Features of the structure of the musculoskeletal system in children. Hip dysplasia

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Introduction
1. Anatomical and physiological features of the structure of the musculoskeletal system in children
2. Chemical composition of bone. Ossification
3. Muscles, their shape, classification and properties
4. Posture. Signs of correct posture. Poor posture. Prevention of poor posture
Conclusion
List of used literature

Introduction

The organs of movement are unified system, where every part and organ is formed and functions in constant interaction with each other. The elements included in the movement organ system are divided into two main categories: passive (bones, ligaments and joints) and active elements of the movement organs (muscles).

The size and shape of the human body is largely determined by the structural basis - the skeleton. The skeleton provides support and protection for the entire body and individual organs. The skeleton contains a system of movably articulated levers, driven by muscles, due to which various movements of the body and its parts are made in space. Individual parts of the skeleton serve not only as a container for vital important organs, but also provide their protection. For example, the skull, chest and pelvis serve as protection for the brain, lungs, heart, intestines, etc.

Until recently, the prevailing opinion was that the role of the skeleton in the human body is limited to the function of supporting the body and participation in movement (this was the reason for the appearance of the term “musculoskeletal system”). Thanks to modern research, the understanding of the functions of the skeleton has expanded significantly. For example, the skeleton is actively involved in metabolism, namely in maintaining the mineral composition of the blood at a certain level.

The purpose of the work is to study the characteristics of the musculoskeletal system in children.

· Study the chemical composition of bones;

· Consider the properties and types of muscles;

· Analyze the need for correct posture in children.

1. Anatomical and physiological features of the structure of the musculoskeletal system in children

During prenatal development in children, the skeleton consists of cartilage tissue. Ossification points appear after 7-8 weeks. The newborn has ossified diaphysis of the tubular bones. After birth, the ossification process continues. The timing of the appearance of ossification points and the end of ossification varies for different bones. Moreover, for each bone they are relatively constant; from them one can judge normal development skeleton in children and their age.

The skeleton of a child differs from the skeleton of an adult in its size, proportions, structure and chemical composition. Skeletal development in children determines the development of the body (for example, muscles develop more slowly than the skeleton grows).

There are two ways of bone development.

1. Primary ossification, when bones develop directly from the embryonic connective tissue- mesenchyme (bones of the calvarium, facial part, partly the collarbone, etc.). First, a skeletogenic mesenchymal syncytium is formed. It contains cells - osteoblasts, which turn into bone cells - osteocytes, and fibrils, impregnated with calcium salts and turning into bone plates. Thus, bone develops from connective tissue.

2. Secondary ossification, when bones are initially laid down in the form of dense mesenchymal formations, having the approximate outlines of future bones, then turn into cartilaginous tissue and are replaced by bone tissue (bones of the base of the skull, torso and limbs).

With secondary ossification, development bone tissue replacement occurs both outside and inside. Externally, the formation of bone substance occurs by osteoblasts of the periosteum. Internally, ossification begins with the formation of ossification nuclei, and gradually the cartilage is resorbed and replaced by bone. As the bone grows, it is absorbed from the inside by special cells - osteoclasts. Bone growth occurs from the outside. Bone growth in length occurs due to the formation of bone substance in the cartilage located between the epiphysis and diaphysis. These cartilages gradually shift towards the epiphysis Galperin S.I. Human anatomy and physiology. M.: Higher School, 2004. P. 93..

Many bones in human body are not laid as a whole, but in separate parts, which then merge into a single bone. For example, the pelvic bone first consists of three parts, merging together by the age of 14-16 years. Tubular bones are also formed in three main parts (the ossification nuclei in the places where bony protrusions are formed are not taken into account). For example, tibia in the embryo it initially consists of solid hyaline cartilage. Ossification begins in the middle part at approximately the eighth week of intrauterine life. Replacement of the diaphysis with bone occurs gradually and occurs first from the outside and then from the inside. In this case, the epiphyses remain cartilaginous. The ossification nucleus in the upper epiphysis appears after birth, and in the lower epiphysis - in the second year of life. In the middle part of the epiphyses, the bone first grows from the inside, then from the outside, as a result of which two layers of epiphyseal cartilage remain separating the diaphysis from the epiphyses.

In the upper epiphysis femur The formation of bone beams occurs at the age of 4-5 years. After 7-8 years they lengthen and become uniform and compact. The thickness of the epiphyseal cartilage reaches 2-2.5 mm by the age of 17-18 years. By the age of 24, the growth of the upper end of the bone ends and the upper epiphysis fuses with the diaphysis. The lower epiphysis grows to the diaphysis even earlier - by the age of 22. With the end of ossification of the tubular bones, their growth in length stops.

2. Chemical composition of bone. Ossification

Chemical composition of bone. Dried and defatted bone has the following composition: organic matter - 30%; minerals - 60%; water - 10%.

The organic substances of bone include fibrous protein (collagen), carbohydrates and many enzymes.

Bone minerals are represented by salts of calcium, phosphorus, magnesium and many trace elements (such as aluminum, fluorine, manganese, lead, strontium, uranium, cobalt, iron, molybdenum, etc.). The adult human skeleton contains about 1200 g of calcium, 530 g of phosphorus, 11 g of magnesium, i.e. 99% of all calcium present in the human body is contained in the bones.

In children, organic substances predominate in the bone tissue, so their skeleton is more flexible, elastic, and easily deformed under prolonged and heavy loads or incorrect body positions. The amount of minerals in bones increases with age, causing bones to become more fragile and more likely to break.

Organic and mineral substances make bone strong, hard and elastic. The strength of the bone is also ensured by its structure, the location of the bone crossbars of the spongy substance according to the direction of the pressure and tensile forces.

Bone is 30 times harder than brick, granite - 2.5 times. Bone is stronger than oak. It is nine times stronger than lead and almost as strong as cast iron. In an upright position, the human femur can withstand load pressure of up to 1500 kg, and the tibia - up to 1800 kg.

The process of ossification. General ossification of the tubular bones is completed by the end of puberty: in women - by 17-21 years, in men - by 19-24 years. Because men reach puberty later than women, they are taller on average.

From five months to one and a half years, i.e., when the child stands on his feet, the main development of the lamellar bone occurs. By 2.5-3 years, the remains of coarse fibrous tissue are no longer present, although during the second year of life most of the bone tissue has a lamellar structure.

Reduced function of the endocrine glands (anterior part of the adenohypophysis, thyroid, parathyroid, thymus, sex) and a lack of vitamins (especially vitamin D) can cause delayed ossification. Acceleration of ossification occurs with premature puberty, increased function of the anterior part of the adenohypophysis, thyroid gland and adrenal cortex. Delay and acceleration of ossification most often appear before the age of 17-18, and the difference between “bone” and passport age can reach 5-10 years. Sometimes ossification occurs faster or slower on one side of the body than on the other.

As we age, the chemical composition of our bones changes. Children's bones contain more organic matter and less inorganic. As it grows, the amount of calcium salts, phosphorus, magnesium and other elements increases significantly, and the ratio between them changes. Thus, in young children, calcium is retained most in the bones, but as they grow older, a shift to the side occurs. longer delay phosphorus. Inorganic substances in the bones of a newborn make up one-second of the weight of the bone, in an adult - four-fifths Matyushonok M.T., Turin G.G., Kryukova A.A. Physiology and hygiene of children and adolescents. M.: Higher School, 2004. P. 156..

Change of structure and chemical composition changes in bones also entail a change in their physical properties. Children's bones are more elastic and less brittle than adults'. Cartilage in children is also more flexible.

Age-related differences in the structure and composition of bones are especially clearly manifested in the number, location and structure of the Haversian canals. With age, their number decreases, and their location and structure change. The older the child, the more dense substance there is in his bones; young children have more spongy substance. By the age of 7, the structure of the tubular bones is similar to that of an adult, however, between 10-12 years, the spongy substance of the bones changes even more intensively, its structure stabilizes by 18-20 years.

The younger the child, the more the periosteum is fused to the bone. The final differentiation between bone and periosteum occurs by the age of 7 years. By the age of 12, the dense substance of the bone has an almost uniform structure; by the age of 15, single areas of resorption of the dense substance completely disappear, and by the age of 17, large osteocytes predominate in it.

From 7 to 10 years, the growth of the bone marrow cavity in the tubular bones slows down sharply, and it is finally formed from 11-12 to 18 years. The enlargement of the medullary canal occurs in parallel with the uniform growth of the dense substance.

Between the plates of the spongy substance and in the medullary canal there is bone marrow. Due to the large number blood vessels in the tissues of newborns there is only red bone marrow - hematopoiesis occurs in it. Starts at six months gradual process replacement of red bone marrow in the diaphysis of tubular bones with yellow bone marrow, consisting mostly of fat cells. Replacement of the red brain ends by 12-15 years. In adults, red bone marrow is stored in the epiphyses of long bones, in the sternum, ribs and spine and amounts to approximately 1500 cubic meters. cm.

The healing of fractures and the formation of callus in children occurs after 21-25 days; in infants this process occurs even faster. Dislocations in children under 10 years of age are rare due to the high extensibility of the ligamentous apparatus.

3. Muscles, their shape, classification and properties

General information about muscles. IN human body there are about 600 skeletal muscles. The muscular system makes up a significant part total mass human body. So, at the age of 17-18 years it is 43-44%, and in people with good physical fitness it can even reach 50%. In newborns, the mass of all muscles is only 23% of body weight.

The growth and development of individual muscle groups occurs unevenly. First of all, infants develop the abdominal muscles, and a little later - the chewing muscles. The muscles of a child, unlike the muscles of an adult, are paler, softer and more elastic. By the end of the first year of life, the muscles of the back and limbs noticeably increase, at which time the child begins to walk.

During the period from birth to the end of the child’s growth, muscle mass increases 35 times. At 12-16 years of age (puberty), due to the lengthening of the tubular bones, the muscle tendons also intensively lengthen. During this time, the muscles become long and thin, making teenagers appear long-legged and long-armed. At 15-18 years of age, transverse muscle growth occurs. Their development continues until 25-30 years.

Muscle structure. The muscle is divided into a middle part - the belly, consisting of muscle tissue, and the end sections - tendons, formed by dense connective tissue. Tendons attach muscles to bones, but this is not necessary. Muscles can also attach to various organs (the eyeball), to the skin (muscles of the face and neck), etc. In the muscles of a newborn, the tendons are rather poorly developed, and only by the age of 12-14 are muscle-tendon relationships established, which are characteristic of muscles adult. The muscles of all higher animals are the most important working organs - effectors.

Muscles are smooth and striated. In the human body, smooth muscles are found in internal organs, blood vessels and skin. They have little control over the central nervous system, which is why they (and the heart muscle) are sometimes called involuntary. These muscles have automaticity and their own nervous network (intramural or metasympathetic), which largely ensures their autonomy. Regulation of the tone and motor activity of smooth muscles is carried out by impulses arriving through the autonomic nervous system and humorally (i.e. through tissue fluid). Smooth muscles are capable of fairly slow movements and prolonged tonic contractions. The motor activity of smooth muscles is often rhythmic, such as pendulum-like and peristaltic movements of the intestines. Prolonged tonic contractions of smooth muscles are very clearly expressed in the sphincters of the hollow organs, which prevents the release of contents. This ensures that urine accumulates in bladder and bile in gallbladder, decor feces in the colon, etc.

The smooth muscles of the walls of blood vessels, especially arteries and arterioles, are in a state of constant tonic contraction. The tone of the muscular layer of the artery walls regulates the size of their lumen and thereby the level blood pressure and blood supply to organs.

Striated muscles consist of many individual muscle fibers, which are located in a common connective tissue sheath and are attached to tendons, which, in turn, are connected to the skeleton. Striated muscles are divided into two types: a) parallel-fiber (all fibers are parallel to the long axis of the muscle); b) pinnate (the fibers are located obliquely, attached on one side to the central tendon cord, and on the other to the outer tendon sheath).

The strength of a muscle is proportional to the number of fibers, i.e., the area of the so-called physiological cross-section of the muscle, the surface area crossing all active muscle fibers. Each skeletal muscle fiber is a thin (diameter from 10 to 100 microns), long (up to 2-3 cm) multinuclear formation - symplast - arising in early ontogenesis from the fusion of myoblast cells.

The main feature of a muscle fiber is the presence in its protoplasm (sarcoplasm) of a mass of thin (about 1 micron in diameter) filaments - myofibrils, which are located along the longitudinal axis of the fiber. Myofibrils consist of alternating light and dark areas - disks. Moreover, in the mass of neighboring myofibrils in striated fibers, the discs of the same name are located at the same level, which gives regular transverse striations (striations) to the entire muscle fiber.

