Rehabilitation of children with cerebral palsy: description of methods. Disabled children: help from the state. What gives a child a disability

What is cerebral palsy (CP)?

The term "cerebral palsy" is used to characterize a group of chronic conditions in which motor and muscle activity is affected with impaired coordination of movements. The cause of cerebral palsy is damage to one or more parts of the brain, either in the process prenatal development, either during (or immediately after) childbirth, or in the breast / infancy. This usually occurs during a complicated pregnancy, which is a harbinger of preterm labor. The word "cerebral" means "cerebral" (from Latin word"cerebrum" - "brain"), and the word "paralysis" (from the Greek "paralysis" - "relaxation") defines insufficient (low) physical activity. By itself, cerebral palsy does not progress, because. does not relapse. However, in the process of treatment, the patient's condition may improve, worsen, or remain unchanged. Cerebral palsy is not hereditary disease. They never get infected or sick. Although cerebral palsy is not curable (not "curable" in the conventional sense), constant training and therapy can lead to an improvement in the condition of the disabled person.

Story

In 1860 English surgeon William Little first published the results of his observations on children who, after undergoing birth injury limb paralysis developed. The condition of the children did not improve or worsen as they grew: there were problems with the grasping reflex, crawling and walking. Signs of such lesions in children for a long time called "Little's disease", they are now known as "spastic diplegia". Little suggested that these lesions were caused by oxygen starvation(hypoxia) during childbirth. However, in 1897, the famous psychiatrist Sigmund Freud, noting that children with cerebral palsy often suffered from delayed mental development, a disorder of visual perception and epileptic seizures, suggested that the cause of such deeper brain lesions is rooted in the pathology of the development of the infant's brain in an earlier period of life - during the development of the fetus while still in the womb.
Despite this assumption by Freud, until the 1960s of our century, it was widely believed among doctors and scientists that the main cause of cerebral palsy was complications during childbirth. But in 1980, after analyzing data from national studies of more than 35,000 cases of newborns with signs of cerebral palsy, scientists were amazed that complications due to birth trauma were less than 10%. In most cases, the causes of cerebral palsy have not been identified. And since then, extensive studies of the perinatal period of life have begun: from the 28th week of the intrauterine life of the fetus to the 7th day of the newborn's life

Causes of Cerebral Palsy

Cerebral palsy can be caused by most factors that disrupt brain development. The main reason is the lack of oxygen supply to the brain - hypoxia (intrauterine or in a newborn). Oxygen supply may be interrupted by premature separation of the placenta from the uterine wall, abnormal fetal presentation, protracted or rapid labor, impaired circulation in the umbilical cord. preterm birth, prematurity, low birth weight, RH factor or group incompatibility of the blood of the fetus and mother according to A-B-O system maternal infection with rubella measles or other viral diseases during the period early pregnancy- and microorganisms attack the central nervous system of the fetus - all these are also risk factors. In the USA, in particular, all research is aimed at studying the two main causes of cerebral palsy: rubella measles and the incompatibility of the blood of the fetus and mother. So the main causes of cerebral palsy are associated with the development of pregnancy and childbirth, and these conditions are not inherited: and such paralysis is often called congenital cerebral palsy (associated with intrauterine pathology or with the delivery process). A less common type, acquired cerebral palsy, usually develops before the age of two (craniocerebral injuries from accidents or brain infections).

Consequences of cerebral palsy

Characteristic features cerebral palsy are disorders motor activity, the muscular sphere is especially affected - there is a violation of coordination of movements. Depending on the degree and location of areas of brain damage, one or more forms of muscle pathology may occur - muscle tension or spasticity; involuntary movements; gait and mobility impairment. The following pathological phenomena can also occur - abnormal sensation and perception; decreased vision, hearing and speech impairment; epilepsy; impaired mental function. Other problems: difficulties in eating, decreased urinary and bowel control, breathing problems due to posture disorder, pressure sores and learning difficulties Types of Cerebral Palsy

There are three main types of cerebral palsy: spastic (spastic) - the patient has great stiffness and difficulty in movement: 70-80% of patients; athetoid (athetoid), or dyskinetic - the presence of involuntary, uncontrolled movements (hyperkinesis): 10-20% of patients; ataxic (ataxic) - imbalance, the presence of deep mental abnormalities: 5-10% of patients. More Possible mixed type(of the above). There are other types of cerebral palsy, although they are quite rare.

