Acute paralytic spinal poliomyelitis and other flaccid paralysis (paresis). Rehabilitation complex for the treatment of patients with flaccid paralysis

This group includes people with peripheral diseases nervous system(including with degenerative-dystrophic changes in the spine), the consequences of poliomyelitis and central hemiparesis, not accompanied by an increase in muscle tone. Based on the nature of the indicated restorative measures, patients with mild muscle spasticity, in whom, with the help of the therapeutic measures described above, it was possible to reduce pathologically increased muscle tone, are also included in this group. After successful reduction of spasticity, further restorative treatment is indicated to gradually eliminate the neuromuscular loss present in such patients.

Main tasks rehabilitation treatment of patients in this group are disinhibition of inactive cells in the central nervous system, regeneration of fibers in the trunks of peripheral nerves and roots, normalization of muscle functioning and restoration of active life of patients based on dosed training and work adaptation, and the main methods are the use of electrical stimulation of muscles, therapeutic exercises, massage and occupational therapy.

Electrical stimulation is carried out using sinusoidal modulated or pulsed currents of exponential shape. First of all, the most weakened, hypotonic muscles are stimulated: on the upper limb - extensors of the hand and fingers, arch support, muscles that abduct the hand outwards, on the lower - dorsal flexors of the foot and extensors of the toes. As a rule, electro-gymnastics is carried out using a bipolar method with the participation of volitional tension of the exercised muscles of the patient. Such active electrical stimulation according to Obrosov-Liventsev is very important for the restoration of voluntary movements, and in the future for the resumption of purposeful labor acts. A slight increase in muscle tone is not an obstacle to electro-gymnastics of antagonists of spastic muscles. The course of treatment includes 15 - 30 procedures performed daily or every other day.

Simultaneously with electrical stimulation, it is necessary to prescribe therapeutic exercises that improve the functionality of atrophic muscles, joints and the sensitive apparatus of joints, tendons, muscles (proprioceptors), as well as coordination of movements. For flaccid paralysis, all types of movements are used: passive, active with help and in lightweight starting positions, completely independent, and as the function of the paretic muscles improves, exercises with increasing effort: with weights with projectiles and overcoming resistance. Hydrokinesitherapy (therapeutic gymnastics in water) is also indicated, especially in case of damage spinal cord, polyradiculoneuritis and polyneuritis.

Therapeutic exercises should be accompanied by a massage of the muscles of paretic limbs. When saving small increase To tone, selective massage is carried out: an inhibitory technique of acupressure of spastic muscles and stimulating massage of their antagonists. In case of flaccid paralysis, it is necessary to prescribe a deep massage using the techniques of kneading, tapping, vibration and stimulating point-to-point massage techniques, as well as an underwater shower-massage.

Already on early phases rehabilitation treatment, occupational therapy is regularly carried out, which is varied in nature and includes a gradual increase in physical activity, degree of complexity and differentiation of the exercises performed. At the initial stage of treatment, elementary exercises related to self-care and the implementation of simple labor processes are used, which gradually become more complex, accompanied by training on special simulators. Subsequently, patients proceed to work in special labor therapy workshops using writing and calculating machines, carpentry, drilling, turning and other equipment. In the treatment of lesions of individual nerve trunks upper limbs Separate occupational therapy complexes developed by L. A. Lasskaya, G: A. Pavlova and R. M. Golubkova are recommended (they are described in Chapter III).

The background to the rehabilitation treatment of patients with flaccid paralysis are medications and physiotherapeutic procedures that help improve the regeneration of nervous tissue, facilitate the conduction of nerve impulses and disinhibit inactive neurons, as well as activating psychotherapy.

The most commonly used medications are anticholine esterase drugs (proserin, galantamine, oxazil, nibufin), vitamins B (B1, B6, B12, calcium pantothenate) and C, dibazol, pyrimidine derivatives (pentoxyl, methyluracil), glutamic acid, phosphorus and potassium preparations (ATP, MAP, panangin, etc.). To speed up the process of nerve tissue regeneration, they are prescribed biogenic stimulants(aloe extract, humisol, rumolon, plasmol, pyrogenal, etc.), and to disinhibit inactive nerve cells - drugs from the strychnine group (strychnine, securinine, etc.). In order to activate regeneration nerve fibers galvanic current is widely used, often in the form of electrophoresis on the paretic limb of novocaine, anticholinesterase drugs(prozerin, galantamine), dibazole, vitamin B15 iodine, applications to the limb and the corresponding segments of the spine of paraffin, ozokerite or mud at a temperature of 42 - 46 ° in the absence of pain and 36 - 40 ° in its presence. Local exposure to centimeter and decimeter waves in a low dose, general or local hydrogen sulfide, radon, carbon dioxide and oxygen baths are also used.

