Cerebral palsy: causes and forms. What is cerebral palsy in a child - the main risks and consequences of cerebral palsy What brain structures are affected by cerebral palsy

Cerebral palsy is one of the most severe diagnoses that parents of infants can hear from doctors. If you want to understand what this disease is, what the symptoms and treatment are, read this article.

Cerebral palsy - what is it?

Cerebral palsy is not a specific disease with specific symptoms. This is a whole group of pathologies of the motor system, which became possible due to serious disorders in the central nervous system. Problems with the musculoskeletal system cannot be considered primary; they always follow lesions of the brain.

Anomalies in the cerebral cortex, subcortex, capsules and brain stem most often occur during the fetal development of the baby. The exact causes that ultimately lead to cerebral palsy in newborns are still being studied by scientists. However, doctors (despite a lot of hypotheses) seriously consider two periods when global changes in the brain can lead to severe pathology - the period of pregnancy and the period immediately before, during and immediately after childbirth.

Cerebral palsy does not progress, the stage of the lesion and the limitation of motor functions do not change. The child grows, and some disorders become more noticeable, so people mistakenly believe that cerebral palsy can develop and become more complicated.

The group of diseases is quite common - based on statistics, it can be noted that out of a thousand children, two are born with one form or another of cerebral palsy. Boys are almost one and a half times more likely to get sick than girls. In half of the cases, in addition to motor dysfunction, various mental and intellectual disorders are observed.

Pathology was noticed back in the 19th century. Then the British surgeon John Little began studying birth injuries. It took him exactly 30 years to formulate and present to the public the idea that the lack of oxygen experienced by the fetus at the moment of its birth can result in paresis of the limbs.

At the end of the 19th century, the Canadian doctor Osler came to the conclusion that cerebral disorders are still associated with the hemispheres of the brain, and not with the spinal cord, as the British Little argued before him. However, medicine was not very convinced by Osler’s arguments, and for a very long time Little’s theory was officially supported, and birth trauma and acute asphyxia were named as starting mechanisms for cerebral palsy.

The term “cerebral palsy” was introduced by the famous doctor Freud, who was a neurologist and studied the problem in his own practice. He formulated intrauterine damage to the child’s brain as the main cause of the pathology. He was the first to draw up a clear classification of the different forms of this disease.

Causes

Modern doctors believe that cerebral palsy cannot be considered a hereditary disease. Damages to the musculoskeletal system and problems with mental development become possible in the event of improper development of the baby’s brain during the mother’s pregnancy, as well as banal underdevelopment of the brain.

If a child is born much earlier than expected, the risk of cerebral palsy is several times higher. This is confirmed by practice - many children with musculoskeletal disorders and an established diagnosis of cerebral palsy were born very premature.

However, it is not prematurity itself that is scary; it only creates the preconditions for the development of disorders.

The likelihood of cerebral palsy is usually influenced by other factors, which, in combination with premature birth, lead to the disease:

• “mistakes” during the appearance and development of brain structures (first trimester of pregnancy);
• chronic oxygen starvation of the fetus, prolonged hypoxia;
• intrauterine infections that the baby suffered while still in the womb, most often caused by herpes viruses;
• severe form of Rh conflict between mother and fetus (occurs when the mother is Rh negative and the child is Rh positive), as well as severe hemolytic disease of the child immediately after birth;
• brain injury during childbirth and immediately after it;
• brain infection immediately after birth;
• toxic effects on the child’s brain from heavy metal salts and poisons - both during pregnancy and immediately after birth.

However, it is not always possible to establish the true cause of a child’s illness. If only because there is no way to understand at what stage of development of the embryo and fetus that total “mistake” occurred, just as there is no way to prove that brain damage is the result of a conflict of Rh factors. Some children with cerebral palsy have not one, but several causes for the development of the disease.

Forms and their characteristics

Since cerebral palsy is a group of disorders, there is a fairly detailed classification of the forms of each type of lesion. Each form of cerebral palsy has certain signs and manifestations:

Hyperkinetic (dyskinetic)

This form is most often diagnosed in children who suffer an antibody attack in utero associated with Rh conflict. When they are born, the development of hemolytic disease of the newborn (HDN) plays a role, its nuclear icteric form is especially dangerous. In this case, the subcortex of the brain is affected, as well as the auditory analyzers.

The child suffers from hearing loss and has uncontrollable eye twitching. He makes involuntary movements. Increased muscle tone. Paralysis and paresis can develop, but are not considered obligatory. Children with this type of cerebral palsy are quite poorly oriented in the surrounding space, they have difficulties with intentional actions of their limbs - for example, it is difficult for the child to pick up this or that object.

With all this, intelligence suffers to a lesser extent than with some other types of cerebral palsy. Such children (with due effort on the part of parents and teachers) are well socialized, they are able to study at school, many later manage to enter a university, get a profession and find a job.

Ataxic (atonic-astatic)

This type of cerebral palsy is associated with damage to the cerebellum, the frontal lobes of the brain, and the pathway between the cerebellum and the frontal lobe. Such damage is most often a consequence of chronic severe fetal hypoxia, anomalies in the development of these brain structures. Birth trauma to the frontal lobes is often cited as a likely cause.

With this form, the child’s muscle tone is reduced. When moving, the muscles are not coordinated with each other, so the child is not able to make purposeful movements. It is practically impossible to maintain balance due to decreased muscle tone. Shaking (tremor) of the limbs may be observed.

Such children are most susceptible to epileptic seizures. At an early age there are problems with the development of vision and speech. With proper care, systematic training, and adequate therapy, children with the atanic-astatic form of cerebral palsy can demonstrate certain low intellectual abilities, which allow them to only slightly master the basics of speech and understand what is happening. In more than half of the cases, speech remains undeveloped, and the children themselves do not show any interest in this world.

Spastic tetraplegia (spastic tetraparesis)

This is the most severe form of cerebral palsy. It occurs due to damage to the brain stem, both hemispheres or the cervical spine. The most likely causes are intrauterine fetal hypoxia, mechanical asphyxia when the umbilical cord entangles the neck, and cerebral hemorrhage (due to damage by toxins, for example, or due to a brain infection). Often the cause is considered to be a birth injury in which the cervical spine was damaged.

With this form of cerebral palsy, the motor activity of all four limbs (both arms and legs) is impaired - to approximately the same extent. Since the arms and legs cannot move, their inevitable and irreversible deformation begins.

The child experiences muscle and joint pain and may have difficulty breathing. More than half of children with such cerebral palsy have impaired activity of the cranial nerves, resulting in strabismus, blindness, and hearing impairment. In 30% of cases, microcephaly is observed - a significant decrease in the volume of the brain and cranium. More than half of patients with this form suffer from epilepsy.

Unfortunately, such children cannot take care of themselves. Big problems also arise with learning, since the intellect and psyche suffer to a significant extent, and the child not only does not have the opportunity to take something with his hands, he does not have the banal motivation to take something or do something.

Spastic diplegia (Little's disease)

This is the most common form of cerebral palsy; it is diagnosed in three out of four sick children. When the disease occurs, some parts of the white matter of the brain are usually affected.

Spastic lesions are bilateral, but the legs are more affected than the arms and face. The spine becomes deformed very quickly and joint mobility is limited. Muscles contract uncontrollably.

Intelligence, mental development and speech development suffer quite markedly. However, this form of the disease is subject to correction, and a child with Little’s disease can be socialized - however, the treatment will be long and almost permanent.

Hemiplegic

This is a unilateral spastic lesion that most often affects the arm rather than the leg. This condition becomes possible as a result of hemorrhage in one hemisphere of the brain.

Socialization of such children is possible if their intellectual capabilities are sufficiently great. Such children develop far behind their peers. They are characterized by delayed mental and psychological development, problems with speech. Sometimes epilepsy attacks occur.

Mixed

With this form of pathology, brain dysfunction can be observed in a variety of structures and areas, so the likelihood of a combination of disorders of the motor system is quite real. Most often, a combination of spastic and dyskinetic forms is detected.

Unspecified

This form of the disease is spoken of when the lesions are so extensive that it is not possible to identify the specific parts of the brain in which the anomaly occurred (developmental defect or traumatic impact).

Symptoms and signs

It is not always possible to see the first signs of cerebral palsy in an infant in the maternity hospital, although serious brain disorders are noticeable from the first hours of the child’s life. Less severe conditions are sometimes diagnosed a little later. This is due to the fact that as the nervous system grows and the connections in it become more complex, disorders of the motor and muscular systems become obvious.

There are alarming symptoms that should make parents wary and consult a doctor. These symptoms are not always signs of cerebral palsy; quite often they indicate neurological disorders that are in no way related to cerebral palsy.

