Infantile cerebral palsy (ICP): symptoms, diagnosis and treatment. Forms of cerebral palsy: main forms of cerebral palsy, classification of the form of cerebral palsy in children, spastic forms of cerebral palsy, hemiplegic forms of cerebral palsy, dyskinetic forms of cerebral palsy, ataxic and mixed forms of cerebral palsy cerebral palsy of the left

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 isolated. 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. V 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.

Plan:

1. Characteristics of the stages of cerebral palsy. 2. Forms of cerebral palsy: spastic diplegia.

3. Spastic hemiplegia 4. Double hemiplegia.

5. Hyperkinetic form of cerebral palsy. 6. Atonic form of cerebral palsy.

7. Syndromes of speech disorders. 8. Sensory disturbances.

9. Vegetative-metabolic disorders. 10. Violations of the intellect.

In clinical practice, the classification of K.A. Semenova is used. The clinical picture of cerebral palsy (CP) is different depending on which parts of the brain the pathological process has mainly spread to. The intensity of damage to one or another part of the brain is the basis for many classifications of diseases.

There are three stages of cerebral palsy.

initial stage is diagnosed immediately after birth and is characterized by a severe general condition of the child, impaired muscle tone, trembling, nystagmus, impaired sucking reflex, etc.

Early residual stage, the beginning of which in the case of intrauterine damage or damage during childbirth should be attributed to the end of the second month of life. At this stage, the following are observed: a) symptoms of a delay in the development of statokinetic reflexes in the first year of life; b) developmental delay and pathology of subcortical-stem structures that regulate muscle tone; c) developmental delay and disturbances in the system of neural circuits of the premotor and motor cortex and subcortical structures, resulting in paralytic and hyperkinetic syndromes.

Late residual stage characterized by the presence of contractures and deformities, fibrous degeneration of muscle tissue, on the basis of which a pathological proprioceptive-motor stereotype is created.

Forms of cerebral palsy. Depending on the severity and prevalence, the following forms of cerebral palsy are distinguished: spastic diplegia, spastic hemiplegia, double hemiplegia, monoplegia, hyperkinetic form, atonic form, speech disorder syndromes, pseudobulbar syndrome, vegetative-metabolic disorders, intellectual development delays.

Spastic diplegia(Little's syndrome) - the most common form of cerebral palsy with motor disorders in the arms and legs; And the legs are more affected than the arms. Muscle tone in the legs is sharply increased: the child stands on bent legs and brought to the midline; when walking there is a crossing of the legs. The degree of involvement in the pathological process of the hands can be different - from severe paresis to mild awkwardness, which is revealed when the child develops fine motor skills. Contractures develop in large joints. Tendon reflexes are high, foot clonuses are noted. Caused pathological reflexes.

At spastic hemiplegia violations are noted mainly on one side. In the arm, the tone of the flexors is more increased, and in the leg - the extensors. Therefore, the arm is bent at the elbow joint, brought to the body, and the hand is clenched into a fist. The leg is extended and turned inward. When walking, the child leans on his toes. Tendon reflexes are high with an extended zone on the side of the paresis, there may be clonuses of the foot and patella, pathological reflexes are caused. Paretic limbs lag behind healthy ones in growth. With this form, the child may experience a delay in speech development due to alalia with damage to the left hemisphere of the brain. Half of the children have hyperkinesis. They appear as muscle tone decreases. Mental development is slow and varies from mild to severe. Developmental delay is affected by the presence of frequently occurring epileptiform seizures.

double hemiplegia characterized by motor impairment in all limbs, but usually the hands are affected more than the legs. Muscle tone is often asymmetrical. Severe damage to the arms, facial muscles and muscles of the upper body entails a pronounced delay in speech and mental development. Children do not sit, do not walk, cannot serve themselves. At preschool age, when motor activity becomes more pronounced, some children develop hyperkinesis in the distal parts of the arms and legs, as well as oral synkinesis. Most patients have pseudobulbar syndrome. Tendon reflexes are high, but may be difficult to elicit due to high tone and contractures. This form of cerebral palsy is often combined with microcephaly and minor developmental anomalies (dysembryogenetic stigmas), which indicates intrauterine brain damage. Often there are epileptiform seizures. In connection with severe motor disorders, contractures and deformities form early.