In accordance with the described basic principles, restorative treatment of patients with lesions is carried out facial nerve. One should only remember about easily occurring contractures of the facial muscles, and therefore the use of galvanic current and electrical stimulation in the rehabilitation treatment of patients with neuritis of the facial nerve should be carried out with great caution.

Psychotherapy in patients with predominant symptoms of neuromuscular loss is carried out in the form of explanatory conversations aimed at developing faith in the possibility of restoring lost motor function, but only subject to the mobilization of the necessary volitional and physical efforts to achieve this goal. In addition, a special technique is used autogenic training, aimed at eliminating the existing motor defect and activating voluntary movements. In patients with severe loss of motor functions important has a stage system positive emotions: every, even small, improvement in the patient’s condition appears to him as a significant achievement, which, however, is only one of the stages on the way to more full use available opportunities.

When implementing stimulating rehabilitation treatment, a certain sequence of therapeutic measures is advisable. At the beginning of the day, the patient is given medications that facilitate the conduction of nerve impulses and promote the resumption of activity of inhibited nerve cells (anticholinesterase drugs, dibazole, strychnine group drugs, B vitamins), after which he is sent to a psychotherapy session. 1 - 1.5 hours after the administration of the drugs, an electrical stimulation procedure is carried out, after a 15 -20-minute rest - therapeutic exercises with a stimulating massage and an occupational therapy session.

In a significant proportion of cases, diseases of the peripheral nervous system are secondary in nature and are associated with degenerative changes (osteochondrosis) in the spine. Rehabilitation therapy patients with spinal lesions retain all the main features inherent in the treatment of flaccid paresis, but also have their own specific features. First of all, it includes this pathogenetic method impact, how various techniques spinal traction: vertical, on an inclined plane and horizontal, “dry” and in water.

Another feature of the treatment of patients with spinal osteochondrosis is a special set of gymnastic exercises aimed at reducing pathological impulses from the spine to the upper or lower extremities and restoring the full range of movements. If the cervical spine is affected, a complex of therapeutic exercises according to Z. V. Kasvande is prescribed, which is carried out with mandatory immobilization of the cervical vertebrae with a cotton-gauze collar of the Shants type and includes exercises for the muscles of the limbs and strengthening the muscular corset of the neck, alternating with relaxation exercises and breathing exercises. For lumbosacral localization of osteochondrosis, a gymnastic complex according to V.N. Moshkov is used with predominant movements in the hip and knee joints, in lighter starting positions - at the beginning of treatment, with a consistent increase in muscle tension, and gradual learning to walk.

For cervical and lumbosacral radiculitis, plexitis and radiculoneuritis, absorbable agents are used: bijoquinol and lidase; lidase and some biogenic stimulants (aloe, vitreous) can also be administered by electrophoresis to the affected area of the spine or limb. Ultrasound also has a resolving and analgesic effect, the effect of which can be enhanced by the introduction of painkillers and anti-inflammatory drugs (ultraphonophoresis of analgin, anesthesin, hydrocortisone).

Pain syndromes with vertebrogenic lesions of the peripheral nervous system require the use of analgesics (amidopyrine, analgin, butadione, reopirin), preparations from bee and snake venom (venapiolin, apizartron, vipraxin, viperalgin, etc.), ganglion blockers (benzohexonium, pentamin, pyrylene and others). etc.) and physiotherapeutic procedures. Local effects on the cervical spine are carried out using diadynamic and sinusoidal modulated currents, ultrasound, and erythemal doses of ultraviolet rays; electrophoresis of novocaine (according to I. G. Shemetilo, it is better to administer novocaine using sinusoidal modulated currents), analgesics, ganglion blockers, bee and snake venom preparations, as well as the use of vibration and turpentine baths. With damage to the peripheral nervous system, especially accompanied by pain syndrome, the use of acupuncture is indicated, which not only reduces pain, but also helps improve motor, sensory and trophic functions.

Expressed degenerative changes in the spine, leading to the formation of a hernia intervertebral disc and accompanied by signs of increasing compression of the nerve roots or spinal cord, are, in the absence of effect from complex therapy, indications for neurosurgical surgery to remove a herniated disc and stabilize the spine. After spinal surgery, patients should also receive comprehensive rehabilitation treatment.

