What is cerebral palsy, what are the symptoms of this disease and how is it treated? Causes of the birth of children with cerebral palsy What is cerebral palsy in children symptoms

The diagnosis that scares everyone and everyone is cerebral palsy. Causes, forms of cerebral palsy - these questions concern any modern parent if, during the bearing of a child, the doctor speaks of a high probability of such a deviation, or if he had to deal with it after birth.

What is this about?

Cerebral palsy is a collective term, it is applied to several types and types of conditions in which the human support system and the ability to move suffer. The cause of congenital cerebral palsy is damage to the brain centers responsible for the possibility of performing various voluntary movements. The patient's condition inexorably regresses, sooner or later the pathology becomes the cause of brain degeneration. Primary disorders occur even during the development of the fetus in the mother's body, somewhat less often cerebral palsy is explained by the characteristics of childbirth. There is a risk that the cause of cerebral palsy will be some events that happened to the child shortly after birth and negatively affected the health of the brain. External factors can have such an impact only in the early period after birth.

Even today, doctors know a huge number of factors that can provoke cerebral palsy. The reasons are varied, and protecting your child from them is not always easy. However, from medical statistics it is clear that most often the diagnosis is made to premature babies. Up to half of all cases with cerebral palsy are babies born prematurely. This reason is considered the most significant.

Factors and risks

Previously, of the reasons why children are born with cerebral palsy, the first and most important was the trauma received at the time of birth. It can be provoked by:

• too fast birth;
• technologies, methods used by obstetricians;
• narrowed maternal pelvis;
• abnormal pelvic anatomy of the mother.

Currently, doctors know for certain that birth injuries lead to cerebral palsy only in a very small percentage of cases. The predominant share is the specificity of the development of the child while in the mother's womb. Previously considered the main cause of cerebral palsy, the problem of childbirth (for example, prolonged, very difficult) is now classified as a consequence of violations that occurred during childbearing.

Let's consider this in more detail. Modern doctors, finding out with cerebral palsy, analyzed the statistics of the influence of autoimmune mechanisms. As it was found, some factors have a significant impact on the formation of tissues at the stage of the appearance of the embryo. Modern medicine believes that this is one of the reasons explaining a considerable percentage of cases of health deviations. Autoimmune disorders affect not only while in the mother's body, but also affect the child after childbirth.

Shortly after birth, a previously healthy child may become a victim of cerebral palsy due to infection, against which encephalitis has developed. Trouble can be caused by:

• measles;
• chicken pox;
• flu.

It is known that the main causes of cerebral palsy include hemolytic disease, which manifests itself as jaundice due to insufficient functioning of the liver. Sometimes a child has an Rhesus conflict, which can also provoke cerebral palsy.

It is far from always possible to determine the reason why children are born with cerebral palsy. Doctors' comments are disappointing: even MRI and CT (the most effective and accurate research methods) cannot always provide enough data to form a complete picture.

The complexity of the question

If a person is different from those around him, he attracts attention to himself - this fact no one doubts. Children with cerebral palsy are always an object of interest to those around them, from laymen to professionals. The particular complexity of the disease lies in its effect on the whole organism. With cerebral palsy, the ability to control one's own body suffers, as the functionality of the central nervous system is impaired. Limbs, facial muscles do not obey the patient, and this is immediately evident. With cerebral palsy, half of all patients also have developmental delays:

• speech;
• intellect;
• emotional background.

Often, cerebral palsy is accompanied by epilepsy, convulsions, tremors, an incorrectly formed body, disproportionate organs - the affected areas grow and develop much more slowly than healthy elements of the body. In some patients, the visual system is disturbed, in others cerebral palsy is the cause of mental, auditory, and swallowing disorders. Possible inadequate muscle tone or problems with urination, defecation. The strength of manifestations is determined by the magnitude of the violation of brain functionality.

Important nuances

There are cases when patients successfully adapted to society. They have access to a normal human life, full, filled with events, joys. Another scenario is also possible: if quite large areas of the brain were affected during cerebral palsy, this will be the reason for assigning the status of a disabled person. Such children are completely dependent on others, as they grow older, the dependence does not become weaker.

To some extent, the future of the child depends on his parents. There are some approaches, methods, technologies that allow to stabilize and improve the patient's condition. At the same time, one should not count on a miracle: the cause of cerebral palsy is a lesion of the central nervous system, that is, the disease cannot be cured.

Over time, in some children, the symptoms of cerebral palsy become more widespread. Doctors disagree on whether this can be considered the progress of the disease. On the one hand, the root cause does not change, but the child tries to learn new skills over time, often encountering failure along the way. Having met a child with cerebral palsy, you should not be afraid of him: the disease is not transmitted from person to person, it is not inherited, therefore, in fact, its only victim is the patient himself.

How to notice? The main symptoms of cerebral palsy

The cause of the violation is a malfunction of the central nervous system, leading to dysfunction of the motor brain centers. For the first time, symptoms can be seen in a baby at the age of three months. Such a child:

• develops with a delay;
• noticeably lagging behind peers;
• suffers from convulsions;
• makes strange, unusual movements for babies.