A complex of one dark disk and two adjacent halves of light disks, delimited by thin Z-lines, is called a sarcomere. Sarcomeres are the minimum element of the contractile apparatus of muscle fiber Matyushonok M.T., Turin G.G., Kryukova A.A. Physiology and hygiene of children and adolescents. M.: Higher School, 2004. P. 73..

The muscle fiber membrane - the plasmalemma - has a similar structure to the nerve membrane. Its distinctive feature is that it produces regular T-shaped invaginations (tubes with a diameter of 50 nm) approximately at the boundaries of the sarcomeres. Invaginations of the plasmalemma increase its area and, consequently, the total electrical capacitance.

Inside the muscle fiber, between the bundles of myofibrils, parallel to the longitudinal axis of the symplast, there are systems of tubules of the sarcoplasmic reticulum, which is a branched closed system, closely adjacent to the myofibrils and with its blind ends (terminal cisterns) to the T-shaped invaginations of the plasmalemma (T-system). The T-system and the sarcoplasmic reticulum are devices for transmitting excitation signals from the plasmalemma to the contractile apparatus of myofibrils.

Outside, the entire muscle is enclosed in a thin connective tissue sheath - fascia.

Contractility as the main property of muscles. Excitability, conductivity and contractility are the main physiological properties of muscles. Muscle contractility consists of shortening the muscle or developing tension. During the experiment, the muscle responds with a single contraction in response to a single stimulus. In humans and animals, muscles from the central nervous system receive not single impulses, but a series of impulses, to which they respond with a strong, prolonged contraction. This muscle contraction is called tetanic (or tetanus).

When muscles contract, they do work that depends on their strength. The thicker the muscle, the more muscle fibers it contains, the stronger it is. Muscle when converted to 1 sq. cm cross section can lift a load of up to 10 kg. The strength of muscles also depends on the characteristics of their attachment to bones. Bones and the muscles attached to them are like levers. The strength of the muscle depends on how far from the fulcrum of the lever and closer to the point of application of gravity it is attached Galperin S.I. Human anatomy and physiology. M.: Higher School, 2004. P. 53..

A person is able to maintain the same posture for a long time. This is called static muscle tension. For example, when a person simply stands or holds his head in an upright position (i.e., makes so-called static efforts), his muscles are in a state of tension. Some exercises on rings, parallel bars, and holding a raised barbell require such static work that requires simultaneous contraction of almost all muscle fibers. Of course, this state cannot last long due to developing fatigue.

During dynamic work, various muscle groups contract. At the same time, the muscles performing dynamic work contract quickly, work with great tension and therefore soon get tired. Typically, during dynamic work, different groups of muscle fibers contract alternately. This gives the muscle the opportunity to perform work for a long time.

By controlling the work of muscles, the nervous system adapts their work to the current needs of the body; therefore, the muscles work economically, with a high efficiency. The work will become maximum, and fatigue will develop gradually, if for each type of muscle activity you select the average (optimal) rhythm and load value.

The work of muscles is a necessary condition for their existence. If muscles are inactive for a long time, muscle atrophy develops and they lose their performance. Training, i.e. constant, fairly intense work of muscles, helps to increase their volume, increase strength and performance, and this is important for the physical development of the body as a whole.

Muscle tone. In humans, muscles are somewhat contracted even at rest. A condition in which tension is maintained for a long time is called muscle tone. Muscle tone may decrease slightly and the body may relax during sleep or anesthesia. Complete disappearance of muscle tone occurs only after death. Tonic muscle contraction does not cause fatigue. The internal organs are held in their normal position only due to muscle tone. The amount of muscle tone depends on the functional state of the central nervous system.

The tone of skeletal muscles is directly determined by the arrival of nerve impulses from motor neurons of the spinal cord to the muscle with a large interval. The activity of neurons is supported by impulses coming from the overlying parts of the central nervous system, from receptors (proprioceptors) that are located in the muscles themselves. The role of muscle tone in ensuring coordination of movements is great. In newborns, the tone of the arm flexors predominates; in children 1-2 months old - the tone of the extensor muscles, in children 3-5 months old - the balance of the tone of the antagonist muscles. This circumstance is associated with increased excitability of the red nuclei of the midbrain. As the pyramidal system, as well as the cortex, functionally matures cerebral hemispheres brain muscle tone decreases.

The increased muscle tone of a newborn's legs gradually decreases (this occurs in the second half of the child's life), which is a necessary prerequisite for the development of walking.

Fatigue. During prolonged or strenuous work, muscle performance decreases, which is restored after rest. This phenomenon is called physical fatigue. With pronounced fatigue, prolonged shortening of the muscles and their inability to completely relax (contracture) develop. This is primarily due to changes that occur in the nervous system, disruption of the conduction of nerve impulses at synapses. When tired, reserves chemical substances, which serve as sources of contraction energy, are depleted, and metabolic products (lactic acid, etc.) accumulate.

The rate of onset of fatigue depends on the state of the nervous system, the frequency of the rhythm in which the work is performed, and the magnitude of the load. Fatigue may be associated with an unfavorable environment. Uninteresting work quickly causes fatigue.

The younger the child, the faster he gets tired. IN infancy Fatigue sets in after 1.5-2 hours of wakefulness. Immobility and prolonged inhibition of movements tire children.

posture supporting motor child

4. Posture. Signs of correct posture. Poor posture. Prevention of poor posture

The importance of posture for the formation of general health is proven by the high prevalence of diseases of the cardiovascular and respiratory systems among schoolchildren with poor posture.

Not only the appearance of people, but also their health depends on the ability to hold their body correctly. Poor posture adversely affects the physical development of the body, especially the functions of the musculoskeletal system, cardiovascular, respiratory and nervous systems. With normal posture, favorable conditions are created for the functioning of internal organs.

Posture is of great aesthetic importance. Millions of spectators watch with admiration the participants in competitions in rhythmic and artistic gymnastics, acrobatics, and figure skating, admiring the slender, harmoniously developed athletes with good posture.

Posture is the habitual, involuntary posture of a person at rest and during movement. Its basis is the spine. The nature of posture depends on the curves of the spine and chest, the relative position of the head, shoulder girdle, arms, torso, pelvis and legs Craze R. To health through natural posture. M.: 2009. P. 26..

It is formed in the process of human growth and development and changes depending on living conditions, study, work, and physical exercise. Therefore, it is very important from the day a child is born to take care of the formation of correct posture and his physical development.

In a person with correct posture, the chest protrudes forward, the shoulders are slightly pulled back, the stomach is tucked, the head is raised, the knees are straight, and the arms are lowered. He behaves freely, at ease, but not relaxed either.

Posture depends on the shape and flexibility of the spine, the angle of the pelvis, the position of the head, the shoulder girdle, the condition of the muscles, ligaments, nervous system, vision, etc. A person with a depressed mood lowers his head, puts his shoulders forward, a myopic person slouches, a healthy happy person holds his head straight and proud, straightens his shoulders. Professor E.A. very successfully spoke about the psychological significance of posture. Arkin: “By straightening his back, a child, to a certain extent, straightens his soul.”

According to the new concept, the internal cause of poor posture and scoliosis in children is the lack of stability in their overall center of gravity of the body. In this case, posture plays the role of a system that ensures the balance of the body in space.

At home, children need to create all the conditions for proper physical development and eliminate everything that could cause poor posture. It is important to systematically monitor the correct position of children during classes, rest and exercise. Parents should remind children that when standing, they distribute the weight of the body evenly on both legs, keep their head and torso straight, do not hunch over, do not stand with their heads tilted forward or their stomachs sticking out.

It is necessary to systematically monitor your posture while walking. Girls should walk easily, gracefully and gracefully. They should be reminded that while walking they keep their shoulders at the same level and slightly pull them back, the lower corners of the shoulder blades are slightly brought together, and the abdominal muscles are tightened. A walking girl should look relaxed, but also not tense. When walking, you should not bend your torso forward or sway to the sides. Correct posture is developed through training.

When postural defects appear, not only a person’s appearance changes (clumsy gait, asymmetrical position of the shoulder and pelvic girdle), but also serious deviations from the norm occur. Thus, changes in the chest (chicken and flat chest), lumbar curve, protrusion of the abdomen, shortening pectoral muscles and other defects in posture impede the functioning of internal organs, affect the mental and physical development of children, and lead to a decrease in their performance. Timely identification of bad habits that give rise to unfavorable changes will prevent the occurrence of changes in the musculoskeletal system. Comprehensive physical development prevents poor posture.

Possible posture defects:

1. Round posture is characterized by an increase in the curvature of the thoracic vertebrae, a smoothing of the cervical and lumbar lordosis. The muscles of the back and abdomen are weak and stretched.

The chest is underdeveloped, sunken, the shoulders hang forward, the shoulder blades protrude. The functions of the respiratory and cardiac organs are difficult.

2. With a stooped posture, the bend is pronounced thoracic spine. The chest is sunken, the shoulder blades lag behind, the shoulders protrude forward, the head is tilted forward.

3. Lordotic posture is characterized by an increase in lumbar curve. The angle of the pelvis increases, the stomach protrudes forward.

4. With a round-concave back, the curves in the thoracic and lumbar spine are increased. The pelvic tilt angle is increased. The buttocks are sharply protruded back, the stomach is forward, the chest is sunken, the waist is somewhat shortened.

5. With a flat back, all the curves of the spine are underdeveloped, the angle of the pelvis is reduced, the stomach is retracted, and the buttocks are excessively protruded back. The anterior-posterior size of the chest is reduced, and the transverse size is increased. The child holds himself tensely, pointedly straight, and his movements are clumsy.

6. An oblique back (asymmetrical posture) occurs when the shoulder girdle and pelvis are asymmetrically positioned, the legs are of different lengths, or the pelvis is oblique. If measures are not taken to correct posture, changes in the intervertebral discs and bone tissue may occur, characteristic of a very serious disease - scoliosis.

The main role in the formation of posture is played by the uniform development of muscles and the correct distribution of muscle traction. Usually the cause of poor posture is poor development of the muscles of the back (which cannot hold the spine in a straight position for a long time) and the abdomen. Therefore, at school age, their development must be given great importance. Children whose back muscles are not prepared for long periods of sitting at a desk and at a table, due to fatigue, change their position, find the most comfortable position, which is gradually fixed and turns into the usual Galperin S.I. Human anatomy and physiology. M.: Higher School, 2004. P. 67..

Poor posture also occurs as a result of deviations in health caused by various infectious diseases, the development of strabismus, etc.

Schoolchildren spend a lot of time sitting, and often sit incorrectly: they hunch over, bow their heads low, and hold their shoulders unevenly. This bad habit has a very detrimental effect on your posture.

While reading, you need to sit comfortably, resting your back against the back of the chair, place your hands on the table symmetrically, without tension, keep your shoulders at the same level, tilt your head slightly forward; The table should be 2-3 cm above the elbow of the arm, bent at a right angle. The distance from the notebook to the eyes is 35 cm, with the lower left corner of the notebook near the middle of the chest.

An important reason contributing to the occurrence of postural defects in schoolchildren is also a violation of diet, sleep, and insufficient exposure to fresh air.

The sooner postural defects are identified and the causes are eliminated, causing deviations(inappropriate furniture for activities, carrying a load in one hand, violation of diet, sleep, rest, etc.), the easier it is to correct them.

When starting the method of educating posture, it is important to know which sitting position is considered correct. One that provides a stable position for the child's body. It can be achieved provided that the body has at least three points of support:

1) chair seat,

2) the back of the chair,

3) floor or footrest.

First, the suitability of the stool for the child is determined. To do this, you should pay attention to the angle in the knee joint: when sitting, it should be equal to a straight line.

To determine the height of the table, you need to sit the student opposite him, place his arm, bent at the elbow, on the edge of the table and ask the student to bring the fingers of the unfolded hand to the outer corner of the eye. If the forearm placed in this way is freely placed between the edge of the table and the child’s eyes, then the table corresponds to his height. If the hand is placed above eye level, the table is high, below it, the table is low.

When using furniture that is smaller in size than the height of students, wooden blocks are placed under tables and chairs.

Monitoring whether furniture matches the height of children should be carried out at school at least 2 times per school year.

At the same time, it should be recognized that the recommendations presented are forcedly adapted to the low scale of possible material costs, which most people resort to in practice. modern schools. According to sanitary standards and rules, each educational institution must be equipped with five sizes of school furniture (for student heights from 115 cm to more than 175 cm), taking into account the need for each height size.