A peculiarity of the treatment of patients with polyneuritis of infectious and infectious-allergic origin is the inclusion of anti-inflammatory, analgesic and anti-intoxication drugs in the recovery complex medicines and physiotherapeutic procedures. A 40% solution of hexamine, a 20 - 40% solution of glucose with ascorbic acid is administered intravenously, antibiotics are prescribed orally wide range actions - terramycin, tetracycline, etc., antihistamines (diphenhydramine, diprazine, suprastin) and analgesics (analgin, amidopyrine, reopirin). Physiotherapeutic procedures include: inductothermy of the limbs, four-chamber, general or local hydrogen sulfide baths, long (40 - 60 min) general wet wraps, ultraviolet irradiation hands, forearms, feet and legs in erythema dosage, mud, ozokerite or paraffin applications in the form of stockings or gloves. Restorative treatment of patients with vegetative polyneuritis will be described below.

Rehabilitation measures for patients with polio are carried out during the recovery and residual periods of the disease. In addition to the treatment prescribed for all types of flaccid paralysis, various methods are used to combat the increased tone of the antagonists of weakened muscles: alcohol-novocaine blockades, thermal procedures, and in severe cases, corrective surgical interventions. Anti-inflammatory physiotherapeutic procedures are indicated with effects on the spine according to the level of the lesion (UHF or inductothermy - transverse technique) and longitudinally on paretic limbs, as well as mud (40 - 42 °), paraffin or ozokerite (45 - 48) applications on the same areas, electrophoresis iodine and calcium on the spine, general salt and hydrogen sulfide baths. Has some features and treatment of patients with neuralgia trigeminal nerve. From medicines the greatest efficiency Carbamazepine (Tegretol) has an anticonvulsant and ganglion blocking agent, the course of treatment of which is 40 days. Drugs with antidepressant effects are also used - morpholep and nialamide, phenothiazine derivatives (especially aminazine), ganglion blockers (pachycarpine, pyrylene and pentamin), analgesics (amidopyrine, analgin, etc.), vitamins (B1, B6, B12), ATP. Physiotherapeutic procedures include the appointment of diadynamic and sinusoidal modulated currents, or pulsed ultrasound to the exit points of the corresponding branches of the trigeminal nerve, electrical UHF fields in a weak dose or darsonvalization on the affected area, as well as electrophoresis using a Bergonier half mask of aconitine, novocaine, analgin, amidopyrine or iodine.

Demidenko T. D., Goldblat Yu. V.

"Rehabilitation complex for the treatment of patients with flaccid paralysis" and others

Flaccid paresis is a decrease in strength in one or more muscles. It develops only secondarily, that is, it is a consequence of one or another disease. In this case, strength can be measured using a special test, which cannot be said about another condition called paralysis.

Depending on how badly the muscles are damaged, there are 5 types of this condition. To determine one degree or another, you can use a scale specially developed for this purpose.

Determination system

Pathology is determined on a five-point scale, which was developed and has been successfully used in neurology for many years.

Five points are given to a person whose muscle strength is completely preserved, that is, there are no signs of paresis.

A score of four is given when the strength is slightly reduced compared to the recent past.

Three points is already a significant decrease in muscle strength.

Two points are given if the patient cannot overcome gravity. That is, he can bend the elbow joint if the arm is lying on the table, but is not able to do this if the arm is hanging along the body.

One point is given when only individual muscle bundles contract, but not the entire muscle.

Zero points – complete absence of muscle tone. This condition is also called plegia.

Depending on the root cause of paresis, two forms can be distinguished. The first form is central or spastic. The second form is peripheral, or flaccid paresis. Depending on how many limbs are affected, we can distinguish:

Monoparesis, diagnosed in only one arm or only one leg.
, diagnosed in the leg and arm on the right or left side of the body.
, diagnosed only in the arms or only in the legs.
, which covers both arms and legs.

Reasons

The main cause of flaccid paresis of an arm or leg is a stroke, which resulted in acute disorder cerebral or spinal circulation. In second place in frequency are tumors of the brain or spinal cord, and head or back injuries.

Other reasons include:

Brain abscess.
Encephalitis.
Disseminated encephalomyelitis.
Poisoning with poisons, salts, alcohol.
Botulism.
Epilepsy.

Most often, this symptom does not require any diagnostic measures, since making the above diagnoses already implies a decrease in muscle strength in a person.

The doctor must examine the patient and interview him. The main complaints are identified, from what period the strength in the arms or legs began to decrease, and whether anyone in the family has similar symptoms.

After this is carried out neurological examination on a five-point scale, which allows you to identify flaccid paresis lower limbs and evaluate general condition muscular system. After this is carried out general analysis blood and, if necessary, toxicological tests.

Other diagnostic procedures include electroencephalography, computed tomography, magnetic resonance angiography. If necessary, a neurosurgeon is consulted.

Treatment

Acute flaccid paresis is not separate disease, but just a consequence of other, more serious diseases. Therefore, treating it alone will not give any results. First of all, it is necessary to identify and direct treatment to the cause that caused this condition.