A distinctive feature of such an early age is increased brain compensatory capabilities, so the therapeutic course will be more effective if it is possible to make an early diagnosis. The later the disease is detected, the worse the prognosis.

Reasons and discussions

The cause of the main symptoms of cerebral palsy is a violation in the work of the brain centers. This can be provoked by a variety of injuries formed under the influence of a wide range of factors. Some appear during development in the mother's body, others at birth and shortly after. As a rule, cerebral palsy develops only in the first year of life, but no later. In most cases, dysfunction of the following brain regions is detected:

• bark;
• area under the bark;
• brain stem;
• capsules.

There is an opinion that the functionality of the spinal cord suffers with cerebral palsy, but there is no confirmation at the moment. Spinal cord injuries were found in only 1% of patients, so there is no way to conduct reliable studies.

Defects and pathologies

One of the most common reasons for the diagnosis of cerebral palsy is defects obtained during fetal development. Modern doctors know the following situations in which there is a high probability of deviations:

• myelination is slower than normal;
• abnormal cell division of the nervous system;
• disruption of connections between neurons;
• errors in the formation of blood vessels;
• the toxic effect of indirect bilirubin, which led to tissue damage (observed with a conflict of Rh factors);
• infection;
• scarring;
• neoplasms.

On average, in eight children out of ten patients, the cause of cerebral palsy is one of the indicated.

Especially dangerous infections are toxoplasmosis, influenza, rubella.

It is known that a child with cerebral palsy can be born to a woman suffering from the following diseases:

• diabetes;
• syphilis;
• heart pathology;
• vascular diseases.

Both infectious and chronic pathological processes in the mother's body are possible causes of cerebral palsy in a child.

The mother's body and the fetus may have conflicting antigens, Rh factors: this leads to severe health problems for the child, including cerebral palsy.

The risks are increased if during pregnancy a woman takes medications that can adversely affect the fetus. Similar dangers are associated with drinking and smoking. Finding out what causes cerebral palsy, doctors found that more often such children are born to women if the birth was postponed before the age of majority or over forty. At the same time, it cannot be said that the listed reasons are guaranteed to provoke cerebral palsy. All of them only increase the risk of deviations, they are recognized patterns that must be taken into account when planning a child and bearing a fetus.

I can not breathe!

Hypoxia is a common cause of cerebral palsy in children. The treatment of pathology, if it is provoked precisely by a lack of oxygen, is no different from other causes. As such, there will be no recovery over time, but with early detection of signs, an adequate course of patient rehabilitation can begin.

Hypoxia is possible both during gestation and during childbirth. If the child's weight is less than normal, there is every reason to assume that hypoxia accompanied a certain stage of pregnancy. Diseases of the heart, blood vessels, endocrine organs, virus infection, and kidney disorders can provoke the condition. Sometimes hypoxia is provoked by toxicosis in severe form or in the later stages. One of the causes of cerebral palsy in children is a violation of blood flow in the mother's small pelvis during childbearing.

These factors negatively affect the supply of blood to the placenta, from which the cells of the embryo receive nutrients and oxygen, which are vital for proper development. If the blood flow is disturbed, the metabolism weakens, the embryo develops slowly, there is a possibility of low weight or growth, impaired functionality of various systems and organs, including the central nervous system. They talk about underweight if the newborn weighs 2.5 kg or less. There is a classification:

• children born before 37 weeks of gestation with adequate weight for their age;
• premature babies with a small mass;
• low birth weight babies born on time or late.

Hypoxia and developmental delay are discussed only in relation to the last two groups. The first is considered normal. For premature, born on time and later than the term of underweight children, the risk of developing cerebral palsy is estimated to be quite high.

The health of the child depends on the mother

Mostly the causes of cerebral palsy in children are due to the period of development in the mother's body. Anomalies in the fetus are possible under the influence of various factors, but most often the cause is:

• the development of diabetes (violations on average - in three children out of a hundred born to mothers who suffered from gestational diabetes);
• disturbances in the work of the heart and blood vessels (heart attack, sudden changes in the level of pressure);
• infectious agent;
• physical injury;
• acute poisoning;
• stress.

One of the risk factors is multiple pregnancy. This cause of cerebral palsy in newborns has the following explanation: when carrying several embryos at once, the mother's body is faced with increased load indicators, which means that the probability of having children prematurely, with low weight, is significantly higher.

Birth: not everything is so simple

A common cause of cerebral palsy in newborns is birth trauma. Despite the stereotypes that this is possible only in the event of an obstetrician's mistake, in practice, injuries are much more often explained by the characteristics of the mother's or child's body. For example, a woman in labor may have a very narrow pelvis. Another reason is also possible: the child is very large. During the birth, the body of a child may suffer, the harm done to it becomes the cause of various diseases. Often there are clinical manifestations of cerebral palsy in newborns for reasons:

• incorrect position of the embryo in the uterus;
• placing the head in the pelvis along the wrong axis;
• too fast or very long labor;
• use of unsuitable accessories;
• obstetrician's mistakes;
• asphyxia for various reasons.

