What is cerebral palsy in children, why does the disease occur, and how can it be dealt with? Clinical forms of cerebral palsy Clinical forms of cerebral palsy briefly.

Cerebral palsy is the most severe disease that breaks the life of a child. This neurological disease associated with brain damage develops into a disability of the baby. But with timely and proper treatment, the disease stops progressing, some symptoms disappear.

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

(lack of oxygen during the childbearing by the mother);
Infections during gestation;
Failures in the formation of brain structures;
The conflict of the Rh factor of the mother and baby;
Brain injuries during gestation and childbirth;
Toxic poisoning;
Disorders during childbirth.

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

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

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

Genetic. Damage to the parents' chromosomes stimulates the onset of cerebral palsy in their child.
Hypoxia. Lack of oxygen supply to the fetus, both during pregnancy and at the time of childbirth.
Infections. Meningitis, encephalitis, and arachnoiditis transferred at the age of less than a year increases the risk of cerebral palsy, especially in severe forms.
Poisoning. The defeat of the body of a pregnant woman or baby with toxic poisons or drugs leads to a disease. Harmful production, contact with toxic substances, potent medications are sources of risk for a woman in position.
Physical. Various radiations and electromagnetic fields cause damage to the child in the prenatal period, radiation exposures also belong to the same sources of risk.
Mechanical. A child receives mechanical damage during childbirth - these are birth injuries.

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

Forms

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

Spastic tetraplegia

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

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

Dyskinetic

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

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

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

Ataxic

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

Muscle tone is reduced;
Trembling of hands and feet is observed;
Mental retardation;
Speech disorders.

mixed

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

Symptoms

Symptoms of cerebral palsy may appear immediately after the birth of a child or in the first months of life. Parents and doctors should be attentive to absolute reflexes and, if their manifestations fade, urgently carry out a complete diagnosis.

It is important to monitor the timeliness of the development of gaming skills, the development of speech, the lack of contact with the mother may be an alarm signal.

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

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

Treatment

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

Preparations

To stop convulsions and epileptic seizures, anticonvulsant-type drugs are prescribed, to improve blood circulation - nootropic drugs, in case of muscle hypertonicity - muscle relaxants. With the manifestation of pain symptoms, antispasmodics are prescribed.

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

Massage

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

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

Exercises

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

Development of motor skills

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

Development of joint functions

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

Development of abdominal muscles

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

Removal of hypertonicity

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

leg muscle training

From a supine position, an adult helps the baby to perform flexion and extension movements in the hip joint.

Exercising in water will help relieve tension in the muscles, increase their tone. A kid bathing in a central pool or even in a bath becomes much more energetic, fights stress and depression better. The presence of a sick child in a dolphinarium has an amazing impact, and helps to greatly advance the process of treatment.

Child development

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

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

Prevention

To prevent the occurrence of cerebral palsy in an infant, you can follow certain rules:

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

Cerebral palsy (ICP) is a general medical term that is used to refer to a group of motor disorders that progress in an infant due to trauma to various areas of the brain in the perinatal period. The first symptoms of cerebral palsy can sometimes be detected after the birth of a child. But usually the signs of the disease appear in infants in infancy (up to 1 year).

Etiology

Cerebral palsy in a child progresses due to the fact that certain parts of his central nervous system were damaged directly in the prenatal period of development, during the birth process, or in the first months of his life (usually up to 1 year). In fact, the causes of cerebral palsy are quite diverse. But they all lead to one thing - some areas of the brain begin to function incompletely or completely die.

Causes of cerebral palsy in a child in the prenatal period:

toxicosis;
untimely detachment of the "children's place" (placenta);
risk of miscarriage;
nephropathy of pregnant women;
trauma during childbearing;
fetal hypoxia;
fetoplacental insufficiency;
the presence of somatic ailments in the mother of the child;
rhesus conflict. This pathological condition develops due to the fact that the mother and child have different Rh factors, so her body rejects the fetus;
ailments of an infectious nature that the expectant mother suffered during the gestation of the fetus. The most potentially dangerous pathologies include,;
fetal hypoxia.