So, for example, it may require surgical removal tumor or hemorrhage caused by a stroke. The same method is used to remove the abscess (abscess) and begin antibacterial therapy.

Treatment can use drugs that improve blood circulation, reduce blood pressure, improve metabolism. Also antibacterial therapy may be performed if a brain or spinal cord infection has been diagnosed. For botulism - administration of serum. And, of course, drugs that improve nerve conduction are always used.

It turns out that the treatment of flaccid foot paresis will depend entirely on what causes the pathology, and the therapy itself must be strictly individual.

During treatment, massage, exercise therapy, physiotherapy and other procedures are required that are aimed at preventing the muscles from atrophying.

It is very rare to be completely cured, so in most cases the patient receives disability.

By the way, you may also be interested in the following FREE materials:

Free books: "TOP-7 harmful exercises For morning exercises things you should avoid" | “6 Rules for Effective and Safe Stretching”
Rehabilitation of knee and hip joints for arthrosis- free video recording of the webinar conducted by a physical therapy and sports medicine doctor - Alexandra Bonina
Free lessons on treating low back pain from a certified physical therapy doctor. This doctor developed unique system restoration of all parts of the spine and has already helped more than 2000 clients With various problems with your back and neck!
Do you want to know how to treat pinching? sciatic nerve? Then carefully watch the video at this link.
10 Essential Nutrition Components for healthy spine - in this report you will find out what it should be like daily diet so that you and your spine are always in healthy body and spirit. Very useful information!
Do you have osteochondrosis? Then we recommend studying effective methods of treating lumbar, cervical and thoracic osteochondrosis without drugs.

Peripheral paralysis is a consequence of profound changes in the neurons of the spinal cord. Expressed in partial loss of reflexes, muscle atrophy, loss of muscle tone and impairment reflex arc. Peripheral paralysis sometimes results in sudden, uncontrollable twitching of the affected muscles.

With this type of disease, a change in the reaction of muscles to electric current is very characteristic. IN in good condition The muscle conducts an electrical current, which causes it to contract. In the case of muscles affected by paralysis, the usual reaction does not occur in them, but processes are observed that are called the reaction of degeneration or degeneration.

With such reactions, the nerve does not pass current to the muscle, since its main fibers are either degenerated or destroyed, and the muscle itself loses the ability to contract in response to exposure to faradic current, leaving a reaction only to galvanic current. But even this reduction is happening much more slowly than usual. This condition occurs approximately 2 weeks after the onset of negative processes in the nerve. In case of partial damage motor neuron an incomplete degeneration reaction occurs if the nerve’s susceptibility to both types of current is not completely lost, but only weakened. These signs are necessarily present in any type of this paralysis.

Types of disease

Doctors distinguish between flaccid and spastic paralysis. Flaccid paralysis (the second name for peripheral paralysis) is accompanied by a decrease in muscle tone and even complete muscle atrophy. Spastic paralysis, on the contrary, is characterized by greater muscle tension. In this case, patients may even lose control of their muscles. This disease originates in the peripheral nerve, but the spastic one appears in various parts of both the spinal cord and the brain.

But these clinical types are not considered independent diseases, because the root cause of these syndromes is various factors. But there are some types of paralysis that are distinguished in individual diseases. For example, Parkinson's disease, polio in children, cerebral palsy and others.

Acute flaccid paralysis is characterized by the following symptoms:

the muscle does not resist passive movements;
pronounced atrophy;
deep reflexes are reduced or absent;
change in electrical excitability of nerves and muscles.

These signs make it possible to separate patients with peripheral paralysis from patients suffering.

If patients with cent the muscle treats with paralysis nerve impulses, only emanating from the spinal cord, then in the case of peripheral paralysis the muscle does not perceive any information. So if in the first case there is some semblance of muscle activity (constant spasm or tension), then in the second such activity is practically impossible.

There are also pathologies (for example, lateral amyotrophic sclerosis) with more extensive neuronal damage. Here the central and peripheral nerves are involved in the process. The subtype of the resulting paralysis is mixed, that is, it will have signs of both the first and second types. There will be 3 symptoms of acute flaccid paralysis: muscle weakness, atony and absence of typical reflexes. But due to influences on the spinal cord from neighboring nodes of the nervous system, a fourth symptom is added, already characteristic of central paralysis. These are atypical reflexes, but since the muscles are almost inactive, they will be very faintly noticeable and will fade away completely as the disease progresses.

Disease in children

One of the main problems of modern pediatrics is acute flaccid paralysis in children. Over the past 20 years, the number of cases of polio in children has decreased worldwide from 350,000 to 400 per year. But, despite this, the risk of developing AFP in children remains serious due to the high prevalence of other non-polio enteroviruses.