Currently, caesarean section is considered one of the safest birth options, but even this approach cannot guarantee the absence of birth trauma. In particular, there is a possibility of damage to the vertebrae of the neck or chest. If at birth a caesarean section was resorted to, it is necessary to show the baby to an osteopath soon after birth to check the adequacy of the condition of the spine.

On average, cerebral palsy occurs in two girls out of a thousand, and for boys the frequency is slightly higher - three cases per thousand babies. There is an opinion that this difference is due to the large body size of boys, which means that the risk of injury is higher.

At present, it is impossible to insure against cerebral palsy, as there is no one hundred percent guarantee to foresee and prevent it. In an impressive percentage of cases, the causes of acquired cerebral palsy, congenital, can be established after the fact, when anomalies manifest themselves in the development of the child. In some cases, already during pregnancy there are signs indicating the likelihood of cerebral palsy, but in their bulk they cannot be corrected or are eliminated only with great difficulty. And yet, you should not despair: you can live with cerebral palsy, you can develop, be happy. In modern society, a rehabilitation program for such children is being actively promoted, equipment is being improved, which means that the negative impact of the disease is mitigated.

Relevance of the issue

Statistical studies show that, on average, under the age of one year, cerebral palsy is diagnosed with a frequency of up to 7 out of a thousand children. In our country, the average statistical indicators are up to 6 per thousand. Among preterm infants, the incidence is approximately ten times higher than the global average. Doctors believe that cerebral palsy is the first trouble among chronic diseases that affect children. To some extent, the disease is associated with environmental degradation; neonatology is recognized as a factor, since even children whose weight is only 500 g can survive in hospital conditions. Of course, this is a real progress in science and technology, but the frequency of cerebral palsy among such children, unfortunately, is significantly higher than average, so it is important not only to learn how to nurse children weighing so little, but also to develop ways to provide them with a full, healthy life.

Features of the disease

There are five types of cerebral palsy. The most common is spastic diplegia. Various experts estimate the frequency of such cases at 40-80% of the total number of diagnoses. This type of cerebral palsy is established if lesions of the brain centers cause paresis, from which the lower limbs primarily suffer.

One form of cerebral palsy is damage to the motor centers in one half of the brain. This allows you to set the hemiparetic type. Paresis is characteristic of only one half of the body, opposite to that cerebral hemisphere, which has suffered from aggressive factors.

Up to a quarter of all cases are hyperkinetic cerebral palsy, caused by a violation of the activity of the subcortex of the brain. Symptoms of the disease are involuntary movements that are activated if the patient is tired or excited.

If the disorders are concentrated in the cerebellum, the diagnosis sounds like "atonic-astatic cerebral palsy." The disease is expressed by static disorders, muscle atony, inability to coordinate movements. On average, this type of cerebral palsy is detected in one patient out of ten patients.

The most difficult case is double hemiplegia. Cerebral palsy is caused by an absolute violation of the functionality of the cerebral hemispheres, due to which the muscles are rigid. Such children cannot sit, stand, hold their heads.

In some cases, cerebral palsy develops according to a combined scenario, when symptoms of different forms appear simultaneously. Most often, the hyperkinetic type and spastic diplegia are combined.

Everything is individual

The degree of severity of deviations in cerebral palsy is different, and clinical manifestations depend not only on the localization of diseased brain areas, but also on the depth of disorders. There are cases when already in the first hours of life the health problems of the baby are visible, but in most cases it is possible to make a diagnosis only a few months after birth, when a developmental lag is noticeable.

It is possible to suspect cerebral palsy if the child does not have time in motor development for peers. For quite a long time, the baby cannot learn to hold the head (in some cases this does not happen). He is not interested in toys, he does not try to roll over, consciously move his limbs. When you try to give him a toy, the child does not try to keep it. If you put the child on his feet, he will not be able to stand on his foot completely, but will try to rise on his tiptoes.

Paresis of a separate limb or one side is possible, all limbs may be affected at once. The organs responsible for speech are not sufficiently innervated, which means that pronunciation is difficult. Sometimes cerebral palsy is diagnosed with dysphagia, that is, the inability to swallow food. This is possible if the paresis is localized in the pharynx, larynx.

With significant muscle spasticity, the affected limbs can be completely immobile. Such parts of the body lag behind in development. This leads to a modification of the skeleton - the chest is deformed, the spine is bent. With cerebral palsy, contractures of the joints are detected in the affected limbs, which means that the violations associated with attempts to move become even more significant. Most children with cerebral palsy suffer from fairly severe pain due to skeletal disorders. The most pronounced syndrome in the neck, shoulders, feet, back.

Manifestations and symptoms

The hyperkinetic form is indicated by sudden movements that the patient cannot control. Some turn their heads, nod, grimace or twitch, assume ostentatious postures, and make strange movements.

With the atonic astatic form, the patient cannot coordinate movements, is unstable when trying to walk, often falls, and cannot maintain standing balance. Such people are more likely to suffer from tremors, and the muscles are very weak.