The second thing that needs attention in the prevention of postural disorders is monitoring the posture of students during classes. The correct posture during classes depends not only on the suitability of the furniture for the student’s height, but also on the location of the chair relative to the table top. To maintain the correct posture, it is necessary that the edge of the seat be pushed under the table cover by 3-6 cm. When the chair is deeper under the table, the edge of the table begins to put pressure on the student’s chest. If the chair is completely pushed under the table, then in order to maintain balance while working, the student is forced to lie down on the desk. To avoid both, you need to show the student how to self-regulate his position relative to the edge of the table by very simple trick: periodically place a fist between the sternum and the edge of the table Craze R. Towards health through natural posture. M.: 2009. P. 67..

Particular attention should be paid to the position of the shoulders during work. They must be straight. Compliance with this requirement is facilitated if the level of the table surface is located 3-4 cm above the elbow of the seated arm.

But no matter how strict the teacher’s requirements are for younger schoolchildren to observe the correct working posture during lessons, they should know that children are not able to hold such a posture for a long time. And they will undoubtedly be supported in this by holding physical education lessons in the classroom.

Conclusion

Famous teacher and anatomist P.F. Lesgaft put forward a position on the relationship between the physical and mental development of children: physical education is carried out by influencing the psyche of children, which, in turn, affects the development of the psyche. In other words, physical development determines mental development. This is especially clearly detected in congenital underdevelopment of the cerebral hemispheres, which manifests itself in dementia. Children who have such a defect from birth cannot be taught to speak and walk; they lack normal sensations and thinking. Or another example: after removal of the gonads and with insufficient function of the thyroid gland, mental retardation.

Determined that mental performance increases after physical education lessons, a small set of physical exercises in general education lessons and before preparing homework.

List of used literature

1. Buts L.M. About the formation of correct posture. M.: 2008.

2. Galperin S.I. Human anatomy and physiology. M.: Higher School, 2004.

3. Kositsky G.I. Human physiology. M.: Medicine, 2005.

4. Craze R. To health through natural posture. M.: 2009.

5. Lokatskov. P.I. Age physiology. M.: 2005.

6. Small medical encyclopedia: In 6 volumes. T. 6. M.: Medicine, 1991-2006.

7. Matyushonok M.T., Turin G.G., Kryukova A.A. Physiology and hygiene of children and adolescents. M.: Higher School, 2004.

8. Nozdrachev A.D. General course of human and animal physiology: In 2 volumes. T. 2. M.: Higher school, 2001.

9. Nordemar R. Back pain. M.: 2001.

10. Khripkova A.A. Age physiology. M.: Education, 2008.

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1. Development, age-related bone characteristics

Bone development occurs in two ways: from connective tissue; from cartilage.

The bones of the vault and lateral parts of the skull, the lower jaw and, according to some, the clavicle (and in lower vertebrates, some others) develop from connective tissue - these are the so-called integumentary or enclosing bones. They develop directly from connective tissue; its fibers thicken somewhat, bone cells appear between them, and lime salts are deposited in the spaces between them. Islands of bone tissue are first formed, which then merge with each other. Most skeletal bones develop from a cartilaginous base that has the same shape as the future bone. Cartilage tissue undergoes a process of destruction, absorption, and instead of it, bone tissue is formed, with the active participation of a special layer of educational cells (osteoblasts). This process can occur both from the surface of the cartilage, from the shell that covers it, the perichondrium, which then turns into the periosteum, and inside it. Usually, the development of bone tissue begins at several points; in tubular bones, the epiphyses and diaphysis have separate points of ossification.

Everyone, of course, knows that the age of a tree can be easily determined by the annual rings of its trunk. But not everyone knows that the condition of the bone in medical practice can determine a person’s age. Not so long ago, bone was generally considered an inert, frozen substance with purely mechanical functions. But electron microscopy, X-ray diffraction analysis, microradiography and other modern research methods have shown that bone tissue is dynamic, it has the ability to constantly renew itself, and throughout a person’s life, the quantitative and qualitative relationship between organic and inorganic substances changes in it. Moreover, each period of life is characterized by its own relationships (from which, in particular, age is determined).

In a one-year-old child, organic substances predominate over inorganic substances in the bone tissue, which largely determines the softness and elasticity of his bones. After all, it is organic substances and even water that provide bones with extensibility and elasticity. As a person ages, the percentage of inorganic substances in the bone tissue increases and the growing bones become increasingly hard. Bones grow in length due to epiphyseal cartilages located between the body of the bone and its head. When growth ends, and this happens around the age of 20-25, the cartilage is completely replaced by bone tissue. Bone growth in thickness occurs through the application of new masses of bone substance from the periosteum.

But the completion of the formation of the skeleton does not mean that the bone structures have acquired their final, frozen form. Interconnected processes of creation and destruction continue to occur in bone tissue.

When a person crosses the forty-year mark, so-called involutive processes begin in bone tissue, that is, the destruction of osteons occurs more intensely than their creation. These processes can subsequently lead to the development of osteoporosis, in which the bone crossbars of the spongy substance become thinner, some of them are completely resorbed, the interbeam spaces expand, and as a result, the amount of bone substance decreases and bone density decreases.

With age, not only does there become less bone matter, but the percentage of organic matter in bone tissue decreases. And, in addition, the water content in the bone tissue decreases, it seems to dry out. Bones become brittle, brittle, and even with normal physical activity, cracks may appear in them.

The bones of an elderly person are characterized by marginal bone growths. They are caused by age-related changes that the cartilage tissue that covers the articular surfaces of the bones undergoes, as well as the basis of the intervertebral discs. With age, the interstitial layer of cartilage becomes thinner, which adversely affects the function of the joints. As if trying to compensate for these changes, to increase the area of support of the articular surfaces, the bone grows.

Normally, age-related changes in bones develop very slowly, gradually. Signs of osteoporosis usually become apparent after age 60. However, it is often necessary to observe people in whom at the age of 70-75 they are only slightly expressed. But it also happens: according to the state of the skeletal system, a person could be given all sixty, but he is only forty-five. Such premature aging of the skeletal system, as a rule, occurs in people who lead a sedentary lifestyle and neglect physical education and sports.

But bones, no less than muscles, need physical training, under load. Movement is the most important condition for the normal functioning of the body in general and the musculoskeletal system in particular. Observations have shown that the resorption of bone beams occurs especially intensively in those areas of the bones that experience the least load. While the beams located along the most loaded lines of force, on the contrary, thicken. Therefore, perhaps the main factors in the prevention of pathological age-related changes in bone tissue are physical education and physical labor.

During physical activity, blood supply to bone tissue improves and metabolic processes are activated. Adapting to functional loads, bone tissue changes its internal structure, and creative processes are especially intense in it; bones become more massive and stronger.

2. Age-related features of the skeleton

musculoskeletal system children

The skeleton of the body consists of the vertebral column and the rib cage. Together with the brain section of the skull, they form the axial skeleton of the body.

The spinal column is part of the axial skeleton and represents the most important supporting structure of the body, it supports the head and the limbs are attached to it.

The vertebrae (with the exception of the coccygeal vertebrae) at the end of the second month of the embryonic period have two nuclei in the arch, fused from several nuclei, and one main one in the body. During the first year of life, the nuclei of the arch, developing in the dorsal direction, grow together with each other. This process occurs faster in the cervical vertebrae than in the coccygeal vertebrae. Most often, by the age of seven, the vertebral arches, with the exception of I sacral vertebra, fused (sometimes the sacral section remains uncovered until the age of 15-18). Subsequently, a bony connection of the arch nuclei with the core of the vertebral body occurs; this connection appears at the age of 3-6 years and earliest in the thoracic vertebrae. At the age of 8 years in girls and 10 years in boys, epiphyseal rings appear at the edges of the vertebral body, which form the marginal ridges of the vertebral body. During puberty or a little later, ossification of the spinous and transverse processes, which have additional secondary ossification nuclei at their apices, ends. The atlas and axial vertebrae develop somewhat differently. The vertebrae increase as rapidly as the intervertebral discs, and after 7 years the relative size of the disc decreases significantly. The nucleus pulposus contains a large number of water and is much larger in size in a child than in an adult. In a newborn, the spinal column is straight in the anteroposterior direction. Subsequently, as a result of a number of factors: the influence of muscle work, independent sitting, heaviness of the head, etc., curves of the spinal column appear. In the first 3 months. life, the formation of a cervical curve (cervical lordosis) occurs. The thoracic curve (thoracic kyphosis) is established by 6-7 months, the lumbar curve (lumbar lordosis) is quite clearly formed by the end of the year of life.

The anlage of the ribs initially consists of mesenchyme, which lies between the muscle segments and is replaced by cartilage. The process of ossification of the ribs occurs, starting from the second month of the intrauterine period, perichondral, and somewhat later - enchondral. Bone tissue in the rib body grows anteriorly, and ossification nuclei in the region of the rib angle and in the head region appear at the age of 15-20 years. The anterior edges of the upper nine ribs are connected on each side by cartilaginous sternal strips, which, approaching each other first in upper sections, and then in the lower ones, connect with each other, thus forming the sternum. This process occurs during the 3-4th month of the intrauterine period. In the sternum, there are primary ossification nuclei for the manubrium and body and secondary ossification nuclei for the clavicular notches and for the xiphoid process.

The process of ossification in the sternum occurs unevenly in different parts of it. Thus, in the manubrium, the primary ossification nucleus appears in the 6th month of the prenatal period; by the 10th year of life, the fusion of body parts occurs, the fusion of which ends by the age of 18. The xiphoid process, despite the fact that it develops a secondary ossification nucleus by the age of 6 years, often remains cartilaginous.

The sternum as a whole ossifies at the age of 30-35 years, sometimes even later, and not always. Formed by 12 pairs of ribs, 12 thoracic vertebrae and the sternum in conjunction with the articular-ligamentous apparatus, the chest, under the influence of certain factors, goes through a number of stages of development. The development of the lungs, heart, liver, as well as the position of the body in space - lying, sitting, walking - all this, changing with age and functionality, causes changes in the chest. The main formations of the chest - dorsal grooves, lateral walls, upper and lower openings of the chest, costal arch, substernal angle - change their features in one or another period of their development, each time approaching the characteristics of the chest of an adult.

It is believed that the development of the chest goes through four main periods: from birth to two years of age there is very intensive development; in the second stage, from 3 to 7 years, the development of the chest occurs quite quickly, but slower than in the first period; the third stage, from 8 to 12 years, is characterized by slightly slower development, the fourth stage is the period of puberty, when enhanced development is also noted. After this, slow growth continues until 20-25 years, when it ends.

3. Development, age-related characteristics of the muscular system

The muscular system is a collection of muscle fibers capable of contraction, united in bundles, which form special organs - muscles or are independently part of the internal organs. The mass of muscles is much greater than the mass of other organs: in an adult it is up to 40%.

The muscles of the trunk develop from the dorsal part of the mesoderm lying on the sides of the notochord and brain tube, which is divided into primary segments, or somites. After the release of the scelerotome, which goes towards the formation of the spinal column, the remaining dorsomedial part of the somite forms a myotome, the cells of which (myoblasts) are extended in the longitudinal direction, merge with each other and are subsequently transformed into symplasts of muscle fibers. Some myoblasts differentiate into special cells - myosatellites, lying next to the symplasts. The myotomes grow ventrally and are divided into dorsal and ventral parts. From the dorsal part of the myotomes arises the dorsal (dorsal) muscles of the body, and from the ventral part arises the muscles located on the front and lateral sides of the body and called ventral.

In the embryo, muscles begin to develop at the 6-7th week of pregnancy. Until the age of 5, the child’s muscles are not sufficiently developed, the muscle fibers are short, thin, tender and can hardly be felt in the subcutaneous fat layer.

Children's muscles grow during puberty. In the first year of life they make up 20-25% of body weight, by 8 years - 27%, by 15 years - 15-44%. An increase in muscle mass occurs due to a change in the size of each myofibril. In muscle development, an age-appropriate motor regimen plays an important role, and at an older age, playing sports.

Training, repetition, and improving quick skills play a big role in the development of children's muscle activity. As the child grows and muscle fiber develops, the intensity of muscle strength increases. Indicators of muscle strength determined using dynamometry. The greatest increase in muscle strength occurs at the age of 17-18 years.

Different muscles develop unevenly. In the first years of life, large muscles of the shoulders and forearms are formed. Up to 5-6 years, motor skills develop; after 6-7 years, the ability to write, sculpt, and draw develops. From 8-9 years of age, the volume of the muscles of the arms, legs, neck, and shoulder girdle increases. During puberty, there is an increase in the volume of the muscles of the arms, back, and legs. At 10-12 years of age, coordination of movements improves.

