computer into a detailed three-dimensional image of the child's brain;
• electroencephalogram (EEG) - monitoring the activity of the brain using small electrodes attached to the head;
• electromyogram (EMG) - checking muscle activity and the function of peripheral nerves (a network of nerves that run from the brain and spinal cord to other parts of the body);
• blood tests.

Sometimes the diagnosis of cerebral palsy is established to the child in the hospital. However, in most cases, it is possible to assume this disease only after several months or years of observation of the baby. It is possible to finally determine the degree and type of paralysis only at the age of 4–5 years.

Treatment of cerebral palsy

There is no cure for cerebral palsy, but there are approaches to relieve the symptoms and help the child be as independent as possible.

Rehabilitation treatment must be started at an early date, since the children's brain has great compensatory capabilities. In the first years of life, children are prescribed therapeutic measures that help the proper development of various parts of the nervous system. In the future, to improve motor function in children with cerebral palsy, surgical treatment in combination with conservative therapy may be recommended.

Help for patients with cerebral palsy is provided in and specialized children's sanatoriums and boarding schools. Some of the main treatments are described below.

Physiotherapy for cerebral palsy

As a rule, physical therapy is started immediately after the diagnosis of cerebral palsy, as this is one of the most important ways to help the child manage the disease.

The two main goals of physical therapy for cerebral palsy are:

• prevent weakening of muscles that your child does not normally use;
• prevent muscles from contracting and losing their normal range of motion (a phenomenon called muscle contracture).

The risk of developing contractures is increased in children who find it difficult to knead the muscles due to their stiffness (rigidity). If muscles cannot stretch, they cannot grow as fast as bones. This can lead to curvature of the body, causing pain and discomfort to the child.

The physiotherapist teaches the child a series of physical exercises to strengthen and stretch the muscles to be performed every day. Also, special orthopedic attachments for arms or legs can be used to stretch muscles and correct posture.

Development of speech in children with cerebral palsy

Salivary Control and Nutritional Problems in Cerebral Palsy

Children who cannot control their mouth muscles often find it difficult to swallow food and control salivation. This can lead to serious consequences, so nutritional problems with cerebral palsy require treatment.

With difficulty swallowing (dysphagia), the smallest particles of food can enter the lungs, which is accompanied by the development of a dangerous disease - aspiration pneumonia.

If the dysphagia is mild, your doctor may teach your child how to deal with it. A diet consisting of soft foods is also recommended. For more severe dysphagia, tube feeding may be required. This is a tube that is passed into the stomach through the nose or mouth (nasogastric tube) or directly through the abdominal wall (gastrostomy tube).

Salivation irritates the skin around the mouth, chin, and neck, which increases the risk of inflammation in these areas. There are a number of methods to combat salivation in cerebral palsy:

• an anticholinergic medicine in the form of a tablet or patch that reduces saliva production;
• injections of botulinum toxin into the salivary glands (although this is only a temporary solution);
• moving the ducts of the salivary gland with the help of a surgical operation, as a result of which saliva is secreted deep into the oral cavity and is easier to swallow;
• a special device placed in the oral cavity, which contributes to the correct position of the tongue and the regular swallowing of saliva;
• teaching the skills of self-control over the physiological state of the body, during which the child is taught to recognize when his saliva flows and swallow it in time.

Surgery for cerebral palsy

Sometimes, to correct deformities of bones and joints, an operation is prescribed to lengthen too short muscles and tendons that cause inconvenience. This type of surgery is called orthopedic surgery and is indicated if a child with cerebral palsy experiences pain when moving. Surgery can also correct posture and ease movement, as well as improve a child's self-esteem.

However, it is not possible to feel all the benefits of the operation immediately after the intervention. Sometimes this takes several years, during which the child needs repeated courses of physiotherapy.

Surgery may be done to correct a curvature of the spine (scoliosis) or urinary incontinence. The condition of the child will be carefully monitored in order to timely identify those violations that can be effectively corrected with the help of surgery. As an examination, a regular x-ray of the hip joint or spine may be prescribed.

Selective dorsal rhizotomy (SRD) is a surgical operation that is prescribed to improve gait in children with high muscle rigidity (increased muscle tone). As a rule, it is recommended only in cases where examinations have shown that the child has damage to the white matter of the brain (periventricular leukomalacia) and other methods of treating stiffness have not helped.

