Fixed spinal cord in children: symptoms, causes and features of treatment. Spinal hernia in newborns

2. Timely and adequate correction of hydrocephalic-hypertensive syndrome. 3. Carrying out rehabilitation with the aim of influencing the processes of restoration of the function of the spinal cord includes: neuroprotection to stabilize the surviving structures, preserve functionally complete fibers; the use of physical factors to stimulate the regeneration of nerve elements. Therapeutic and physiotherapeutic measures should be determined taking into account dysfunctions pelvic organs.

Problems during treatment in children with spinal hernias: 1. Difficulties in access to the central veins (infusion, sedation) and anesthesia. 2. Immunity is not formed, the risk of infections. 3. Gastroenterological problems (mucositis,

thrush, the need for parenteral nutrition, pseudomembranous colitis). 4. Care in the pre- and postoperative period.

Conclusions: 1. Hydrocephalus, dimensions

hernial sac and sluggish regenerative capabilities of soft tissues have

significant impact on results and

effectiveness of surgery. 2. The choice of tactics for the treatment of children with SMG is determined comprehensive examination

patients. 3. When SMG is combined with hydrocephalus, it is advisable to perform a liquor shunting operation as the first stage. 4. Differentiated surgical tactics in case of SMG with concomitant hydrocephalus, it provides for compliance with the indicated diagnostic and therapeutic recommendations.

DIAGNOSTICS OF ANOMALIES OF DEVELOPMENT OF THE SPINE AND SPINAL CORD IN NEWBORN AND CHILDREN IN THE FIRST YEAR OF LIFE

MM. Akhmediev, Sh.D. Mahmudov

Republican science Center neurosurgery, Tashkent, Uzbekistan

The primary diagnosis of anomalies in the development of the caudal spine and spinal cord is based on the presence of local changes and the degree of damage to the spinal cord and its roots. In newborns and children of the first year of life, neurosonography (NSG) in the diagnosis of anomalies in the development of the caudal spinal cord and spinal column is informative, as well as a public method. In this category of patients, the possibility of ultrasound diagnosis is largely determined by the presence of natural ultrasound windows. Ossification on the posteromedial surface of the spine

ends only by the end of the first year of life, which allows visualization of the spinous and transverse processes, arches, vertebral bodies, as well as a detailed examination of the spinal canal, cervical and lumbar thickening of the spinal cord, fifth ventricle and cone.

Research methodology: two main positions are used to examine a child. First: the child is in a lying position on the left side facing the mother (breastfeeding or from a horn is allowed to relax and create the physiological comfort of the child). Second: the child lies on his stomach, on the assistant's knees with a pronated head. This position is most convenient for examining the atlantooccipital junction. Usage

linear ultrasonic sensors with a frequency of 3.5-5.0-7.5 MHz makes it possible to visualize all the main structures of the spinal cord and spine in newborns and children of the first year of life. Ultrasound examination is carried out in the longitudinal and transverse directions and takes 15-20 minutes. In a longitudinal scan, the transducer is positioned along the spinous processes of the vertebrae and slowly moved caudally. On echograms, in real mode, the skin is visualized in layers, subcutaneous tissue, longitudinal muscles of the back, spinous processes of the vertebrae, membranes, spinal cord, spinal canal and vertebral body. Bone structures, membranes and walls of the spinal canal look like hyperechoic formations. White matter - hypoechoic echostructure, CSF - anechoic. At healthy child conus medullaris contains a natural extension of the central canal - the fifth ventricle (ventriculum terminale). The spinal cord ends at the level of L2-L3 and passes into the cauda equina (filum), which is visualized as separate threads. In itself, the presence of data on a thick (more than 1.0 - 1.5 mm in diameter) terminal filament and a somewhat unusually low (L2-L3) location of the spinal cord cone is not considered a manifestation of pathology. When scanning in the transverse direction, clearly visualized

arches, meninges and spinal canal. When using ultramodern devices, it is possible to visualize the “butterfly” of gray matter, dorsal and ventral roots of the spinal cord. Color Doppler imaging reveals epidural venous plexus, anterior spinal artery and paired posterior spinal arteries. Klippel-Feil syndrome, spinal dysraphia (syringomyelia, spina bifida occulta, spina bifida aperta) can be differentiated from meningo- and meningomyelocele, intramedullary tumors. Expansion of the central spinal canal at the level lumbar allows to differentiate myelocystocele from sacrococcygeal teratoma.