Hyperkinetic form arises from the defeat of subcortical structures more often in Rh-conflict pregnancy. Hyperkinesias appear after the first year of life, except in severe cases, when they can be detected in the first year of life. Hyperkinesis is more pronounced in the muscles of the face, lower limbs and neck muscles. Hyperkinesis such as athetosis, choreoathetosis, torsion dystonia are observed. Epileptiform seizures are rare. Tendon reflexes are high, with an extended zone. Often there are speech disorders. Mental development suffers less than in other forms, however, severe motor and speech disorders impede the development of the child, his education and social adaptation.

Atonic form characterized by muscle hypotension. Tonic neck and labyrinth reflexes are expressed unsharply; they can be detected during the emotional stress of the child and at the time of an attempt to make a voluntary movement. With this form, at the age of 2-3, symptoms of cerebellar damage are revealed: intentional trembling, trunk ataxia, and coordination disorders. In such patients, static functions suffer sharply: they cannot hold their heads, sit, stand, walk, maintaining their balance. Tendon reflexes are high. Frequent speech disorders in the form of cerebellar or pseudobulbar dysarthria. There is marked mental retardation. The degree of decrease in intelligence depends on the location of the brain lesion. With the defeat of predominantly frontal lobes, a deep mental retardation dominates. With a predominant lesion of the cerebellum, mental development suffers less, but in this case, the symptoms of cerebellar damage dominate.

Syndromes of speech disorders characterized by delayed speech development, dysarthria and alalia.

The delay in speech development is noted already in the pre-speech period. Cooing and babble appear late, are distinguished by fragmentation, poor sound complexes, and low vocal activity. The first words are late, the active vocabulary accumulates slowly, the formation of phrasal speech is disturbed. Delayed speech development, as a rule, is combined with various forms of dysarthria or alalia.

In children with cerebral palsy, the most common pseudobulbar dysarthria. It is characterized by an increase in the tone of the speech muscles. The tongue in the oral cavity is tense, its back is spastically curved, the tip is not pronounced. The lips are spasmodically tense. An increase in muscle tone may alternate with hypotension or dystonia in certain muscle groups of the articulatory apparatus. Paresis of the articulatory muscles causes a disorder of sound pronunciation by the type of pseudobulbar dysarthria. Characterized by impaired voice formation and respiratory distress. Friendly movements (synkinesias) in the articulatory muscles are often observed.

Extrapyramidal form of dysarthria observed in hyperkinetic form of cerebral palsy. This form is characterized by muscular dystonia, hyperkinesis of the articulatory muscles, and a pronounced violation of the intonation side of speech. In the atonic form of cerebral palsy, cerebellar dysarthria is noted, a feature of which is asynchrony between breathing, phonation and articulation. Speech is slow and jerky; towards the end of the sentence, the voice fades. Mixed dysarthria is common.

motor alalia leads to underdevelopment of all aspects of speech: phonemic, lexical, grammatical and semantic.

At sensory alalia Difficulty understanding spoken language. Pronounced violations of phonemic perception are noted, the development of motor speech suffers for the second time. Speech disorders in children with cerebral palsy are rarely isolated. More often, dysarthria is combined with delays in speech development or with alalia.

Sensory disturbances with cerebral palsy relate mainly to hearing. Hearing acuity is often reduced. This is more true for high-frequency tones, which can contribute to the violation of the pronunciation of a number of sounds in the absence of dysarthria. A child who does not hear high-frequency sounds (t, k, s, p, e, f, sh) does not use them in his speech. In the future, difficulties are noted in teaching such children to read and write.

Some patients have underdeveloped phonemic hearing. Any violation of auditory perception can lead to a delay in speech development, and in severe cases, to a gross underdevelopment of speech. Hearing loss in a child with a motor impairment can make it difficult to choose the right school for them. In this case, you should choose a school taking into account the leading defect, based on what hinders the child's adaptation.

Pseudobulbar syndrome includes a wide variety of combinations of cranial nerve paresis and spasm of various muscle groups that perform articulation and phonation, create a colorful peculiar picture of pseudobulbar paralysis. In the process of speech development, the phenomena of paralysis of the muscles of the vocal cords are replaced in some children by the same transient spasm that is observed in the masticatory muscles. Then aphonia or hypophonia, in turn, is replaced by dysphonia, in which quiet, often whispered speech is interspersed with uncontrollably loud cries of syllables, words, and sometimes phrases.