Causes that provoke cerebral palsy in the process of labor:

narrow pelvis (injury to the child's head during its passage through the mother's birth canal);
birth injury;
violation of labor activity;
childbirth before the due date;
large weight of the newborn;
rapid childbirth - pose the greatest danger to the baby;
breech presentation of the child.

The reasons for the progression of the disease in the first months of a newborn's life:

defects in the development of elements of the respiratory system;
asphyxia of newborns;
aspiration of amniotic fluid;
hemolytic disease.

Varieties

There are 5 forms of cerebral palsy, which differ from each other by the zone of brain damage:

spastic diplegia. This form of cerebral palsy is diagnosed in newborns more often than others. The main reason for its progression is the traumatization of brain areas that are “responsible” for the motor activity of the limbs. A characteristic sign of the development of the disease in a child under one year old is partial or complete paralysis of the legs and arms;
atonic-astatic form of cerebral palsy. In this case, there is damage to the cerebellum. Signs of cerebral palsy of this type - the patient cannot keep balance, coordination is impaired, muscle atony. All these symptoms appear in a baby under the age of one year;
hemiparetic form. The “target” areas of the brain are the subcortical and cortical structures of one of the hemispheres responsible for motor activity;
double hemiplegia. In this case, two hemispheres are affected at once. This form of cerebral palsy is the most severe;
hyperkinetic form of cerebral palsy. In most clinical situations, it is combined with spastic diplegia. It develops due to damage to the subcortical centers. A characteristic symptom of the hyperkinetic form of cerebral palsy is the commission of involuntary and uncontrolled movements. It is noteworthy that such pathological activity can increase if a child less than a year old or older is worried or tired.

Classification based on the age of the child:

early form. In this case, the symptoms of cerebral palsy are observed in a newborn in the period from birth to six months;
initial residual form. The period of its manifestation is from 6 months to 2 years;
late residual- from 24 months.

Symptoms

Cerebral palsy has many manifestations. The symptoms of the disease directly depend on the degree of damage to the structures of the brain, as well as on the location of the focus in this organ. You can notice the progression of cerebral palsy after birth, but more often it is detected after a couple of months, when it becomes clearly visible that the newborn is lagging behind in development.

Signs of cerebral palsy in a newborn:

the baby is not at all interested in toys;
the newborn does not roll over on its own for a long time and does not hold its head;
if you try to put the baby, then he will not stand on the foot, but only on the toes;
limb movements are chaotic.

Symptoms of cerebral palsy:

paresis. Usually only half of the body, but sometimes they spread to the legs and arms. The affected limbs change - they shorten and become thinner. Characteristic deformations of the skeleton in children with cerebral palsy - deformity of the sternum;
violation of the tone of muscle structures. A sick child has either spastic tension or complete hypotension. If there is hypertonicity, then the limbs take an unnatural position for them. With hypotension, the child is weak, there is a tremor, he can often fall, since the muscle structures of the legs do not support his body;
pronounced pain syndrome. In children with cerebral palsy, it develops due to various bone deformities. The pain has a clear localization. It most commonly occurs in the shoulders, back, and neck;
violation of the physiological process of swallowing food. This sign of cerebral palsy can be detected immediately after birth. Babies cannot fully suckle their mother's breasts, and babies do not drink from a bottle. This symptom occurs due to paresis of the muscular structures of the pharynx. It also causes salivation;
violation of speech function. It occurs due to paresis of the vocal cords, throat, lips. Sometimes these elements are affected simultaneously;
convulsive syndrome. Seizures occur at any time and at any age;
chaotic pathological movements. The child makes sudden movements, can grimace, take certain poses, and so on;
articular contractures;
significant or moderate decrease in hearing function;
developmental delay. This symptom of cerebral palsy does not occur in all sick children;
decreased visual function. Often there is also strabismus;
malfunction of the digestive tract;
the patient involuntarily excretes excrement and urine;
progression of endocrine diseases. Children with such a diagnosis are often diagnosed with dystrophy, growth retardation,.