Can cerebral palsy be cured?

AT this case it is better to talk about “care” or “careful attitude” towards a disabled person, “ability to provide assistance”, than about “treatment”; it means - to create conditions for the maximum realization of the child's potential as it grows and develops. And you need to start as early as possible - with early diagnosis an infant with signs of developmental delay (or disorder), tk. detection of the disease in the early periods of life can improve the health of the child. Recovery programs should begin as early as possible. Such programs include various activities of the child - his education; classes on the development of speech and hearing; conducting classes aimed at the social adaptation of the child; classes on the development of the emotional sphere. Such “management” programs should include supervision of the child’s movements, learning, speech, hearing, social and emotional development. In accordance with various programs, physical therapists, therapists, teachers, nurses, social workers and other professionals help both the family and child (with the use of appropriate medications, surgery, orthopedic devices, etc., to improve neuromuscular coordination and eliminate or prevent dysfunction).
When people with disabilities become adults, they need the support of services such as: personal assistance service, long-term therapy, vocational and special education, independent living services, counseling, transportation, implementation of leisure and recreation programs, employment services - everything that is necessary for development. . People with cerebral palsy can go to school, have a job, get married, support a family, and live in their own home. Most people with cerebral palsy need help in order to, first of all, gain independence and the opportunity to take an active part in society.

How patients with cerebral palsy?

Cerebral palsy is the most common cause of childhood disability, among which diseases of the nervous system are in the first place. Cerebral palsy is the second most common neurological disorder in childhood; the first is mental retardation in children. In third place are congenital anomalies.
Recent publications in the international research journal Evolutionary Medicine and Pediatric Neurology and the Research Foundation of Cerebral Palsy Associations (UCPA, USA) provide an insight into the statistics of the birth of children with cerebral palsy.
Among children with normal birth weight who became disabled due to cerebral palsy: approximately 70% became disabled due to factors that took place before birth (prenatal period);
about 20% - due to factors that manifested themselves either during childbirth (perinatal period) or immediately after birth (first four weeks of life);
10% - due to factors that manifested themselves during the first two years of life ( postnatal period);

The incidence of cerebral palsy in different countries ranges from 1 to 8 cases per 1000 population. More precisely:

in the USSR - 2.5 (1974);
in the USA. - 1.5 (1975);
in England. - 1.0 (1966);
in Switzerland. - 6.0 (1966);
in France - 8.0 (in 1966).

According to the Research Foundation of Cerebral Palsy Associations (UCPA), there are approximately 550,000 patients with this disease in the United States and 9,750 children and newborns are diagnosed each year. Of these, 1.2-1.5 thousand are children of preschool age.
The number of births of patients with signs of cerebral palsy in the United States has increased by 25% over ten years: from 1.5 - 1.8. per 1000 live births in 1990. up to 2.0 - 2.5 infants with this pathology in 2000. On this moment in the United States, there are from 550 to 760 thousand people with cerebral palsy, which is 2.8 people per 1000.
In Moscow, according to Professor E.G. Sologubov, there is an increase in the incidence of cerebral palsy. For 20 years (from 1967 to 1987) the number of births per 1000 children increased from 1.71 to 1.88 (which contradicts the above data for 1974 - 2.5). In 1992, there were 62 thousand in Russia, and 122 thousand patients with cerebral palsy in the territory of the former USSR (patients under 15 were taken into account). The frequency of occurrence in 2001 was (according to various sources) 5.0-6.0 per 1000 newborns.
In Moscow, there are approximately 10,000 disabled people with the consequences of cerebral palsy, half of them are children. In the Moscow region - about 5 thousand people. Based on the frequency of birth of children with signs of cerebral palsy (5.0-6.0 per 1000), it can be assumed that in Russia there are at least 1.5 million such disabled people. There are no exact data on the number of people with disabilities with the consequences of cerebral palsy in Russia.
With regard to the extent of the lesion, one of the most common lesions, which is now associated with new views on cerebral palsy, is spasticity of one or more limbs. It turns out that muscle spasticity of the extremities at the birth of an infant with normal weight is caused by lesions that dominate the prenatal period; and at the birth of premature babies and babies with low birth weight, limb spasticity is caused by lesions that dominate the perinatal (starting from the 28th week of fetal life to the 7th day of the newborn's life) and neonatal periods of the newborn. This study is confirmed by similar data in the USA, Germany, and Russia. It's clear that Special attention attention needs to be paid to when brain damage occurs, what are the risk factors that endanger the infant's health, and what are the most common consequences of cerebral palsy. As the number of surviving preterm infants increases, so does the likelihood cerebral disorders, then priority in research is becoming the study of the causes of low birth weight and preterm birth.