During the operation, the surgeon cuts part of the nerve fibers in the lower spine to relieve muscle tension in the legs. However, after the operation, several months of intensive physical therapy are required to re-teach the child to control his movements.

Like any other surgery, RRS has a risk of complications, including temporary problems with emptying the bladder (urinary incontinence), scoliosis, and changes in sensation in the legs.

There are other methods of surgical correction of cerebral palsy. Intervention depends on the severity and prevalence of paralysis, the nature of disorders of the musculoskeletal system, the age of the patient and his mental state. The optimal age for surgery is 8–16 years.

Discuss the potential benefits and risks of surgery with the surgeon, together with the child (if the child is able to understand the consequences of the procedure).

Complications of cerebral palsy

The brain damage that causes cerebral palsy does not worsen with age, but as a person with the condition grows older, physical and psychological difficulties may arise.

So, many adults under the influence of cerebral palsy develop additional diseases (for example, osteoarthritis), which cause pain, fatigue and weakness. Basically, these diseases are associated with the pathology of muscles and bones inherent in cerebral palsy, and creating a great burden on the body. Therefore, people with cerebral palsy can take much more energy to perform ordinary tasks than those who do not suffer from this disease.

Additional physical therapy sessions and the use of mobility aids, such as a CP wheelchair or special walkers, can help alleviate the physical difficulties that develop over time due to the disease.

Charitable Educational Foundation for Assistance in the Habilitation of Children with Developmental Disabilities;

You can easily find doctors who are involved in the diagnosis and treatment of cerebral palsy using the NaPopravku service. The "Who treats this" section on our website will help you decide on the choice of a suitable doctor. If in doubt, contact your pediatrician. He will conduct an initial diagnosis and direct you to a consultation with a doctor of the desired profile.

Cerebral palsy(ICP) is a severe disease of the nervous system associated with anomalies or damage to the brain and is accompanied by persistent, but not progressive motor, coordination and, in some clinical cases, intellectual disorders. The severity of pathological manifestations in cerebral palsy in different patients is different: some children become completely immobile and helpless, others may well learn to move around, take care of themselves, study and even work.

Causes of cerebral palsy

The causes of cerebral palsy, depending on the time of exposure to the child, are divided into three groups:

• intrauterine factors.
• Intranatal factors (various problems in childbirth).
• Postnatal factors (pathological conditions that occur during the neonatal period - in the first weeks of life).

In most cases, studying the history of a small patient, doctors discover not one, but several reasons that could cause cerebral palsy. But there are also situations when it is not possible to find out which factors provoked cerebral palsy. Therefore, researchers suggest that a certain role in the development of the disease in question is played by hereditary predisposition and gene mutation.

Features of the course of pregnancy and cerebral palsy

The fetal brain is the most vulnerable organ in the entire small body. Of particular danger to nerve cells is oxygen starvation (), infections, toxic substances, and radiation exposure.

Fetal hypoxia can occur in the following situations:

• With the threat of abortion, when the placenta exfoliates and bleeding occurs.
• With severe toxicosis and gestosis. These complications of pregnancy appear because the mother's body cannot get used to the new condition, and various pathological changes occur in it, including those that negatively affect blood circulation between the uterus and the placenta.
• With placental insufficiency - dysfunction, which leads to a violation of gas exchange between the blood of the mother and the fetus.
• With diseases of the mother, accompanied by vasoconstriction and a low concentration of oxygen in the woman's blood. Such ailments include sugar, systemic autoimmune pathologies, anemia, and chronic lung diseases.

Serious damage and developmental abnormalities of the brain can result from exposure of the fetus to infectious agents. The most dangerous in this regard are:

• Herpesviruses (including).

All these infections can harm the fetus if the woman's body encounters them for the first time during pregnancy, that is, it must be a primary infection or a serious exacerbation (for example, cytomegalovirus infection). If a woman has been sick for a long time, and she has antibodies to these pathogens, the risk of the fetus developing is minimal.

The cause of the development of cerebral palsy, as mentioned above, can also be effect on the fetus of toxic substances. These include drugs that have a teratogenic effect (the ability to cause malformations in a child), drugs, alcohol.