There are also signs of acute flaccid paralysis in children, which is expressed by tremors and weakness in one or more limbs, as well as malfunction respiratory and swallowing muscles due to damage to lower motor neurons.

Main viral root causes of this disease- various enteroviruses. Since polio is being systematically defeated throughout the world through vaccination and prophylactic agents, there is a real danger that other neurotropic viruses will conquer its now almost empty niche and become the causes of acute flaccid paralysis. For example, enterovirus type 71 is now considered the most dangerous neurotropic virus, which often leads to epidemics of infantile flaccid paralysis. On the island of Taiwan, over the past 7 years, the overall mortality rate among children under 14 years of age after enterovirus type 71 infection was 16%.

Paralysis and paresis. The reasons for their occurrence

Paralysis is one of the types of impairment of human motor activity and manifests itself in its complete loss (Greek. paralysis- relaxation). This disease is a symptom of many organic diseases nervous system.

In the case of not a complete loss of motor function, but only a weakening of it to one degree or another, this disorder will be called paresis(Greek paresis- weakening). Moreover, in both the first and second cases, motor dysfunction is the result of damage to the nervous system, its motor centers and/or pathways of the central and/or peripheral parts.

Paralysis should be distinguished from movement disorders that occur due to muscle inflammation and mechanical damage osteoarticular apparatus.

Paresis and paralysis - movement disorders, which are due to the same reasons.

The main causes of these diseases.

Paralysis is not caused by any one specific factor. Any damage to the nervous system can lead to impaired motor function. Congenital, hereditary and degenerative diseases central nervous system are usually accompanied by movement disorders.

Birth injuries - common reason children's cerebral palsy, as well as paralysis due to defeat brachial plexus. Unfortunately, over 15 million patients with cerebral palsy have already been recorded in the world.

A number of diseases of unknown origin (for example, multiple sclerosis) is characterized motor disorders varying degrees gravity.

Circulatory disorders inflammatory processes, trauma, tumors of the nervous system can also cause paralysis or paresis.

Often paralysis is of a psychogenic nature and is a manifestation of hysteria.

The causes of paralysis can also be divided into organic, infectious and toxic.

Organic causes include:

Malignant neoplasms;
Vascular lesions;
Metabolic disorders;
Intoxication;
Eating disorders;
Infections;
Injuries;
Multiple sclerosis;

TO infectious causes include:

Meningitis;
Polio;
Viral encephalitis;
Tuberculosis;
Syphilis.

Toxic causes include:

Vitamin B1 deficiency;
Nicotinic acid deficiency;
Heavy metal poisoning;
Alcoholic neuritis.

Paralysis can be observed in one muscle, one limb ( monoplegia), in the arm and leg on one side ( hemiplegia), in both arms or both legs ( paraplegia) (the suffix plegia means paralysis).

By localization lesions distinguish two groups of paralysis, significantly different clinical manifestations: central ( spastic) and peripheral ( sluggish).

Central paralysis occur when central motor neurons are damaged. They are characterized by:

hypertonicity (increased muscle tone), for example, the “jackknife” phenomenon;
hyperreflexia (increased intensity of deep reflexes), especially demonstrably with unilateral damage;
the presence of pathological reflexes (Babinsky, Bekhterev, Astvatsaturov, etc.);
the appearance of pathological synkinesias (friendly movements), for example, when a patient voluntarily clenches a healthy hand into a fist and does not voluntarily repeat this movement with the affected hand, but with less force;
the appearance of clonus (convulsive muscle contractions in response to an impact), for example, foot clonus - when a patient lying on his back, with the affected leg bent at the hip and knee joints, the doctor performs dorsal extension of the foot, and the flexor muscles begin to involuntarily contract rhythmically , the rhythm can be maintained for a long time or fade out almost immediately.

Peripheral paralysis (flaccid) characterized complete absence movements, loss of muscle tone, extinction of reflexes, muscle atrophy. In case of defeat peripheral nerve or plexuses that contain both motor and sensory fibers, sensory disorders are also detected.

When the subcortical structures of the brain are damaged, extrapyramidal paralysis, automated movements disappear, motor initiative is absent. Muscle tone is characterized by plasticity - the limb is held in a passive position given to it.

Classification

There are two scales for assessing the severity of paralysis (paresis) - by the degree of decrease in muscle strength and by the degree of severity of paralysis (paresis), which are the opposite of each other:

1. 0 points “muscle strength” - no voluntary movements. Paralysis.
2. 1 point - barely noticeable muscle contractions, without movements in the joints.
3. 2 points - the range of movements in the joint is significantly reduced, movements are possible without overcoming the force of gravity (along the plane).
4. 3 points - a significant reduction in the range of movements in the joint, the muscles are able to overcome the force of gravity and friction (in fact, this means the possibility of tearing the limb off the surface).
5. 4 points - slight decrease in muscle strength, with full range of motion.
6. 5 points - normal muscle strength, full volume movements.