Paralytic form of pseudobulbar palsy has the following manifestations: aphonia, dysphonia, dysphagia, which lead to the fact that there is no distinct voice formation, and the process of eating and swallowing is much more difficult. Paralysis is observed in the articulatory and facial muscles, in connection with which their amimia is clearly expressed. Spasticity in this form is detected either in certain muscle groups during movement, or at a certain position of the body. An increase in tone is also observed in the articulatory muscles, but insignificant. Restoration of speech goes with great difficulty. It is also difficult to develop coordination between respiratory and articulatory movements. Dysarthria, along with aphonia and nasal tone of voice, lasts a long time.

With extrapyramidal form paralytic disorders of the articulatory muscles are complicated by deep tonic tension of the articulatory muscles. The tongue is collected in a lump at the root, inactive, the vocal cords are tense. Spasticity extends to the respiratory muscles, to the muscles of the larynx, which causes the originality of voice formation, dysphonia.

At cerebellar form of pseudobulbar palsy various variants of atactic disorders, paresis of spastic tension of the articulatory, chewing and respiratory muscles are observed. There is a slowdown in the pace, discoordination of all movements, including speech. There is a direct parallelism between the nature of the pathology of the skeletal and articulatory, chewing and respiratory muscles.

Vegetative-metabolic disorders often observed in children with cerebral palsy - this is acrocyanosis, hyperhidrosis, or vice versa, dry skin, a violation of its trophism, insufficient bone growth, improper metabolism, in particular calcium. Most often, autonomic failure occurs in children under 7 years of age with spastic diplegia, double hemiplegia, hyperkinetic form. The most massive and observed in all children is the insufficiency of the function of the cardiovascular system: hypotension and lability of cardiac activity, asymmetry of blood pressure. In the respiratory system, lability is also observed. There are fluctuations in body temperature up to 38 o. In the vast majority of cases, hyperglycemia and disturbances in the sugar curve after a sugar load are observed. Half of the children have polydipsia (increased water intake): thirst was noted both day and night.

Patients with cerebral palsy often have emotional disturbances in the form of increased excitability, a tendency to mood swings, the appearance of fears. Some children are afraid of heights, closed doors, darkness, new toys, new people. At the same time, children respond to stimuli not with an indicative, but with a protective reaction. Older children have secondary emotional disorders as a reaction to their defect and a tendency to neurotic disorders.

intellectual development children with cerebral palsy proceeds under adverse conditions and is often delayed or distorted. Approximately 30% of children have an underdevelopment of the intellect by the type of oligophrenia, 30% of the intellect is preserved, and the rest have a delay in intellectual development due to motor, speech and sensory disorders.

Literature:

1.Semenova K.A. Clinic and rehabilitation therapy of cerebral palsy.- M., 1972.

What is cerebral palsy - damage to one or more parts of the brain, either in the process of intrauterine development, or during (or immediately after) childbirth.

cerebral palsy - cerebral palsy

T The term "cerebral palsy" is used to characterize a group of chronic conditions in which motor and muscle activity is affected with impaired coordination of movements.

Cerebral palsy- damage to one or more parts of the brain, either in the process of intrauterine development, or during (or immediately after) childbirth, or in infancy / infancy. This usually occurs during a complicated pregnancy, which is a harbinger of preterm labor.

The word "cerebral" means "brain" (from the Latin word "cerebrum" - "brain"), and the word "paralysis" (from the Greek "paralysis" - "relaxation") defines insufficient (low) physical activity.

By itself, cerebral palsy does not progress, because. does not relapse. However, in the course of treatment, the patient's condition may improve, worsen, or remain unchanged.

Cerebral paralysis is not a hereditary disease. They never get infected or sick. Although cerebral palsy is not curable (not “curable” in the conventional sense), constant training and therapy can lead to improvement and minimize the effects of the disease.

How was cerebral palsy diagnosed?

IN In 1860, the English surgeon William Little first published the results of his observations on children who, after suffering a birth injury, developed paralysis of the limbs. The condition of the crumbs did not improve or worsen as they grew: there were problems with the grasping reflex, crawling and walking.

Signs of similar lesions have long been called “ Little's disease', and now they are known as ' spastic diplegia". Little suggested that these lesions were caused (by hypoxia) at birth.

However, in 1897, the famous psychiatrist Sigmund Freud, noting that children with cerebral palsy often suffered from mental retardation, visual impairment and epileptic seizures, suggested that the causes of cerebral palsy are rooted in the pathology of the development of the infant's brain in the womb.