However, they cannot be ignored.

Parents should be suspicious if:

• the child does not fix his head well, cannot hold it even at 3 months;
• the baby’s muscles are weak, which is why the limbs look like “noodles”;
• the child does not roll over on his side, does not crawl, cannot fix his gaze on a toy and does not take toys in his hands, even if he is already 6-7 months old;
• unconditioned reflexes with which every child is born (and which normally should disappear by six months) continue to persist even after 6 months;
• the limbs are spastically tense and do not relax, sometimes spasms occur in “attacks”;
• the child has seizures;
• visual impairment, hearing impairment;
• chaotic movements of the limbs, uncontrolled and random (this symptom cannot be assessed in newborns and children in the first month of life, since for them such movements are a variant of the norm).

It is most difficult to identify signs of cerebral palsy in children under 5 months of age. This task is difficult even for an experienced doctor. He may suspect a pathology, but he has no right to confirm it until the child is 1 year old. One or more of the symptoms from the list above cannot be used to suspect cerebral palsy, nor can one mistake the symptoms of some similar diseases for cerebral palsy.

Parents should be very careful, because if treatment for some forms of pathology begins early, before 3 years of age, the results will be excellent, and the child will be able to lead a completely full life.

Stages of the disease

In medicine, there are three stages of the disease. The first (early) begins at approximately the age of 3-5 months, the initial stage is called a disease identified at the age of six months to 3 years, the late stage is said to be if the child is already 3 years old.

The smaller the stage, the better the prognosis for cure. Even if it is not possible to cure the child completely, it is quite possible to reduce negative manifestations as much as possible. The child’s brain (even one that has suffered from trauma or developmental defects) has a high ability to compensate; this can and should be used when correcting disorders.

Diagnostics

Quite often, genetic diseases, which are completely independent diseases, are mistaken for cerebral palsy, as a result of which children are given a diagnosis that does not correspond to reality. Modern medicine is very developed, but the symptoms associated with brain pathology still remain poorly understood.

The disease can usually be identified closer to 1 year. If a child at this age does not sit, does not crawl, or shows other progressive signs of nervous system disorders, the doctor will prescribe an MRI.

Magnetic resonance imaging is the only more or less reliable study that allows us to judge the presence of cerebral palsy - and even establish its probable form.

For young children, the procedure is carried out under general anesthesia, since you must lie still and for quite a long time in the capsule to obtain images. Children can't do that.

With genuine cerebral palsy, layer-by-layer MRI images show atrophy of the cortical and subcortical zones of the brain, and a decrease in the density of white matter. To distinguish cerebral palsy from a huge list of genetic syndromes and conditions that are similar in manifestation, the child may be prescribed an MRI of the spinal cord.

If a child experiences seizures, the doctor prescribes electroencephalography. Ultrasound of the brain is relevant only for newborns; this technique is sometimes used in maternity hospitals if there is a suspicion of cerebral palsy.

The reason for an ultrasound examination may be such factors as prematurity and low birth weight of the child, the established fact of intrauterine infection, the use of special forceps by obstetricians during childbirth, hemolytic disease, low Apgar score of the newborn (if the child “scored” no more than 5 points at birth) .

At a very early stage after birth, symptoms of very severe forms of cerebral palsy may be visually visible. At the same time, it is also important to distinguish them and separate them from other similar pathologies. Doctors include a sluggish sucking reflex, lack of spontaneous movements of the limbs, and hydrocephalus as alarming symptoms of a newborn.

Treatment

Treatment does not aim to restore the functioning of the affected parts of the brain, since this is practically impossible. Therapy is aimed at enabling the child to acquire skills and abilities that will help him become a member of society, get an education, and serve himself independently.

Not every form of cerebral palsy is subject to such correction, since the severity of brain damage in them varies. But in most cases, doctors and parents, through joint efforts, still manage to help the child, especially if treatment began in a timely manner, before the baby is 3 years old. The following options can be distinguished:

Massage and Bobath therapy

Motor functions are restored sequentially, for this purpose therapeutic massage and Bobath therapy are used. This method was founded by a British couple, therapists Bertha and Karl Bobath. They proposed to influence not only the damaged limbs, but also the child’s psyche. In combination, the psychophysical effect gives excellent results.

This therapy allows the child over time to develop not just the ability to move, but also to do it completely consciously. Bobath therapy is contraindicated only for children with epilepsy and convulsive syndrome. This method is recommended for everyone else.

A physical therapy specialist selects an individual program for each child, since Bobath therapy, in principle, does not provide a unified approach and a specific scheme. Depending on how much and how the limbs are affected, at the first stage the doctor does everything to ensure that the body “forgets” the incorrect position. For this purpose, relaxing technologies, exercises, and massage are used.

At the second stage, the specialist makes the correct physiological movements with the child’s limbs so that the body “remembers” them. At the third stage, the child begins to be motivated (in a playful or other form) to independently perform those very “correct” movements.

Bobath therapy allows the child, albeit later, to go through all the natural stages of development - standing on all fours, crawling, sitting, grasping with his hands, leaning on his legs. With due diligence in their studies, parents and doctors achieve excellent results - the “correct” positions are perceived by the child’s body as habitual and become an unconditioned reflex.

Nutrition

Proper nutrition is very important for a child with cerebral palsy, since many children with this diagnosis have concomitant pathologies of internal organs and the oral cavity. The digestive system is most often affected.

There is no special diet for children with cerebral palsy. When prescribing nutrition, the doctor takes into account the development of sucking and swallowing reflexes, as well as the amount of food that the child “loses” during eating - spills, cannot swallow, regurgitates.

Coffee and carbonated drinks, smoked fish and sausage, canned food and pickled foods, as well as spicy and salty foods are completely eliminated from the diet of children with this diagnosis.

Taking nutritional formulas is encouraged (regardless of age), as they provide a more balanced diet. If a child refuses to eat or cannot do so due to the lack of a swallowing reflex, a special probe may be installed.

Vojta therapy

A method that bears the name of its creator – the Czech doctor Vojta. It is based on the formation in children of motor skills characteristic of their age. To do this, the exercises are based on two starting skills - crawling and turning. Both in a healthy child are formed at the level of reflexes.

In a child with damage to motor skills and the central nervous system, they have to be formed “manually” so that they later become a habit and give rise to new movements - sitting, standing and walking.

The technique can be taught to parents by a vojta therapist. All exercises are carried out independently, at home. The clinical effectiveness of this type of intervention (as well as Bobot therapy) has not been proven to date, but this does not prevent medical statistics from regularly being updated with positive figures of improved conditions of children with cerebral palsy.

Medicines

There is no particular emphasis on pills and injections, since there is no medicine that would help cure cerebral palsy completely. However, some medications significantly alleviate the child’s condition and help him rehabilitate more actively. Not every baby with such a pathology needs their use; the appropriateness of using medications is determined by the attending physician.

To reduce muscle tone, it is often prescribed "Baclofen", "Tolperizon". Botulinum toxin preparations also reduce muscle spasticity - "Botox", "Xeomin". After Botox is injected into a spasmed muscle, visible muscle relaxation appears within 5-6 days.

This action sometimes lasts from several months to a year, after which the tone usually returns. But the motor skills acquired during this time are preserved, which is why botulinum toxins are included in the Russian standard for the treatment of cerebral palsy - as a means of complex therapy.

For epileptic seizures, the child is prescribed anticonvulsants, and nootropic drugs are sometimes prescribed to improve cerebral circulation.

Some disorders in cerebral palsy can be quite successfully corrected surgically. They operate on strained ligaments and tendons, perform muscle-tendon plastic surgery, and surgeons are excellent at eliminating the stiffness and limited movement of joints that accompany some forms of the disease.

Other methods

Treatment of children with cerebral palsy with the help of pets shows very good results. Animal-assisted therapy (this is the international name of the method, not always used in Russia) allows the child to socialize faster and stimulates intellectual and mental functions. Most often, parents of a child with this diagnosis are advised to get a dog or cat. At the same time, the child should communicate and be near his pet as often as possible.

Hippotherapy - treatment with the help of horses - has also become very widespread. In many Russian cities there are clubs and centers where children with cerebral disorders engage in horse riding under the supervision of experienced hippotherapists.

While riding in the saddle, a person uses all muscle groups, and attempts to maintain balance are reflexive, that is, a signal from the brain is not at all necessary to set the muscles in motion. During classes, children develop useful motor skills.

The beneficial impulses that a horse sends to its rider while walking are a natural massage. During the procedure, the child is placed in a saddle, pulled along the horse’s spine, and sat down, trying to load all the “problem” areas of the body and limbs.