Intranatal causes of cerebral palsy

In childbirth, the child may develop acute hypoxia, damaging the brain. Leads to this:

• Premature detachment of the placenta. The placenta loses contact with the uterine circulation, so the blood supplied to the baby ceases to be saturated with oxygen.
• Severe prolonged labor.
• Tight entanglement of the umbilical cord or prolapse of the umbilical cord, in which blood circulation between the fetus and the placenta is disturbed.
• . When the head is the last to leave the birth canal, it compresses the umbilical cord, so if doctors hesitate and do not help the baby be born as quickly as possible, severe hypoxia can develop.

In addition to oxygen starvation, cerebral palsy leads to brain injury received at birth. Injury to the baby's head can occur if a woman has a narrow pelvis, if the baby is large or incorrectly placed in the uterus, if the birth proceeds rapidly or is caused by medications.

A risk factor for the development of cerebral palsy is also application of obstetrical forceps(precisely because of the possibility of brain damage, this method of childbirth is now practically not used), as well as fetal extrusion from the mother's belly.

Premature birth and cerebral palsy

The most dangerous for the child in terms of the development of cerebral palsy are considered premature births, since premature babies are most susceptible to such brain lesions as hemorrhages and periventricular leukomalacia. Moreover, the smaller the baby, the greater the risk of developing postpartum complications (in particular cerebral palsy) in him. For this reason, in many developed countries, where they have learned to successfully nurse children with critically low body weight, the incidence of cerebral palsy in newborns is at a high level.

What can provoke cerebral palsy after childbirth?

In the neonatal period, the baby's brain remains very vulnerable. The following reasons can cause irreversible changes in the central nervous system:

• Severe, in which a large amount of toxic bilirubin is formed in the body of a newborn, damaging the structures of the central nervous system.
• Infectious diseases complicated by or.
• Head injury.

Important:Doctors do not include vaccinations in this group of causes, since there is no confirmed data on the relationship between vaccination and the development of cerebral palsy.

Mechanisms of cerebral palsy development

The fundamental difference between cerebral palsy and other paralysis is the time of occurrence - this perinatal period(the period from 22 weeks of pregnancy to the seventh day of a child's life). Pathological effects on the brain that occurred in this period of time lead to a violation of the extinction of postural reflexes characteristic of newborns - changes in muscle tone and posture when changing body position.

From the point of view of physiology, the interaction between the central nervous system and muscles is as follows: in response to any irritation and a change in the position of the body, the brain potentiates and sends signals along the nerve fibers to the muscles, causing contraction or relaxation of muscle fibers. At the same time, everything goes smoothly - one muscle group contracts, and the other (antagonists) relaxes, or vice versa. It is only thanks to such a clear interaction that a person moves normally. With cerebral palsy, the connections between the central nervous system and muscles are disrupted, so patients cannot fully control their body.

In addition to motor activity and coordination in cerebral palsy child's speech suffers. If the nuclei of the cranial nerves are affected, patients have problems with swallowing, vision, facial expressions. In the most severe cases, brain damage that causes cerebral palsy also becomes the cause intellectual disabilities.

Forms of cerebral palsy

There are five forms of cerebral palsy:

• Little's disease(spastic tetraplegia). This is the most common form of the disease, especially among premature babies. With her, the lower limbs of the child become motionless, but the hands are rarely affected. Violation of movements in the legs is caused by spasticity (persistent muscle contraction), due to which the limbs do not bend or unbend at all. With the growth of the child, deformations of the joints and spine occur, but this does not mean that the pathology is progressing.
• Hemiplegic form. It is characterized by immobility of one half of the body and spasticity, as in the first form of cerebral palsy.
• Atactic form. Its development is associated with damage to the frontal lobes of the brain and cerebellum. In such patients, discoordination of movements of different muscle groups, impaired coordination, tremor, speech and intelligence disorders are noted.
• Dyskinetic form. Most often occurs due to severe hemolytic disease of the newborn. The main signs are involuntary movements, a sharp change in muscle tone and body position, and a violation of facial expressions. Intellect in such patients, as a rule, does not suffer.
• Spastic tetraplegia- the most severe form of the disease, in which almost complete paralysis of the limbs is accompanied by constant convulsive seizures, impaired intelligence and speech. Some patients are diagnosed with microcephaly.