The article is taken from the website of the Regional Public Charitable Organization of the Disabled "Promoting the Protection of the Rights of the Disabled with the Consequences of Cerebral Palsy", Moscow

What kind of assistance do disabled children and disabled children receive from the state?

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Housing Benefits

Benefits for public transport

Children with disabilities, as well as persons accompanying them, receive the right to free use of public transport plying on urban and suburban routes.

The state provides free transportation to the place of treatment and rehabilitation for children with disabilities. The possibility of free travel exists for both parents and social workers, but only when their accompaniment is required for a disabled person of group 1.

In addition, disabled children of groups 1 and 2 and disabled children receive a discount of up to 50% for a trip by air, river or rail transport from October to May. The discount is provided once a year in any selected period.

To receive benefits, you must present a pension certificate when buying a ticket. For relatives, social welfare authorities issue a special certificate.

This benefit does not apply to taxis.

Sphere of training and rehabilitation

tax incentives

For parents or guardians of a disabled child, the Tax Code provides for a number of benefits:

Monthly deduction of personal income tax from the salary of parents (in the amount of 3,000 rubles for each parent, or in the amount of 6,000 rubles for a parent raising a child alone).
Other deductions, such as treatment costs.
Exemption of a child from property tax.

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Disability in cerebral palsy is given not on the basis of an existing diagnosis, but if the disease is accompanied by disability. In this case, it means limited capacity to movement, speech contact, self-service, learning. It has different degrees severity, but in many cases it leads to disability. This disease is not considered genetic, but is congenital. This is what makes her unique.

What causes cerebral palsy in a child?

The main cause of this serious disease is considered to be damage to the parts of the brain that are responsible for the functioning of the whole body. Damage to the child's brain can begin already in the womb, from the first days of life or during childbirth.

The following factors can increase the likelihood of cerebral palsy:

intrauterine infections;
low hemoglobin in pregnant women;
infection of the nervous system in an infant;
difficult childbirth;
asphyxia during childbirth.

In addition, the abuse of alcoholic products by a woman during pregnancy significantly increases the likelihood of cerebral palsy. It is quite difficult to determine whether a child has this disease in early age. The fact is that the baby's motor activity is limited, and he sleeps for a long part of the day. Only the most severe forms of the disease can be detected on this early stage. With the development of the baby, some deviations may be observed, usually 2 months after birth.

To identify cerebral palsy in a child, a neurologist prescribes a list of medical examinations with which you can put correct diagnosis. At infants for this, neurosonography is used (study of parts of the brain through the fontanel). For older children, the procedure of electroencephalography and electroneuromyography is used, which determines the performance of the muscles. If the diagnosis is confirmed, a child with cerebral palsy is assigned a disability group.

How can you visually determine this disease?

Initially, you should observe how the child's arms and legs function correctly. Cerebral palsy can cause spasms of motor activity in both the upper and lower extremities. In addition to this, the muscle fibers are under great tension, so that it is difficult to bend or unbend them. Symptoms of lethargy are also likely, in which there are difficulties in the implementation of movements of the arms and legs.

The other is hyperkinesis. With it, involuntary movements are observed in muscle structures. When identifying the described symptoms of the child, it is urgent to show the doctor. These signs can lead to severe disability.

During the life of a child, other manifestations or complications may be noticeable. These include impaired speech abilities due to spasm of the speech apparatus. This leads to the fact that the child begins to stutter or pronounce slow speech. In addition, cerebral palsy can be accompanied by a mental disorder from the simplest to the most severe form. The final stage of this disorder is oligophrenia.

Today, modern equipment is used, which makes it possible to detect cerebral palsy in a timely manner. Wherein rehabilitation period works best for children. For in order to make a diagnosis, prescribe various examinations depending on age.

Only an institution of the state service of medical and social expertise can recognize a child as disabled. In this place, the state of health and the degree of restriction of the activity of the disabled person are assessed.

What gives a child a disability?

The main reason for calling for a disability for a child with cerebral palsy is the pension payments made by the state. These are funds intended for the purchase of the necessary medicines and various means for the care of a disabled child.