Emotionally, children perceive a live horse much better; emotional contact is precisely the factor that allows a child with cerebral palsy to develop motivation.

If parents and children do not have the opportunity to communicate live with such an animal, then a hippo trainer will come to the rescue, on which all movements are monotonous and the same.

Methods with unproven effectiveness

Quite often, children are prescribed vascular drugs “Cerebrolysin”, “Actovegin” and others, classified as nootropic. Although their use is widespread, it raises serious doubts, since clinical trials have not shown a significant change in the condition of children with cerebral palsy after a course of treatment with nootropic drugs.

Quite often on the Internet, parents who are constantly looking for new methods and ways to overcome a terrible illness come across modern homeopathic remedies, which promise “improved brain function.” None of these products currently have official approval from the Ministry of Health, and their effectiveness has not been proven.

Treatment of cerebral palsy stem cells- another commercial and very profitable step by manufacturers of drugs with unproven effects. Clinical trials have shown that stem cells cannot restore motor disorders, since they do not have any effect on the connection between the psyche and motor skills.

Experts believe that there is little benefit for cerebral palsy and from manual therapy. No one belittles its importance; for a number of other pathologies during the recovery period after injuries, the technique gives positive results. However, it is in children with cerebral palsy that its use is inappropriate.

Forecasts

With the modern level of medicine, a diagnosis of cerebral palsy is not a death sentence. Certain forms of the disease are amenable to complex therapy, which includes the use of medications, massage, rehabilitation techniques, and work with a psychologist and special education teacher. Just some 50-60 years ago, children with cerebral palsy rarely lived to adulthood. Now life expectancy has changed significantly.

On average, with treatment and good care, a child with cerebral palsy today lives to be 40-50 years old, and some have managed to overcome the retirement age line. It is quite difficult to answer the question of how many people live with such a diagnosis, because much depends on the degree and severity of the disease, its form and the characteristics of the course in a particular child.

A person with cerebral palsy is susceptible to premature aging; his actual age is always lower than his biological age, because deformed joints and muscles wear out faster, creating the preconditions for early aging.

Disability

Disability for cerebral palsy is issued based on the form and severity of the disease. Children can count on the status of “disabled child”, and after they reach adulthood, they can receive the first, second or third disability group.

To receive disability, a child will have to undergo a medical and social examination, which should establish:

• form and degree of cerebral palsy;
• the nature of the damage to the motor function (on one or both sides, whether there are skills to hold objects, support on the legs);
• severity and nature of speech disorders;
• severity and degree of mental impairment and mental retardation;
• presence of epileptic seizures;
• the presence and degree of hearing and vision loss.

Children with severe disabilities are usually given the category “disabled child,” which needs to be re-confirmed before their 18th birthday. Parents of such a child will be able to count on receiving the necessary rehabilitation means for their child and visiting a sanatorium at the expense of the federal budget.

Features of development

In infants, cerebral palsy has almost no obvious manifestations (at least until 3-4 months). After this, the baby begins to rapidly lag behind his healthy peers in development.

Children with cerebral palsy have difficulty in coordinated movements. As the child gets older, he will try to avoid them. If at the same time intellectual abilities are preserved, then the kids grow up “slow”; they do everything very slowly, unhurriedly.

Children with a slight People with cerebral palsy are rarely aggressive or angry. On the contrary, they are characterized by incredible affection for their parents or guardians. She can reach the point of panic if the baby is afraid to be left alone.

Some forms of cerebral palsy “deform” the personality so much that the child can become withdrawn, embittered, and aggressive (for no apparent reason). However, it would be wrong to attribute everything solely to the form of the disease. Parents play a very important role in shaping a child’s character. If they are positive, good-natured, and encourage the child’s achievements, then the likelihood of getting an aggressive child is minimized.

At the physical level, in children with cerebral palsy, the first place is the lack of understanding of what the correct position of the body in space should be. Since an erroneous signal comes from the affected brain, the muscles receive it incorrectly, hence the inability to do something consciously and spontaneous movements.

Reflexes (Moro, grasping and others), which are characteristic of all newborns, disappear in order to give way to new skills. In children with cerebral palsy, these innate reflexes are often preserved, and this makes it difficult to learn new movements.

Many children with cerebral palsy are characterized by insufficient body weight, minimal subcutaneous fat, and weak (often blackened and crooked) teeth. Individual developmental characteristics are determined by a single factor - the preservation of intellectual potential. If it exists, then a lot can be adjusted and corrected.

Rehabilitation means

Special means that make the life of a child with cerebral palsy easier can be obtained from the federal budget. True, this is only possible if the doctor has included an exact list of them in the rehabilitation card, and the ITU commission, when confirming the disability, has recorded a list of necessary means for rehabilitation.

All devices are divided into three large groups:

• hygienic devices;
• devices that make movement possible;
• devices for child development, training and therapeutic procedures.

In addition, the child may need special furniture adapted for children with cerebral palsy, as well as shoes and dishes.

Hygiene

Such facilities include toilet chairs and bathing chairs in the bathroom. In order not to carry the child to the toilet (especially if he is already large and heavy), a toilet chair is used, which consists of a chair equipped with a removable sanitary tank. The chair also has wide, comfortable straps to securely hold the child in place.

The bathing chair has an aluminum frame and a seat made of waterproof material. On it, parents will be able to place the child comfortably and calmly give him a bath. The tilt adjustment allows you to change the angle to change your body position, and the seat belts keep your baby securely in place during the bath.

Mobility

A child who cannot move independently definitely needs a wheelchair, and more than one. Indoor strollers are used to move around the house, and strollers are used for walking. Walking option (for example, "Stingray") more lightweight, sometimes equipped with a removable table. Manufacturers of electric wheelchairs offer very good options, but their prices are quite high.

If a child has learned to walk, but cannot (or cannot always) maintain balance, he needs a walker. A well-fitting walker can also help with learning to walk. In addition, they train coordination of movements. Typically, a walker looks like a frame with four wheels and a safety device. The wheels cannot roll back, this completely eliminates tipping.

A more complex version of walkers is the parapodium. This is a dynamic verticalizer that will allow the child not only to stand, but also to exercise on the simulator at the same time. In such an orthosis, the child will be able to move independently. However, the parapodium is only suitable for children who have retained intellectual functions; for everyone else, it is better to use a regular static verticalizer.

The verticalizers secure the child in the popliteal space, as well as the feet, hips and waist. It allows for slight forward bends. If the model is equipped with a table, then the child can even play there.

Devices for child development

Such devices include special furniture, tables and chairs, some verticalizers, splints, a bicycle, exercise equipment and complex orthopedic shoes. All furniture is equipped with body position regulators and seat belts. It can be one item (chair or table) or a whole set, where each element is combined and matched with another.

A special bicycle for children with cerebral palsy is not only a toy, but also a means of active rehabilitation. It has a special (unusual for most people) design. It is always three-wheeled, and its steering wheel is not connected to the pedals. Therefore, turning the steering wheel in the wrong direction does not lead to the wheels turning in the desired direction.

This bicycle is equipped with attachments for the hands, legs and feet, as well as a cane, which allows parents to push the device with the child forward if the child cannot pedal independently.

Using a bicycle allows you to prepare your child well for learning to walk; it trains the leg muscles and alternating movements.

Exercise equipment

The modern medical industry has stepped far forward, and children with cerebral palsy today have access to not only the most familiar exercise bikes, but also real exoskeletons that will take on all the “work” of the muscles. In this case, the child will make movements together with the exoskeleton, due to which reflexive correct movement will begin to form.

The most popular in Russia is the so-called Adele costume. This is a whole system of supporting and load flexible elements. Exercising in such a suit allows the child to correct his posture and the position of his limbs, which ultimately has a good effect on other functions of the body. The baby begins to speak better, draw better, and it is easier for him to coordinate his own movements.

Adele's costume is very reminiscent of the outfit of a volunteer cosmonaut from a science-fiction film, but this should not be scary. The average course of treatment in such an outfit is about a month. In this case, a child (from 3 years old) will have to walk, bend and unbend, and squat (if possible) in this suit for 3-4 hours a day.

After such courses, which can be completed at a rehabilitation center, children feel more confident, they have easier control of their own arms and legs, their arches are strengthened, their stride appears wider, and they learn new skills. Doctors say that the risk of developing “fossilized” joints is reduced several times.

For home use, the most common treadmill, ellipsoid, as well as expensive (but very useful and effective) exoskeletons "Motomed" and "Lokomat" are well suited.

And at home, in a rehabilitation center, you can use the Gross simulator. It is very easy to attach it in the country house, in the apartment, on the street, and even in the pool so that the child can exercise in the water. The simulator is a movable block with a tensioned cable, elastic rods, and hand rings for the child to hold on to. Insurance and a special lever-carbine mechanism are provided.