During puberty, due to an increase in muscle mass, angularity, awkwardness, and abruptness of movements appear. Physical exercises during this period must be of a strictly defined volume.

In the absence of motor load on the muscles (hypokinesia), a delay in muscle development occurs, obesity, vegetative-vascular dystonia, and impaired bone growth may develop.

4. Poor posture in children

Poor posture is not just an aesthetic problem. If it is not corrected in time, it can become a source of diseases of the spine and more.

Typically, poor posture occurs during periods of rapid growth: at 5-8, and especially at 11-12 years. This is the time when bones and muscles increase in length, and the mechanisms for maintaining posture have not yet adapted to the changes that have occurred. Deviations are observed in the majority of children aged 7-8 years (56-82% of primary schoolchildren). There are many factors that cause spinal curvature. For example, poor nutrition and illness often disrupt the proper growth and development of muscle, bone and cartilage tissue, which negatively affects the formation of posture. An important factor is congenital pathologies of the musculoskeletal system. For example, with bilateral congenital dislocation of the hip joints, an increase in lumbar curve may be observed. An important role in the formation of deviations is played by the uneven development of certain muscle groups, especially against the background of general muscle weakness. For example, shoulders that are pulled forward are the result of a predominance of the strength of the pectoral muscles and insufficient strength of the muscles that bring the shoulder blades together, and “dangling shoulders” are the result of insufficient work of the trapezius muscle of the back. An important role is played by overload of certain muscles with unilateral work, for example, incorrect position of the torso during games or activities. All these reasons lead to an increase or decrease in the existing physiological curves of the spine. As a result, the position of the shoulders and shoulder blades changes, resulting in an asymmetrical position of the body. Incorrect posture gradually becomes habitual and can become fixed. You should definitely pay attention to how the child sits at the table during classes: whether he puts one leg under him. Perhaps he is slouching or “leaning” to one side, leaning on the elbow of his bent arm. Incorrect body position when sitting includes a position in which the torso is turned, tilted to the side or strongly bent forward. The reason for this situation may be that the chair is far away from the table or the table itself is too low. Or maybe the book the baby is looking at lies too far from him. An asymmetrical position of the shoulder girdle can be formed as a result of the habit of sitting with the shoulder raised high. right shoulder. The weakness of the muscular corset in children is primarily due to the lack of adequate physical activity, while with rapid growth the strength of the abdominal and back muscles is simply necessary.

5. Flat feet in children

Flat feet are one of the most common diseases of the musculoskeletal system in children. This is a deformation of the foot with a flattening of its arch (in children, the longitudinal arch is usually deformed, which is why the sole becomes flat and its entire surface touches the floor).

It is possible to accurately determine whether a child has flat feet or not only when the child turns five (or even six) years old. Why? Firstly, for children under a certain age, the bone structure of the foot is not yet strong; it is partly a cartilaginous structure; the ligaments and muscles are weak and susceptible to stretching. Secondly, the soles appear flat because the arch of the foot is filled with a fatty soft “pad” that masks the bony base. With normal development of the musculoskeletal system, by the age of five to six years, the arch of the foot acquires the shape necessary for proper functioning. However, in some cases, a developmental deviation occurs, which causes flat feet.

Factors influencing the development of flat feet:

· heredity (if one of your relatives has/had this disease, you need to be especially careful: the child should be regularly shown to an orthopedic doctor),

· wearing “wrong” shoes (flat soles, no heels, too narrow or wide),

Excessive stress on the legs (for example, when lifting heavy objects or with increased body weight),

Excessive flexibility (hypermobility) of joints,

· paralysis of the muscles of the foot and leg (due to polio or cerebral palsy),

· foot injuries.

Flat feet is a disease that, in the absence of adequate treatment, leads to serious complications and severe deformation of the bones of the foot, as well as diseases of the musculoskeletal system. Timely treatment and prevention will return the child to health and confidence in his attractiveness!

6. Musculoskeletal hygienedevices for children in preschool educational institutions and in the family

Any children's furniture must meet sanitary and hygienic requirements aimed at ensuring long-term performance, harmonious physical development, and the prevention of poor posture and vision in children. When using correctly selected, high-quality furniture in kindergartens and schools, children maintain visual and hearing acuity, stable body balance is observed, the cardiovascular, respiratory, and digestive systems function normally, muscle tension and the possibility of premature fatigue are reduced.

The hygienic requirements for children's furniture primarily concern the size of tables and chairs, as well as the ratio of the main elements: table top, back and chair seat.

During schoolwork, children experience stress caused by the need to maintain a working posture for a long time. This load increases sharply if the furniture is arranged incorrectly and its size does not correspond to the height and proportions of the body. Therefore, furniture must be selected in accordance with the distribution of children by height groups. As a result special research For children of toddler and preschool age up to 100 cm tall, a height scale is adopted with an interval of 10 cm, for school-age children taller than 100 cm - 15 cm.

For children in the younger nursery group (from 7 months to 1 year 8 months), feeding tables with a ratio of elements corresponding to group A furniture can be used.

In nurseries, three types of children's tables should be used: four-seater for children 1.5 - 5 years old, two-seater with a variable tilt lid and drawers for teaching aids for children 5 - 7 years old; double trapezoidal for children 1.5 - 4 years old.

It is equally important to select children's tables and chairs not only according to the child's current height, but also taking into account the fact that children grow in different ways. Therefore, if you are selecting, for example, school furniture for elementary grades, you should pay attention to height-adjustable student tables and chairs, the size of which can vary from 2 to 4 or from 4 to 6 height groups. The price of such furniture is slightly higher than usual, but its purchase eliminates the need to purchase furniture for groups of different heights, and therefore avoids additional costs in the future.

Hygienic requirements for children's shoes.

From a hygienic point of view, children's shoes must protect the body from hypothermia and overheating, protect the foot from physical damage, provide assistance to muscles and tendons, keep the arch of the foot in the correct position, provide a suitable climate around the foot, help maintain the necessary temperature regime in all weather conditions environment. Children's shoes must meet hygienic requirements - be comfortable, light, not restrict movement, and be suitable for the size and shape of the foot. Then the toes are placed freely and can be moved. But it can cause a huge number of foot diseases. Narrow and small children's shoes complicate gait, pinch the leg, impair blood circulation, cause pain and over time change the shape of the foot, disrupt its normal growth, change the shape of the toes, contribute to the formation of difficult-to-heal ulcers, and in winter - frostbite. Very loose children's shoes are also harmful. Walking in it quickly becomes tiring, and there is every chance of abrasions, especially in the instep area. Children are not recommended to wear narrow shoes. Wearing it often leads to ingrown nails, bent fingers, the formation of calluses and contributes to the development of flat feet. Flat feet are also observed when wearing shoes without heels for a long time, for example, slippers. Daily wearing of shoes with high (above 4 cm) heels is not recommended for teenage girls, because... complicates walking by shifting the center of gravity forward. The emphasis is transferred to the toes. The support area and stability are reduced. The man leans back. Such a deviation, at a young age, when the bones of the pelvis have not yet fused, entails a change in its shape, and even changes the position of the pelvis. This may subsequently have a negative impact on reproductive function. At this time, a large lumbar curve is formed. The foot moves forward, the toes are compressed in the narrow toe, the load is on anterior section The size of the foot increases, eventually developing flattening of the arch of the foot and deformation of the toes. In high-heeled shoes, it’s easy to twist your foot in the joint and it’s easy to lose your balance.

Organization of physical activity (while walking).

Planning work on the development of movements during a walk should help consolidate, improve games and physical exercises, and increase the motor activity of children. It is important to choose the right time for games and exercises. Organized motor activity should not be allowed to take place at the expense of children’s independent activity time.

The choice of time and exercises during the walk depends on previous work in the group. If a physical education or music lesson was held in the first half of the day, then it is advisable to organize games and exercises in the middle or end of the walk, and at the very beginning to provide children with the opportunity to play independently and practice with a variety of aids.

On other days, it is advisable to organize the motor activity of children at the beginning of the walk, which will enrich the content of their independent activity.

On the days of physical education classes, one outdoor game and some physical exercise (sports exercise or exercise in the main type of movement) is organized with children. On other days, when there is no lesson, an outdoor game, sports exercise and exercise in the main form of movement (jumping, climbing, throwing, throwing and catching a ball, etc.) are planned.

When conducting exercises and basic types of movements, different methods of organization should be used (frontal, subgroup, individual). The most appropriate is mixed use different ways organizations.

Due to the peculiarities of performing some movements (climbing a gymnastic ladder, balance exercises, long and high jumps from a running start), continuous and individual methods are used.

The combination of different methods of organization significantly increases the effectiveness of games and exercises during a walk. For example, a climbing exercise is performed by children one by one, and an exercise with balls is performed frontally, i.e. by all children at the same time.

It is advisable to organize children’s exercises in the main types of movements into subgroups, depending on the degree of mobility of the children. Each subgroup performs its own task. For example, children of the first and second subgroups (with high and average levels of mobility) perform exercises that require concentration, coordination and dexterity, while the teacher exercises control. Children of the third subgroup (with a low level of mobility) practice different types of jumping rope.

The duration of organized motor activity is 30-35 minutes.

Formation correct posture - when sittingwalking, walking, standing, lying down

Preschool age is the period of formation of posture, and it should be noted that deficiencies in posture in preschoolers are still unstable. The child can take the correct position if he is reminded of this, but his muscles, especially the back and abdomen, are unable to hold the spine in an upright position for a long time, as they quickly tire. Therefore, sufficient muscle strength, as well as their development and strengthening, play an important role in the formation of correct posture. Work on developing correct posture should be constantly carried out with all children, and not just with those who have any deviations.

Systematic physical exercise is required in the form of daily morning exercises, physical education classes, and outdoor games in groups. Medical workers conduct special classes in exercise therapy, hardening, and herbal medicine. It is very important to monitor the posture of preschool children and develop the ability to sit and stand correctly:

- posture at the table when drawing, looking at illustrations, when playing board games, it should be comfortable: the elbows of both hands are on the table, the forearms are symmetrical and free (according to upper third just below the elbow joints) lie on the table surface. The shoulders are at the same level, the head is slightly tilted forward, the distance from the eyes to the table is 30-35 cm. The child should sit with an equal load on both buttocks, without tilting to one side. Feet are on the floor. The ankle, knee and hip joints form a right angle;

- posture during sleep. It is best if the child sleeps on his back, on a small pillow. Sleeping on your side bends the spine, as does the habit of standing with support on one leg;

- standing posture. You need to stand with an even distribution of body weight on both legs;

- walking posture. Keep your shoulders at the same level, straighten your chest, pull your shoulder blades back without tension, tighten your stomach, look straight without lowering your head.

The main means of preventing postural disorders in preschoolers is physical exercise.

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Anatomical and physiological features of the development of the musculoskeletal system of preschool children

In the development of a child, the condition of the musculoskeletal system - the bone skeleton, joints, ligaments and muscles - is of great importance.
The bone skeleton, along with performing a supporting function, performs the function of protecting internal organs from adverse effects - various types of injuries. Bone tissue in children contains few salts, it is soft and elastic. The process of bone ossification does not occur in the same period. Particularly rapid restructuring of bone tissue and changes in the skeleton are observed in a child when he begins to walk.
The spine of a small child consists almost entirely of cartilage and has no bends. When the child begins to hold his head up, he develops a cervical curve, convexly facing forward. At 6-7 months, the child begins to sit, he has a bend in the thoracic part of the spine with a convexity backwards. When walking, a lumbar curvature is formed with a convexity forward. By 3-4 years, the child’s spine has all the curves characteristic of an adult, but the bones and ligaments are still elastic and the curves of the spine are aligned in a supine position. The constancy of the cervical and thoracic curvature of the spine is established by 7 years, and the lumbar curvature by 12 years. Ossification of the spine occurs gradually and is completed only after 20 years.
The chest of a newborn has a rounded cylindrical shape, its anteroposterior and transverse diameters are almost the same. When a child begins to walk, the shape of the chest approaches that of an adult. The ribs of young children have horizontal direction, which limits the movement of the chest. By the age of 6–7 years, these features do not appear.
The bones of the arms and legs undergo changes as the child grows. Until the age of 7 years, rapid ossification occurs. For example, ossification nuclei in a child’s femur appear in different areas at different times: in the epiphyses - even in prenatal period, in the epicondyles - at 3-8 years of life; in the epiphyses of the leg - in the 3rd - 6th year, and in the phalanges of the foot - in the 3rd year of life.
The pelvic bones of a newborn child consist of separate parts - iliac, ischial, pubic, the fusion of which begins at 5-6 years of age.
Thus, the skeletal system of children under 7 years of age is characterized by the incompleteness of the bone formation process, which necessitates the need to carefully protect it.
Muscle in early and preschool age it undergoes morphological growth, functional improvement and differentiation. When standing upright and walking begins, the muscles of the pelvis and lower extremities develop intensively. The muscles of the hands begin to develop rapidly at 6-7 years of age after the structural development of the bone base and under the influence of exercise of the hand muscles as a result of the child's activities.