NSG defines not only hernial opening, but also the contents of the hernia, associated

hernia-related malformations and anomalies in the development of the skull and spine, brain and spinal cord: hydrocephalus, deformity and

asymmetry in the structure of the brain and skull, aplasia of the septum pellucidum, atrophy of the brain and spinal cord, connections between the contents of the sac with the ventricles of the brain and the subarachnoid space. The severity of hydrocephalus in SMG correlates with the severity of the spinal cord defect. Most of all, hydrocephalus occurs in the localization of SMG in the lumbar and lumbosacral spine.

Thus, knowledge of the normal echographic anatomy of the spinal cord, as well as the use of modern ultrasound technology, make it possible to diagnose congenital anomalies spinal cord spinal cord and spinal column.

RESULTS OF TREATMENT OF CHILDREN WITH LIPOMATOUS SPINAL FORMATIONS

G.M. Elikbaev, V.A. Khachatryan

Russian Research Neurosurgical Institute. prof. A.L. Polenov, St. Petersburg, Russia

The results of the examination and treatment of 34 children with spinal lipomas aged from 4 months to 18 years, treated at the FGU RNHI named after N.N. prof. A.L. Polenov from 1991 to 2008. There were 23 boys and 11 girls. In 27 (79.4%) cases, lipomas were located at the level of the lumbar sacral department spine.

The main clinical feature in the diagnosis of spinal lipomas was skin stigmas in the lumbosacral region and neurological disorders.

79.4% of children with lipomas have different skin changes were manifested by hyperpigmentation, elongated hair, funnel-shaped retraction, tumor-like formation. In 70.6% of cases, dysfunction of the pelvic organs was found, which in all cases was combined with movement disorders. Gradually progressive clubfoot was noted in 73.5% of children and more in children older than 3 years. Hydrocephalus was noted in 5 patients.

Spinal lipoma was combined with spina bifida of the lumbar and sacral vertebrae (32) with spinal hernia (10), with the syndrome of a fixed spinal cord in the lumbosacral region (18).

Lipomas were located extra-intravertebral-tebrally in 30 cases and only extravertebral - in 4 cases. Among intravertebral spreading tumors

leu epidural location of the tumor was in 13 cases, episubdural, subdural with ingrowth into the cone of the spinal cord - in 8 cases. Among the various forms of fatty formations related to spinal dysraphism, lipomeningocele was the most common type (in 31 cases).

MRI examination of the spine and spinal cord was performed in 24 (70.6%) children, CT examination was performed in 26% of cases. Spondylography in two projections was performed in patients with lipomatous formations in 16 (47.1%) cases, which showed an expansion of the bone canal. 7 (20.6%) patients underwent myelography with water-soluble contrast "Omniopak", which revealed a filling defect in the subarochnoid space at the location of the lipoma. The complex of preoperative examination included electroneuromyography (10 children), evoked potentials and ultrasound (3 patients each).

Target surgical treatment lipoma of the spinal cord was the release, decompression of the spinal cord, nerve roots and prevention of re-compression of the spinal cord. Concomitant diseases and anomalies in children operated on with lipomatous spinal formations were found in the urinary (32.4%), osteoarticular and respiratory systems(according to 2 observations).

The content of the article:

Did you know that during the first year of life, a newborn baby's brain doubles in size? Biologists confirm that if it were not for size limits female pelvis, the baby remained in the stomach for some time to be able to develop longer.
But since there is a special biological program, the pregnancy ends at 39 - 40 weeks, and the child is born with a brain that is only a quarter developed. In this case, the immaturity of the brain of a newborn is not considered a pathology.

Some experts refer to the first 3 months of life as the fourth trimester.

The brain of a newborn weighs an average of 390 grams (340 - 430) in boys and 355 grams (330 - 370) in girls, which is 10-12% of body weight. For comparison: in an adult, the mass of the brain is only 2.5%. As they grow older, by the age of 20-27, the weight of the brain becomes maximum: on average, 1355 g for men and 1220 g for women.