Cerebral palsy is often accompanied by strabismus, gastrointestinal disturbances, respiratory dysfunction, and urinary incontinence. Up to 40% of patients suffer from epilepsy, and 60% have impaired vision. Some can't hear well, others can't hear sounds at all. Up to half of all patients have disorders in the endocrine system, expressed by hormonal imbalance, excess weight, growth retardation. Often, with cerebral palsy, oligophrenia, retarded mental development, and a decrease in the ability to learn are revealed. Many patients present with behavioral and perceptual disturbances. Up to 35% of patients have a normal level of intelligence, and every third mental impairment is assessed as mild.

The disease is chronic, regardless of the form. When the patient becomes older, previously hidden pathological disorders gradually appear, which is perceived as false progress. Often, the deterioration of the condition is explained by secondary health difficulties, since with cerebral palsy the following are often:

• strokes;
• somatic diseases;
• epilepsy.

Hemorrhages are often diagnosed.

How to discover?

So far, it has not been possible to develop such tests and programs that would make it possible to establish cerebral palsy for certain. Some typical manifestations of the disease attract the attention of doctors, so that the disease can be detected at an early stage in life. It is possible to assume cerebral palsy by a low score on the Apgar scale, by violations of muscle tone and motor activity, lagging behind, lack of contact with the next of kin - patients do not respond to their mother. All these manifestations are a reason for a detailed examination.

2.3.

Clinical forms of cerebral palsy

Since the term cerebral palsy cannot include all the variety of pathological changes that occur with this disease, for many years the search and development of an optimal classification of this suffering has been underway. The first clearly defined classification of cerebral palsy belongs toS. Freud(96). It is based on clinical criteria.

Classification of cerebral palsy(96)

hemiplegia

Cerebral diplegia (bilateral cerebral palsy)

Generalized rigidity

Paraplegic rigidity

Bilateral paraplegia

Generalized chorea

double athetosis

This classification for the first time made it possible to single out the types of cerebral palsy, which later became the basis for all subsequent classifications.

More than twenty classifications of cerebral palsy have been proposed in the world literature. They are based on etiological signs, the nature of clinical manifestations, pathogenetic features. In domestic clinical practice, the classification of K.A. Semenova (65), which includes the author's own data and elements of the classification by D.S. Footer (76) and M.B. Zucker (80). According to this classification, there are five main forms of cerebral palsy:

double hemiplegia;

Spastic diplegia;

Hemiparetic form;

Hyperkinetic form;

Atonic-astatic form.

In practice, a mixed form of cerebral palsy is also distinguished. Let us dwell on a brief description of the clinical forms of cerebral palsy.

Double hemiplegia - the most severe form of cerebral palsy, occurs with significant brain damage in the period of intrauterine life. All clinical manifestations are associated with pronounced destructive-atrophic changes, expansion of the subarach-

Noidal spaces and ventricular system of the brain. There is a pseudobulbar symptom, salivation, etc. All the most important human functions are severely impaired: motor, mental, and speech (82).

Movement disorders are detected already in the neonatal period, as a rule, there is no protective reflex, all tonic reflexes are sharply expressed: labyrinthine, cervical, reflex from the head to the body and from the pelvis to the body. Chain setting reflexes do not develop; the child cannot learn to sit, stand and walk independently.

The functions of the hands, like the legs, are practically absent. Rigidity of the muscles always predominates, aggravated under the influence of persistent intense topical reflexes (cervical and labyrinthine). Due to the increased activity of tonic reflexes, the child in the position on the stomach or back has a pronounced flexion or extension posture (Fig. 1). When supported in an upright position, as a rule, an extension posture is observed with the head hanging down. All tendon reflexes are very high, muscle tone in the arms and legs is sharply impaired. Voluntary motor skills are completely or almost not developed.

The mental development of children is usually at the level of mental retardation in a moderate or severe degree.

No speech: anartria or severe dysarthria.

The prognosis for the further development of motor, speech and mental functions is extremely unfavorable. The diagnosis of "double hemiplegia" indicates the complete disability of the child.

Spastic diplegia

This is the most common form of cerebral palsy, known as Little's disease or syndrome. In terms of the prevalence of motor disorders, spastic diplegia is tetraparesis (i.e. arms and legs are affected), but the lower limbs are affected in a much greater steppe.

In children with spastic diplegia, secondary mental retardation is often observed, which can be eliminated by the age of 6-8 with early and properly administered treatment. 30-35% of children with spastic diplegia suffer from mild mental retardation. In 70% - there are speech disorders in the form of dysarthria, much less often - in the form of motor alalia.

The severity of speech, mental and motor disorders varies widely. This is due to the time and strength of the action of harmful factors. Depending on the severity of the brain damage, already in the neonatal period, congenital motor reflexes are weakly expressed or do not appear at all: protective, crawling, supports, stepping movements of the newborn, etc., i.e., the basis is violated, on the basis of which the installation reflexes are formed. The grasping reflex, on the contrary, is most often strengthened, as well as tonic reflexes: cervical, labyrinth; and the degree of their severity can increase by 2-4 months. life.

The tone of the muscles of the tongue is sharply increased, so that it is brought to the root, and its mobility is sharply limited. The child's eyes go up. Thus, the functions of vision and speech are drawn into a vicious circle.