Separately allocate mixed form ICP, in which patients show signs of several forms of the disease at once. The task of doctors in such cases is to identify the leading syndrome and direct all efforts to its correction.

Cerebral palsy, or cerebral palsy, is a pathology of the central nervous system associated with underdevelopment of the brain, not progressive, but manifested by a lag in the physical and mental development of the baby.

Movement disorders can have varying degrees of severity: from muscle twitching to paralysis and severe imbalance. Mental retardation and speech disorders also depend on the prevalence of brain damage.

In any case, cerebral palsy interferes with the normal development of the child and the acquisition of vital skills. According to statistics, the prevalence of cerebral palsy in Russia is 2 cases per 1000 children.

The reasons

Brain damage can occur during fetal development (about 70% of all cases), or after birth. The most dangerous is the first trimester of pregnancy.

The most common cause is brain damage due to infection. The body of the pregnant woman herself can cope with the disease, but this does not protect the fetal brain from the damaging effects of the infection.

For the development of cerebral palsy, such infections of pregnant women are important as:

• herpetic infection;
• toxoplasmosis.

Increase the risk of disease:

• late toxicosis;
• Rhesus conflict between mother and fetus;
• developmental disorders of the embryo;
• malposition;
• rapid or, conversely, prolonged labor;
• severe jaundice of the newborn;
• birth trauma.

All of these conditions lead to oxygen starvation (hypoxia), which contributes to the disruption of the bookmark and the subsequent development of the brain.

Higher risk factors are also:

• endocrine pathology of the mother (especially hypothyroidism);
• dementia and epilepsy;
• bad habits (drug addiction and alcoholism);
• prolonged infertility;
• stressful situations;
• the age of the pregnant woman is up to 18 years and over 40 years.

In the birth process, the occurrence of cerebral palsy may be associated with birth trauma or fetal hypoxia during prolonged labor. In many cases, damage is caused by a combination of several factors.

In rare cases, the pathology can be caused by radiation and radiological exposure or other electromagnetic radiation; women during childbearing; .

After the birth of a child, meningoencephalitis (inflammation of the membranes and brain matter) and craniocerebral trauma can become the cause of brain damage.

Symptoms

It is impossible to determine cerebral palsy before the birth of a child. As a rule, the first manifestations of the disease are noticed only when the baby lags behind in physical and psychomotor development.

Signs of cerebral palsy are divided into early and late. The timing of the onset of symptoms and their nature depend on the severity and localization of underdeveloped areas of the brain. The severity of manifestations can also be different: from mild to very severe.

Early symptoms include:

• violation of muscle tone in a newborn: the child does not hold his head in due time, cannot roll over on his own, subsequently cannot crawl and sit;
• hearing impairment up to its complete loss;
• delayed psychomotor, including speech, development, lack of interest in toys;
• difficulties in developing feeding skills.

Late signs include:

• the appearance of skeletal deformities: scoliosis, shortening of the limbs, etc.;
• mobility disorders in the joints;
• convulsions and seizures of epilepsy (in 40% of cases);
• delayed intellectual development;
• impaired hearing, vision and other sensory organs (in 20% of cases);
• increased salivation;
• and defecation.

Most of all, impaired functions of the musculoskeletal system become noticeable: in addition to increased muscle tone, involuntary twitches may be noted, limbs may move poorly or not move at all. The child does not stand on his feet or leans only on his toes, cannot hold the toy in his hand.

Stiffness in the joints further restricts movement. The developed paralysis of the limbs makes them thin and shortened. The occurrence of epileptic seizures is not ruled out. Strabismus, decreased visual acuity, twitching of the eyeballs, etc. may develop.

The child's psyche is disturbed, his education becomes inaccessible due to restlessness and lack of concentration, memory loss. He does not like to draw or color pictures and does not know how.

With mild symptoms, the child is perceived as awkward, awkward. He cannot catch the ball, kick it, does not know how to properly hold the spoon in his hand. The kid does not show interest in games and communication with other children.

Violation of coordination of movements leads to the fact that the child cannot fasten a button and tie a shoelace, cannot jump (over a rope or an obstacle), and often bumps into objects.