Despite Freud's assumption, until the 1960s of the last century, it was widely believed among doctors and scientists that complications during childbirth were the main ones.

True, in 1980, after analyzing data from national studies on more than 35,000 cases of newborns with signs of cerebral palsy, scientists were amazed: complications due to birth trauma were less than 10% ...

In most cases, the causes of cerebral palsy have not been identified. Since then, extensive studies of the perinatal period have begun, i.e. from the 28th week of intrauterine life of the fetus to the 7th day of the life of the newborn.

What types of cerebral palsy exist?

ABOUT The answer to the question of what types of infantile paralysis distinguishes modern medicine is of interest to all parents. There are several classifications of types of cerebral palsy, but I will focus on the classification proposed by Professor K. A. Semenova.

Depending on the area of brain damage and the characteristic manifestations of the disease, Semenova distinguishes the following forms of cerebral palsy:

1. Spastic diplegia. The most common form of cerebral palsy. In the general statistics of such babies - 40-80%. Damage to the parts of the brain responsible for the motor activity of the limbs is observed, which, in turn, leads to complete or partial paralysis of the legs (to a greater extent) and hands.

2. Double hemiplegia. This form of cerebral palsy is expressed by the most severe manifestations. The cerebral hemispheres or the entire organ are affected. Rigidity of the muscles of the limbs is clinically observed, children cannot hold their heads, stand, sit.

3. Hemiparetic form. Unlike other types of cerebral palsy, this form of the disease is characterized by damage to one of the cerebral hemispheres with cortical and subcortical structures responsible for motor activity. The right or left side of the body suffers (hemiparesis of the extremities), crossed in relation to the diseased hemisphere.

4. Hyperkinetic form(up to 25% of patients). Subcortical structures are affected. It is expressed in hyperkinesis - involuntary movements, an increase in symptoms with fatigue, excitement is characteristic. This type of cerebral palsy in its pure form is relatively rare, more often in combination with spastic diplegia.

5. Atonic-astatic form occurs with damage to the cerebellum. Most of all, coordination of movements and a sense of balance suffer, muscle atony is observed.

Consequences of cerebral palsy

Characteristic features of cerebral palsy are impaired motor activity. The muscular sphere is especially affected, which worsens coordination of movements.

Depending on the degree and location of areas of brain damage, one or more types of muscle pathology may occur - muscle tension or spasticity; muscle paresis, involuntary movements; gait and mobility impairment.

Also, with all types of cerebral palsy in children, the following pathological phenomena may occur:

abnormal sensation and perception;
decreased vision, hearing;
deterioration of speech;
epilepsy;
impaired mental function.

Other problems are also possible: difficulty in eating, weakening the control of urination and bowel function, breathing problems due to violation of body position, bedsores. Training is not easy either.

In order to help the child, first you need to identify and only then develop a plan of action.

I hope you have found the answer to the question of what types of cerebral palsy exist. You can also search the Web for other common classifications of forms of cerebral palsy, and not just for Semenova.

Everyone has heard about such a disease as cerebral palsy at least once, although, perhaps, they have not encountered it. What is cerebral palsy in general terms? The concept unites a group of chronic movement disorders that occur as a result of damage to brain structures, and this happens before birth, in the prenatal period. Violations observed in paralysis can be different.

Cerebral palsy disease - what is it?

Cerebral palsy is a disease of the nervous system resulting from damage to the brain: trunk, cortex, subcortical regions, capsules. The pathology of the nervous system of cerebral palsy in newborns is not hereditary, but some genetic factors are involved in its development (in a maximum of 15% of cases). Knowing what cerebral palsy is in children, doctors are able to diagnose it in time and prevent the development of the disease in the perinatal period.

Pathology includes various disorders: paralysis and paresis, hyperkinesis, changes in muscle tone, speech and motor coordination disorders, lag in motor and mental development. Traditionally, it is customary to divide the disease of cerebral palsy into forms. The main five (plus unrefined and mixed):

Spastic diplegia- the most common type of pathology (40% of cases), in which the functions of the muscles of the upper or lower extremities are impaired, the spine and joints are deformed.
Spastic tetraplegia, partial or complete paralysis of the limbs is one of the most severe forms, expressed in excessive muscle tension. A person is unable to control his legs and arms, suffers from pain.
Hemiplegic form characterized by weakening of the muscles of only one half of the body. The arm on the affected side suffers more than the leg. The prevalence is 32%.
Dyskinetic (hyperkinetic) form sometimes found in other types of cerebral palsy. It is expressed in the appearance of involuntary movements in the arms and legs, muscles of the face and neck.
Ataxic- a form of cerebral palsy, manifested in reduced muscle tone, ataxia (inconsistency of actions). Movements are slowed down, balance is severely disturbed.