In addition to pension accruals, a disabled child is entitled to the following benefits:

free travel in the city public transport(excluding taxis);
benefits for travel in railway, air and river transport;
free treatment in a sanatorium;
providing a disabled person with the necessary medical equipment;
free receipt of medicines in a pharmacy according to a prescription issued by a doctor.

These rights are due not only to children with disabilities, but also to their mothers. This is a benefit when calculating the tax payment from the income received, the right to a reduced work schedule, additional leave and early retirement. Receipt of benefits will depend on which disability group is given to the child.

Group 1 is considered the most dangerous and is assigned to a child who does not have the ability to carry out independent care (move, eat, dress, etc.) without anyone's help. At the same time, a disabled person does not have the opportunity to fully communicate with people around him, therefore, he needs regular monitoring.

Group 2 disability implies some limitations in the above manipulations.

Also, a child who received group 2 does not have the ability to learn.

However, there is an opportunity to gain knowledge in institutions designated for these purposes for disabled children with disabilities.

Group 3 is assigned to a disabled person who is able to individually move, communicate, and learn. But at the same time, children have a slow reaction, therefore, they require additional control due to their state of health.

Disability in children with cerebral palsy

As mentioned above, children receive disability when diagnosing cerebral palsy. Mandatory assistance in documenting disability must be provided by a doctor at the site. In addition, he must give direction to the passage medical commission. At the next stage, a medical and sanitary examination (ITU) is carried out, with the help of which the diagnosis is confirmed. When preparing for its passage, it should be clarified how pronounced motor disorders are, the degree of damage to the hand, the degree of violation of support, speech, mental disorder and other factors.

Parents must prepare the required documents in order to issue a disability group for a child with cerebral palsy. The kit includes: a referral received at the clinic, with the results of the studies performed, a birth certificate, a passport of one of the parents, an application, a certificate of registration from the ZhEK, photocopies of all necessary documents. In addition, other documents may be required to confirm general condition health (the result of an examination or hospital extracts).

Within about a month, parents should be issued a certificate on the basis of which a certain disability group will be assigned. This document should be applied to the Pension Fund for registration of pension payments.

Thus, childhood diseases can be quite serious, as in the case of cerebral palsy. If the child has this pathology, him in without fail must be assigned a disability group by a higher authority. Children with disabilities are entitled to free health care and life-sustaining medicines.

Apart from medical care children with cerebral palsy also need pedagogical assistance. To do this, parents, together with teachers, must draw up a comprehensive plan for influencing a disabled child. It should include classes on teaching the right movements, therapeutic exercises, massage, work on simulators. The main role is given to early speech therapy activities.

The result of physiotherapeutic and speech therapy effects is increased due to treatment medicines.

However, it is completely impossible. But with timely measures provided, the correct behavior of parents and teachers, a disabled child can achieve great success in self-service and acquiring skills.

Effective rehabilitation of children with cerebral palsy includes a set of measures. Attention is paid not only to the physical, but also to the mental development of the child, the acquisition of skills of independence and social adaptation. For children with disabilities, free observation, provision of vouchers for treatment in sanatoriums, provision of medicines and means technical rehabilitation.

Causes of the disease and risk factors

The causes of cerebral palsy are divided into intrauterine provoking factors and postpartum. The first type includes:

severe pregnancy;
unhealthy lifestyle of the mother;
hereditary predisposition;
difficult childbirth, during which fetal asphyxia occurred;
sharp or some chronic diseases mothers;
children born ahead of time and with low weight;
infectious processes occurring in a latent form in the mother's body;
toxic poisoning of the brain of a child due to incompatibility between mother and fetus in terms of blood group and Rh factor, or liver failure child.

Postpartum triggers include:

baby weight up to 1 kg at birth;
the birth of twins or triplets;
head trauma at an early age.

In every third case, however, it is not possible to identify the specific cause of the pathology. And as a rule, the rehabilitation of children with cerebral palsy does not depend on the causes of the development of the disease. may be revised except in the case of premature and small children - such patients often require more careful care and medical supervision.