Complications

Cerebral palsy is a chronic disease, but over time it does not progress. The patient's condition may worsen if secondary pathologies occur, such as hemorrhages, somatic ailments.

Complications of cerebral palsy:

disability;
violation of adaptation in society;
the occurrence of muscle contractures;
violation of food intake, as the paresis affected the muscles of the pharynx.

Diagnostic measures

The diagnosis of the disease is carried out by a neurologist. The standard diagnostic plan includes the following examination methods:

careful inspection. A medical specialist evaluates reflexes, visual and hearing acuity, muscle function;
electroencephalography;
electroneurography;
electromyography;

Additionally, the patient can be referred for consultations to narrow specialists:

speech therapist;
ophthalmologist;
psychiatrist;
epileptologist.

Therapeutic measures

It should be said right away that such a pathology cannot be completely cured. Therefore, the treatment of cerebral palsy is primarily aimed at reducing the manifestation of symptoms. Special rehabilitation complexes provide an opportunity to gradually develop speech, intellectual and motor skills.

Rehabilitation therapy consists of the following activities:

sessions with a speech therapist. It is necessary for a sick child to normalize speech function;
exercise therapy. A set of exercises is developed only by a specialist strictly individually for each patient. They must be performed daily in order for them to have the desired effect;
massage for cerebral palsy is a very effective method of rehabilitation. Doctors resort to segmental, point and classical types. Massage with cerebral palsy should be carried out only by a highly qualified specialist;
use of technical means. These include crutches, special inserts placed in shoes, walkers, and more.

Physiotherapeutic methods and animal therapy are also actively used in the treatment of cerebral palsy:

hydrotherapy;
oxygen barotherapy;
mud treatment;
electrical stimulation;
warming up the body;
electrophoresis with pharmaceuticals;
dolphin therapy;
hippotherapy. This is a modern method of treatment based on the patient's communication with horses.

Medical therapy:

if a child has epileptic seizures of varying degrees of intensity, then he must be prescribed anticonvulsant drugs to stop the seizures;
nootropic pharmaceuticals. The main purpose of their appointment is the normalization of blood circulation in the brain;
muscle relaxants. These pharmaceuticals are prescribed to patients if they have hypertonicity of muscle structures;
metabolic agents;
antiparkinsonian drugs;
antidepressants;
neuroleptics;
antispasmodics. These drugs are prescribed to the patient with a strong pain syndrome;
analgesics;
tranquilizers.

Medical specialists resort to surgical treatment of cerebral palsy only in severe clinical situations, when conservative therapy does not have the desired effect. They resort to the following types of interventions:

brain surgery. Doctors carry out the destruction of structures that are the cause of the progression of neurological disorders;
spinal rhizotomy. Doctors resort to this operable intervention in case of severe muscle hypertonicity and severe pain syndrome. Its essence lies in the interruption of pathological impulses that come from the spinal cord;
tenotomy. The essence of the operation is to create a support position for the affected limb. It is prescribed if the patient develops contractures;
sometimes specialists perform tendon or bone grafts to stabilize the skeleton a little.

According to the classification of cerebral palsy (CP), adopted in our country and abroad, there are 5 main forms.

According to the classification of cerebral palsy developed by K.A. Semenova in 1973, as well as the International Classification of Diseases of the 10th revision (ICD-10), distinguish 5 main forms of cerebral palsy:

1. Spastic diplegia - violation of the muscles of the arms and legs, while the legs are more affected, and the child has problems with walking of varying severity. The involvement of the hands also varies from clumsiness when performing movements to pronounced movement restrictions. The neurologist can detect the first clinical manifestations from 4-6 months, in the form of a delay in the extinction of congenital reflexes, as well as an increase in muscle tone. Speech disorders are noted in 80% of cases in the form of dysarthria, dyslalia, etc., a decrease in intelligence in 30-50% of cases. Forecast: with timely started and regular treatment; up to 20-25% of children walk independently, with the use of crutches and other means - up to 40-50% of patients.