Classes on such a simple simulator (according to the Ministry of Health) give amazing results - every fifth child with cerebral palsy develops the skills to move their legs independently, about a third of children with this diagnosis, after systematic training, were able to attend specialized schools and study.

In half of the cases, speech development improves. More than half of the children had significantly improved coordination of movements, 70% of the children had the prerequisites for acquiring new skills - they were able to learn to sit, stand up, and take their first steps.

Orthoses, splints and splints are often used to fix joints in the correct position. The most popular manufacturing companies are Swash And Gait Corrector.

Children from 1 year old can play with special toys for “special” babies; they include sets for fine motor skills with small movable and securely fastened parts. The production of special toys for medical rehabilitation of such children is carried out in St. Petersburg; they are produced under the brand "Tana-SPb". Unfortunately, the cost of the sets is quite high. A complete set costs about 40 thousand rubles, but it is possible to buy one or two toys from the set (1500-2000 rubles each).

These motor toys are also great for children with severe mental retardation; they stimulate not only motor skills, but also many other functions of the child’s body.

Charitable foundations

Parents should not be left alone with a child’s serious illness. Many rehabilitation equipment cannot be purchased from the budget, and income does not allow you to buy them yourself. In this case, charitable foundations created to help children with cerebral palsy will help. No one will ask parents for any “entry fees”; it is enough to send letters to the funds describing the problem, confirming the diagnosis - and wait for the necessary support.

If you don’t know where to turn, here are just a few organizations operating throughout Russia and well-established in helping children with cerebral palsy:

• Charitable Foundation “Children of Cerebral Palsy” (Tatarstan, Naberezhnye Chelny, Syuyumbike St., 28). The fund has been operating since 2004.
• "Rusfond" (Moscow, PO Box 110 "Rusfond"). The foundation has been operating throughout the country since 1998.
• Charitable Foundation "Creation" (Moscow, Magnitogorskaya str., 9, office 620). Since 2001, the Foundation has been working with children who are undergoing treatment and rehabilitation with cerebral palsy in clinics across the country.
• Charitable Foundation “Spread Your Wings” (Moscow, Bolshoi Kharitonyevsky Lane, building 24, building 11, office 22). The foundation has been operating since 2000 and provides support to disabled children.
• Foundation "Kindness" (Moscow, Skatertny Lane, 8/1, building 1, office 3). Works only with children with cerebral palsy since 2008.
• Charitable Foundation “Children of Russia” (Ekaterinburg, 8 Marta St., 37, office 406). Helping children with cerebral and other disorders of the central nervous system since 1999.

Definition. [Infantile] Cerebral palsy (CP or CP) is a term used to refer to a group of non-progressive disorders of body posture and movement caused by damage to the central nervous system occurring during the antenatal, intrapartum or neonatal period. Motor disorders characteristic of CP are often accompanied by cognitive, speech, and paroxysmal disorders (note: the concept of “[infantile] cerebral palsy” is somewhat arbitrary, since in most cases there is no true paralysis, but there is a violation of control of various forms movement).

The term “cerebral palsy” belongs to Sigmund Freud. In 1893, he proposed combining all forms of spastic paralysis of intrauterine origin with similar clinical signs into the group of cerebral palsy. In 1958, at the meeting of the VIII revision of the WHO in Oxford, this term was approved and defined: “cerebral palsy is a non-progressive disease of the brain that affects its parts that control movements and body position; the disease is acquired in the early stages of brain development.” The following definition by WHO (1980): “Infantile paralysis represents non-progressive motor and psycho-speech disorders that are the result of brain damage in the pre- and perinatal period of ontogenesis of the nervous system.” However, to date there is no consensus on this issue. There is also ambiguity in terminology. In the specialized literature you can find a large number of terms to refer to this suffering. In the English-language literature the terms “cerebral palsy” and “spastic paralysis” are used, in German - “cerebral movement disorder” and “cerebral palsy”. In publications by French authors the term “motility disorders of cerebral origin” is found. [ !!! ] The search for a term to more adequately define the essence of this violation continues to this day.

more details in the article “Evolution of ideas about cerebral palsy” Osokin V.V., Autonomous non-profit organization “Institute of Medical Correction, Rehabilitation and Support”, Irkutsk (magazine “Modern Science: Current Problems and Ways to Solve Them” No. 9, 2014) [ read ]

Epidemiology. According to I. A. Skvortsov (2003), the prevalence of cerebral palsy is 1.5 - 2 cases per 1000 live newborns. However, in surviving premature infants with a birth weight of less than 1500 grams, the risk of cerebral palsy increases to 90 per 1000 live newborns, and in premature infants weighing less than 1000 g, the incidence of cerebral palsy can reach 500 per 1000. Thus, the increase in the incidence of cerebral palsy is associated not only with perinatal pathology , but also with an increase in the number of children who can be cared for with prematurity and low weight. Numerous studies have found that more than 80% of cases of cerebral palsy are of prenatal origin and only 6 - 7% of cases are a consequence of asphyxia at birth.

Classifications. According to the International Statistical Classification ICD-10, the following forms of cerebral palsy are distinguished: spastic cerebral palsy, spastic diplegia, infantile hemiplegia, dyskinetic cerebral palsy, ataxic cerebral palsy, another type of cerebral palsy, unspecified cerebral palsy.

Today, the classification of forms of cerebral palsy by K.A. is most widely used in Russia. Semenova, proposed in 1978: spastic diplegia, double hemiplegia, hemiparetic) form, hyperkinetic form, atonic-astatic form, ataxic cerebral palsy.

Since the classification of motor disorders in infants according to traditional categories of cerebral palsy is difficult, L.O. Badalyan et al. in 1988 proposed to make adjustments to this classification taking into account the age of the patients. This classification highlights [ 1 ] forms of cerebral palsy of early age - spastic, dystonic and hypotonic, and [ 2 ] forms of older age - spastic (hemiplegia, diplegia, bilateral hemiplegia), hyperkinetic, atactic, atonic-astatic and mixed forms of cerebral palsy (spastic-atactic, spastic-hyperkinetic, ataxic-hyperkinetic).

In 1997, Professor Robert Polisano, together with colleagues from Canada's McMaster University, developed a functional classification of cerebral palsy, which is the Global Motor Function Classification System (GMFCS). In 2005, the executive committee of the American-British Academy of Cerebral Palsy proposed this classification as a working one. Currently, GMFCS is considered the generally accepted global standard for assessing the functional capabilities of patients with cerebral palsy.. GMFCS is a descriptive system that takes into account the degree of motor development and limitations of movements in daily life for 5 age groups of patients with cerebral palsy: up to 2 years, from 2 to 4, from 4 to 6, from 6 to 12 and from 12 to 18 years. There are five levels of development of gross motor functions: I - walking without restrictions, II - walking with restrictions, III - walking using manual devices for movement, IV - independent movement is limited, motorized vehicles can be used, V - complete dependence of the child on others ( transportation in a stroller/wheelchair). According to this classification, spastic, dyskinetic and atactic types of cerebral palsy are distinguished. In addition, concomitant disorders, data from neuroimaging research methods and the causality of the disease are taken into account (you can read more about GMFCS in User's Manual[read ]).

Risk factors for the formation of cerebral palsy. Taking into account the leading etiopathogenetic causes of cirrhosis, all cases of the disease can be divided into two large groups: genetic and non-genetic, but most patients will be somewhere in the middle. Therefore, it is preferable to use a classification based on the time of exposure to the pathological factor and to distinguish prenatal, intranatal and postnatal groups of causes of the disease (cases of cerebral palsy associated with multiple pregnancies and premature births should be considered separately).

Antenatal (prenatal) factors. Some infectious diseases of the mother and fetus increase the risk of cirrhosis, including rubella virus, herpes virus, cytomegalovirus (CMV), and toxoplasmosis. Each of these infections is potentially dangerous to the fetus only if the mother encountered it for the first time during pregnancy or if the infection actively persists in her body.

Just like an adult, a fetus can experience a stroke during intrauterine development. Fetal stroke can be either hemorrhagic (hemorrhage due to damage to a blood vessel) or ischemic (due to embolism of a blood vessel). Both in children with cirrhosis and in their mothers, various coagulopathies are identified significantly more often than in the population, which cause a high risk of intrauterine episodes of hyper- or hypocoagulation. Specific nosological pathologies of the blood coagulation system, as well as a deficiency of individual coagulation factors, thrombocytopathy, etc. can be hereditary in nature.