The main phases of the course of the disease

Rehabilitation of children with cerebral palsy depends on the phase of the disease, the severity of the course of the disease and the age of the patient. There are three phases of the course of the disease:

Early (up to 5 months). Cerebral palsy is manifested by developmental delay, preservation of unconditioned reflexes.
Primary (up to 3 years). The child often chokes on food, does not seek to speak, asymmetry, hypertonicity or excessive muscle relaxation is noticeable.
Late (over three years). It is manifested by the shortening of one limb compared to the other, swallowing, hearing, vision, speech disorders, convulsions, urination and defecation disorders, mental retardation.

Early signs of cerebral palsy

To early signs Cerebral palsy includes the following deviations:

delayed physical development: head control, turning over, sitting without support, crawling or walking;
preservation of "children's" reflexes upon reaching 3-6 months of age;
predominance of one hand by 18 months;
any symptoms that indicate hypertonicity or excessive relaxation (weakness) of the muscles.

Clinical manifestations of the disease can be both pronounced and almost imperceptible - it all depends on the degree of damage to the central nervous system and brain. Apply for medical care follows if:

the child's movements are unnatural;
the child has convulsions;
muscles appear excessively relaxed or tense;
baby does not blink in response to loud noise in one month;
at 4 months, the child does not turn his head to a loud sound;
does not sit without support at 7 months;
does not speak single words at 12 months;
the baby does not walk or walks unnaturally;
the child has strabismus.

Comprehensive rehabilitation of children with cerebral palsy provides the best top scores if it starts at an early age. In severe forms of the disease, untimely recovery physical activity or late development social skills, the child may remain completely unadapted to life.

Is it possible to cure the disease

Cerebral palsy refers to diseases that are almost impossible to cure completely. However, comprehensive and timely rehabilitation allows children with such a diagnosis to be trained on an equal footing with healthy children and lead a full-fledged lifestyle. Significant progress can be considered the preservation of individual symptoms of the disease in the child.

Modern methods of treatment of cerebral palsy

The main task for children with paralysis is the gradual development of skills and abilities, physical and social adaptation. Methods that are developed individually for each child gradually correct motor defects, improve motor activity, develop the patient emotionally, personally and socially, develop independence skills in Everyday life. As a result of systematic rehabilitation, the child can integrate into society and adapt to later life independently.

The rehabilitation program for children with cerebral palsy includes the following approaches:

treatment with water procedures: swimming, balneo- or hydrotherapy;
PET therapy, or animal treatment: psycho hippotherapy physical rehabilitation in the process of communicating with dolphins and swimming;
the use of orthopedic devices, exercise equipment, gymnastic balls, ladders;
increasing the bioelectric activity of muscles;
massotherapy, allowing to reduce the degree of lethargy and muscle spasm;
drug treatment: Botox, botulinum toxin, xeomin, dysport are used;
Vojta therapy, which allows you to restore natural patterns of behavior;
physiotherapy treatment: myoton, ultrasound, magnetotherapy, darsonvalization;
Montessori therapy, which allows you to form the ability to concentrate and develop independence;
classes with a psychologist;
speech therapy classes that correct speech disorders (program "Logorhythmics");
special pedagogy;
shiatsu therapy - massage of biologically active points;
classes according to the Bobath method - special gymnastics using certain equipment;
laser impact on reflexogenic zones, nose tip, joints, reflex-segmental zones, area of paretic muscles;
art therapy aimed at preparing the child for learning;
Peto's technique - division of movements into separate acts and their learning;
surgical orthopedic interventions;
Spa treatment;
alternative methods of treatment: osteopathy, manual therapy, catgut therapy, vacuum therapy, electroreflexotherapy.

Of course, not all methods of rehabilitation of children with cerebral palsy are listed above. There are many ready-made programs developed and currently being developed by rehabilitation centers, alternative approaches and techniques.

Physical rehabilitation of children with cerebral palsy

The physical recovery of a sick child should begin as early as possible. Leading experts in the world have recognized that the rehabilitation of a disabled child (CP) brings the best results up to three years, but in Russia many centers refuse to accept children under one or three years old, and doctors are in no hurry to establish a diagnosis and formalize disability. However, physical rehabilitation milestone adaptation special child to later life, and you should start working with a small patient immediately after the diagnosis of "cerebral palsy" is established.

Rehabilitation of children with cerebral palsy is necessary in order to prevent weakening and atrophy of muscles, to avoid the development of complications, and it is also resorted to in order to promote the motor development of the child. Therapeutic massage, physical education and exercises on special simulators are used. In general, any motor activity is useful, and the supervision of a specialist will help to form motor stereotypes, to correctly develop physical form and prevent addiction to pathological positions.