Disorders of the musculoskeletal system in children.

Content Introduction.....................................................................................1 ............1-2 ..2-3 Scoliosis and poor posture.....................................................4 .............................................4 Correct posture....................................................................4-5 .............................5-6 Causes of poor posture....................................................6-7 Posture disorders.....................................................................7-8 Scoliosis.....................................................................................8-9 Treatment.......................................................................................9 Prevention of poor posture and scoliosis................. 10-12 Cerebral palsy............................................12-13 History of the study........................................................ ...................13-14 Factorsrisks and causes of cerebral palsy............................................14-15 Symptoms of cerebral palsy.....................................................................15-16 Causes of motor disorders in cerebral palsy......................16-18 Forms of cerebral palsy...........................................................................18-21 Prevalence of forms of cerebral palsy...............................................21 .....................................21-22 Other consequences of cerebral palsy.........................................................22 Features of the manifestation of violations...................................22-23 Features of emotional and personal developmentin children with cerebral palsy......................................................................23-24 Treatment and correctional work with children with cerebral palsy............24-27 Exercise therapy technique for cerebral palsy...........................................................27. Prevalence of cerebral palsy.........................................................28 Conclusion................................................................................28 Literature.................................................................................29

1 Introduction Movement, movement in space is one of essential functions living beings, including humans. The function of movement in humans is performed by the musculoskeletal system, which combines bones, their joints and skeletal muscles. Despite the fact that the musculoskeletal system is seemingly the strongest structure of our body, in childhood it is the most vulnerable. It is in infancy and adolescence that pathologies such as torticollis, flat feet, scoliosis, kyphosis and other postural disorders are discovered. And if proper measures are not taken in time to eliminate congenital or emerging defects in a child, much more serious consequences can await him in adulthood: intervertebral hernias, osteochondrosis, osteoporosis, etc. The musculoskeletal system is divided into passive and active parts. The passive part includes bones and their connections, on which the nature of movement depends. The active part consists of skeletal muscles, which, due to their ability to contract, move the bones of the skeleton. In humans, the functions of the musculoskeletal system are associated with what provides an advantage over other representatives of the organic world - work and speech. With all the variety of congenital and early acquired diseases and injuries of the musculoskeletal system, the majority of these children have similar problems. The leading ones are: delayed formation, underdevelopment, impairment or loss of motor functions.Causes of musculoskeletal disorders . In order to avoid or maximally correct disorders of the musculoskeletal system, it is necessary to understand the causes of their occurrence. For example, such a common pathology as torticollis is a disease of the cervical musculoskeletal system, manifested by an incorrect position of the child’s head and limited mobility. The most common congenital muscular torticollis in children is caused by shortening and weakness of the sternocleidomastoid muscle during intrauterine pregnancy.2 baby development. This happens for a number of reasons, one of which is the incorrect position of the baby’s head in the womb, due to which excessive one-sided pressure is exerted on it by the walls of the uterus, and as a result of this, the attachment points of the sternocleidomastoid muscle come closer together and the muscle shortens. Shortening of the sternocleidomastoid muscle can also occur due to its injury during difficult childbirth or due to muscle inflammation suffered in the womb, which has become chronic. At first, torticollis is difficult to notice: the manifestation of the disease occurs gradually, starting with thickening of the muscle on one side, a fixed tilt of the child’s head, and ending with limited mobility of the neck and the appearance of asymmetry of the left and right halves of the face. By the way, congenital torticollis is one of the reasons for the development of scoliosis in a child - an abnormal lateral curvature of the spine, since, trying to give the head a vertical position, the baby begins to raise his shoulders and slouch. Of course, scoliosis develops for a number of other reasons: the child’s weak physique, lack of regular physical activity, spending a long time at the computer, incorrect body position while the child is sitting. The fundamental factor in the occurrence of deformation of the spinal column is the developing weakness of the muscles surrounding the spine, due to which they cannot perform their supporting function. Muscle weakness is also responsible for the development of flat feet in a child, both congenital and acquired. Congenital flat feet occur as a result of weakness of the connective tissue of the foot, due to which the muscles and ligaments of the foot are unable to form the correct arch. Flat feet can also develop if the foot muscles are not sufficiently stimulated by the external environment, for example, when the child’s shoes have excessively thick soles.Classification of musculoskeletal disorders . Various types of pathology of the musculoskeletal system are noted. -diseases of the nervous system;- congenital pathology of the musculoskeletal system;- purchaseddiseases and injuries of the musculoskeletal system.Pathology of the musculoskeletal system is observed in 5-7% of children.3 The majority of them (89%) are children with cerebral palsy (CP). In such children, movement disorders are combined with mental and speech disorders. They need:- medical and social assistance;- psychological, pedagogical and speech therapy correction. The other categories of children mentioned above, as a rule, do not need special education. However, all categories of children require support in the process of their social adaptation, which has the following directions: - adaptation of the environment to the child (with the help of special technical means of transportation, special household items, simple devices on the street, in hallways, etc.) ; adaptation of the child himself to the usual conditions of the social environment). 1 . Diseases of the nervous system include:cerebral palsy (CP); poliomyelitis (inflammation gray matter spinal cord; acute poliomyelitis is an infectious disease with a predominant lesion of the anterior horns of the spinal cord, characterized by paralysis). 2 . Congenital pathology of the musculoskeletal system:congenital hip dislocation; torticollis; clubfoot and other foot deformities; abnormalities of the spine (scoliosis); underdevelopment and defects of the limbs; developmental anomalies of the fingers; arthrogryposis (congenital deformity).3 . Acquired diseases and injuries of the musculoskeletal system:- traumatic injuries of the spinal cord, brain and limbs; - polyarthritis (simultaneous or sequential inflammation of many joints); - skeletal diseases - tuberculosis, bone tumors, osteomyelitis (inflammation of the bone marrow affecting all bone elements); - systemic diseases: - chondrodystrophy - a congenital disease of the osteochondral system, characterized by abnormal, disproportionate growth of body parts and impaired ossification, as a result of which the patient has dwarf stature, shortened limbs with normal length spine; - stinks - a disease caused by vitamin deficiency and characterized by metabolic disorders and damage to the functions of a number of organs and systems; observed mainly in infants.4 Scoliosis and poor posture . Scoliosis (Greek)σκολιός - “crooked”, lat.scoliō sis) - three-plane deformity of the human spine. The curvature can be congenital or acquired. Scoliosis and postural disorders are the most common diseases of the musculoskeletal system in children and adolescents. These diseases serve as a prerequisite for the occurrence of a number of functional and morphological health disorders in childhood and have a negative impact on the course of many diseases in adults. According to the latest data, the number of children with postural disorders reaches 30 - 60%, and scoliosis affects an average of 10 - 15% of children.About the spine and its changes The spine (spinal column) is the main part of the human axial skeleton and consists of 33–34 vertebrae, which are connected by cartilage, ligaments and joints. In the womb, the child's spine looks like a uniform arc. When a child is born, his spine straightens and takes on the appearance of an almost straight line. It is from the moment of birth that posture begins to form. If you have the skill of holding your head up, a forward bend gradually appears in the baby’s cervical spine, the so-called cervical lordosis. If the time has come when the child can already sit, a bend is also formed in the thoracic region of his spine, only facing backwards (kyphosis). And if the child begins to walk, over time a curve with a convexity that faces forward is formed in the lumbar region. This is lumbar lordosis. That is why it is important to monitor the further correct formation of children's posture.Correct posture . Correct posture is characterized by the same level of shoulder girdles, nipples, angles of the shoulder blades, equal length of the neck-shoulder lines (the distance from the ear to the shoulder joint), the depth of the waist triangles (the depression formed by the notch of the waist and the freely lowered arm), straight5 the vertical line of the spinous processes of the spine, evenly expressed physiological curves of the spine in the sagittal plane, the same relief of the chest and lumbar region (in the forward tilt position). A correctly formed spine has physiological curves in the sagittal plane (when viewed from the side) in the form of cervical and lumbar lordosis and kyphosis in the thoracic and sacral regions. These curves, along with the elastic properties of the intervertebral discs, determine the shock-absorbing properties of the spine. In the frontal plane (when viewed from the back), the spine should normally be straight. Normally, the depth of lordosis in the cervical and lumbar spine corresponds to the thickness of the palm of the patient being examined. These signs together create a beautiful appearance of a person. Deviation of these indicators from the norm indicates the presence of poor posture or scoliosis.Formation of correct posture in children . The formation of correct posture in children largely depends on the environment. It is the responsibility of parents, as well as employees of preschool and school institutions, to monitor the correct position of children when standing, sitting and walking, as well as to use exercises that mainly develop the muscles of the back, legs and abdomen. This is necessary for the child to develop a natural muscle corset. The spine and the muscles surrounding it play a major role in the formation of correct posture. POSTURE is a complex concept about the habitual position of the body of a casually standing person. It is determined and regulated by postural reflexes and reflects not only the physical, but also the mental state of a person, being one of the indicators of health. You can safely begin to stimulate the growth and develop the muscles of a child from the moment of his birth. This way their growth and strength will quickly develop and multiply. For infants, massage (as prescribed by a doctor) is an excellent assistant in this regard. A baby at the age of 2-3 months can begin to do exercises to train the muscle groups responsible for holding the body in the correct position. To do this, it will be enough to lift the child with the help of your palms, moving him from the “lying” position to the “up” position, and then hold him in weight for a short time. In this position the muscles and6 The baby's joints will move, while training all muscle groups. After 1.5 years, you can start doing gymnastics with your child in a playful way. Together you can “chop wood,” arch your back “like a cat,” “pump water,” walk along a drawn line as if on a tightrope, roll on the floor, go through an obstacle course, etc. You can ask the child to pretend to be a bird: lie on his stomach, “spread his wings” (spread his arms to the sides) and hold on to the ankles of his raised legs. A child’s posture is formed before puberty. All this time it is necessary to monitor its formation. If a child has already developed a certain disorder, it can be corrected before this period. In this case, the child must regularly visit an orthopedic doctor, while being registered with him at the dispensary, and undergo all available types of treatment. This can be physical therapy, swimming, massage, physiotherapy, manual therapy, as well as surgical treatment (according to indications).Causes of poor posture . The reasons that can lead to poor posture (scoliosis) are numerous. The following have a negative impact on the formation of posture:- unfavorable environmental conditions;- social and hygienic factors, in particular the child’s prolonged stay in an incorrect body position;- insufficient physical activity of children (hypodynamia);- irrational passion for monotonous physical exercises; - improper physical education;- insufficient sensitivity of receptors that determine the vertical position of the spine- weakness of the muscles that hold the vertical position;- limitation of mobility in joints;- acceleration of modern children;- irrational clothing;- diseases of internal organs;- decreased vision, hearing;- insufficient illumination of the workplace;- furniture that is inappropriate for the child’s height, etc. In 90-95% of cases7 Postural disorders are acquired, most often found in children of asthenic physique. Scoliosis develops mainly during periods of intense skeletal growth, i.e. at 6-7 years old, 12-15 years old. With the end of spinal growth, the increase in deformity usually stops, with the exception of paralytic scoliosis, in which the deformity can progress throughout life.Posture disorders . Posture is the ability of a person to hold his body in a variety of positions. It can be right and wrong. Posture is considered correct if a casually standing person, being in his usual position, does not make