Cerebral palsy - causes

If one of the forms of cerebral palsy develops, the causes may be different. They affect the development of the fetus during pregnancy and the first month of a baby's life. Serious risk factor -. But the root cause cannot always be determined. The main processes leading to the fact that such a disease as cerebral palsy develops:

and ischemic lesions. Those areas of the brain that respond to the provision of motor mechanisms suffer from a lack of oxygen.
Violation of the development of brain structures.
with the development of hemolytic jaundice in newborns.
Pathologies of pregnancy (,). Sometimes, if cerebral palsy develops, the causes lie in the past mother's diseases: diabetes mellitus, heart defects, hypertension, etc.
viral, such as herpes.
Medical error during childbirth.
Infectious and toxic lesions of the brain in infancy.

Cerebral palsy - symptoms

When the question arises: what is cerebral palsy, pathology with impaired motor activity and speech immediately comes to mind. In fact, almost a third of children with this diagnosis develop other genetic diseases that are similar to cerebral palsy only superficially. The first signs of cerebral palsy can be detected immediately after birth. The main symptoms that appear in the first 30 days:

lack of lumbar bend and folds under the buttocks;
visible asymmetry of the body;
muscle tone or weakness;
unnatural, slow movements of the baby;
muscle twitching with partial paralysis;
loss of appetite, anxiety.

Subsequently, when the child begins to actively develop, the pathology manifests itself in the absence of the necessary reflexes and reactions. The baby does not hold the head, reacts sharply to touch and does not respond to noise, makes the same type of movements and takes unnatural postures, sucks the breast with difficulty, shows excessive irritability or lethargy. Until the age of three months, it is realistic to make a diagnosis if you carefully monitor the development of the baby.

Stages of cerebral palsy

The earlier the disease is diagnosed, the greater the chance of a complete cure. The disease does not progress, but it all depends on the degree of brain damage. The stages of cerebral palsy in children are divided into:

early, the symptoms of which appear in infants up to 3 months;
initial residual (residual), corresponding to the age from 4 months to three years, when pathological motor and speech stereotypes develop, but are not fixed;
late residual, which is characterized by a set of manifestations that are not detected at an earlier age.

The diagnosis of cerebral palsy does not always guarantee disability and failure, but it is important to start complex therapy on time. The brain of the baby has more opportunities to restore its functions. The main task of treatment in childhood is the development of all skills and abilities to the maximum. At an early stage, this includes the correction of movement disorders, gymnastics and massage, stimulation of reflexes. The efforts of doctors are aimed at stopping pathologies, they can be prescribed:

drugs to reduce;
stimulant drugs for the development of CSN;
vitamin therapy;
physiotherapy.

Can cerebral palsy be cured?

The main question that worries the parents of a sick baby: is it possible to cure cerebral palsy in a child completely? It is impossible to state this unequivocally, especially when changes have occurred in the structures of the brain, but the disease can be corrected. At the age of up to 3 years, in 60-70% of cases, it is possible to restore the normal functioning of the brain and especially motor functions. On the part of parents, it is important not to miss the first symptoms, not to ignore the manifestation of abnormalities during pregnancy and childbirth.

The main task of doctors dealing with a child with cerebral palsy is not so much to cure as to adapt the patient. The kid must realize his full potential. Treatment involves drug and other types of therapy, as well as education: the development of the emotional sphere, the improvement of hearing and speech, social adaptation. When diagnosed with cerebral palsy, treatment cannot be unambiguous. It all depends on the complexity and location of the lesion.

Massage for cerebral palsy

Understanding what cerebral palsy is and how important it is to start rehabilitation in a timely manner, the baby's parents should regularly take courses of therapeutic massage and exercise therapy with him. Daily procedures, not only when visiting a doctor, but also at home, are the key to success. Patients with cerebral palsy benefit greatly from massage: lymph flow and blood flow improve, metabolism is activated, damaged muscles are relaxed or stimulated (depending on the problem). Massage should be carried out on certain muscle groups and combined with respiratory movements. Classic relaxation technique:

Superficial and light movements of the massage therapist, stroking the skin.
Rolling the shoulder muscles and the hip joint.
Felting large muscle groups.
Rubbing, including strong, of the whole body, back, buttocks.