Rehabilitation Bobath Therapy

The most common form of rehabilitation is Bobath therapy in combination with other, no less effective methods. The essence of therapy is to give the limb a position opposite to that which, due to hypertonicity, it seeks to accept. Classes should be held in a calm environment, three times a day or a week, each movement is repeated 3 to 5 times. The movements themselves are carried out slowly, because the main goal of treatment is to relax the muscles. Complexes of exercises are developed individually. Treatment according to the Bobath therapy method can also be carried out at home - a parent or guardian is trained to perform techniques with the help of a specialist in a rehabilitation center.

Means of technical rehabilitation

In the physical restoration of the motor activity of a child with cerebral palsy, the means of technical rehabilitation of children are also used. Severe cerebral palsy requires mobility aids (walkers, wheelchairs), development (exercise bikes, special tables and chairs) and hygiene (bath seats, toilet seats) of the child. Also, rehabilitation means for children with cerebral palsy involve the use of orthopedic devices and exercise equipment. For example, the Adele suit is used, which redistributes the load, develops motor skills, Veloton, which stimulates muscles, the Spiral suit, which allows you to form new movement stereotypes, and so on.

Social rehabilitation of disabled children with cerebral palsy

closer to school age more attention is paid to the social adaptation of the child. Efforts are directed to the formation of independence skills, mental development, preparing the child for collective learning and communication. In addition, the patient is taught to dress himself, serve himself, exercise hygiene, move around, and so on. All this will reduce the burden on those caring for a disabled child, and little patient- adapt to life.

Psychologists, speech therapists and teachers work with special children. The role of parents or guardians who will deal with the child at home is extremely important. Social rehabilitation children (cerebral palsy) pursues the following goals:

expansion of vocabulary and horizons;
development of memory, attention and thinking;
education of personal hygiene skills;
education of self-service skills;
speech development, culture formation.

Children with this diagnosis can study in experimental classes, which are more often formed in private schools, but with significant restrictions, it is better to think about boarding or homeschooling. In the boarding school, the child can communicate with peers, receive special skills and participate in career guidance activities. Homeschooling requires more active parental involvement and daily medical supervision.

In many cases, further labor activity person diagnosed with cerebral palsy. Such people can master the profession mental labor(teachers, but not lower grades, economists, architects, junior medical staff), work at home as programmers, freelancers and even (with the preservation of hand movements) seamstresses. Employment is impossible only in severe cases.

Disability with cerebral palsy

It has several forms and degrees of severity. Disability in cerebral palsy is issued if the disease is accompanied by restrictions in relation to normal life, learning, self-service, speech contact. Disability registration is possible only after medical examination. A mother with a child will have to undergo a neurologist, surgeon, psychiatrist, pediatrician, orthopedist, ophthalmologist and ENT specialist. This "adventure" does not end there. Followed by:

issue a final conclusion from the head of the medical institution;
go through the procedure of reconciliation of documents already in an adult polyclinic;
give a package of documents to the point of acceptance of papers for medical and social examination.

Depending on the period of establishment of disability, carry out medical and social expertise(and consequently, to go through all the doctors again) must be repeated after a certain period of time. It is also necessary to obtain conclusions again if the completed individual rehabilitation program undergoes changes - for example, if a child, as prescribed by a specialist, needs a new means of rehabilitation.

Benefits for disabled children with cerebral palsy

Registration of disability for some families is a vital issue, because it makes it possible to receive cash payments for rehabilitation and benefits.

So, families with disabled children with cerebral palsy are entitled to the following benefits:

free rehabilitation in federal and regional centers and sanatoriums;
a discount of at least 50% on the payment of municipal or public housing, as well as housing and communal services;
right to receive priority land plots for individual construction, gardening and housekeeping;
provision of medicines (as prescribed by a doctor), medical nutrition products;
free travel to the place of sanatorium treatment and back, as well as in public transport (the benefit is for a disabled child and one accompanying person);
compensation for the services of a psychologist, teacher and speech therapist, determined by an individual rehabilitation program (in the amount of no more than 11.2 thousand rubles per year);
exemption from payment in kindergartens;
compensation payments to unemployed persons caring for a disabled child (a parent, adoptive parent or guardian can receive 5.5 thousand rubles, another person - 1.2 thousand rubles);
pension for a disabled child and additional payments (in total 14.6 thousand rubles as of 2017);
the period of caring for a child with a disability is included in the mother's seniority;
mother of a disabled child with cerebral palsy has a number of benefits for labor law: cannot be involved in overtime work, business trips, has the right to work part-time, retire earlier, and so on;
a single mother raising a disabled child cannot be dismissed, except in cases of complete liquidation of the enterprise.