The most significant features of peripheral paralysis are:

1. atony (decreased tone) of muscles;

2. muscle atrophy due to decreased nerve trophism;

3. fasciculations (involuntary contractions of individual muscle fibers, perceived by the patient and visible to the eye doctor), which develop when large alpha motor neurons of the anterior horns of the spinal cord are damaged.

Determination of the stage of paralysis (paresis.)

An external examination can detect deformities of the spine, joints, feet, hands, asymmetry of skeletal development, and leg length.
Swelling of the legs, arms, changes in the trophism of the nails, skin, folding of the skin over the spine, stretch marks, varicose veins veins, areas of skin pigmentation, tumors, burn scars.

The most common method of examining muscles, bones and joints is palpation. Palpation of muscles is the main method of determining their tone.

Hypotension (decreased tone) is observed in cases of pure pyramidal paresis, in violation of muscle-articular sensitivity, in a number of neuromuscular diseases, cataplexy, attacks of sudden falling, hysterical paralysis, in lesions of the cerebellum, etc.
With hypotension, the muscle is relaxed, spread out, has no contours, the finger easily sinks into the thickness muscle tissue, its tendon is relaxed, and greater mobility is noted in the corresponding joint. Hypotension can be mild, moderate, or severe.

Atony- lack of normal skeletal muscle tone and internal organs, developing as a result of insufficiency general nutrition, disorders of the nervous system, infectious diseases, disorders of the glands internal secretion. With atony, movement is not possible.

At hypertonicity the muscle is tense, shortened, prominent, compacted, the finger has difficulty penetrating the muscle tissue, movements in the joint are, as a rule, limited in volume.

Spasticity or spastic paresis.

Paresis is characterized by a peculiar selective increase in tone in the adductor muscles of the shoulder, flexors of the forearm, hand, fingers and pronators of the hand. In the leg, hypertonicity is noted in the extensors of the hip and knee joints, the adductor muscles of the thigh, plantar flexors of the foot and toes (Wernicke-Mann position). With repeated movements, the springy muscle resistance may disappear and the spastic posture is overcome - a “jackknife” symptom.

In conditions of a spinal lesion above the cervical enlargement, spastic hemi- or tetraplegia develops; damage at the level of the thoracic segments causes lower paraplegia.

With spastic paresis, a number of accompanying symptoms are noted:

1. Tendon-periosteal hyperreflexia with expansion of the reflex zone, clonus of the feet, hands, and lower jaw.
2. The most reliable of them is the Babinski reflex, which is caused by streak irritation of the outer part of the sole with a pen from the heel to the toes. In response, the first finger extends and the remaining fingers flex and fan out.
3. Hoffman reflex - increased flexion of the fingers of a dangling hand in response to pinch stimulation nail phalanx third finger.
4. Protective reflexes - a triple flexion reflex of the leg when the skin of the foot is irritated by a pinch or a cold object, as well as a reflex of lengthening the leg in response to a thigh prick.
5. The absence of abdominal reflexes and signs of peripheral neuron damage (fibrillary muscle twitching, atrophy) complements the picture of spastic paresis.

Extrapyramidal pseudoparesis, rigidity.

Pseudoparesis manifests itself as uniform hypertonicity in massive muscle groups - agonists and antagonists, flexors and extensors of the limbs, which leads to a plastic increase in tone, freezing of the limb in its given state uncomfortable position(waxy flexibility).
Stronger flexors give the patient a “petitioner” posture. - The torso and head are tilted forward, the arms are bent in elbow joints and pressed to the body. Movements are slow, awkward, and their initiation is especially difficult. When studying passive movements, intermittent muscle resistance is noted during flexion and extension of the limb. Rhythmic constant tremor of the fingers at rest is often observed.

Peripheral paresis (flaccid).

At flaccid paresis peripheral type pathological signs, synkinesis and protective reflexes are absent.
Nerve damage (neuritis, mononeuropathy) leads to selective atrophy of the muscle group innervated by this nerve.
Polyneuritis contribute to symmetrical paresis of the distal muscles (feet, legs, hands, forearms).
Plexus lesion (plexite) accompanied by unilateral paresis with predominant localization in the upper or lower limbs, in the muscles of the pelvic or shoulder girdle.

Mixed paresis.

In some cases, patients have both signs of flaccid paresis and symptoms of damage to the central motor neuron. This type of paresis is called mixed.
It causes damage to the cells of the anterior horn and pyramidal tract.
TO mixed type Paresis includes central type defects after strokes, with tumors (hematomas) with compression on this area. This category of patients presents together with hemiparkinsonism and spastic hemiparesis.