unnecessary active tension and keeps his head and body straight. In addition, he has an easy gait, slightly lowered and laid back shoulders, a forward-directed chest, a tucked stomach and legs bent at the knees. With incorrect posture, a person does not know how to hold his body correctly, therefore, as a rule, he slouches, stands and moves on half-bent legs, with his shoulders and head down, and his stomach thrust forward. With such a posture, the normal functioning of internal organs is disrupted. Various postural disorders, be it stoop, lordosis, kyphosis or scoliosis (lateral curvature of the spine), are quite common in children of preschool and school age. Basically, these are children who are either physically weakened, or suffering from some chronic illness, or who have already suffered from serious illnesses in early childhood. Posture disorders can occur in the sagittal and frontal planes. Disorders in the sagittal plane. The following variants of postural disturbance in the sagittal plane are distinguished, in which the correct ratios of the physiological curves of the spine change:A). “stooping” - an increase in thoracic kyphosis in the upper sections while smoothing the lumbar lordosis;b). “round back” - increased thoracic kyphosis throughout the entire thoracic region postureshoney bee;V). “concave back” - increased lordosis in the lumbar region;G). “round-concave back” - increased thoracic kyphosis and increased lumbar lordosis;8 d). “flat back” - smoothing out all physiological curves;e). "flat-concave back" - reduction of thoracic kyphosis with normal or slightly increased lumbar lordosis. Disorders in the frontal plane Postural defects in the frontal plane are not divided into separate types. They are characterized by a violation of symmetry between the right and left halves of the body; the spinal column is an arch with its apex facing to the right or left; the asymmetry of the triangles of the waist, the belt of the upper limbs (shoulders, shoulder blades) is determined, the head is tilted to the side. Symptoms of poor posture can be identified in varying degrees; from barely noticeable to pronounced. Lateral curvature of the spine with functional disorders of posture can be corrected by volitional muscle tension or in a lying position.Scoliosis . Historically, in the post-Soviet space, scoliosis is called any deviation of the spine in the frontal plane, fixed or not fixed, and medical diagnosis, describing serious illness spine - so-called "scoliotic disease" Scoliotic disease is a progressive (that is, worsening) dysplastic disease of the growing spine of children aged 6-15 years, more often than girls (3-6 times). Scoliotic disease is a lateral curvature of the spine with mandatory rotation of the vertebral bodies (torsion), characteristic feature which is the progression of deformation associated with the age and growth of the child. Outside the former USSR, scoliotic disease is called idiopathic scoliosis or rapidly progressive scoliosis. Scoliosis at the initial stage of development of the process, as a rule, is characterized by the same changes as poor posture in the frontal plane. But, unlike postural disorders, with scoliotic disease, in addition to lateral curvature of the spine, twisting of the vertebrae around a vertical axis (torsion) is observed. This is evidenced by the presence of a costal bulge along the posterior surface of the chest (and as the process progresses, the formation of a costal hump) and a muscle cushion in the lumbar region. At a later stage of scoliosis development, wedge-shaped deformation of the vertebrae located at the apex of the spinal curvature develops.9 Classifications of scoliosis:by origin;according to the shape of the curvature: C-shaped scoliosis(with one arc of curvature).S-shaped scoliosis (with two curves).Z- figurative scoliosis (with three arcs of curvature); by localization of curvature; X-ray classification (according to V.D. Chaklin): Usually there are 3 degrees of spinal curvature (scoliosis) in the sagittal plane. To determine whether the curvature is already established and stable, the child is asked to straighten up. Deformity of the 1st degree - the curvature of the spine is leveled to a normal position when straightened; 2nd degree deformity - partially leveled out when the child straightens or hangs on a gymnastics wall; Grade 3 deformity - the curvature does not change when the child hangs or straightens. 1st degree of scoliosis. Scoliosis angle 1° - 10°. 2nd degree scoliosis. Scoliosis angle 11° - 25°. 3rd degree scoliosis. Scoliosis angle 26° - 50°. 4th degree of scoliosis. Scoliosis angle > 50°; by changing the degree of deformation depending on the load on the spine; according to the clinical course. 80% of scoliosis is of unknown origin and is therefore called idiopathic (Greek: idiopathic).ἴδιος - own +πάθος - suffering), which roughly means “illness itself.” Abroad, classification based on the age of the patient at the time of diagnosis of the disease is widely used. The diagnosis of scoliosis is made by an orthopedic doctor based on a clinical and x-ray examination.Treatment . As a matter of fact, treating postural disorders is a long and painstaking process. It's like running a long distance. Treatment is carried out by an orthopedist. Manual therapy, therapeutic exercises, the use of corsets, etc. are used. With the help of gymnastics, muscles are developed and help maintain the spine in normal condition. These are the muscles of the abdomen, lower back, back, and in case of cervical scoliosis - the muscles of the neck and shoulders. Experts do not recommend coming up with a set of exercises on your own, since some exercises for scoliosis are strictly prohibited (for example, jumping, lifting weights). In extreme cases, surgical treatment is performed.10 Prevention . Prevention of any disorders associated with posture should be comprehensive and based on the principles presented below. Proper nutrition. A child’s continuously developing body needs beneficial nutrients throughout its growth. Nutrition should be complete and varied, since this determines how correct the development of muscles and bones will be. Physical activity. Physical exercises, various sports (especially skiing and swimming), gymnastics, as well as tourism, active games in the fresh air, etc. are very important for the health of children's posture. It should be borne in mind that with physical development, the child should not be forced to perform sudden and rapid loads. Correct daily routine. To avoid problems with posture, it is necessary not only to organize the correct daily routine (time for walking, sleeping, waking, eating, etc.), but also to strictly observe it, without making any exceptions, for example, on weekends. Comfortable children's room. The room must have high-quality lighting. A children's desk should be equipped with an additional desk lamp. The height of the table should be 2-3 cm higher than the elbow of a child standing with his arms down. There are also special desks that are designed to correct the student’s posture. The chair should follow the curves of the body. True, instead of such an orthopedic chair, you can place a rag cushion behind your back at the level of the lumbar region in addition to a regular flat chair. The height of the chair should ideally be equal to the height of the shin. Use a footrest if your feet don't reach the floor. The child should sit so that his back rests on the back of the chair, his head leans slightly forward, and his palm easily fits between his body and the table. When sitting down, you should not bend your legs under you, as this can lead to curvature of the spine and poor circulation. A child's bed should have a flat and firm mattress. Thanks to this mattress, the child’s body weight is distributed evenly, and the muscles relax as much as possible after the vertical position of the body for the whole day. Do not allow your child to sleep on a soft surface. This provokes the formation of irregular curves of the spine during sleep. In addition, a soft mattress stimulates the warming of the intervertebral discs, due to which the11 thermoregulation. As for the baby pillow, it should be flat and placed exclusively under the head, and not under the shoulders. Proper shoe correction. Correct, accurate and timely selection of children's shoes allows parents to avoid and even eliminate many problems, such as functional shortening of the limb resulting from poor posture or compensation for foot defects (clubfoot and flat feet). Uniform distribution of loads. It is known that most often it is at school age, when children experience rapid growth in bone and muscle mass, that they, unfortunately, acquire spinal curvature. This happens due to the fact that at this age the child’s spine is not adapted to heavy loads. Parents should try not to overload the child when carrying a satchel, backpack or briefcase. Remember that according to the standard, the weight that a child is allowed to lift is 10% of the total body weight. The back of the school backpack should be flat and firm, its width should not be greater than the width of the shoulders. Also, the backpack should not hang below the waist, and the straps on it should be soft and wide, adjustable in length. It is unacceptable to carry heavy bags on one shoulder for a long time, which is especially important for girls. In this case, spinal curvature may become an inevitable problem for them. As for the correct transfer of weights, it is known that bending down, taking a weight and lifting it is a huge load on the spine and this should not be done. The correct thing to do would be to first sit down with a straight back, then pick it up, press it to your chest, rise and carry it. And as a piece of advice to parents: even if you don’t follow this rule yourself, teach it to your child. I. Useful exercises To form correct posture in children, as well as to prevent its violations during morning exercises, physical education and during physical education at home and, mainly, in preschool and school institutions, you can use various useful exercises. Below are examples of such exercises. The child stands on one leg or walks on a log. Holding a hoop behind his back, the child bends to the sides. Holding a gymnastic stick in his hands, the child squats, standing on his toes. Spreading his arms to the sides, the child bends back. With his feet apart and holding a gymnastic stick in his hands, the child bends forward and bends forward. The child raises his legs up while lying on his back. The child crawls on all fours. The child, maintaining correct posture, walks while holding some12 or a weight on the head. With his hands down, the child holds the gymnastics stick by the ends and raises his arms up, placing the stick behind his back, after which he alternates bending left and right. Using a horizontal bar or wall bars, the child, tightly grasping the bar with his hands, bends his legs at a right angle and remains in this position for several seconds. Being in the “legs together, arms down” position, the child takes his right leg back, spreads his arms to the sides and freezes, after which he repeats the exercise with the left leg. Lying on his back, the child uses his legs to “peddle a bicycle” or pretend to be “scissors.” Lying on his stomach, the child raises his legs bent at the knees, clasps his ankles with his hands and begins to sway like a boat on the waves. Standing in front of a mirror, the child alternates between first breaking and then correcting his posture. The child leans against the wall at five points (back of the head, shoulder blades, buttocks, calves and heels). These points are the main outward curves of our body and should normally be in contact with the wall. After this, he performs various movements, for example, squats or spreading his legs and arms to the sides, tensing his muscles for an average of 5 seconds. 4Cerebral palsy . Cerebral palsy The majority of children with musculoskeletal disorders are children with cerebral palsy. Cerebral palsy is a clinical term that unites a group of chronic non-progressive symptom complexes of motor disorders secondary to lesions or abnormalities of the brain that arise in the perinatal period. False progression is noted as the child grows. Approximately 30-50% of people with cerebral palsy have intellectual impairment. Difficulties in thinking and mental functioning are more common among patients with spastic quadriplegia than among those who suffer from other types of cerebral palsy. Brain damage can also affect the acquisition of native language and speech. Cerebral palsy is not a hereditary disease. But it has been shown that some genetic factors are involved in the development of the disease (in approximately 14% of cases). In addition, the existence of many cerebral palsy-like diseases poses a certain difficulty. Children's cerebral13 paralysis (cerebral palsy) refers to a group of movement disorders that occur when the motor systems of the brain are damaged and are manifested in the lack or absence of control by the nervous system over voluntary movements. Currently, the problem of cerebral palsy is acquiring not only medical, but also socio-psychological significance, since psychomotor impairments, motor limitations, and increased irritability prevent such children from adapting to life in society and mastering the school curriculum. Under unfavorable circumstances, such children cannot realize their abilities and do not have the opportunity to become full members of society. Therefore, the problem of correction is especially relevant negative manifestations cerebral palsy. Cerebral palsy occurs as a result of underdevelopment or damage to the brain early stages development (during the prenatal period, at the time of birth and in the first year of life). Movement disorders in children with cerebral palsy are often combined with mental and speech disorders, and with dysfunction of other analyzers (vision, hearing). Therefore, these children need therapeutic, psychological, pedagogical and social assistance.History of the study . For the first time in detail similar violations was taken up in the 1830s by the eminent British surgeon John Little when he lectured on birth injuries. In 1853 he published a work entitled "On the Nature and Treatment of Deformities of the Human Skeleton" (English)."On the nature and treatment of the deformities of the human frame").In 1861, in a report presented at a meeting of the Obstetrical Society of London, Little stated that asphyxia caused by pathology during childbirth leads to damage to the nervous system (he meant the spinal cord) and the development of spasticity and plegia in the legs. Thus, he was the first to describe what is now known as one of the forms of spastic cerebral palsy - spastic diplegia. For a long time it was called Little's disease. In 1889, the no less eminent Canadian physician Sir Osler published the book “Thecerebralpalsiesofchildren", introducing the term cerebral palsy (in its English version -cerebralpalsy) and showed that the disorders concern the cerebral hemispheres, and not damage to the spinal cord. Following Little, for more than a century, the main cause of cerebral palsy was considered asphyxia during childbirth.14