Rehabilitation centers in Russia

In special centers, the rehabilitation of children with cerebral palsy is carried out comprehensively and under the supervision of relevant specialists. As a rule, systematic classes, an individual program and professional medical support for both children and parents can achieve significant results in a relatively short period of time. Of course, to consolidate the result, you need to continue to engage in the proposed program at home.

Russian Scientific and Practical Center for Physical Rehabilitation and Sports (Grossko Center)

There are several rehabilitation centers in Russia. The Grossko Center in Moscow operates on integrated program: upon admission, diagnostics are carried out, then with special child Specialists-instructors in physical recovery are engaged. Physical rehabilitation of children with cerebral palsy at the Grossko Center provides for physiotherapy exercises, swimming, exercises with special simulators that allow you to develop coordination of movements and consolidate motor stereotypes, classes on a treadmill, roller skating. Based on the results of pedagogical testing, programs are adjusted so that recovery meets the needs and condition of a particular small patient.

The cost of rehabilitation of a child (cerebral palsy) in the Grossko Center, of course, is not small. For example, for initial appointment you will have to pay 1,700 rubles, and the cost of 10 physical therapy sessions (45-50 minutes each) is 30 thousand rubles. One lesson with a speech therapist (lasting 30 minutes), as well as a massage session (30-40 minutes according to the doctor's testimony) will cost 1000 rubles. However, the results of the classes really are, and the Grossko Center itself is a prominent institution.

Russian Research Institute of Traumatology and Orthopedics. R. R. Vredena

The Rehabilitation Center for Children with ICP named after R. R. Vreden (RNIITO - Russian Research Institute of Traumatology and Orthopedics) in St. Petersburg provides its clients with full complex services: from diagnostics to surgical intervention including, of course, treatment and recovery. More than twenty fully equipped departments are at the disposal of highly professional specialists of the center with many years of practical experience.

Moscow Scientific and Practical Center for the Rehabilitation of the Disabled Due to Cerebral Palsy

The Moscow Scientific and Practical Center for the Rehabilitation of Persons with Disabilities Due to Cerebral Palsy is considered one of the most accessible and well-known. The doctors of the center work on the basis of several dozen rehabilitation programs, use all modern domestic developments and find individual approach to each patient. The center accepts children from three years of age. In addition to direct physical recovery, psychologists-defectologists, speech therapists, professional massage therapists and conductologists are involved with young patients - teachers who work with children and adults with CNS disorders.

Institute for Conductive Pedagogy and Rehabilitative Movement Therapy in Budapest, Hungary

Rehabilitation of a disabled child (CP) at the Institute. A. Petyo in Budapest - the capital of Hungary - is the center where hundreds of families aspire to get. The institution is famous for its excellent specialists, the use of the most modern developments in the treatment of young patients, as well as the visible results achieved by children with cerebral palsy who have completed a rehabilitation course.

There are many other rehabilitation centers and sanatoriums that accept children with cerebral palsy for rehabilitation. Only in Moscow, for example, the Center for the Rehabilitation of Children with Cerebral Palsy "Movement" operates, Rehabilitation center"Spark", Rehabilitation Center "Overcoming" and others. In some institutions, free rehabilitation of children with cerebral palsy is also possible. Families with disabled children are also supported by charitable organizations and social centers.

Currently, the problem of rehabilitation of disabled people in all Western countries is one of the key issues in the implementation of various public and privately funded social programs. Disability associated with a violation of the musculoskeletal system is a significant share in the structure of disability in general. Wherein leading place among this kind of disorders is cerebral palsy / cerebral palsy /. In this disease, it is observed as a lesion of the musculoskeletal system varying degrees severity, often resulting in severe disability, and changes in work internal organs, and, most importantly, intellectual and characterological disorders. In this regard, cerebral palsy belongs to the group of psycho-diseases (handicapted diseases), leading to the exit of the patient beyond the standard framework of existence, familiar to most healthy people. Therefore, the social and physical adaptation of such patients is very important, especially in Russia, where almost the entire population faces social issues. Naturally, it is especially difficult for disabled children, disabled children with disorders of the nervous system, to adapt to the complex socio-political situation that has developed in Russia in recent years. In view of this, the task of the social guardianship authorities, medical services and many other organizations is the creation of systems of measures aimed at the rehabilitation of children with disabilities and their adaptation in society. It is no secret that despite the disability associated with disorders of the musculoskeletal system in cerebral palsy, many and many people are talented scientists, artists, athletes, etc.