In general, any pathological factor affecting the fetal central nervous system antenatally can increase the risk of subsequent developmental disorders of the child. In addition, any medical condition that increases the risk of preterm birth and low birth weight, such as alcohol, tobacco or drugs, also puts the baby at risk for subsequent physical, motor and mental defects. Moreover, since the fetus receives all its nutrients and oxygen from the blood that circulates through the placenta, anything that interferes with the normal function of the placenta can adversely affect fetal development or increase the risk of premature birth. Therefore, pathological neoplasms or scars of the uterus, structural abnormalities of the placenta, premature separation of the placenta from the uterine wall and placental infections (chorioamnionitis) also pose a danger in terms of disruption of the normal development of the fetus and child.

Certain illnesses or injuries of the mother during pregnancy can also pose a danger to the development of the fetus, leading to the formation of neurological pathology. Women with autoimmune anti-thyroid or anti-phospholipid antibodies also have an increased risk of having a child with neurological disorders. A potentially key issue in this case is high levels of cytokines in the mother and fetus, which are proteins associated with inflammation, such as in infectious or autoimmune diseases, and can be toxic to fetal neurons. Severe physical injury to the mother during pregnancy may result in direct injury to the fetus or compromise the availability of nutrients and oxygen to developing fetal organs and tissues.

Intrapartum factors. Severe asphyxia during childbirth is not so common today in developed countries, but it is quite enough to lead in the future to the formation of severe motor and mental disorders. The causes of asphyxia can be mechanical: for example, tight entanglement of the umbilical cord around the fetal neck, its prolapse and prolapse, as well as hemodynamic: bleeding and other complications associated with premature abruption of the placenta or its pathological presentation. Particular attention must be paid to infectious factors. It must be taken into account that infections are not necessarily transmitted to the fetus from the mother through the placenta; infection can occur directly during childbirth.

Postnatal factors. About 15% of cases of cirrhosis in children are caused by causes that affect the child’s body after birth. Incompatibility of mother and child by blood type or Rh factor can lead to fetal bilirubin encephalopathy (the so-called “kernicterus”), which is fraught with the formation of hyperkinetic or dyskinetic syndromes. Serious infections that affect the brain directly, such as meningitis and encephalitis, can also cause permanent brain damage, leading to permanently disabling motor and mental deficits. Neonatal seizures can either directly cause damage to the central nervous system or be a consequence of other hidden pathological factors (encephalitis, stroke, metabolic defect), which will also contribute to the formation of persistent deficits in motor skills and psyche. When discussing the postnatal causes of CP, it is necessary to remember once again that in most foreign countries (D)CP is considered a symptom complex of persistent disabling motor disorders that arise as a result of the influence of pathological factors on the central nervous system of the fetus and child antenatally, intranatally or postnatally before the child reaches the age of 3 - 4 years old. Thus, the category of patients with (D)CP according to foreign standards may include patients with consequences of physical trauma, drowning, suffocation, intoxication, leading to persistent neurological disorders.

Symptoms. Clinical manifestations of CP (and, accordingly, classifications) are varied; they depend on the nature, degree of developmental disorder and pathological state of the brain:

The following are concomitant neurological manifestations of CP that are not related to the motor sphere (but are also a consequence of damage to the central nervous system, often, but not necessarily, accompanying CP): [ 1 ] intellectual (cognitive) and behavioral disorders; [ 2 ] epilepsy and other paroxysmal disorders; [ 3 ] visual and hearing impairments; [ 4 ] speech disorders (dysarthria) and nutrition.

Read more about clinical disorders in children with CP in the article “Modern approaches to the diagnosis and objectification of disorders in cerebral palsy” by M.S. Balgaeva, Astana Medical University JSC, Astana, Kazakhstan (journal “Neurosurgery and Neurology of Kazakhstan” No. 4 (41), 2015) [read]

read also the article “Cerebral palsy in adults: current state of the problem” Shulyndin A.V., Antipenko E.A.; Nizhny Novgorod State Medical Academy, Department of Neurology, Psychiatry and Narcology FPKV, Nizhny Novgorod (magazine “Neurological Bulletin” No. 3, 2017) [read]

Diagnostics. Diagnosis of cirrhosis is based on clinical manifestations. Among the anamnestic data, one should take into account the course of pregnancy, childbirth, assessment of the child’s condition after birth [Apgar score, resuscitation measures, video analysis of Prechtl’s generalized movements (GMS)]. Most often, the diagnosis is determined by the end of the first 6 - 12 (18) months of the child’s life, when, in comparison with healthy peers, the pathology of the motor system becomes obvious. To confirm the pathology of the central nervous system, neuroimaging methods are used: ultrasound diagnostics (neurosonography), magnetic resonance and computed tomography (detection of periventricular leukomalacia, ventriculomegaly, foci of ischemia or hemorrhage or structural abnormalities of the central nervous system, etc.).

Neurophysiological studies (electroencephalography, electromyography, recording of evoked potentials) and laboratory (biochemical tests, genetic tests) are usually used to identify pathological conditions that often accompany CP (optic atrophy, hearing loss, epileptic syndromes) and differential diagnosis of CP with many hereditary and metabolic diseases that debut in the first year of a child’s life.

read the post: Early diagnosis of cerebral palsy(to the website)

Principles of therapy. CP cannot be cured, which is why we are talking about restorative treatment or rehabilitation, however, timely and correct restorative treatment can lead to a significant improvement in the functions impaired by the disease. The rehabilitation treatment program for a child with CP depends on the severity, nature and predominant localization of the symptoms, as well as on the presence or absence of disorders accompanying CP that are not related to the motor sphere (see section “Symptoms”). The most serious obstacles to the rehabilitation of a child with CP are concomitant impairment of intelligence and cognitive activity, which interferes with adequate interaction between the patient and the instructor, and epileptic seizures, which, in the absence of drug control, can create a risk for the child of life-threatening complications against the background of active stimulating treatment. However, today special “soft” rehabilitation programs have been developed for children with epilepsy, as well as methods of communicating with intellectually disabled patients with CP, that is, for each patient, their own individual rehabilitation program can and should be developed, taking into account its capabilities, needs and problems. The main goal of rehabilitation for CP is the adaptation of the sick person to society and his full and active life.

note! The duration of rehabilitation treatment for a patient with cirrhosis is not limited, and the program must be flexible and take into account the constantly changing factors of the patient’s life. Despite the fact that cirrhosis is not a progressive disease, the degree and severity of its main symptoms may change over time and may also be accompanied by complications (for example, long-term spasticity can lead to the formation of contractures, pathological postures and deformities of the joints and limbs, requiring surgical corrections).

more details in the article “Cerebral palsy: clinical recommendations for treatment and prognosis” by N.L. Tonkonozhenko, G.V. Klitochenko, P.S. Krivonozhkina, N.V. Malyuzhinskaya; Department of Childhood Diseases, Pediatric Faculty of Volgograd State Medical University (magazine “Medicinal Bulletin” No. 1 (57), 2015) [read]

Cerebral paralysis the most common cause of disability in children and young people in developed countries. Its prevalence is approximately 2 - 2.5 cases per 1000 people. The term describes a group of chronic, non-progressive brain abnormalities that develop during the fetal or neonatal period, leading primarily to disturbances of movement and posture, causing "activity limitation" and "functional impairment."

Risk factors for cerebral palsy: [I] antenatal factors: [ 1 ] premature birth, [ 2 ] chorio-amnionitis, [ 3 ] respiratory or genitourinary infections in the mother requiring hospital treatment; [ II] perinatal factors: [ 1 ] low birth weight, [ 2 ] chorioamnionitis, [ 3 ] neonatal encephalopathy, [ 4 ] neonatal sepsis (especially with birth weight less than 1.5 kg), [ 5 ] respiratory or genitourinary infections in the mother requiring hospital treatment; [ III] postnatal factors: [ 1 ] meningitis.

Immediate causes of cerebral palsy:

Several studies using MRI in children have found that in cerebral palsy there are: [ 1 ] white matter damage (in 45% of cases); [ 2 ] damage to the basal ganglia or deep gray matter (13%); [ 3 ] congenital anomaly (10%); [ 4 ] focal infarctions (7%).

When assessing the probable cause of cerebral palsy, consider that white matter damage (including periventricular leukomalacia) detected on neuroimaging: [ 1 ] more common in premature babies, [ 2 ] can be recorded in children with any functional or motor impairment, but are more common in spastic than in dyskinetic type of cerebral palsy.

When assessing the likely cause of cerebral palsy, consider that damage to the basal ganglia or deep gray matter is primarily associated with dyskinetic cerebral palsy.

When assessing the likely cause of cerebral palsy, consider that congenital malformations as a cause of cerebral palsy: [ 1 ] are more common in children born on time than in those born prematurely; [ 2 ] may occur in children with any level of functional impairment or motor subtype; [ 3 ] are associated with higher rates of functional impairment than other causes.