Although still at the endXIXcentury, Sigmund Freud did not agree with this concept, saying that pathology during childbirth is only a symptom of earlier fetal disorders. Freud, being a neurologist, noticed a connection between cerebral palsy and some types of mental retardation and epilepsy. In 1893, he introduced the term “cerebral palsy” (German).infantileZerebrallä hmung), and in 1897 he suggested that these lesions are more associated with impaired brain development in the prenatal period. It was Freud who, based on his work in the 1890s, combined various disorders caused by abnormal postneonatal brain development under one term and created the first classification of cerebral palsy. Classification of cerebral palsy according to Freud (from the monograph “Cerebral Palsy”, 1897):1) hemiplegia,2) cerebral diplegia (bilateral cerebral palsy): generalized rigidity (Little's disease), paraplegic rigidity, bilateral hemiplegia, generalized chorea and double athetosis. Based on this classification, all subsequent ones were compiled. “Paraplegic rigidity” does not currently apply to cerebral palsy. The ataxic form was described in detailO. Forster(1913) in the article “Deranatomischeastatichetypusderinfantilezerebrallaehmung». Risk factors and causes of cerebral palsy . The main cause of cerebral palsy is the death or malformation of any part of the brain that occurs at an early age or before birth. In total, there are more than 100 factors that can lead to pathologies of the central nervous system in a newborn; they are combined into three large groups associated with:1. The course of pregnancy;2. The moment of birth;3. The period of adaptation of the baby to the external environment in the first 4 weeks of life (in some sources this period is extended to 2 years). According to statistics, from 40 to 50% of all children with cerebral palsy were born prematurely. Premature babies are especially vulnerable because they are born with underdeveloped organs and systems, which increases the risk of brain damage from hypoxia (oxygen starvation). Asphyxia at the time of birth accounts for no more than 10% of all15 cases, and latent infection in the mother is of greater importance for the development of the disease, mainly due to its toxic effect on the fetal brain. Other common risk factors: large fruit; incorrect presentation;narrow maternal pelvis;premature placental abruption;Rhesus conflict;rapid labor;drug induction of labor;accelerating labor by puncturing the amniotic sac. After the birth of a baby, there are the following probable causes of damage to the central nervous system:severe infections (meningitis, encephalitis, acute herpetic infection);poisoning (lead), head injuries;incidents leading to brain hypoxia (drowning, blockage of the airways with pieces of food, foreign objects). It should be noted that all risk factors are not absolute, and most of them can be prevented or their harmful effects on the child’s health can be minimized.Symptoms of cerebral palsy . Symptoms of cerebral palsy range from subtle clumsiness to severe muscle spasticity (tightness) that interferes with the movement of arms and legs and leaves the child confined to a wheelchair. There are four main types of cerebral palsy:spastic, in which the muscles are stiff and weak; occurs in approximately 70% of children with cerebral palsy; choreoathetoid, in which, in the absence of conscious control, the muscles spontaneously twitch; occurs in approximately 20% of children with cerebral palsy;ataxic, in which coordination is impaired, the child’s movements are uncertain; occurs in approximately 10% of children with cerebral palsy;16 mixed, in which the manifestations of two types of cerebral palsy are combined, usually spastic and choreoathetoid; occurs in many sick children. With spastic cerebral palsy, there may be impaired mobility of the arms and legs (quadriplegia), mainly the legs (diplegia), or the arms and legs on only one side (hemiplegia). The affected arms and legs are poorly developed, weak, and their mobility is impaired. With choreoathetoid cerebral palsy, movements of the arms, legs and body are slow, difficult, poorly controlled, but can be sharp, as if jerky. Against the background of strong experiences, the twitching becomes even more intense; There are no pathological movements during sleep. In ataxic cerebral palsy, muscle coordination is poor and muscle weakness and tremors are noted. Children with this condition have difficulty making quick or small movements; the gait is unsteady, so the child places his legs wide apart.With all types of cerebral palsy, speech may be slurred because the child has difficulty controlling the muscles involved in making sounds. Often children with cerebral palsy have other disabilities, such as reduced intelligence; In some, mental retardation is significant. However, approximately 40% of children with cerebral palsy have normal or nearly normal intelligence. About 25% of children with cerebral palsy (usually spastic) have seizures (epilepsy). All symptoms: seizures, mental retardation, muscle weakness, unsteady gaitP causes of movement disorders in cerebral palsy . The cause of any cerebral palsy is pathology in the cortex, subcortical areas, capsules or brain stem. The incidence is estimated at 2 cases per 1000 births. The fundamental difference between cerebral palsy and other paralysis is the time of onset and the associated impairment in the reduction of postural reflexes characteristic of newborns. The variety of movement disorders is due to the action of a number of factors: pathology of muscle tone (such as spasticity, rigidity, hypotension, dystonia); limitation or impossibility voluntary movements(paresis and paralysis); the presence of violent movements (hyperkinesis, tremor); impaired balance, coordination and sensation of movement. Deviations in mental development in cerebral palsy also17 specific. They are determined by the time of brain damage, its degree and location. Lesions at an early stage of intrauterine development are accompanied by gross underdevelopment of the child's intelligence. A feature of mental development with lesions that developed in the second half of pregnancy and during childbirth is not only its slow pace, but also its uneven nature (accelerated development of some higher mental functions and the immaturity and lag of others). The causes of these disorders can be different: these are various chronic diseases of the expectant mother, as well as infectious diseases she has suffered, especially viral diseases, intoxications, incompatibility of mother and fetus according to the Rh factor or group affiliation, etc. Predisposing factors may be prematurity or distortion of the fetus. In some cases, the cause of cerebral palsy may be obstetric trauma, as well as protracted labor with the umbilical cord entwined around the fetal neck, which leads to damage to the nerve cells of the child’s brain due to lack of oxygen. Sometimes cerebral palsy occurs after birth as a result of infectious diseases complicated by encephalitis (inflammation medulla), after severe head injuries. Cerebral palsy, as a rule, is not a hereditary disease. At differential diagnosis Cerebral palsy with various movement disorders should first of all take into account the medical history. The history of children suffering from cerebral palsy often contains indications of a pathological pregnancy in the mother and birth trauma with the use of obstetric methods of delivery. Among the reflexes that adversely affect the development of motor skills, the following are of greatest importance. Labyrinthine tonic reflex, which manifests itself when the position of the child’s head in space changes. Thus, in the supine position, when this reflex is expressed, the tone of the extensor muscles increases. This determines the characteristic position of the child on his back: the head is thrown back, the hips are adducted, turned inward, and in severe forms of cerebral palsy - crossed; arms extended in elbow joints, palms turned down, fingers clenched into fists. If the labyrinthine tonic reflex is pronounced in the supine position, the child does not raise his head or does it with great difficulty. He cannot stretch his arms forward and take an object, pull himself up and sit down, or bring his hand or spoon to his mouth. This prevents the development of skills in sitting, standing, walking, self-care, and voluntary grasping of an object under visual control. In a child's position18 on the abdomen, the influence of this reflex is manifested in an increase in the tone of the flexor muscles, which determines the characteristic posture: the head and back are bent, the shoulders are extended forward and down, the arms are bent under the chest, the hands are clenched into fists, the thighs and legs are adducted and bent, the pelvic region of the body raised This forced position inhibits the development of voluntary movements: lying on his stomach, the child cannot raise his head, turn it to the side, stretch out his arms for support, kneel down, take a vertical position, or turn from his stomach to his back. Delayed motor development and disturbances of voluntary movements constitute the structure of the leading defect and are associated with damage to the motor areas and adductor pathways of the brain. Depending on the severity of the lesion, complete or partial absence certain movements. In this case, first of all, the most subtle differentiated movements suffer: turning the palms and forearms up (supination), differentiated movements of the fingers. Restriction of voluntary movements in cerebral palsy is always combined with a decrease in muscle strength. The limitation or impossibility of voluntary movements delays the development of static and locomotor functions. In children with cerebral palsy, the age sequence of development of motor skills is disrupted. Motor development in children with cerebral palsy is not just delayed, but qualitatively impaired at every age stage. Forms of cerebral palsy . In Russia, the classification of cerebral palsy according to K. A. Semyonova (1973) is often used. Currently, the following classification is used according to ICD-10:G80.0 Spastic tetraplegia With greater severity of movement disorders in the hands, the clarifying term “bilateral hemiplegia” can be used. One of the most severe forms of cerebral palsy, which is a consequence of abnormalities in brain development, intrauterine infections and perinatal hypoxia with diffuse damage to the cerebral hemispheres. In premature infants, the main cause of perinatal hypoxia is selective neuronal necrosis and periventricular leukomalacia; in full-term infants - selective or diffuse necrosis of neurons and parasagittal brain damage during intrauterine chronic hypoxia. Clinically diagnosed19 spastic quadriplegia (quadriparesis; a more appropriate term compared to tetraplegia, since noticeable impairments are detected approximately equally in all four limbs), pseudobulbar syndrome, visual impairment, cognitive and speech impairment. 50% of children experience epileptic seizures. This form is characterized by the early formation of contractures, deformations of the trunk and limbs. In almost half of cases, movement disorders are accompanied by pathology cranial nerves: strabismus, optic nerve atrophy, hearing impairment, pseudobulbar disorders. Quite often, microcephaly is noted in children, which, of course, is secondary. Severe motor defects of the hands and lack of motivation exclude self-care and simple work activities.G80.1 Spastic diplegia (“Tetraparesis with spasticity in the legs”, according toMichaelis) The most common type of cerebral palsy (3/4 of all spastic forms), previously also known as “Little’s disease”. The function of the muscles on both sides is impaired, more so in the legs than in the arms and face. For spastic diplegia characterized by early formation of contractures, deformities of the spine and joints. It is mainly diagnosed in children born prematurely (consequences of intraventricular hemorrhages, periventricular leukomalacia, and other factors). In this case, in contrast to spastic quadriplegia, the posterior and, less often, middle sections of the white matter are more affected. With this form, tetraplegia (tetraparesis) is usually observed, with muscle spasticity noticeably predominant in the legs. The most common manifestations are delayed mental and speech development, the presence of elements pseudobulbar syndrome, dysarthria, etc. Pathology of the cranial nerves is common: convergent strabismus, atrophy of the optic nerves, hearing impairment, speech impairment in the form of delayed development, moderate decline in intelligence, including those caused by the influence of the environment on the child (insults, segregation). The prognosis for motor abilities is less favorable than for hemiparesis. This form is the most favorable with regard to the possibilities of social adaptation. The degree of social adaptation can reach the level of healthy people with normal mental development and good hand function.G80.2 Hemiplegic form Characterized by unilateral spastic hemiparesis. The arm usually suffers more than the leg. The cause in premature babies is20 periventricular (periventricular) hemorrhagic infarction (usually unilateral), and congenital cerebral anomaly (for example, schizencephaly), ischemic infarction or intracerebral hemorrhage in one of the hemispheres (usually in the basin of the left middle cerebral artery) in full-term children. Children with hemiparesis master age-related skills later than healthy ones. Therefore, the level of social adaptation, as a rule, is determined not by the degree of motor defect, but by the intellectual capabilities of the child. Clinically characterized by the development of spastic hemiparesis (Wernicke-Mann type gait, but without leg circumduction), delayed mental and speech development. Sometimes it manifests itself as monoparesis. With this form, focal epileptic seizures often occur.G80.3 Dyskinetic form (the term “hyperkinetic form” is also used) One of the most common causes of this form is transferred hemolytic disease newborns, which was accompanied by the development of nuclear jaundice. Also the reason isstatusmarmoratusbasal ganglia in full-term infants. With this form, as a rule, the structures of the extrapyramidal system and the auditory analyzer are damaged. The clinical picture is characterized by the presence of hyperkinesis: athetosis, choreoathetosis, torsion dystonia (in children in the first months of life - dystonic attacks), dysarthria, oculomotor disorders, hearing loss. It is characterized by involuntary movements (hyperkinesis), increased muscle tone, which may simultaneously cause paralysis and paresis. Speech disorders are observed more often in the form of hyperkinetic dysarthria. Intelligence develops generally satisfactorily. There is no correct alignment of the torso and limbs. Most children show preservation of intellectual functions, which has a favorable prognosis for social adaptation and learning. Children with good intelligence finish school, secondary special and higher educational establishments, adapt to certain work activities. There are athetoid and dystonic (with the development of chorea and torsion spasms) variants of this form of cerebral palsy.G80.4 Atactic form (the term “atonic-astatic form” was previously used) Characterized by low muscle tone, ataxia and high tendon and periosteal reflexes. Speech disorders in the form of cerebellar or pseudobulbar dysarthria are common. Observed with predominant damage to the cerebellum, fronto-pontine-cerebellar tract and,21 probably the frontal lobes due to birth trauma, hypoxic-ischemic factor or congenital developmental anomaly. Clinically characterized by a classic symptom complex (muscle hypotonia, ataxia) and various symptoms cerebellar asynergia (dysmetria, intention tremor, dysarthria). With this form of cerebral palsy, there may be a delay in the development of intelligence in rare cases. More than half of the cases diagnosed with this form are unrecognized early hereditary ataxias.G80.8 Mixed forms Despite the possibility of diffuse damage to all motor systems of the brain (pyramidal, extrapyramidal and cerebellar), the above clinical symptom complexes allow in the vast majority of cases to diagnose a specific form of cerebral palsy. The last point is important in drawing up a patient’s rehabilitation chart. Often a combination of spastic and dyskinetic (with combined severe damage to the extrapyramidal system) forms is also noted, the presence of