With a pronounced symmetrical tonic neck reflex, when the head is flexed, a flexion posture occurs in the arms and an extensor posture in the legs, and when the head is extended, on the contrary, extension of the arms and flexion of the legs occur. This rigid connection of tonic reflexes with muscles by 2-3 years leads to the formation of persistent pathological synergies and, as a result, to persistent vicious postures and attitudes.

The most characteristic postures of children with spastic diplegia are shown in fig. 2.

By the age of 2-3, vicious postures and attitudes become persistent, and from that time on, depending on the severity of motor disorders, severe, moderate and mild degrees of spastic diplegia are distinguished.

Children with severe unable to move independently or using crutches. The manipulative activity of their hands is significantly reduced. These children do not serve themselves or serve partially. They relatively quickly develop contractures and deformities in all joints of the lower extremities. 70-80% of children have speech disorders, 50-60% - mental retardation, 25-35% - mental retardation. In these children, for 3-7 years or more, tonic reflexes are not reduced and adjusting rectifying reflexes are hardly formed.

Children from moderate severity motor lesions move independently, although with a defective posture. They have a well-developed manipulative activity of the hands. Tonic reflexes are expressed slightly. Contractures and deformities develop to a lesser extent. Speech disorders are observed in 65-75% of children, ZPR - in 45-55%, in 15-: 25% - mental retardation.

Children with mild severity motor lesion, awkwardness and slowness of the pace of movements in the hands, a relatively slight limitation of the volume of active movements in the legs, mainly in the ankle joints, a slight increase in muscle tone are noted. Children move independently, but their gait remains somewhat defective. Speech disorders are observed in 40-50% of children, mental retardation - in 20-30%, mental retardation - in 5%.

Prognostically, spastic diplegia is a favorable form of the disease in relation to / overcoming mental and speech disorders and less favorable in relation to the formation of locomotion.

A child suffering from spastic diplegia can learn to serve himself, write, master a number of labor skills (25, 82).

Hemiparetic form

This form of the disease is characterized by lesions of the same-named arms and legs (82). In 80% of cases, it develops in a child in the early postnatal period, when, due to injuries, infections, etc., the emerging pyramidal pathways of the brain are affected.

Brain. With this form, one side of the body is affected: the left with a right-sided brain lesion, and the right, with a left-sided one. With this form of cerebral palsy, the upper limb is usually more severely affected. Right-sided hemiparesis is more common than left-sided. Apparently, the left hemisphere, when exposed to harmful factors, suffers primarily as a younger phylogenetically, the functions of which are the most complex and diverse. 25-35% of children have a mild degree of mental retardation, 45-50% have secondary mental retardation, which can be overcome with timely rehabilitation therapy. Speech disorders are observed in 20-35% of children, more often by the type of pseudobulbar dysarthria, less often by motor alalia.

After the birth of a child with this form of cerebral palsy, all innate motor reflexes are formed. However, already in the first weeks of life, limitation of spontaneous movements and high tendon reflexes in the affected limbs can be detected; the support reflex, stepping movements, crawling are worse expressed in the paretic leg. The grasp reflex is less pronounced in the affected hand. The child begins to sit on time or with a slight delay, while the posture is asymmetrical, which can lead to scoliosis.

Manifestations of hemiparesis are formed, as a rule, by 6-10 months. child's life, which gradually increase (Fig. 3).

Starting from 2-3 years, the main symptoms of the disease do not progress, they are in many ways similar to those observed in adults. Movement disorders are persistent, despite ongoing therapy.

There are 3 degrees of severity of the hemiparetic form of cerebral palsy: severe, moderate and mild.

With a severe degree lesions in the upper and lower limbs, there are pronounced violations of muscle tone by the type of spasticity and rigidity. The volume of active movements, especially Fig. 3. Hemiparetic form in the forearm, hand, fingers and

Stop, minimal. Manipulative activity of the upper limb is practically absent. The hand, the length of all phalanges of the fingers, the shoulder blade, and the foot are reduced.

In the paretic arm and leg, muscle hypotrophy and a slowdown in bone growth are noted. Children begin to walk on their own only from 3-3.5 years, while there is a gross violation of posture, scoliosis of the spinal column and pelvic tilt are formed. In 25-35% of children, mental retardation is detected, in 55-60% - speech disorders, in 40-50% - convulsive syndrome.

With moderate severity lesions of motor functions, violations of muscle tone, trophic disorders, limitation of the volume of active movements are less pronounced. The function of the upper limb is significantly impaired, but the patient can take objects with his hand. Children begin to walk independently from 1.5-2.5 years old, limping on a sore leg, relying on the forefoot. 20-30% of children have mental retardation, 15-20% have mental retardation, 40-50% have speech disorders, and 20-30% have convulsive syndrome.

With mild degree lesions of violation of muscle tone and trophism are insignificant, the volume of active movements in the hand is preserved, but awkwardness of movements is noted. Children begin to walk independently from 1 year. 1 month - 1 year. 3 months. without rolling the foot in the affected leg. In 25-30% of children, mental retardation is noted, in 5% - mental retardation, in 25-30% - speech disorders.