Be aware that the clinical syndrome of neonatal encephalopathy can result from various pathological conditions (eg, hypoxic-ischemic brain injury, sepsis) and the presence of one or more of these conditions can cause damage and interfere with brain development.

When assessing the likely cause of cerebral palsy, consider that neonatal encephalopathy syndrome in infants with cerebral palsy born after 35 weeks: [ 1 ] is associated with perinatal hypoxic-ischemic injury in 20% of cases; [ 2 ] is not associated with perinatal hypoxic-ischemic injury in 12%.

Consider that if cerebral palsy is associated with perinatal hypoxic-ischemic brain injury, the degree of long-term functional impairment often depends on the severity of encephalopathy, and that dyskinetic movement disorders are more common than other subtypes of disorders.

Keep in mind that in case of cerebral palsy, which manifests itself after the neonatal period, the following diseases may be the causes: [ 1 ] meningitis (20%); [ 2 ] other infections (30%); [ 3 ] head injury (12%).

When assessing the probable cause of cerebral palsy, consider that independent factors: [ 1 ] may have a cumulative effect, adversely affecting brain development and leading to cerebral palsy; [ 2 ] can affect any stage of child development, including the antenatal, perinatal and postnatal periods.

An extensive multidisciplinary team assessment program should be established for children under 2 years of age (adjusted for gestational age) who are at increased risk of developing cerebral palsy (see Risk Factors for Cerebral Palsy).

It is advisable to use the General Movement Assessment (GMA) test during routine assessment of newborns aged 0 to 3 months if they are at increased risk of developing cerebral palsy.

The following motor characteristics in the early period of a child’s life should raise alarm bells regarding cerebral palsy: [ 1 ] unusual fidgety movements or other movement abnormalities, including movement asymmetry or hypokinesis; [ 2 ] tone abnormalities, including hypotonia, spasticity (stiffness), or dystonia; [ 3 ] abnormal motor development (including delayed development of head-holding, rolling, and crawling skills); [ 4 ] difficulties with feeding.

If a child has an increased risk of developing cerebral palsy and/or the abnormal signs listed above, it is necessary to urgently contact an appropriate specialist.

The most common signs of motor delay in children with cerebral palsy are: [ 1 ] baby not sitting at 8 months of age (adjusted for gestational age); [ 2 ] the child is not walking at 18 months of age (adjusted for gestational age); [ 3 ] early asymmetry of hand function (preference to use one of the hands) before the age of 1 year (adjusted for gestational age).

All children with motor delay require consultation with specialists for further assessment and correction of management tactics. Children who constantly walk on their tiptoes (on the balls of their feet) should be consulted by a specialist.

If there is concern that a child may have cerebral palsy, but there is insufficient evidence to make a definitive diagnosis (the diagnosis is uncertain), discuss this with the child's parents or guardians and explain that additional testing and observation will be required to establish a definitive diagnosis.

Red flags for other neurological disorders:

If the child's condition has been assessed as cerebral palsy, but the child's clinical signs or development are not consistent with those expected for cerebral palsy, reassess the differential diagnosis, taking into account that the functional and neurological manifestations of cerebral palsy change over time.

The following signs/symptoms should be considered red flags for neurological disorders unrelated to cerebral palsy. If they are identified, it is necessary to refer the child/adolescent/young person (up to 25 years of age) to a neurologist: [ 1 ] no known risk factors for cerebral palsy (see “Risk Factors for Cerebral Palsy”); [ 2 ] family history of progressive neurological diseases; [ 3 ] loss of already achieved cognitive or developmental abilities; [ 4 ] development of unexpected/new focal neurological symptoms; [ 5 ] MRI results indicate progressive neurological disease; [ 6 ] MRI results do not correspond to clinical signs of cerebral palsy.

Principles of treatment:

It is recommended that all children with suspected cerebral palsy be immediately referred to an appropriate specialized institution for a multidisciplinary assessment for the purpose of early diagnosis and treatment. Parents or caregivers of children and adolescents with cerebral palsy play a central role in decision-making and care planning.

Patients with cerebral palsy should be provided with access to care from a local multidisciplinary team that: [ 1 ] is able to accommodate individual treatment and rehabilitation needs within agreed patient management plans; [ 2 ] can, if necessary, provide the following types of assistance: consultation and treatment with a doctor, nursing, physical therapy, occupational therapy, speech and language therapy, nutritional counseling, psychology; [ 3 ] can provide access to other services, if necessary, including such types of assistance as: neurological, pulmonological, gastroenterological and surgical specialized care, rehabilitation and neurorehabilitation, orthopedics, social assistance, consultation and assistance from an ENT and ophthalmologist, pedagogical support for preschool and school children age.

It is advisable to organize a clear routing of the patient to ensure the availability of specialized care necessary in the presence of concomitant pathology. It must be remembered that ongoing coordination and communication between all levels and types of care for children and adolescents with cerebral palsy is critical from the moment of diagnosis.

The most serious disease that destroys the life of a child is cerebral palsy. This neurological disease associated with brain damage develops into a disability for the baby. But with timely and correct treatment, the disease stops progressing and some symptoms disappear.

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

• (lack of oxygen while the mother is carrying a child);
• Infections during pregnancy;
• Failures in the formation of brain structures;
• Conflict of Rh factor between mother and baby;
• Brain injuries during pregnancy and childbirth;
• Toxic poisoning;
• Disturbances during childbirth.

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

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

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

• Genetic. Damage to the parents' chromosomes stimulates the occurrence of cerebral palsy in their child.
• Hypoxia. Lack of oxygen supply to the fetus, both during pregnancy and at the time of birth.
• Infections. Having suffered from meningitis, encephalitis, arachnoiditis before the age of one year, increases the risk of cerebral palsy, especially in severe forms.
• Poisoning. Damage to the body of a pregnant woman or baby by toxic poisons or drugs leads to illness. Harmful production, contact with toxic substances, potent medications are sources of risk for pregnant women.
• Physical. Various radiations and electromagnetic fields cause damage to the child in the prenatal period; these same sources of risk include radiation.
• Mechanical. A child receives mechanical damage during childbirth - these are birth injuries.

Determining the cause of cerebral palsy as accurately as possible will help identify the main pain points and prescribe appropriate treatment.

Forms

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

Spastic tetraplegia

The cause of spastic tetraplegia is oxygen starvation of the fetus during the intrauterine period or at the time of birth. Due to hypoxia, neurons in the baby’s brain die, and the nervous tissue loses the necessary characteristics. Brain lesions reveal such signs of cerebral palsy in a child as strabismus, speech impairment, decreased hearing and vision up to blindness, possible impaired mental abilities and developmental delays.

With an unexpressed impairment of hand activity, a patient with cerebral palsy with spastic syndromes can find his place in society, doing feasible work.

Dyskinetic

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

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

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

Ataxic

In the ataxic form, a decrease in muscle tone is observed, tendon reflexes are actively manifested, and disturbances of the speech apparatus may occur. This type of cerebral palsy occurs due to hypoxia and damage (most often due to injury) to the frontal lobes of the brain. Symptoms of cerebral palsy in the ataxic form include the following manifestations:

• Muscle tone is reduced;
• There is trembling of the arms and legs;
• Mental retardation;
• Speech disorders.

Mixed

Damage to the baby's brain structures occurs as a result of a complex of the above forms in various combinations.

Symptoms

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

It is important to monitor the timeliness of the development of gaming skills and speech development; a lack of contact with the mother can be a signal of alarm.

Cerebral palsy is not the main diagnosis for developmental disorders in a child under one year of age, but if after this period the child cannot sit, does not show speech skills, or exhibits mental disorders, then the likelihood of diagnosing this disease increases.

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

Treatment

Treatment for cerebral palsy is prescribed by a neurologist after identifying the causes of the disease and making a diagnosis. During diagnosis, electroencephalography and electroneuromyography are performed to study in more detail the functioning of the child’s brain and muscles. Based on the data received, the treatment process begins immediately in order to avoid more severe consequences, and, as a maximum, to get rid of the disease itself.

Drugs

To relieve convulsions and epileptic seizures, anticonvulsant medications are prescribed, to improve blood circulation - nootropic medications, and in the case of muscle hypertonicity - muscle relaxants. When pain symptoms occur, antispasmodics are prescribed.

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

Massage

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

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

Exercises

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

Development of motor skills

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

Development of joint functions

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

Abdominal muscle development

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

Removing hypertension

• Develop the baby’s hand, moving it in different directions, and lightly shake the hand at short intervals, relaxing the muscles.