The treatment of such patients must be approached individually. Treatments for this disease include sulfur and radon baths, segmental and acupressure massage, balance therapy, and stem cell treatment. But the main method of treatment is special therapeutic exercises.

For voluntary movements human body responds to two groups of neurons, namely peripheral and central. They have different structures and differ in the functions they perform. Therefore, the manifestations of the disease vary.

When there is a disturbance in the functioning of central neurons, it develops spastic paralysis, whereas with abnormalities in the functioning of peripheral neurons, sluggishness occurs.

Central paralysis provokes a general impairment of motor activity. A person develops spasticity of muscle fibers, but at the same time they do not lose their integrity and do not undergo atrophy. With the development of central paralysis, clinical convulsions appear in certain groups of muscle tissue, but deep tendon reflexes are completely preserved.

With this form of paralysis, a positive Babinski sign often appears, in which the big toe of the lower limb performs a flexion movement when the foot is irritated.

With peripheral paralysis, a decrease in muscle tone is observed and atrophic processes develop. In this case, there are no deep tendon reflexes, while abdominal reflexes are preserved. Also characteristic of this form of paralysis is negative symptom Babinsky. People often complain of loss of sensitivity.

Species

There are different types of disease - classification is carried out depending on the severity of the disorders, manifestations and prevalence of the pathological process. So, doctors distinguish between complete and incomplete paralysis. It can also be reversible or irreversible, local or widespread.

Depending on the affected area there is:

To indicate the number of limbs affected by the pathological process, doctors use the following terms:

Paralysis as a separate disease

In most cases, paresis and paralysis do not act as independent diseases. They are a symptom that indicates organic lesions of the central nervous system. However, there are some types of paralysis that are independent diseases.

Bulbar	This disease can have 2 types - acute and progressive. The basis acute form pathology is polio. At the onset of the disease, a person develops a fever and severe headache. In this case, there is no discomfort in the muscles. Bulbar palsy results from damage to structures and the pons medulla oblongata. This process provokes disruption of organ function oral cavity– a person loses the ability to hold food in the mouth and speak normally. In some cases, the symptoms of the disease are accompanied by mono- or hemiplegia. Symptoms of the pathology increase over a short time, and breathing and heart contractions become arrhythmic. After a few days, the patient may die. If the outcome is positive, the person’s functions are partially restored. In case of progressive bulbar palsy A similar process takes place, but it proceeds much more slowly. The causes of this pathology have not yet been established. It is known that it is more common in middle-aged men. Unfortunately, there is no effective treatment for this disease, and therefore fatal outcome occurs within 1-3 days.
Bella	This condition is characterized by paralysis, which is accompanied by damage to the facial nerve. This disease is considered quite common. The main reasons for its development include infectious diseases, tumor formations, hypothermia, and surgical interventions. The main symptom of the pathology is severe pain, reminiscent of a migraine. This condition is also characterized by complete immobility of half the face. Such patients have difficulty speaking and eating. Muscles can completely atrophy or recover after a certain time - it all depends on the cause of the disease.
Supranuclear	Progressive supranuclear palsy is extremely rare. This is a degenerative pathology of the central nervous system, which is characterized by gliosis and death of neurons in the midbrain, cerebellar nucleus, and basal ganglia. The cause of this disease is a disruption of connections between the gaze centers, which are located in the brain stem and cortex. It is characterized by gaze paralysis, which is accompanied by the absence of friendly eye movements. Similar problems can be observed in the vertical or horizontal plane.
Larynx	Paresis and paralysis of the larynx may be associated with compression of this part of the body by certain structures, traumatic injuries or involvement of nerves in an abnormal process. Such paralysis can be supranuclear, which, in turn, is divided into cortical and corticobulbar, as well as bulbar. Thus, cortical palsies are always bilateral in nature and are the result of congenital cerebral palsy, diffuse atherosclerosis, and encephalitis. Corticobulbar palsy occurs when there is a lack of blood circulation in the area vertebral artery. And the bulbar form of the disease often occurs with polio, syphilis, rabies, polysclerosis, etc.
Peripheral, flaccid	This form of paralysis develops with profound changes in the neurons of the spinal cord and manifests itself in the form of partial loss of reflexes, atrophy of muscle tissue and loss of tone. Also, with this diagnosis, the functioning of the reflex arc is disrupted. Peripheral paralysis in some cases provokes sudden muscle twitching. With this form of the disease, the reaction of muscle tissue to the influence changes electric current. In a normal state, it provokes its contraction. If the muscles are affected by paralysis, they lose the ability to adequately respond to the current and degeneration processes develop.
Landry, Rising	This type of paralysis is acute illness nervous system. It is characterized by damage to the lower extremities, which successively spreads to the upper cranial nerves. This pathology has an acute course and ends in death. Most cases of Landry's nerve palsy result from infection. acute infections– these include diphtheria, pneumonia, whooping cough, rabies, sepsis.
Accommodations	This paralysis is a visual impairment at close range. This disease can be a consequence of various neurological diseases, the use of certain medications and contusion of the eyeball. Paralysis of accommodation manifests itself as complete violation vision at close distances. In this case, the closest point clear vision moves away from the eye so much that it merges with a further point.
Dejerine-Klumpke	This paralysis is a type partial defeat inferior branches of the brachial plexus. It is characterized by peripheral paresis or paralysis of the muscle tissue of the hand. Also in the affected area, sensitivity changes and vegetative-trophic disorders are observed, including pupillary disorders. Symptoms of this disease include deep muscle paralysis of the hands. It is also characterized by numbness in the area of innervation of the ulnar nerve. Anesthesia affects the inner surface of the shoulder, hand and forearm.
Progressive, Bayle's disease	This disease is an organic brain lesion that is of syphilitic origin and is determined by the rapid development of dementia. At the same time, it is typical for patients neurological manifestations and cachexia. Progressive paralysis usually develops between the ages of 30 and 55, about 10 to 15 years after contracting syphilis. Initially, a person experiences asthenia or depression. Such problems are always accompanied by memory impairment, headaches and dizziness, increased irritability. Then symptoms of total dementia may increase or psychosis may develop.
Polio	This term means viral infection, which is characterized pronounced manifestations acute intoxication, pain in the muscles, damage to the nervous system and symptoms of dyspepsia. As a rule, with this pathology paralysis of the lower extremities and torso appears. Sometimes the neck muscles are also affected. Most serious consequence the disease is paralysis respiratory muscles. If their function is impaired, breathing stops and the patient dies. Thanks to timely treatment manages to stop pathological process and gradually restore the functioning of muscle tissue. After pathology, atrophic disorders and deformations of the torso may be present.
Parkinson's disease (shaking)	This disorder is more common among older people. It is caused by the death of neurons located in the substantia nigra of the brain. The reason also lies in a decrease in the synthesis of dopamine, which is involved in the process of impulse transmission. As a result, a person develops trembling in the limbs and head, the tone of muscle tissue increases, stiffness appears and the ability to move in space is impaired. People with this diagnosis are unable to perform activities that require precision. Intellectual abilities gradually decrease and emotional deviations arise.