2. Hemiplegic form - Unilateral injury of the arm and leg. Clinical manifestations, depending on the severity, become noticeable at the age of several weeks to a year. As a rule, parents notice that their child uses his hands differently in his activities, or closer to the year, when the child begins to walk, that the child drags one leg. The prognosis for timely treatment is usually favorable. Children often walk independently, and disability depends on the limitations of movement in the hand. Speech disorders are noted in 40% of patients, cognitive decline - in 40% of patients, convulsions - in 30% of patients. This is the most favorable form for the future prognosis of a child's development.

3. Double hemiplegia (tetraparesis) is the most severe form of cerebral palsy. The doctor can see clinical manifestations already in early infancy. All limbs are affected, but more often the hands are affected somewhat more than the legs. Intellectual deficiency is noted in more than 90% of children, up to 50-75% of children have microcephaly, 40% have various lesions: atrophy of the optic nerves, hearing impairment. These children often have problems with swallowing and chewing, which can lead to choking when eating and increase the risk of chronic aspiration pneumonia (inflammation in the lung tissue around inhaled food particles), which is the most severe complication, often leading to the death of the child. The prognosis is unfavorable, children, despite treatment, are very difficult to verticalize, that is, they learn to sit down and stand up on their own. But even in the case of positive dynamics in the motor development of the child, it is very difficult to socialize (integrate into society) such a child due to pronounced intellectual impairments.

4. Hyperkinetic form (dyskinetic) - there are various involuntary movements in the arms, legs, face, torso, which interfere with maintaining an even posture, coordinated manipulations of the limbs. Pathological movements appear closer to a year. Movements can be both slow and artsy, and fast, jerky. Up to 75% of children can walk independently without support, however, as a rule, not earlier than from 5-6 years. Very often there is a hearing impairment - up to 40-50% of children, increased salivation, impaired swallowing and articulation, but a decrease in intelligence in this form is rare. The prognosis of development and social adaptation in hyperkinetic forms of cerebral palsy is not bad, many children can study in secondary and higher educational institutions and work in their specialty.

5. Atonic-astatic form - characterized by impaired coordination and balance in the child. The expressed general muscular weakness ("flaccid child") is characteristic. Independent walking in some children is possible, but rather late. The gait is unsteady, with legs wide apart. The high frequency of intellectual deficiency and speech disorders - up to 90% of cases, which makes it difficult for such children to adapt socially. It is believed that under the mask of the atonic-astatic form of cerebral palsy, many hereditary diseases and syndromes that are difficult to diagnose can be hidden.

6. Mixed form is a combination of two or more forms in a child. The prognosis depends on the severity of motor, mental disorders, as well as timely treatment.

Cerebral palsy symptoms and severity can vary throughout life, even though brain damage remains the same.

Also, it is worth remembering that cerebral palsy is not a hereditary disease, it is not transmitted from parents to children, however, causes predisposing to cerebral palsy (for example, family blood clotting disorders leading to premature birth) can be transmitted from parents to children.

Cerebral palsy () is a disease that causes disturbances in the functioning of the motor system, which occur as a result of damage to areas of the brain or their incomplete development.

Back in 1860, Dr. William Little took up the description of this disease, which was called Little's disease. Even then it was revealed that the cause is oxygen starvation of the fetus at the time of birth.

Later, in 1897, the psychiatrist Sigmund Freud suggested that the source of the problem could be a violation of the development of the brain of a child in the womb. Freud's idea was not supported.

And only in 1980 it was found that only in 10% of cases of cerebral palsy occurs due to birth injuries. Since that moment, experts began to pay closer attention to the causes of brain damage and, as a result, the appearance of cerebral palsy.