Hyperkinetic form

The cause of this form of cerebral palsy is most often bilirubin encephalopathy as a result of hemolytic disease of the newborn. Less commonly, the cause may be prematurity followed by traumatic brain injury during childbirth, in which there is a rupture of the arteries that supply blood to the subcortical nuclei.

In the neurological status of these patients, hyperkinesias (violent movements), muscle rigidity of the neck, trunk, and legs are observed. Despite the severe motor defect, the limited possibility of self-service, the level of intellectual development in this form of cerebral palsy is higher than in the previous ones.

After the birth of such a child, congenital motor reflexes are disturbed: congenital movements are sluggish and limited. The sucking reflex is weakened, coordination of sucking, swallowing, breathing is disturbed. In some cases, muscle tone is reduced. At 2-3 months, sudden muscle spasms may occur. Reduced tone is replaced by dystonia. Adjusting chain reflexes are significantly late in their form.

Mirirovaniye. The delay in the formation of adjusting reflexes, muscular dystonia, and subsequently hyperkinesis disrupt the formation of normal postures and lead to the fact that the child cannot learn to sit, stand and walk independently for a long time. Very rarely, a child begins to walk independently from 2-3 years old, most often independent movement becomes possible at 4-7 years old, sometimes only at 9-12 years old.

In the hyperkinetic form of cerebral palsy, hyperkinesis of a different nature can be observed, they are most often polymorphic, there are types of hyperkinesis: choreiform, athetoid, choreatetosis, parkinson-like tremor. Choreiform hyperkinesis is characterized by fast and jerky movements, most often it is more pronounced in the proximal limbs (Fig. 4).

Hyperkinesis occurs from 3-4 months of a child's life in the muscles of the tongue and only by 10-18 months appears in other parts of the body, reaching its maximum development by 2-3 years of age. The intensity of hyperkinesis increases under the influence of exteroceptive, proprioceptive and especially emotional stimuli. At rest, hyperkinesis is significantly reduced and almost completely disappears during sleep.

Violation of muscle tone is manifested by dystonia. Often, many children have ataxia, which is masked by hyperkinesis and is detected during its reduction. Many children have a decrease in facial expressions, paralysis of the abducens and facial nerves. Almost all children have expressed vegetative disorders, significantly reduced body weight.

Speech dysfunction occurs in 90% of patients, more often in the form of hyperkinetic dysarthria, mental retardation - in 50%, hearing loss in 25-30%.

Intelligence in most cases develops quite satisfactorily, and unlearned children may be due to severe disorders of speech and voluntary motor skills due to hyperkinesis.

Prognostically, this is a completely favorable form in terms of learning and social adaptation. The prognosis of the disease depends on the nature and intensity of hyperkinesis: in choreic - children, as a rule, master independent movement by 2-3 years; with double athetosis, the prognosis is extremely unfavorable.

Atonic-astatic form

This form of cerebral palsy occurs much less frequently than other forms, it is characterized by paresis, low muscle tone in the presence of pathological tonic reflexes, impaired coordination of movements, balance (25, 82).

From the moment of birth, the failure of congenital motor reflexes is revealed: there are no support reflexes, automatic gait, crawling, weakly expressed or absent, protective and grasping reflexes (Fig. 6) Reduced muscle tone (hypotension). Chain adjusting reflexes are significantly delayed in development. Such patients begin to sit independently by 1-2 years, walk - by 6 years.

By the age of 3-5, with systematic, directed treatment, children, as a rule, master the possibility of voluntary movements. Speech disorders in the form of cerebellar or pseudobulbar dysarthria are observed in 60-75% of children, there is a mental retardation.

As a rule, with this form of cerebral palsy, the fronto-cerebellopontine path, the frontal lobes and the cerebellum are affected. Characteristic symptoms are ataxia, hypermetry, intentional tremor.

In those cases where there is a pronounced immaturity of the brain as a whole and the pathological process extends mainly to its anterior sections, mental retardation is detected more often. in mild, less often - moderately pronounced, there is euphoria, fussiness, disinhibition.

This form is prognostically severe.

mixed form

The most common form of cerebral palsy. With it, there are combinations of all the forms listed above: spastic-hyperkinedic, hyperkinetic-cerebellar, and so on. Violations of speech and intelligence occur with the same frequency. Sometimes the disease proceeds as a spastic form, and later hyperkinesis appears and manifests itself more and more clearly.

According to the motor defect, there are three degrees of severity of cerebral palsy in all of the listed forms of the disease:

Easy - a physical defect allows you to move around, use public transport, have self-service skills.

Medium - children need partial help from others when moving and self-service.

Severe - children are entirely dependent on others.

The presence of hypertensive, hydrocephalic, convulsive syndromes in patients significantly worsens the course of cerebral palsy; dysfunction of the hypothalamus, the entire hypothalamic-pituitary-adrenal system, which adapts the role to the external environment.

Cerebral palsy is a group of syndromes of movement disorders resulting from brain damage in the prenatal and natal periods. Often, cerebral palsy is supplemented by various problems on the part of the child, such as symptomatic epilepsy, delays in motor and psychoverbal development.