Leg muscle training

• From a position lying on his back, the adult helps the baby perform flexion and extension movements in the hip joint.

Exercises in water will help relieve muscle tension and increase their tone. A baby swimming in the central pool or even in the bathtub becomes much more energetic and better fights stress and depression. Finding a sick child in a dolphinarium has an amazing effect and helps greatly advance the treatment process.

Child development

The symptoms of cerebral palsy can be overcome by additional development of the child using play manipulations. Fine motor skills involved in playing with pyramids and cubes, rolling a ball, holding and releasing objects, affects the development of both the baby’s mental abilities and his speech apparatus.

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

Prevention

You can prevent the occurrence of cerebral palsy in an infant by following certain rules:

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

Cerebral palsy is a serious chronic disease. combines those that are associated with impaired human motor function. Most often, the disease affects the fetus during its intrauterine development.

Cerebral palsy is non-progressive in nature, which means that the disease does not spread within the body, does not affect healthy areas of the nervous tissue, and only specifically damages certain areas of the brain.

Appears at the age of 5 – 7 months.

The atonic-astatic form of cerebral palsy becomes more obvious after seven months. Differential diagnosis of this form is quite complicated due to the similarity of its symptoms with the symptoms of other diseases.

Until the age of six months, the baby may not notice any disorders, and only as he grows do symptoms gradually appear. Most often they are associated with mental development disorders and neurological disorders. The child experiences outbursts of unreasonable aggression and increased excitability. There are movement disorders, loss of balance.

The hyperkinetic form of the disease is determined somewhat later - by the beginning of the second year of life.

Additional diagnostics are carried out using the following instrumental methods:

• ultrasound examination of the brain;
• Craniography, etc.

The results of the study make it possible to obtain information about the depth of changes in the nervous system, determine the degree and severity of damage to a particular area of ​​the brain, and identify other disorders.

To make a diagnosis of cerebral palsy, the presence of specific movement disorders in a child at the initial stage of development of the disease is sufficient. As additional measures, studies are done, which allows you to assess the type of damage and determine the specific location of the brain damage.

Such a study is necessary in order to exclude the presence of other diseases with similar symptoms. For the same purposes, differential diagnosis is carried out.

Cerebral palsy is not a progressive disease, its symptoms do not increase over time, and the patient’s condition does not worsen over time. If the opposite happens, then most likely the disease has a different nature.

The following diseases have the same symptoms as cerebral palsy:

• traumatic and non-traumatic brain damage;
• early autism;
• phenylketonuria;
• spinal cord lesions;
• schizophrenia, etc.

Prevalence of various forms of impairment

It is a common disease. According to rough estimates, for every one thousand healthy children there are up to 3 patients with cerebral palsy. If we consider the data on the prevalence of forms of cerebral palsy, we can note that

• Among all forms, spastic diplegia is the leader,
• second place – hemiparetic form,
• third - double hemiplegia,
• fourth – atonic-astatic form,
• and finally, the fifth most common form of cerebral palsy is the hyperkinetic form of the disease.

Hyperkinetic form of cerebral palsy is for girls

Boys are much more likely to suffer from spastic diplegia and double hemiplegia, while girls are more likely to suffer from the hyperkinetic form of cerebral palsy.

If we compare the overall ratio of boys and girls diagnosed with cerebral palsy, it turns out that boys make up 58.1%, girls – 41.9%.

Cerebral palsy is an incurable disease, but this does not mean that its treatment does not need to be treated at all.

Patients need the help of both doctors and teachers so that they can achieve the maximum possible positive results for this disease and can adapt to the environment to the extent possible. For these purposes, it is necessary to identify the disease as early as possible and begin its treatment.

Cerebral palsy (CP) is a collective term for a group of neurological diseases that cause impairment of motor function and coordination.

Cerebral palsy occurs due to damage to the part of the brain responsible for muscle activity. The disease may be caused by abnormal brain development or injury to the brain before, during, or shortly after childbirth.

The cause of cerebral palsy in most cases begins during the fetal development of the baby and is associated with diseases of the pregnant woman, pregnancy pathology or mutations. And in rare cases - with problems during childbirth and injuries received after birth.

According to statistics, the main cause of disability in children is damage to the nervous system (47.9%), and the most common pathology in this group is cerebral palsy. Approximately 1 in 400–500 people in Russia has cerebral palsy.

As a rule, symptoms of cerebral palsy appear during the first three years of a child’s life.

Initial stage of cerebral palsy appears immediately after birth. Changes in the child’s behavior are associated with disruption of signal transmission from damaged parts of the brain. The baby’s movements are constrained due to constant muscle tension or, on the contrary, muscle weakness and lethargy. The child may shudder periodically, convulsions and trembling in the body are possible. Parents can pay attention to the fact that the baby cannot fix his gaze and sucks poorly. All these changes often occur against the background of a serious general condition of the child: problems with breathing, heartbeat, intracranial pressure, etc.

Early residual stage of cerebral palsy begins at 2–4 months of age. In parallel with the child growing up, disorders appear, determined by the location and extent of brain damage. Developmental delay is observed, such children begin to sit, crawl, walk, talk late, and stiffness and unnatural movements of the damaged part of the body become clearly noticeable. For example, a child can perform all movements with only one hand, and tuck the other one towards the body, walk on tiptoes, and so on.

Late residual stage of cerebral palsy occurs in older children. No new symptoms appear. Due to the lack of full movements, the development of irreversible body deformations, muscle atrophy, and the formation of a specific gait are observed.

There are various treatment methods that can reduce the symptoms of cerebral palsy and increase the child's independence. These include physical therapy, occupational therapy, and medications to relieve muscle tension and spasms. In some cases, surgery may be required.

Symptoms of cerebral palsy in a child

Typically, symptoms of cerebral palsy appear during the first three years of life. A child with cerebral palsy may be slower to reach important developmental milestones such as crawling, walking and talking.

There are four main forms of cerebral palsy:

• Spastic. This is the most common form of the disease. With it, the muscles are in constant tension, so the child is poorly able to make quick and precise movements. The arms are bent at the elbows, the legs are often brought together or crossed, which makes swaddling the baby difficult. The degree of damage to cerebral palsy can vary - from severe paralysis to slight awkwardness in movements, which are noticeable only when performing complex manipulations.
• Dyskinetic. It can manifest itself as either muscle tension or flaccidity. As a rule, newborn children with a dyskinetic form of cerebral palsy behave sluggishly and hardly move. At the age of 2–3 months, attacks of a sudden increase in muscle tone (sharp muscle tension) appear in response to strong emotions, loud sounds, and bright light. After 1–1.5 years, hyperkinesis appears - slow worm-like movements of the arms and legs (athetosis), fast and jerky movements (choreic cerebral palsy) or contractions of the trunk muscles, which lead to its rotation, head turns and other changes in posture (torsion movements). Hyperkinesis usually does not appear at rest and disappears when the child sleeps. Children with this form of cerebral palsy often experience decreased hearing and speech, as well as difficulty eating. At the same time, mental development suffers less frequently than in other forms of the disease.
• Ataxic. With this form of cerebral palsy, imbalances and coordination come to the fore, causing movements to become jerky and awkward. Children begin to stand and walk at the age of 1.5–2 years, but these functions still have to be brought to automaticity for a long time. Tremor (involuntary shaking) of the hands and head may also be observed. Possible decrease in intelligence.
• Mixed. With it, patients exhibit signs of more than one of the forms of cerebral palsy described above.

The severity of symptoms can vary greatly from person to person. For some, the symptoms are mild, while for others the disease turns them into disabled people.

Cerebral palsy can also affect different parts of the body. In some, the right or left side of the body is affected, in others, the legs are primarily affected, and in others, both legs and arms are affected. Depending on which part of the brain is damaged, cerebral palsy may be accompanied by a violation of not only motor, but also other functions of the body. Therefore, children with cerebral palsy may experience the following symptoms:

• repeated convulsions or seizures (epilepsy);
• drooling and difficulty swallowing (dysphagia);
• gastroesophageal reflux disease (GERD);
• skeletal disorders or abnormalities, especially hip dislocation or spinal curvature (scoliosis);
• problems with controlling bladder emptying (urinary incontinence);
• speech disorder (dysarthria);
• visual impairment;
• learning difficulties (although mental abilities are often not impaired).

Causes of cerebral palsy

In the recent past, doctors believed that the cause of cerebral palsy was damage to the brain during childbirth due to a temporary lack of oxygen (hypoxia). However, in the 1980s. A large study was conducted, during which it was proven that hypoxia during childbirth causes cerebral palsy in no more than 10% of cases. Also, sometimes brain damage can occur during the first few months of a child's life. This condition can be caused by an infection (such as meningitis), very low blood sugar, severe head injury, or stroke.