hemiplegia against the background of spastic diplegia (with asymmetric cystic foci in the white matter of the brain, as a consequence of periventricular leukomalacia in premature infants).Prevalence of forms of cerebral palsy . spastic tetraplegia - 2%spastic diplegia - 40%hemiplegic form - 32%dyskinetic form - 10%ataxic form - 15%Orthopedic consequences of cerebral palsy . In many cases, orthopedic complications of cerebral palsy are primary in relation to motor activity disorders, and by eliminating them, you can literally put the child back on his feet. Of greatest importance in the pathogenesis of this type of consequences are the dystrophic processes of skeletal muscles, which lead to the formation of rough scar tissue with multiple contractures and subsequently to deformation of the nearby joint and bones. This not only causes movement disorders, but also causes persistent pain and antalgic symptoms.22 (forced) postures in patients. Muscle contractures further limit the already difficult ability to move, therefore the treatment of orthopedic consequences of cerebral palsy occupy a special place in general process recovery of the patient.Other consequences of cerebral palsy . Symptoms when this violation can be very different: from barely noticeable to complete disability. It depends on the degree of damage to the central nervous system. In addition to the above symptoms, the following may also be observed: characteristic features diseases:pathological muscle tone;uncontrolled movements;impaired mental function;convulsions;speech, hearing, and vision disorders;difficulty swallowing;violations of acts of defecation and urination;emotional problems. Features of the manifestation of disorders in children with cerebral palsy . In children with cerebral palsy, the formation of all motor functions is delayed and impaired: holding the head, sitting, standing, walking, and manipulating skills. At an early stages of cerebral palsy motor development may be uneven. The child may not yet be able to hold his head up at 8-10 months, but he is already beginning to turn and sit up. He does not have a support reaction, but he is already reaching for the toy and grasping it. At 7-9 months. the child can sit only with support, but stands and walks in the playpen, although the alignment of his body is defective. During the newborn period, children with cerebral palsy often experience general anxiety, tremor (trembling of the arms, chin), an increase or, on the contrary, a sharp decrease in muscle tone, sometimes there is an increase in the size of the head, increased tendon reflexes, absence or weakness of cry, and disturbances in sucking due to weakness sucking reflex, convulsions often occur. Already in the first months of life, a lag in psychomotor development appears, which is combined with a delay in extinction of course 23 reflex motor automatisms, among which the most important are the so-called postural reflexes. With normal development, by 3 months of life these reflexes no longer appear, which creates favorable conditions for the development of voluntary movements. The preservation of even individual elements of these reflexes after 3-4 months of life is a symptom of risk or a sign of damage to the central nervous system. Motor disorders in children with cerebral palsy have varying degrees of severity: - severe, when the child cannot walk and manipulate objects; - mild, in which the child walks and cares for himself independently. Children with cerebral palsy are characterized by: various disorders of cognitive and speech activity; a variety of disorders of the emotional-volitional sphere (in some - in the form of increased excitability, irritability, motor disinhibition, in others - in the form of lethargy, lethargy), a tendency to mood swings; originality of personality formation (lack of self-confidence, independence; immaturity, naivety of judgment; shyness, timidity, hypersensitivity, touchiness). Features of emotional and personal development of children with cerebral palsy . Children with cerebral palsy are characterized by a variety of emotional and speech disorders. Emotional disorders manifest themselves in the form of increased emotional excitability, increased sensitivity to common environmental stimuli, and a tendency to mood swings. Increased emotional excitability can be combined with a joyful, elevated, complacent mood (euphoria), with a decrease in criticism. Often this excitability is accompanied by fears, especially the fear of heights. Also, increased emotional excitability can be combined with behavioral disorders in the form of motor disinhibition, affective outbursts, sometimes with aggressive manifestations, and protest reactions towards adults. All these manifestations intensify with fatigue, in a new environment for the child, and may be one of the reasons for school and social maladjustment. With excessive physical and intellectual stress, and errors in upbringing, these reactions are reinforced, and there is a threat of the formation of a pathological character. The most commonly observed disproportionate variant 24 personality development. This is manifested in the fact that sufficient intellectual development is combined with a lack of self-confidence, independence, and increased suggestibility. Personal immaturity is manifested in egocentrism, naivety of judgment, poor orientation in everyday and practical issues of life. Moreover, this dissociation usually increases with age. The child easily develops dependent attitudes, inability and unwillingness to engage in independent practical activities; Thus, a child, even with intact manual activity, does not master self-care skills for a long time. When raising a child with cerebral palsy important has the development of its emotional-volitional sphere, the prevention of neurotic and neurosis-like disorders, especially fears, increased excitability combined with self-doubt. A child with cerebral palsy often experiences a peculiar development similar to mental infantilism. To prevent mental infantilism, it is important to develop the child’s will and self-confidence. Treatment and correction work for cerebral palsy . Early stimulation of mental and speech development Children with cerebral palsy need early comprehensive treatment and pedagogical work, aimed primarily at the development of speech motor skills and communicative behavior. Corrective work is carried out differentially, taking into account the form of the disease and the age of the child. Stimulation of mental development in the first year of life is aimed at the formation of visual, auditory and kinesthetic perception, visual-motor manipulative behavior, positive emotional communication with adults. From the first months of life, the child is actively stimulated to accumulate sensory experience. He is encouraged to examine surrounding objects through sight, hearing, and touch. Based on object-based practical and play activities, carried out with the help of an adult, sensory-motor behavior and vocal reactions are stimulated using the methods of so-called inhibition and facilitation. Inhibits unwanted pathological movements, 25 accompanied by an increase in muscle tone, and at the same time “facilitate” voluntary sensorimotor activity. Apply various devices for fixing the head, torso and limbs in order to facilitate the functions of the articulatory apparatus, training hand-eye coordination and other reactions. Special series of exercises aimed at stimulating sensory functions with simultaneous correction of motor disorders create conditions for the formation of perceptual actions. At the age of 1 to 3 years, the child develops object-manipulative activities, teaching him to master the skills of operating with various objects and initial ways of communicating with others. The main tasks at this stage are the development of verbal and objective-effective communication, the education of differentiated sensations, initial forms social behavior, independence. On the basis of objective-practical activities, carried out with the help of an adult, connections between words, objects and actions are consolidated. Children are taught to name objects, their purpose is explained, and new ones are introduced to them using vision, hearing, touch, and, where possible, smell and taste; show how to perform actions with these objects and stimulate active implementation. They teach the intonation of a request. Special series of exercises aimed at training sensory functions introduce children to the various qualities of objects and create conditions for the formation of perceptual actions. To do this, they use objects of different shape, length, color, temperature and other properties, arranged in the form of classification groups, for example: a series of rings of different sizes, a series of surfaces of different roughness, balls of different colors, etc. The child is taught to compare objects in pairs according to their properties , performing objective actions, choosing according to a model. The material used is pairs of geometric shapes, objects of all primary colors, tabs, and paired pictures. The main task of the teacher is to teach external orientation actions. Conductive education and early speech therapy work for cerebral palsy (CP) Conductive education and training for cerebral palsy includes complex methodology therapeutic and pedagogical influence using the regulating function of inner speech, rhythmic organization of movement. For this purpose, the child is encouraged to perform movements counting from 1 to 5, based on the same type of instructions, for example, up - down, etc. Rhythmic stimulation of movements is based 26 on psychological research many domestic psychologists(L.S. Vygotsky, N.A. Bernstein, A.R. Luria), considering voluntary motor activity based on the concept of functional systems, including kinesthetic and kinetic foundations and visual-spatial organization. Conductive education methodology based on this concept, in in turn, not only facilitates the execution of movements with cerebral palsy, but also contributes to the formation of voluntary regulation of behavior. Using this technique, an inextricable relationship is achieved in the development of motor skills, speech and voluntary regulation of behavior. An initial situational understanding of addressed speech and obedience to individual verbal instructions in familiar phrases are formed. To develop understanding simple instructions you need to pronounce them, at the same time showing the actions they indicate, helping the child to perform them. When carrying out this work, the emotional-positive interaction of the child with the adult implementing the system of conductive education is of particular importance. Speech therapy work for cerebral palsy is particularly specific. It is known that in children with cerebral palsy, the most common forms of speech disorders are various forms of dysarthria, the specificity of which is the commonality of speech and skeletal motor disorders with a lack of kinesthetic perception. One of the important tasks of speech therapy work for cerebral palsy is the development of sensations of articulatory postures and movements, overcoming and preventing oral dyspraxia. To improve the sensation of articulatory postures and movements, resistance exercises are used, alternating exercises with open eyes with visual control using a mirror and with closed eyes to focus on proprioceptive sensations. The relationship between general and speech motor impairments in cerebral palsy is also evident in the fact that the severity of articulatory motor impairments usually correlates with the severity of hand dysfunction. These data determine the need to combine speech therapy work with the development of hand function and general motor skills of the child. Violations of the sound pronunciation aspect of speech in cerebral palsy manifest themselves in the form of various forms of dysarthria. Speech therapy work is differentiated depending on the form of dysarthria, the level of speech development and the age of the child. With cerebellar dysarthria, it is important to develop the accuracy of articulatory movements and their sensations, to develop intonation, rhythmic and melodic 27 aspects of speech, work on synchronizing the processes of articulation, breathing and voice formation. The system of speech therapy treatment for all forms of dysarthria in children with cerebral palsy is complex in nature and includes correction of sound pronunciation in combination with the formation of sound analysis and synthesis, lexico-grammatical aspects of speech and coherent utterance. The main goal of the treatment of cerebral palsy: the most complete possible development skills of the child and his communication skills. The main method for correcting spastic movement disorders in cerebral palsy: ontogenetically consistent development of motor functions through sequential stimulation of chain righting reflexes while weakening pathological myelencephalic postural activity with reflex-inhibitory positions. Applicable: Massage, therapeutic gymnastics, including Bobath therapy, use of auxiliary technical devices, including for therapeutic gymnastics: load suit ("Adelie", "Gravistat"), pneumatic suit ("Atlant") speech therapy work, classes with a psychologist, as well as , if necessary: drug therapy: drugs that reduce muscle tone - baclofen (including: implantation of a baclofen pump), tolperisone botulinum toxin drugs: "Dysport", "Botox", "Xeomin" surgical orthopedic interventions: tendon plasty, tendon-muscular plasty, corrective osteotomy, arthrodesis, surgical elimination of contractures manually (for example, Ulzibat operations) and using distraction devices; functional neurosurgery: selective rhizotomy, selective neurotomy, chronic epidural neurostimulation of the spinal cord, operations on the subcortical structures of the brain, Voight method. Treatment comorbid disorders(epilepsy, etc.). At an early stage: treatment of the underlying disease that caused the development of cerebral palsy. spa treatment animal therapy. Exercise therapy technique for cerebral palsy . Regularity, systematicity, continuity Strict individualization of exercise therapy exercises in accordance with the stage of the disease, its severity, the age of the child, his mental development. Gradual strict dosing, increasing physical exercise Methods and 28 content of exercises for working with children with cerebral palsy: To stretch muscles, relieve muscle tension, expand range of motion. Mutual influence exercises to strengthen leading and antagonistic muscle groups. Endurance exercises to maintain the efficiency of the functional state of organs Relaxation training to eliminate muscle spasms, eliminate cramps Training to teach the patient to walk normally Exercise to climb an inclined plane to improve balance and motor strength Resistance exercise, gradual increase, resistance training to develop muscle strength Prevalence of cerebral palsy . At the moment, cerebral palsy occupies a leading place in the structure of chronic diseases of childhood. According to world statistics, the number of children with this disease is 1.7-7 per 1000 healthy ones; in Russia this figure ranges from 2.5-5.9. In some countries this figure is significantly higher; for example, according to France, in 1966 it was 8 people. The increase in the number of patients is associated not only with environmental deterioration, but also with progress in perinatal and neonatal medicine. Today, infants born prematurely, including those weighing 500 grams, are successfully cared for; as is known, prematurity is one of the main risk factors for cerebral palsy. Conclusion . Some children with pathologies do not have deviations in the development of cognitive activity and do not require special training and education. But all children with musculoskeletal disorders need special conditions for living, learning and subsequent work. 29 Literature . Badalyan L.O., Zhurba L.T., Timonina O.V. Cerebral palsy. M., 1989. Mastyukova E.M. Speech disorders hyperkinetic form of cerebral palsy and medical justification for speech therapy measures // Defectology. 1999. No. 3. Mastyukova E.M., Moskovkina A.G. What is the most important thing in raising a child with cerebral palsy? // Raising and teaching children with developmental disorders. 2002. No. 2. Shipitsina L.M., Mamaichuk L.M. Cerebral palsy. St. Petersburg, 2001. Arkhipova E.F. Corrective work with children with cerebral palsy.M., 1989. Ermolaev Yu.A. Age physiology, 1985

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