Information for doctors. The ICD diagnosis is coded under G80. At the same time, under the cipher G80.0, most cases with a predominance of spasticity without a clear definition of the form are encrypted. Under the code G80.1 - diplegic form (Little's disease), G80.2 - hemiplegic form, G80.3 - hyperkinetic form, G80.4 - cerebellar form, G80.8 - other forms, including atonic-astatic form. Under the code G80.9 are unspecified forms of cerebral palsy. F without fail, the diagnosis indicates all syndromal manifestations, indicating the degree of their severity.

The reasons

There are many reasons for the development of cerebral palsy. In this case, it is necessary to highlight the most frequent of them:

• Intrauterine brain injury
• Hypoxia in childbirth
• Intoxication
• Somatic and endocrinological diseases of the mother
• Rh-conflict of mother and child
• Anomalies of labor activity (including birth trauma)
• past infections

Under the influence of these and other causes, a direct damage to the brain tissue occurs, and disturbances in the processes of its development begin to form. At the same time, special attention should be paid to the transferred infectious diseases of the mother, which, today, account for more than half of all causes of cerebral palsy in a child.

Morphological changes in brain tissues are diverse. Often, a child develops hemorrhages in the intershell spaces and the brain tissue itself, degeneration of the structures of the cerebral cortex, cicatricial changes occur. The lesion often affects (but is not limited to) predominantly the anterior regions of the brain.

Symptoms (forms of cerebral palsy)

The symptoms of cerebral palsy vary greatly. Based on the clinical picture, It is customary to distinguish several different forms of cerebral palsy, each of which will be discussed below.

The hemiplegic form is the most common form of cerebral palsy. Its development is associated with damage mainly to one of the hemispheres of the brain. In this case, the symptoms of the disease are as follows: paresis of the extremities develops on the one hand, contractures of the joints of the arms and legs are observed. Muscle tone is increased according to the pyramidal type. In the neurological status, attention is drawn to the increase in all tendon reflexes, often pathological reflexes are caused. Most often, the severity of the phenomena is greater in the arm than in the leg. During active movements, frequent synkinesis is noticed - hand movements to the side, violent movements. The limbs on the side of the lesion lag behind in development. Also, quite often this form of cerebral palsy is accompanied by the development of symptomatic epilepsy, mental development disorders.

Diplegic form (Little's disease). It is a variant of cerebral palsy, expressed in spastic paresis mainly of the lower extremities. The child is severely retarded in motor development, often such children do not begin to walk independently. At the same time, a pronounced increase in muscle tone in the calf muscles makes the gait of such patients very peculiar: patients rely only on their fingers, their knees touch each other while walking, while it seems that the patient will now fall forward. This sign is so bright that it allows diagnosing this form of cerebral palsy at a distance. In the neurological examination, an increase in reflexes also develops, and pathological foot signs occur. Intelligence in most cases suffers little.

The hyperkinetic form develops with damage to the subcortical ganglia (often with Rhesus conflict). Among the symptoms of the hyperkinetic form of cerebral palsy, hyperkinesis proper comes to the fore - violent movements like athetosis, chorea, etc. Usually hyperkinesias are diverse, but one of them still has a leading significance. As the child grows and develops, the nature of hyperkinesis may change.

The atonic-astatic form is manifested by a decrease in the tone of the muscles of all limbs, the inability to maintain a vertical posture. Motor skills are practically not developed. Often there is dysarthria.

A rare cerebellar (atactic) form develops with a predominant lesion of the cerebellum. Leading importance is acquired by vestibular disorders, ataxia, gait and coordination disorders.

Diagnostics

Diagnosis of the disease, as a rule, is based on the fact that there is a cause that led to cerebral palsy, as well as the clinical picture and neurological status. In modern medicine, neuroimaging methods of MRI and MSCT are also important, but their use is limited by the need for anesthesia during the study.

* MRI scan for cerebral palsy

Also, in the presence of symptoms such as epileptic seizures, mental and motor retardation, such research methods as EEG, psychological testing, etc. are useful.

The course of the disease and the prognosis of life

Cerebral palsy, especially at an older age, is not a progressive disease, but the presence of persistent residual consequences of a brain injury. In this case, as a rule, there is a regression of symptoms to one degree or another. The possibilities of compensating for disturbed functions are quite large in early childhood, and sometimes make it possible to achieve an almost complete recovery.

It is difficult to assess the signs of cerebral palsy at the age of three months, or, say, at the age of 6 months. The phenomena of developmental delay, signs of paresis of the limbs come to the fore. However, each case is individual, and it is impossible to single out the exact signs of cerebral palsy in the first year of life.

The prognosis of the life of patients with cerebral palsy, as a rule, is favorable. Patients live to a ripe old age, may have offspring. A decrease in life expectancy is more often associated with mental underdevelopment, lack of social adaptation, and the presence of frequent symptomatic epilepsy.

Treatment

Therapy of cerebral palsy is a multifaceted task. It should be comprehensive and include medications, physiotherapy, psychotherapy, logocorrection, massage, the use of special orthopedic devices, physiotherapy exercises.