Note that individual variability in one direction or another is possible.
It is wonderful when a child fits into normal indicators in all respects. But it is very important to make sure that there is no baby in the brain serious pathologies, and if there is, courageously accept the situation and make every effort to normalize the condition, if possible. And in these cases, ultrasound diagnostics comes to the rescue.

Neurosonography of the brain of newborns

Informative and safe method diagnosis of brain pathologies in babies up to 12 months is ultrasound diagnostics, or neurosonography.

Prior to the introduction of these unique devices into practice, a child’s brain examination was performed according to strict vital indications using tomography under anesthesia. There were a huge number of contraindications to the study, and there were also many undesirable consequences.

Ultrasound of the brain in a newborn is currently considered a screening study and is carried out for preventive purposes for each newly born baby in order to identify abnormalities in the early stages.

The procedure itself does not require the use of anesthetics, any preparation and lasts 10 - 12 minutes.

Features of ultrasound examination of the brain in children under the age of one year

There are some nuances in conducting neurosonography in infants. The fact is that visualization is carried out through a large fontanel, which is reduced after a year. For an ultrasound wave, dense fused bones of the skull are an obstacle, and after closing the fontanelles, a reliable sonogram (picture ultrasound) impossible. If necessary, use the methods computer diagnostics(magnetic - resonance imaging, CT scan), but it is very difficult to carry out these studies, since none Small child will not be able to lie quietly alone in an enclosed space for 35 to 40 minutes while the scan is being performed.

Some mothers ask if the gel that the doctor of ultrasound diagnostics puts on the baby's head is harmful? Experts say that the use hypoallergenic gel and ultrasound itself is absolutely harmless and is used in diagnostic purposes even in the intensive care unit of the most debilitated young patients.

Mom is present at the study and holds the baby's head. How calmer baby, topics better conditions for the work of a doctor. Therefore, so that the child does not cry and does not show increased activity, he should not be hungry or wet.

Indications for neurosonography

A neonatologist, in order to clarify the diagnosis, prescribes an ultrasound of the brain to a child with the following indications:

Difficult childbirth;
delay prenatal development;
low birth weight;
neurological symptoms in a newborn;
hypotonicity;
hypertonicity;
brain hypoxia during pregnancy and childbirth;
stigmas and visible anomalies in the development of the fetus;
burdened obstetric history in the mother associated with the birth of a handicapped child or fetal death;
intrauterine infection;
with various visible deformations of the skull;
fetoplacental insufficiency;
overlay obstetric forceps;
asphyxia;
an increase in the volume of the head;
burdened genetics;
any suspicion of brain damage in the newborn.

The norm of brain size is a rather flexible concept, a slight decrease or increase cannot be the final criterion for diagnosis. Neonatologists believe that 70% of newly born babies with ultrasound diagnostics one or another neurological pathology is detected, which resolves on its own by 12-14 months of age.
This fact must be taken into account when obtaining a conclusion with the described changes. Given the imperfection of the brain of a child at birth, before panicking and assuming the worst, it is wiser to talk in detail with a pediatric neurologist and neonatologist.

Neurosonography of infants: norms of indicators

During the examination, all data and measurements are recorded in a special protocol.

Pay attention to the following aspects:

Symmetry of the right and left hemispheres;
clarity of furrows and convolutions;
the presence or absence of neoplasms;
symmetrical structure of the cerebellum;
absence free liquid;
homogeneity of the ventricles;
the condition of the vessels;
developmental defects.

What does the conclusion (norm) of an ultrasound of the brain in a newborn look like?

Of course, each specialist describes the sonogram in his own way, but a normal description of an ultrasound of the brain in a newborn might look like this:

There is no displacement of the median structures, the brain tissue is of normal echogenicity. Differentiation of brain structures is satisfactory, the relief of the cortex is visualized well. Structure subcortical nuclei expressed clearly. The lateral ventricles are arranged symmetrically.

Monroe holes on the right and left are passable.

The vascular plexuses are homogeneous, no neoplasms were found.

Conclusion: no pathology.

What pathologies can an ultrasound of the brain of a newborn reveal?

With ultrasound, the doctor can diagnose the following changes in the brain of a newborn:

hemorrhages;
hematomas;
congenital tumors;
cysts;
ischemic disorders;
ventricular changes;
inflammatory - infectious diseases such as meningitis.