Features of children with cerebral palsy

It can be difficult for parents to accept the diagnosis that their child has been made, but here it is important not to give up and direct all efforts to the rehabilitation and adaptation of the baby. When receiving proper care and treatment, people with cerebral palsy feel like full members of society. But it is important to understand that each pathology manifests itself individually, this determines the nature of therapy, its duration and prognosis (positive or not). Features of the development of children with paralysis are due to the difficulties that arise when coordinating movements. This manifests itself in the following:

Slowness of movements, which forms an imbalance in the development of thinking. There are problems with the development of mathematics, as it is difficult for children to count.
Emotional disorders- increased vulnerability, impressionability, attachment to parents.
Altered working capacity of the mind. Even in cases where the intellect develops normally and only the muscles suffer, the child cannot digest all the incoming information as quickly as peers.

Caring for a child with cerebral palsy

What is important to consider and how to care for a child with cerebral palsy mentally and physically? The latter implies compliance with all the recommendations of the doctor, physical education, ensuring proper sleep, regular walks, games, bathing, classes. It is important that the child perceives daily routine activities as an additional exercise to consolidate movement patterns. Emotionally, the future of the child depends on the parents. If you show pity and excessive guardianship, the baby can withdraw into himself, striving for development.

The rules are:

Do not focus on the behaviors that are caused by the disease.
On the contrary, manifestations of activity should be encouraged.
Build the right self-esteem.
Encourage new development steps.

If cerebral palsy in newborns may not manifest itself in any way, then at a later age the differences are noticeable. It is difficult for a child to maintain a stable position lying, sitting, coordination of movements is disturbed. The support is movable and no, he can get it with the help of a special device. Rehabilitation of children with cerebral palsy (including infants) involves the use of such devices:

Wedge- a triangle made of dense material, which is placed under the baby's chest for the convenience of lying. The upper part of the body rises, it is easier for the child to control the position of the head, move arms and legs.
corner board involves fixing the position of the body on its side. Designed for children with severe disabilities.
Stender oblique is necessary for mastering the standing posture. The child is at a certain angle of inclination (it is adjustable).
Riser- similar to a stander, but designed for children who can hold the position of the torso, but are not able to stand without support.
Hanging hammocks, with which the baby is able to keep the pelvis and shoulders at the same level, the head in the midline. Stops attempts to arch the back.
Game accessories- soft rollers, inflatable balls.

Development of children with cerebral palsy

To improve the prognosis, in addition to undergoing therapy, it is necessary to practice developmental activities with children, cerebral palsy requires daily exercises: speech therapy, moving, water, etc. It is useful to play games with kids, improving tactile, auditory, visual sensations, developing concentration. Animal figurines and balls are the most affordable and useful toys. But no less than purchased products, a child is attracted by simple objects:

buttons;
fabric scraps;
paper;
dishes;
sand;
water, etc.

Cerebral palsy - forecast

If cerebral palsy is diagnosed, the prognosis for life is usually favorable. Patients can become normal parents and live to a ripe old age, although life expectancy can be reduced due to mental underdevelopment, the development of a secondary illness - epilepsy, and the lack of social adaptation in society. If you start treatment on time, you can achieve an almost complete recovery.

What is cerebral palsy? An unpleasant, but not fatal pathology with which there is a chance to live a full life. According to statistics, 2-6 out of 1000 newborns suffer from cerebral palsy and are forced to undergo lifelong rehabilitation. Development is complicated, but most patients (up to 85%) have a mild and moderate form of the disease and lead a full life. A guarantee of success: a diagnosis made in childhood and the passage of a full range of measures - medication and physiotherapy, regular homework.

Causes of cerebral palsy

Cerebral palsy is a whole group of childhood diseases with pathologies of the central nervous system, impaired coordination of speech, movement, intellectual retardation, dysfunction of the muscular and motor systems. As the analysis showed, in most cases it is impossible to single out only one cause, which entails the occurrence of cerebral palsy. Very often, a combination of several negative factors that manifest themselves both during childbirth and during pregnancy leads to such a disease.