Cerebral palsy is a collective diagnosis that requires additional interpretation. The nature movement disorders this disease is based on the classification of K.A. Semenova can be subdivided into five main forms.

1. The first of these is the so-called spastic form.

Children suffering from the spastic form (diplegic child) have an increased muscle tone rear and front leg muscle groups, muscle imbalance, and as a result of this, it is difficult for them to stand and move around. Often in pathological process hands are involved. The spastic form of cerebral palsy or, as it is called, spastic diplegia in the structure of cerebral palsy is the most common - 65% among other forms.

2. Another form of the disease is hemiparetic, which is in second place after spastic. With this type of lesion, either one of the sides of the body as a whole suffers, or one of the limbs - an arm or leg.

In the hyperkinetic form, patients experience all sorts of involuntary movements that prevent them from carrying out purposeful activities and disorders of the autonomic nervous system, such as, for example, salivation.

3. A severe form of the disease is the atonic-astatic form, which occurs in about 5% of cases and leads primarily to the difficulty of maintaining balance when standing and walking.

4. Practically incurable (not treatable) and rare form disease is double hemiplegia, in which movements in the upper and lower limbs from both sides. In general, these are bedridden patients requiring special social care and attention, since hospital treatment they are practically not shown, due to the difficult-to-treat form of the disease.

5. Intellectual deficiency (oligophrenia) is a formidable symptom that can accompany any form of cerebral palsy, but especially atonic-astatic. On the other hand, in addition to intellectual insufficiency in cerebral palsy, as in a number of other severe, disabling diseases, characterological disorders are possible.

Cerebral palsy is a disease that occurs perinatally (during pregnancy) or in early childhood, which means that the depth and dimensions of damage to brain structures are very large here. Therefore, the prevention of this disease is very important and, if it has arisen, then as much as possible is required. early start medical and rehabilitation measures. Due to the difficulties of social adaptation, finding work for such patients, targeted support for programs aimed at their social adaptation is vital. In the 18 children's psycho-neurological hospital, a purposeful integrated approach to the treatment and rehabilitation of patients with all forms of cerebral palsy. Children's Psychoneurological Hospital N 18 is the leading medical rehabilitation institution in Russia. It was founded in 1983. Here they receive rehabilitation assistance, conservative and surgical treatment children aged 7 days to 20 years with cerebral palsy, consequences of spinal injuries and spinal cord, as well as with other psychoneurological diseases. The only pediatric neurosurgical department in Russia operates here, where patients with consequences of spinal cord and spinal cord injuries are treated. Hospital doctors are the authors of original methods of rehabilitation and surgical correction movement disorders in cerebral palsy, the consequences of injuries of the spine and spinal cord, the inventors of devices for recovery motor functions and study of muscle tone disorders. Every year, 3,300 patients undergo treatment and rehabilitation here, and more than 25,000 children are served in the advisory polyclinic.

Various simulators and methods are used in the hospital physiotherapy exercises, balneotherapy (mud therapy), water procedures in the form of hydromassage and swimming in the pool, especially useful for patients with spastic form of cerebral palsy. Psychologists and teachers work with sick children, the hospital has secondary school and an occupational therapy room with an exhibition of works by disabled children. AT recent times The method of treatment of patients with all forms of cerebral palsy is widely used - dynamic proprioceptive correction by wearing the PENGUIN space load suit and its modification - the ADELIE suit. Results have been obtained demonstrating after the application of this new method an improvement in gait and standing in patients, a decrease in spasticity, hyperkinesis, an increase in stability and, very importantly, the development of intellectual functions. An important activity of the hospital is the physical rehabilitation of patients with cerebral palsy, for which surgical treatment is also widely used, especially for patients with spasticity. The use of surgical intervention in severe children with severe contractures in the joints, with pathological synkinesis and deformities, almost completely equalizes muscle tone, restores range of motion in the limbs.