Some changes do not pose a threat to the life and development of the child, while others may require urgent hospitalization with possible surgical treatment.

What are anomalies in the development of the brain in a child

If you reproduce the meaning of the word "anomaly", you get "irregularity, deviation from normal indicators, a violation of the general pattern.

In neonatology and neurology, anomalies in the structure of the brain in a child have structural abnormalities that occurred during embryogenesis. If the anomalies are too clear, we are talking about developmental defects. Significant vices development are considered deformities, for obvious reasons, this name is not entirely correct for use in pediatric practice.

Malformations of the brain

Malformations of the brain in a newborn can be genetically determined and manifest in a variety of combinations.

In a separate group of anomalies, secondary malformations of the skull and brain are distinguished.

There are many reasons for the appearance of anomalies in the development of the brain in the fetus:

Diseases transferred during pregnancy;
primary infection with the herpes virus, rubella;
exposure to radiation;
chronic alcohol, nicotine intoxication, drug use;
taking teratogenic drugs;
genetic diseases, etc.

Let us dwell on the frequently occurring pathological changes in the brain, which are not gross malformations and can be leveled over time.

Brain cyst in newborns

Cystic formations are divided into congenital and acquired.

Congenital cysts are formed due to deviations in the development of the membranes of the brain, past illnesses during pregnancy, chronic hypoxia.

The reasons that lead to the formation of acquired (secondary) cysts are more often associated with a traumatic effect, and look like this:

hemorrhages,
head injury,
transferred diseases.

A cyst is a cavity delimited by a capsule and filled with some kind of content, in most cases, liquid. Cysts of the brain in newborns are classified according to the place of localization and the period of occurrence. A neoplasm can occur anywhere, some cysts occur in utero, but resolve on their own by the time of birth.

Predisposing factors lead to the death of tissues in the brain and the formation of a cavity, which can affect the full development of the baby.

There are the following types:

Arachnoid cyst: localization - between the arachnoid membrane and the brain. It tends to grow aggressively, which leads to compression of brain structures and the appearance of corresponding symptoms.

Subelendemic cyst: may increase in size, which requires adequate dynamic monitoring. Occurs as a result birth injury or hemorrhage. With a pronounced increase in cystic neoplasm, there is a possibility of surgical intervention.

Choroid plexus cysts: are laid during fetal development, can resolve on their own. Common cause- intrauterine infection.

The choroid plexuses of the brain in newborns do not have nerve cells, their role is to produce cerebrospinal fluid, which is so necessary for normal functioning and nutrition of brain cells. At accelerated growth CSF in the brain fills the space between the choroid plexuses, which is considered as a cyst. The prognosis for life is quite favorable if no other pathology is found during the examination of the brain.

The examination is carried out every 3 months during the first year of life.

Symptoms and signs of a brain cyst in a child

Which symptoms will appear depends on the size of the neoplasm and its location.

We list common symptoms that are not pathognomonic for cysts, but may be signs of a brain tumor in a newborn, or may represent some kind of neurological disorder. Possible signs bad looks like this:

Anxiety;
swelling and pulsation of the fontanel;
restless sleep;
tremor of the limbs;
lack of sensitivity to pain;
regurgitation;
convulsive syndrome;
sudden loss consciousness;
muscle hypertonicity / hypotonicity.

As you get older, you may experience the following symptoms:

Visual impairment, hearing impairment;
headache;
discoordination of movements;
weakness/paralysis of limbs;
developmental delay.

At the first signs of pathology from the side nervous system you should see a doctor.

Treatment of neonatal brain cysts

If the pathology is diagnosed by ultrasound and does not manifest itself in any way, it is shown dynamic surveillance. Begin treatment with conservative therapy.

Medications for cysts in newborns:

Antiviral and antibacterial agents with confirmed viral or microbial genesis of pathology;

Drugs that improve blood supply to the brain, nootropics, antihypoxants.

If the treatment is unsuccessful, they resort to surgical intervention: open (trepanation of the skull), endoscopic (a minimally invasive method when a cyst is removed from a newborn using an endoscope).