Many researchers have evidence that brain damage begins during fetal development in about eighty percent of cases of cerebral palsy. Intrauterine pathology in the future can be aggravated by intrapartum. The cause of this disease cannot be established in about every third case. Modern medicine knows more than four hundred factors that can affect the course of intrauterine development.

The impact on the brain of a combination of harmful factors causes the appearance of cerebral pathology in approximately 70-80% of cases. In many children, the cause of the disease is the pathology of the mother's pregnancy (various infections, impaired placental circulation, toxicosis), which can lead to insufficient development of brain structures, especially those parts of it that are responsible for maintaining body balance and the formation of reflex mechanisms.

As a result, the distribution of muscle tone occurs incorrectly in the skeleton, and pathological motor reactions begin. Birth injuries caused by types of obstetric pathology (improper structure of the pelvis and narrow pelvis of the mother, rapid or prolonged labor, weakness of labor) are only in a small number of cases the only cause that leads to brain damage in the fetus.

The severity of childbirth, in most cases, is determined by the pathology already present in the child, resulting from intrauterine damage. Hemolytic disease of the newborn, also called nuclear jaundice, can also cause cerebral palsy. This jaundice can be caused by various mechanisms - liver failure of the newborn, incompatibility of the blood of the fetus and mother according to the Rh factor or group.

In addition, chronic or acute diseases in the mother are an extremely unfavorable factor - first of all, they include rubella, diabetes mellitus, obesity, anemia, heart defects, and hypertension. Also, perinatal risk factors include the use of certain drugs during pregnancy, such as tranquilizers, and some activities related to professional activities - physical injuries, psychological discomfort, alcoholism.

The influence of various infectious agents on the fetus, especially of viral origin, has recently been given considerable importance in the etiology of cerebral palsy. Violation of the normal course of pregnancy - immunological incompatibility of the fetus and mother, threats of interruption, toxicosis - are also negative factors. Complication in childbirth. In this case, it should be borne in mind that if a child has a pathology of intrauterine development, then childbirth often has a protracted and severe course.

This creates conditions for the appearance of asphyxia and mechanical trauma to the head, which can be attributed to secondary factors that cause additional discord in the primary damaged brain. But many researchers attribute premature birth to the factors most conducive to the development of cerebral palsy. It is worth noting that cerebral palsy predominantly affects males. On average, in boys, cerebral palsy occurs 1.3 times more often and is more severe than in girls.

Forms of cerebral palsy

The classification of cerebral palsy is based on the nature and prevalence of movement disorders. There are five types of such violations:

1. Spasticity - an increase in muscle tone (its severity decreases with repeated movements).

2. Athetosis is a constant involuntary movement.

3. Rigidity - tense, tight muscles, constantly resisting passive movements.

4. Ataxia - imbalance, accompanied by frequent falls.

5. Tremor or trembling of the limbs.

In about 85% of cases, an athetoid or spastic type of disorder is observed. According to localization, four forms are distinguished:

1. Monoplegic (one limb is involved).

2. Hemiplegic (complete or partial involvement of both limbs on only one side of the body).

3. Diplegic (involving either both lower or both upper limbs).

4. Quadriplegic (full or partial involvement of all four limbs).

Symptoms of cerebral palsy

Symptoms of this disease can be detected immediately after the birth of a child, and may gradually appear in infancy. In the latter case, it is very important to identify and diagnose them as soon as possible. Doctors advise all parents to keep a special diary of the development of the child, where the main achievements of the baby will be indicated. It is very important for parents to monitor the manifestation of absolute reflexes that arise in a child after birth, and then gradually fade away.

For example, the reflex of automatic walking and the palmar-mouth reflex should disappear in 1-2 months, but if they persist for up to 4-6 months, then dysfunction of the nervous system can be suspected. In addition, it is very important to follow: the sequence and timing of speech development and the development of motor skills, the development of playing skills (for example, a lack of interest in toys). The following situations should also be noted: lack of contact with the mother, head nodding, involuntary movements, freezing in one position.

Pediatricians are not in all cases in a hurry with the diagnosis of cerebral palsy. In many cases, based on the detected specific symptoms (inhibition of reflexes, increased excitability, and so on), a child under one year of age is diagnosed with encephalopathy. The child's brain has great compensatory capabilities that can completely eliminate the consequences of brain damage.