How to treat

In most cases, paralysis and paresis are not independent diseases. Therefore, effective treatment is impossible without adequate therapy main pathology.

If a peripheral nerve is damaged, its integrity must be restored. For this purpose, a neurosurgical operation is performed.

If a person has had a stroke, he needs to undergo full course restorative treatment. If a tumor appears that compresses nerve endings or brain structures, it should be removed.

Therapy of paralysis in the event of a stroke requires restoration of the affected area and activation of neighboring zones that are able to take on lost functions. Several categories of drugs are used for this:

Of no small importance is symptomatic treatment diseases. To restore the function of the limbs, it is very important to position them correctly on the bed. This will reduce the risk of developing contracture.

An important component of complex therapy is physical therapy and massage. By kneading the affected limbs and stimulating nerve endings muscles, it is possible to restore broken connections with the central zones of the cortex.

Peripheral paralysis responds well to electrotherapy and other physiotherapeutic techniques. Most often, doctors prescribe galvanization and balneotherapy. In this case, massage and special exercises are also very effective.

There are no therapeutic exercises to treat facial paralysis, and therefore such types of therapy are considered ineffective. Thanks to the use of drugs, it is possible to stimulate the restoration of the myelin sheath and the transmission of impulses.

For this purpose, B vitamins, aloe, and vitreous are used. The same drugs are used during the rehabilitation period after surgery to restore the integrity of the nerves.

Neuropathies of a tunnel nature can be successfully treated with local drug blockades. During this procedure, painkillers, anti-inflammatory drugs and vitamin preparations are injected into the affected area. Thanks to this in short terms it is possible to restore muscle mobility.

Paralysis is a fairly serious condition, which in most cases is a symptom of more dangerous pathologies. To cope with this disease, it is very important to establish the causes of its occurrence, and for this it is important to consult an experienced doctor as early as possible.

Leg paralysis is a loss of motor ability caused by damage to the spinal cord. Paralysis can be complete or partial. In the second case they talk about paresis. Paralysis may indicate development large number diseases. If the limbs are paralyzed, you should carefully monitor the dynamics of changes in the condition....