Hydrocephalus

The accumulation of fluid in the brain in a newborn is eliminated by shunting: a shunt is inserted and a drain is installed.

Hydrocephalus is not independent disease is a syndrome. Dropsy (edema) of the brain in a child is congenital and acquired. Causes of congenital hydrocephalus include:

Malformations of the cerebrospinal fluid system;
intrauterine infection of the fetus;
birth trauma.

The development of acquired dropsy of the brain is caused by the following diseases:

All types of inflammation of the brain and its membranes;
vascular disorders;
tumor processes.

Signs of hydrocephalus in children and treatment

In newborns, hydrocephalus is manifested by an increase in the head, bulging of the veins, lack of pulsation of the large fontanel, and developmental delay.

Treatment of congenital dropsy of the brain in a child is always operative, intervention is performed to eliminate the cause. If you refuse the proposed operation, there is a risk of cerebral hemorrhage and an unfavorable outcome. Without surgical treatment as they grow older, mental and physical development suffers.

What is a brain pseudocyst in a newborn

pseudocyst- a neoplasm that is the result of prolonged hypoxia or hemorrhage. To date, there are no clear criteria by which a pseudocyst differs from a cyst. Some experts believe that the difference in histological structure shells.

Even without therapy, pseudocysts in newborns resolve without consequences. If by the year the neoplasm remains in the brain tissues, the diagnosis is made: a true cyst, which requires lifelong observation by a neuropathologist.

Enlargement of the ventricles of the brain in newborns

Specialists call the expansion of the ventricles ventriculomegaly. If the ventricles in a newborn are dilated symmetrically, this may be a variant of the norm, this is often found in large newborns.

In addition, the reason similar condition can be:

intrauterine hypoxia;
hydrocephalus - accumulation of fluid in the brain in a newborn;
violations in the development of the central nervous system;
prematurity.

If the sonogram shows signs of ventricular asymmetry, the likelihood of hemorrhage is primarily considered.

Posthypoxic brain changes in newborns

Some neurological pathologies are associated with oxygen starvation during fetal development.

If hypoxia was expressed significantly and adequate trophism was disturbed, most likely, the pregnancy ended unfavorably. With prolonged chronic hypoxia, which has some signs of compensation, the risk of giving birth to a low-weight, weakened child is increased. In the future, the baby can become a patient of a neurologist and undergo regular treatment.

The consequences of hypoxia depend on the duration, severity and changes in the structure of the brain. Acute hypoxia can develop during childbirth. The life of a child depends on the literacy and speed of actions of doctors.

The most favorable in terms of prognosis - mild degree oxygen starvation, it can pass on its own and without consequences.

Read on baby.ru: newborn head size table

The brain is the largest organ of the newborn. Its weight is on average 1/8-1/9 of body weight, and by the end of the first year of life - 1/11-1/12, while in an adult it is only 1/40 of body weight. IN childhood the brain grows relatively little: its mass increases by 3.76 times, and the mass of the whole body - by 21 times. By appearance child's brain in general terms resembles the brain of an adult, although the furrows are less pronounced, some are completely absent. However, in its own way microscopic structure the brain is an immature organ. The brain tissue in newborns is very rich in water. There are almost no myelin sheaths of nerve fibers; in the cut, the gray matter differs little from the white. This feature of the brain is microscopically determined at the age of 4-5, when it is still developing morphologically. But signs of immaturity in various departments expressed differently. Mature are evolutionarily old areas containing vital centers ( brain stem and hypothalamus). The most mature (morphologically and functionally) is cerebral cortex . Although it functions already in a newborn, its significance at this age is small. In newborns, functionally, the influence of the thalamopalidar system predominates, causing a reflex-stereotypical and athetosis-like character of movements. Subsequently, the function becomes more and more important. striatum and the cerebral cortex, movements become coordinated and purposeful, conditioned reflexes, which begin to form in the first months of life, play an increasingly important role in the child's behavior.

The spinal cord at the time of birth is a mature formation. Relative to the spine, it is larger than in an adult, reaching in newborns to the lower edge of the second lumbar vertebra.