Much more often, the disease develops due to brain damage that occurs before the birth of the child. Researchers believe that damage to the baby's brain in the womb, leading to cerebral palsy, occurs for three main reasons.

Cause No. 1 - periventricular leukomalacia. This is a lesion of the white matter of the brain. White matter is a collection of nerve fibers that connect the nerve cells responsible for mental activity with the rest of the body. When white matter is damaged, the connection between the brain and organs and parts of the body is disrupted.

It is believed that the damage is caused by a reduction in the volume of blood flowing to the fetal head, or a lack of oxygen. In the future, this is fraught with serious consequences for the child’s muscular system, since the white matter is responsible, among other things, for transmitting signals from the brain to the muscles of the body.

The exact cause of periventricular leukomalacia is unclear. But it is believed that risk factors may include:

• very low maternal blood pressure - for example, due to a caesarean section;
• premature birth, especially before the 32nd week of pregnancy.

Reason number 2 is a violation of brain development. Any damage to the brain can disrupt the transmission of signals from nerve cells to muscles and other parts of the body, and therefore can cause cerebral palsy in children.

The following factors can affect brain development:

• changes (mutations) in genes affecting brain development;
• an infectious disease suffered by a woman during pregnancy;
• fetal head injury.

Reason number 3 - intracranial hemorrhage and stroke. Intracranial hemorrhage is bleeding in the brain. This is potentially dangerous, since if there is a lack of blood, parts of the brain can die, and the accumulation of blood itself can damage surrounding tissue. Intracranial hemorrhage usually occurs in premature babies, but can also occur after a stroke in a child in the womb.

Factors that increase the risk of fetal stroke:

• initial weakness or pathology of the blood vessels of the fetus or maternal placenta;
• maternal high blood pressure;
• an infectious disease in a woman during pregnancy, especially chlamydia, trichomoniasis and other sexually transmitted diseases.

Diagnosis of cerebral palsy

If you notice signs of cerebral palsy in a child, contact your pediatrician. If a disease is suspected, he will write out a referral for a consultation with, who will check the baby’s reflexes, posture, muscle tone and movements. If the diagnosis is confirmed, you will undergo additional examination by an orthopedist, who will prescribe treatment and develop a habilitation (adaptation to life) program. Depending on the child's age, they may also be referred to a psychologist to evaluate their intellectual development.

To exclude similar diseases and confirm the diagnosis of cerebral palsy, the doctor may prescribe additional examination, for example:

• magnetic resonance imaging (MRI) - creating a detailed image of the brain using magnetic fields and radio waves;
• Ultrasound (ultrasound) - creating images of brain tissue using sound waves;
• computed tomography (CT) - the creation of a series of X-rays that are assembled by a computer into a detailed three-dimensional image of the child’s brain;
• electroencephalogram (EEG) - monitoring brain activity using small electrodes attached to the head;
• electromyogram (EMG) - a test of muscle activity and the function of peripheral nerves (the network of nerves running from the brain and spinal cord to other parts of the body);
• blood tests.

Sometimes the diagnosis of cerebral palsy is made for a child while still in the maternity hospital. However, in most cases, this disease can be suspected only after several months or years of monitoring the baby. It is possible to definitively determine the degree and type of paralysis only at the age of 4–5 years.

Treatment of cerebral palsy

There is no cure for cerebral palsy, but there are approaches to relieve symptoms and help your child be as independent as possible.

Rehabilitation treatment must begin early, since the children's brain has great compensatory capabilities. In the first years of life, children are prescribed therapeutic measures to help the proper development of various parts of the nervous system. In the future, to improve motor function, children with cerebral palsy may be recommended surgical treatment in combination with conservative therapy.

Help for patients with cerebral palsy is provided in specialized children's sanatoriums and boarding schools. Some basic treatment methods are described below.

Physiotherapy for cerebral palsy

Typically, physical therapy begins immediately after a diagnosis of cerebral palsy is made, as it is one of the most important ways to help a child manage the condition.

The two main goals of physical therapy for cerebral palsy are:

• prevent weakening of muscles that your child does not usually use;
• prevent muscles from contracting and losing their normal range of motion (this is called muscle contracture).

The risk of developing contractures is increased in children who find it difficult to stretch their muscles due to their stiffness. If muscles cannot stretch, they cannot grow as quickly as bones. This can lead to curvature of the body, causing pain and discomfort to the child.

The physical therapist teaches the child a series of physical exercises to strengthen and stretch the muscles that need to be performed every day. Also, special orthopedic attachments for arms or legs can be used to stretch muscles and correct posture.

Speech development in children with cerebral palsy

Salivation control and nutritional problems in cerebral palsy

Children who cannot control their mouth muscles often have difficulty swallowing food and maintaining saliva flow. This can lead to serious consequences, so nutritional problems in cerebral palsy require treatment.

If you have difficulty swallowing (dysphagia), tiny particles of food can enter the lungs, which is accompanied by the development of a dangerous disease - aspiration pneumonia.

If dysphagia is mild, the doctor can teach the child how to cope with it. A diet consisting of soft foods is also recommended. More severe dysphagia may require tube feeding. This is a tube that is passed into the stomach through the nose or mouth (nasogastric tube) or directly through the abdominal wall (gastrostomy tube).

Drooling causes irritation of the skin around the mouth, chin and neck, increasing the risk of inflammation in these areas. There are a number of methods to combat drooling in cerebral palsy:

• an anticholinergic medicine in tablet or patch form that reduces saliva production;
• botulinum toxin injections into the salivary glands (although this is only a temporary solution);
• movement of the ducts of the salivary gland through surgery, as a result of which saliva is released deeper into the oral cavity and is easier to swallow;
• a special device placed in the oral cavity, which promotes the correct position of the tongue and regular swallowing of saliva;
• training in self-monitoring skills for the physiological state of the body, during which the child is taught to recognize when he is salivating and swallow it in time.

Surgery for cerebral palsy

Sometimes, to correct bone and joint deformities, surgery is prescribed to lengthen muscles and tendons that are too short and cause discomfort. This type of surgery is called orthopedic surgery and is prescribed if a child with cerebral palsy experiences pain when moving. Surgery can also improve posture and ease of movement, as well as improve a child's self-esteem.

However, it is not possible to feel all the benefits of the operation immediately after the intervention. Sometimes this takes several years, during which the child needs repeated courses of physical therapy.

Surgery may be performed to correct spinal curvature (scoliosis) or urinary incontinence. The child’s condition will be carefully monitored in order to promptly identify those disorders that can be effectively corrected with surgical intervention. As an examination, regular x-rays of the hip joint or spine may be prescribed.

Selective dorsal rhizotomy (SDR) is a surgical operation that is prescribed to improve the gait of children with high muscle rigidity (increased tone). As a rule, it is recommended only in cases where examinations have shown that the child has damage to the white matter of the brain (periventricular leukomalacia) and other methods of treating rigidity have not helped.

During the operation, the surgeon cuts some of the nerve fibers in the lower spine to relieve tension in the leg muscles. However, after surgery, several months of intensive physical therapy are required to re-teach the child to control his movements.

Like any other surgery, SRD has a risk of complications, including temporary problems emptying the bladder (urinary incontinence), scoliosis, and changes in sensation in the legs.

There are other methods of surgical correction of cerebral palsy. The intervention depends on the severity and prevalence of paralysis, the nature of the musculoskeletal system disorders, the age of the patient and his mental state. The optimal age for surgery is 8–16 years.

Discuss the potential benefits and risks of surgery with the surgeon, along with your child (if he is able to understand the consequences of the procedure).

Complications of cerebral palsy

The brain disorder that causes cerebral palsy does not get worse with age, but a person with the condition may experience physical and psychological difficulties as they get older.

Thus, many adults under the influence of cerebral palsy develop additional diseases (for example, osteoarthritis), which cause pain, fatigue and weakness. Basically, these diseases are associated with pathology of the muscles and bones inherent in cerebral palsy, which create a large load on the body. Therefore, people with cerebral palsy may take much more effort to carry out ordinary activities than those who do not suffer from this disease.

Additional physical therapy sessions and the use of mobility aids, such as a wheelchair for cerebral palsy or special walkers, can help alleviate the physical difficulties that develop over time as a result of the disease.

Charitable educational foundation for promoting habilitation of children with special needs;

You can easily find doctors who diagnose and treat cerebral palsy using the NaPopravka service. The “Who Treats It” section on our website will help you decide on the right doctor. If in doubt, consult your pediatrician. He will conduct an initial diagnosis and refer you for a consultation with a doctor of the required profile.