If a child older than a year does not speak, does not walk, does not sit, has mental disabilities, and doctors confirm the stability of neurological symptoms, then cerebral palsy is diagnosed. Movement disorders (tremor of the extremities, ataxia, rigidity, athetosis, spasticity) are the main symptoms of cerebral palsy.

In addition, there may be hearing and vision disorders, changes in orientation in space, perception, epilepsy, speech development disorders, learning problems, delayed emotional and mental development, functional disorders of the urinary system and the gastrointestinal tract. If you notice the above symptoms, you should immediately contact a specialist.

Signs of cerebral palsy

In a newborn, the signs of cerebral palsy are influenced by the location of pathological foci and the degree of brain damage. These signs can be both quite obvious and noticeable only to specialists. External manifestations can be indicated in the form of clumsiness, or as a strong muscle tension, depriving the child of the ability to move independently.

In an infant or older child, early signs of cerebral palsy can be identified by looking at the skill table for certain ages - walking and crawling, sitting, turning over, grasping, tracking movements. The following are some external symptoms that make it possible to suspect the disease of cerebral palsy (only a qualified specialist can make a final diagnosis):

Anxiety and poor sleep in a child;

Lagging behind the child in physical development (began to crawl late, raise his head, roll over);

· There are pauses of sight, shuddering;

· Violations of muscle tone: by 1.5 months, the hypertonicity of the hands does not weaken, and by four months - of the legs. The child's muscles are excessively sluggish or, conversely, tight, movements are slow or abrupt;

There is a slowdown in emotional development (in one month the child does not smile);

bodily asymmetry. For example, one arm is relaxed and the other is tense. Or a visual difference in the limbs, for example, in the thickness of the arms or legs.

If such signs are detected, you should seek qualified medical advice.

Diagnosis of cerebral palsy

It is possible that the symptoms of cerebral palsy are not detected or are not present at birth. Therefore, the attending physician observing the newborn should carefully examine the child so as not to miss these symptoms. Nevertheless, it is not worth overdiagnosing cerebral palsy, since many motor disorders in children at this age are transient. In many cases, the final diagnosis can be made a couple of years after birth, when it is possible to notice movement disorders.

Diagnosis of this disease is based on monitoring the presence of deviations in the intellectual and physical development of the child, these tests, as well as instrumental research methods (in this case, magnetic resonance imaging - MRI is performed). It includes:

Collecting all information about the baby's medical history, including details about the pregnancy. The presence of various delays in the development of the child is often reported by the parents themselves or it is found during the examination in child care facilities.

· To detect signs of cerebral palsy, a physical examination is essential. During it, a qualified specialist evaluates how long the reflexes of newborns persist in the child in comparison with normal periods. In addition, an assessment of the function of muscles, the function of hearing, posture, and vision is carried out.

Samples to detect latent form of the disease. The degree of developmental delay will help determine the various tests and questionnaires for development.

An MRI may also be ordered to identify a brain disorder.

The complex of such diagnostic methods allows you to make a final diagnosis. If the diagnosis is not clear, additional tests may be ordered to exclude possible other diseases and to assess the condition of the brain.
They include: ultrasound examination of the brain, computed tomography of the head, additional questioning. After diagnosing cerebral palsy to identify other diseases that may be at the same time with cerebral palsy, the child is given an additional examination.

Treatment of cerebral palsy

First of all, the treatment of cerebral palsy is carried out with the help of training mental and physical functions, which can reduce the severity of a neurological defect. Occupational therapy and physical therapy help improve muscle function. Hearing correction and speech therapy assistance help the development of the patient's speech. Various orthopedic devices and braces make it easier to maintain balance and walk.

Long-term therapy should include education in special programs, development of communication skills, psychological counseling. Treatment of cerebral palsy also includes special massage courses and a complex of physiotherapy exercises. On the recommendation of doctors, drugs are used to reduce muscle tone and drugs that improve the nutrition of the nervous tissue and microcirculation. The sooner a course of treatment and rehabilitation programs for cerebral palsy is started, the better.

Thanks to this, large deviations in the development of the child can be avoided. All treatment and medicines should be prescribed only by qualified specialists.

Teaching parents to restore muscle movement:

A profoundly premature baby. Full restoration of Bogdan:

Education: In 2005, she completed an internship at the First Moscow State Medical University named after I.M. Sechenov and received a diploma in Neurology. In 2009, she completed her postgraduate studies in the specialty "Nervous Diseases".