Provoking intrauterine factors

Currently, more than 400 causes of cerebral palsy are known. The causes of the disease are correlated with the period of gestation, childbirth, and in the first four weeks after (in some cases, the period of the possibility of the manifestation of the disease is extended to the age of three years of the child).

It is very important how the pregnancy progresses. According to studies, it is during fetal development that in most cases violations of the fetal brain activity are observed.

The key reasons that can cause dysfunction in the work of the developing child's brain, and the occurrence of cerebral palsy during pregnancy:

Postnatal factors

In the postpartum period, the risk of occurrence decreases. But he also exists. If the fetus was born with a very low body weight, then this can pose a danger to the health of the child - especially if the weight is up to 1 kg.

Twins and triplets are more at risk. In situations where a child receives at an early age, this is fraught with unpleasant consequences.

These factors are not the only ones. Experts do not hide the fact that in every third case it is not possible to identify the cause of cerebral palsy. Therefore, the main points that you should pay attention to first of all were listed.

A curious observation is the fact that boys are 1.3 times more likely to be affected by this disease. And in males, the course of the disease manifests itself in a more severe form than in girls.

Scientific research

There is evidence that particular importance in considering the risk of occurrence should be given to the genetic issue.

Norwegian doctors from the field of pediatrics and neurology conducted a major study, which revealed a close relationship between the development of cerebral palsy and genetics.

According to the observations of qualified specialists, if parents already have a child suffering from this disease, then the possibility of having another child in this family with cerebral palsy increases by 9 times.

The research team led by Professor Peter Rosenbaum came to these conclusions as a result of studying data on more than two million Norwegian babies who were born between 1967 and 2002. 3649 babies were diagnosed with cerebral palsy.

Cases with twins were considered, situations with relatives of the first, second and third degree of kinship were analyzed. Based on these criteria, the incidence of cerebral palsy in infants belonging to different categories of kinship was revealed.

As a result, the following data was provided:

if a twin is ill with cerebral palsy, then the probability of having another twin is 15.6 times higher;
if a sibling is sick, then the risk of another child suffering from cerebral palsy increases by 9 times; if single-uterine - 3 times.
in the presence of cousins and sisters with a diagnosis of cerebral palsy, the risk of the baby having the same problem increases by 1.5 times.
parents with this disease increase the likelihood of having a child with the same diagnosis by 6.5 times.

It is necessary to know the causes and risk factors for cerebral palsy, since its development can be prevented, if prematurely take care of the health of the mother and fetus.

To do this, it is worth not only visiting a doctor regularly, but also maintaining a healthy lifestyle, avoiding injuries, viral diseases, the use of toxic substances, pre-treatment and do not forget to consult on the safety of the drugs used.

Understanding the importance of precautions is the best prevention of cerebral palsy.

CEREBRAL PALSY.

The term cerebral palsy combines a number of syndromes that occur in connection with brain damage.

Cerebral palsy occurs as a result of an organic lesion, underdevelopment or damage to the brain in early ontogenesis (intrauterine development, the moment of childbirth or the early postnatal period). At the same time, phylogenetically “young” parts of the brain and the cerebral cortex are especially affected. Cerebral palsy can manifest itself as a whole complex of motor, mental and speech disorders, combined with disorders of vision, hearing, and various types of sensitivity. The main clinical syndrome of cerebral palsy is movement disorders.

The severity of movement disorders can vary from minimal to very gross, severe.

The first clinical description of cerebral palsy was made by V. LITTLE in 1853. For almost 100 years, cerebral palsy was called LITTLE's disease. The term cerebral palsy was coined by Sigmund Freud in 1893. Since 1958, this term has been officially adopted by the WHO (World Health Organization).

The WHO approved the following definition: "Cerebral palsy is a non-progressive disease of the brain that affects its departments that control movements and body position, the disease is acquired in the early stages of brain development"

Currently, cerebral palsy is considered as a disease resulting from brain damage suffered in the prenatal period or during the period of the incomplete formation of the main brain structures, which causes a complex combined structure of neurological and mental disorders.