- Among drug therapy, neuroprotective drugs (cortexin, cerepro), as well as muscle relaxants (baclofen,) are of paramount importance for relieving spasticity. Vitamin and other metabolic preparations are widely used. If necessary, sedatives are used. The presence of symptomatic epilepsy suggests the use of antiepileptic drugs.

Physiotherapy, physiotherapy exercises, massage are aimed at reducing the lag in motor development. Also, the activation of the motor function helps to improve the mental development and social adaptation of a patient with cerebral palsy.

Recently, such methods of treating cerebral palsy as, for example, hippotherapy (treatment by contact with horses) have become fashionable. However, these techniques are not always available and, as a rule, are expensive, therefore, they are not widely used.

Cerebral palsy is not considered an independent disease.

This term is used to refer to a whole range of movement disorders that arise as a result of brain damage in utero.

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

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Concept and characteristics

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

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

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

However, as the baby grows older, the development of the pathology stops, that is, the brain damage does not worsen. A movement disorder amenable to partial correction.

Brain damage can manifest itself in 2 ways:

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

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

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

Causes

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

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

How is it developing?

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

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

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

If the child has a low birth weight, its organs, including the brain, are not fully formed; during hypoxia, some areas of the brain die off, and hollow areas appear in their place.

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

Classification of pathology

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

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

According to the severity are distinguished:

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

Companions of the disease

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

• involuntary convulsions;
• (formation of pathological fluid in the brain area);
• decreased vision and hearing;
• (difficulties in pronunciation of sounds, lack of speech, stuttering);
• difficulties in learning to write, count, read;
• behavioral disorders, emotional disorders.

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Symptoms and signs

A child with cerebral palsy exhibits the following symptoms:

Complications and consequences

DPC leads to the development of such serious complications as:

1. Musculoskeletal disorders(pathological bending of the arms, which in severe cases can provoke dislocation of the joints, deformity of the foot, when the baby moves only on tiptoes, curvature of the spine and persistent violation of posture, as a result of which the child's body loses its symmetry).
2. Speech disorders until its complete absence.
3. mental retardation, problems with adaptation in the team.

Diagnostics

After the baby is born, the child must be examined by a doctor. This allows you to identify the pathology at an early stage of its development and start treatment as soon as possible. Children who have increased risk of developing cerebral palsy.

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

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

If any deviations are found, appoint hardware research:

• ultrasound of the brain;
• CT, MRI.

differential

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

That is why differential diagnosis is of particular importance. It is important to distinguish cerebral palsy from such ailments as amino acid metabolism disorders, mucopolysaccharidosis, neurofibromatosis, and hypothyroidism.

Tasks of treatment and rehabilitation

Properly selected therapy is aimed at solution of the following tasks:

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

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

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Medical

The child is assigned anticonvulsants funds (Valparin, Epilim), if there are convulsions, as well as drugs that help eliminate spasms of muscle tissue (Diazepam).

Usage nootropics and other drugs to improve brain activity in cerebral palsy does not give any results, since brain damage in this case is irreversible.

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

Massage and exercise therapy

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

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

Pathological posture correction

The changes that occur in the body of a child with cerebral palsy lead to disorders of the musculoskeletal system, as a result of which the body is not able to take a physiological position.

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

Correction of contractures with a surgical method

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

This pathology needs to be corrected, otherwise even more serious consequences may develop, such as significant joint deformity, its dislocation.

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

Other ways

Depending on what manifestations of cerebral palsy are observed in a child, for more successful treatment, it is possible to use other methods, such as:

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

Rehabilitation centers

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

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

About, how to recognize cerebral palsy in a child you can learn from the video:

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Cerebral palsy is one of the most severe outcomes of perinatal damage to the nervous system.

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

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

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

Factors contributing to the development of cerebral palsy

Impact on the fetus during pregnancy:

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

Factors affecting the baby at the time of childbirth:

• asphyxia that occurred during childbirth;
• birth injury.

Impact on the child in the neonatal period:

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

Types of cerebral palsy

Forms of cerebral palsy according to clinical manifestations:

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

According to the course of the disease:

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

According to the severity of the process

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

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

This classification includes 5 levels:

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

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

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

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

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

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

There are two groups of changes.

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

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

Early manifestations of cerebral palsy

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

double hemiplegia

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

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

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

Complications of cerebral palsy

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

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

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

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

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

4) Violation of vision and hearing.

Treatment and rehabilitation of the consequences of cerebral palsy

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

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

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

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

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

Kinesiotherapy

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

Types of exercises used in kinesiotherapy.

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

Massage

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

Dynamic proprioceptive correction (DPC)

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

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

This is a necessary component of the rehabilitation treatment of cerebral palsy.

Several groups of drugs are used for treatment.

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

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

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

Physiotherapy

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

Types of physiotherapy used for cerebral palsy:

• electrotherapy;

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

Electroprocedures are not prescribed for patients who have convulsions.

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

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

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

Orthosis therapy

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

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

Basic principles of psychological and pedagogical correction.

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

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

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

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

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