Types of cerebral palsy

According to the classification, the following types of cerebral palsy are distinguished:

• Dyskinetic or athetoid: the mildest form of the disease, manifests itself in the form of convulsive muscle contractions, including twitching of facial muscles, mild speech and hearing impairments. The mental development of children does not suffer.
• Ataxic palsy: due to damage to the cerebellum, which leads to impaired coordination of movement. Mental retardation is expressed moderately.
• For the spastic type, lethargy and a decrease in muscle tone are characteristic. Mental retardation is noted in 60% of cases. This type of cerebral palsy has 3 varieties:

Quadriparesis, or tetraparalysis: develops due to damage during childbirth; the child does not hold his head, the arms are bent at the elbows, the fingers are clenched into fists, the legs are crossed;

Hemiparesis, or hemiplegia: notice it by the unnatural position of the limbs on one side;

Diplegia: Injury to the upper or lower (more often) limbs, which prevents the child from walking.

A mixed form and unspecified cerebral palsy may be noted.

The diagnosis is established on the basis of neurological disorders identified during the examination by a neurologist, additional examination data (determination of the electrical potential of the muscles, electroencephalography), examination results of other specialists (orthopedist, ophthalmologist, ENT doctor, psychiatrist).

Treatment

To select an individual treatment, an assessment of the identified disorders and physical abilities of the child is carried out using special tests.

Since the vast majority of children with cerebral palsy have mental retardation, delayed speech development, they are usually trained in a specialized school or boarding school, where, in addition to teachers, psychologists, physiotherapists, speech therapists and other specialists work with them.

It is extremely important to start the treatment of cerebral palsy in the early stages and carry it out continuously, only in this case you can count on a favorable result. Comprehensive treatment of each child is carried out according to an individual plan.

It may include the following components:

• drug treatment;
• physiotherapy;
• orthopedic and surgical treatment;
• physiotherapy;
• psychological help;
• classes with a speech therapist on the development of speech;
• Spa treatment.

The goal of treating a child with cerebral palsy is to improve muscle elasticity, increase the functionality of the musculoskeletal system and develop psychological health.

Medical treatment is symptomatic in cerebral palsy. It includes the use of brain metabolic drugs, neuroprotectors (Cerebrolysin, Ceraxon, Cortexin, Somazin, Piracetam, etc.), vascular agents (Actovegin).

With severe muscle spasm, muscle relaxants (Mydocalm, Baclofen, etc.), vitamin preparations (Neurovitan, B vitamins) are used. In severe cases, small doses of botulinum toxin (Botox) may be administered to a tense muscle in small doses.

With epileptic seizures, the doctor selects anticonvulsant drugs (Lamotrigine, Toparamat, etc.). If necessary, painkillers, antidepressants or tranquilizers are prescribed.

Widely applied physiotherapy treatment aimed at preventing deformities and contractures of the joints and muscles. A large number of treatment methods are used:

• electrophoresis;
• paraffin therapy;
• applications with ozocerite;
• magnetotherapy;
• electrical muscle stimulation;
• mud treatment and balneotherapy;
• massage.

In the event of muscle contractures (limitation of movement in the joints), in the event of joint dislocations, surgical treatment is possible: lengthening of tendons and muscles, bones (arthroplasty, achilloplasty), nerve surgery. In some cases, orthopedists use plaster casts and hardware development of joints in the treatment.

Since 2006, the method of treating cerebral palsy with stem cell implantation has been used. This technique is a way of biological "cleansing" of the central nervous system. In Russia, this treatment is carried out at the General Hospital of the Armed Police. About 3,000 children with various types of cerebral palsy underwent a course of treatment, the effectiveness of treatment reaches 85% (according to the results for 2013).

The method is based on the ability of stem cells to independently differentiate and replace damaged nerve cells. In addition, these cells can repair the damaged myelin sheath of the nerve cell and thus ensure normal impulse conduction.

As a result of stem cell treatment, motor function improved in children (posture stability in sitting and standing positions, walking improved, etc.), speech and intellectual abilities, memory and concentration of attention developed better, strabismus decreased, salivation normalized.

An indispensable condition for treatment is the daily exercise of physical therapy, special sets of exercises which are selected for each child. At the same time, the use of simulators is widely used.

Psychological help is needed at any age of the child. In case of speech disorders, the speech therapist also selects special exercises for daily speech development exercises.

The sanatorium-resort stage of treatment of children with cerebral palsy is carried out in the sanatoriums of Odessa, Evpatoria, Truskavets, Saki, etc.