Etiology and pathogenesis of cerebral palsy.

The causes of cerebral palsy are varied. It is customary to single out:

prenatal (before the birth of the child, during the mother's pregnancy)

natal (during childbirth)

postnatal (after the birth of a child).

Most often, the causes are prenatal from 37% to 60% of cases.

Natal from 27% to 40% of cases.

Postnatal - from 3 to 25%.

prenatal factors.

The state of health of the mother (somatic, endocrine, infectious diseases of the mother), for example, diseases of the cardiovascular system in the mother, cause oxygen deficiency in the fetus in 45% of cases.

mother's bad habits;

taking various medications by a pregnant woman.

deviations and complications of the course of pregnancy;

The risk factor is the small weight of the fetus, early delivery, incorrect position of the fetus. It was found that a high percentage of children with cerebral palsy had low birth weight. The genetic factor is important, i.e. inheritance of congenital pathology of development.

natal factors.

Asphyxia in childbirth, birth trauma. Asphyxia during childbirth leads to the expansion of the vessels of the brain of the fetus, the occurrence of hemorrhages. Birth trauma is associated with mechanical damage or compression of the baby's head during childbirth.

postnatal factors.

Occur in the early stages of a child's life, even before the motor system is formed.

Skull injuries, neuroinfections (meningitis, encephalitis), drug intoxication (some antibiotics, etc.). Injury due to suffocation or drowning. Brain tumors, hydrocephalus.

In some cases, the etiology remains unclear, unknown.

The pathogenesis of cerebral palsy.

Cerebral palsy is a consequence of changes in brain cells or brain development disorders. Pathological changes in the brain in children with cerebral palsy can be established using computed tomography.

CLINICAL FORMS of cerebral palsy.

Currently, there are more than 20 different classifications of cerebral palsy. In domestic practice, the classification of SEMENOVA K.A. is most often used.

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, mixed forms of cerebral palsy are distinguished.

DOUBLE HEMIPLEGIA.

The most severe form of cerebral palsy. It occurs as a result of significant damage to the brain at the stage of intrauterine development. There is a pseudobulbar syndrome.

The term hemiparesis or hemiplegia means that one half of the body is affected (face, arm, leg on one side).

Clinical manifestations: Rigidity of the muscles (Rigidity - inflexibility, inflexibility, numbness due to muscle tension).

Tonic reflexes that have persisted for many years. Voluntary motor skills are absent or poorly developed. Children do not sit, do not stand, do not walk. Gross speech disorders, severe dysarthria up to anartria. Most children have severe mental retardation, which hinders the development of the child and aggravates the condition.

The absence of an inhibitory effect of the higher parts of the nervous system on the reflex mechanisms of the brain stem or spinal cord contributes to the release of primitive reflexes, as a result, muscle tone changes, and pathological postures appear. There is a delay or impossibility of the gradual development of chain setting reflexes, which normally contribute to the fact that the child gradually learns to raise and hold his head, sit, stand, then walk.

SPASTIC DIPLEGIA.

Known as LITTLE's disease or syndrome. The most common form of cerebral palsy. Spastic diplegia is characterized by tetraparesis when the arms and legs of both sides of the body are affected. The legs are more affected than the arms. The main clinical symptom is increased muscle tone, spasticity. There is a crossing of the legs during support. Limbs can freeze in the wrong position. In 70 - 80% of children, pronounced speech disorders in the form of spastic - paretic (pseudobulbar) dysarthria, sometimes motor alalia, delayed speech development. Early speech therapy significantly improves the state of speech. Mental disorders are manifested in the form of a delay in mental development, which can be compensated for with corrective action. Children can study in special boarding schools for children with disorders of the musculoskeletal system or in general education schools. Some of the children have mental retardation, in which case they study according to the program of the VIII type school. This form of cerebral palsy is prognostically more favorable than double hemiplegia. 20 - 25% of children begin to sit, walk, but with a significant delay (by 2 - 3 years). The rest learn to move around using crutches or in a wheelchair. The child can learn to write, perform some self-service functions.

HEMIPARETIC FORM of cerebral palsy.

This form is characterized by damage to the limb (arm and leg) on one side of the body. The arm is usually more affected than the leg. Right-sided hemiparesis associated with damage to the left hemisphere is observed more often than left-sided. Children acquire motor skills later than healthy children. Already in the first year of life, limitation of movements in the affected limbs is revealed, the child begins to sit on time or with a slight delay, but the posture is asymmetrical, with a bias in one direction. The child learns to walk by giving a healthy hand. Over time, a persistent pathological posture is formed. Adduction of the shoulder, flexion of the arm and hand, scoliosis of the spine. The child brings forward a healthy part of the body. The affected limbs are retarded in growth, shortening of the affected limbs occurs.

There are speech disorders in the form of motor alalia, dysgraphia, dyslexia, and counting disorders. Children have spastic-paretic (pseudobulbar) dysarthria.

Intellectual disabilities range from mild mental retardation to mental retardation.

The prognosis of motor development is favorable, children walk independently, master self-service skills.

HYPERKINETIC FORM of cerebral palsy.

Associated with damage to the subcortical regions of the brain. The cause of this form of cerebral palsy may be the incompatibility of the blood of the mother and fetus according to the Rh factor or hemorrhage in the region of the caudate body as a result of a birth injury. Motor disorders are manifested in the form of involuntary violent movements - hyperkinesis. The first hyperkinesias appear at 4-6 months more often in the muscles of the tongue, then by 10-18 months in other parts of the body. During the neonatal period, there is a reduced muscle tone, hypotension and dystonia. Hyperkinesis occurs involuntarily, intensifies with movement and excitement, with an attempt to move. At rest, hyperkinesis decreases and disappears during sleep.

In the hyperkinetic form, voluntary motor skills develop with great difficulty. Children can not learn to sit, stand, walk on their own for a long time. They begin to move independently only by 4-7 years. The gait is jerky, asymmetrical. Walking balance is easily disturbed, but standing is harder than walking. Difficulty automating motor skills, writing. Speech disorders in the form of hyperkinetic dysarthria (extrapyramidal, subcortical). Mental and intellectual disorders are manifested to a lesser extent than in other forms of cerebral palsy. Most children learn to walk independently, but voluntary movements, especially fine motor skills, are largely impaired. Children are educated either in a special school for children with NOD or in a public school. They can later study at a technical school or university. An insignificant part of the children study according to the program of the auxiliary school.

ATONIC - ASTATIC FORM of cerebral palsy.

With this form of cerebral palsy, there is damage to the cerebellum, sometimes combined with damage to the frontal parts of the brain. There is a low muscle tone, imbalance of the body at rest and when walking, imbalance and coordination of movements, tremor, hypermetry (excessive movements).

In the first year of life, hypotension, delayed psychomotor development are detected, i.e. the functions of sitting, standing, walking do not develop. The child finds it difficult to grasp and play with objects, toys. The child learns to sit by the age of 1-2, stand and walk by the age of 6-8. The child stands and walks with his legs wide apart, his gait is unsteady, his arms are spread out to the sides, he makes many excessive, rocking movements. Hand tremor and coordination disorder of fine movements make it difficult to master the skills of writing, drawing, self-service. Speech disorders in the form of delayed speech development, cerebellar dysarthria, alalia. There may be intellectual impairment of varying severity in 55% of cases. Learning is difficult.

MIXED FORM of cerebral palsy.

With this form, there are combinations of various clinical manifestations characteristic of the above listed forms: SPASTICO - HYPERKINETIC, HYPERKINETIC - CEREBELLAR, etc.

According to the severity of motor disorders, there are three degrees of severity of cerebral palsy.

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

Medium - children need the help of others.

Severe - children are entirely dependent on others.