The cerebrospinal fluid of a newborn baby is somewhat different from the cerebrospinal fluid of older children. In 1 ml of cerebrospinal fluid of a newborn child, there are an average of 15 cells. The protein content can reach 600-1000 mg / l, and in premature babies - 1500-1800 mg / l. The content of cells gradually decreases with age and amounts to an age-independent number in the C month - 4 cells per 1 ml. The protein content also decreases, reaching a minimum at the age of 3-9 months (200 mg/l). In children under 10 years old upper bound protein norm is 300 mg / l, and in adults - 400 mg / l. Because the BBB of newborns is more penetrating, the ratio between cerebrospinal fluid and blood glucose levels is higher than in children outside the neonatal period. It is at least 2/3, while later the level of glucose in the cerebrospinal fluid can be equal to half of its level in the blood.

peripheral nerves. The main feature is the relatively late myelination of the cranial nerves, which ends at 15 months of age, and the spinal nerves - at 3-5 years. Due to the lack of a myelin sheath or incomplete myelination, the speed of excitation along the nerve is reduced in the first months of life.

The autonomic nervous system functions in a child from the moment of birth, when individual nodes merge and powerful plexuses of the sympathetic part, the autonomic nervous system, are formed.

The spinal cord is part of the central nervous system located in the spinal canal. The conditional boundary between the medulla oblongata and the spinal cord is considered to be the place of decussation and discharge of the first cervical root.

The spinal cord, like the brain, is covered meninges(cm.).

Anatomy (structure). According to the length, the spinal cord is divided into 5 sections, or parts: cervical, thoracic, lumbar, sacral and coccygeal. The spinal cord has two thickenings: the cervical, associated with the innervation of the arms, and the lumbar, associated with the innervation of the legs.

Rice. 1. Cross section of the thoracic spinal cord: 1 - posterior median sulcus; 2 - rear horn; 3 - lateral horn; 4 - front horn; 5-central channel; 6 - anterior median fissure; 7- anterior cord; 8 - lateral cord; 9 - posterior cord.

Rice. 2. The location of the spinal cord in the spinal canal (transverse section) and the exit of the roots of the spinal nerves: 1 - spinal cord; 2 - back spine; 3 - front spine; 4 - spinal node; 5 - spinal nerve; 6 - vertebral body.

Rice. 3. Scheme of the location of the spinal cord in the spinal canal (longitudinal section) and the exit of the roots of the spinal nerves: A - cervical; B - chest; B - lumbar; G - sacral; D - coccygeal.

In the spinal cord, gray and white matter. Gray matter is a collection of nerve cells to which nerve fibers come and go. On a transverse section, the gray matter has the appearance of a butterfly. In the center of the gray matter of the spinal cord is the central canal of the spinal cord, barely visible to the naked eye. In the gray matter, anterior, posterior, and in the thoracic region and lateral horns are distinguished (Fig. 1). Processes of cells approach the sensitive cells of the posterior horns spinal nodes, components back roots; the anterior roots of the spinal cord depart from the motor cells of the anterior horns. The cells of the lateral horns belong to (see) and provide sympathetic innervation internal organs, vessels, glands, and the cellular groups of the gray matter of the sacral region - parasympathetic innervation pelvic organs. The processes of the cells of the lateral horns are part of the anterior roots.

The roots of the spinal cord exit the spinal canal through the intervertebral foramina of their vertebrae, heading downward for a more or less significant distance. They make a particularly long journey in lower section vertebral capal, forming a ponytail (lumbar, sacral and coccygeal roots). The anterior and posterior roots come close to each other, forming the spinal nerve (Fig. 2). A segment of the spinal cord with two pairs of roots is called a segment of the spinal cord. In total, 31 pairs of anterior (motor, ending in the muscles) and 31 pairs of sensory (going from the spinal nodes) roots depart from the spinal cord. There are eight cervical, twelve thoracic, five lumbar, five sacral and one coccygeal segments. The spinal cord ends at the level of the I-II lumbar vertebra, so the level of location of the spinal cord segments does not correspond to the vertebrae of the same name (Fig. 3).

White matter is located along the periphery of the spinal cord, consists of nerve fibers collected in bundles - these are descending and ascending pathways; distinguish between anterior, posterior and lateral cords.

The spinal cord is relatively longer than that of an adult, and reaches the third lumbar vertebra. In the future, the spinal cord somewhat lags behind growth, and therefore its lower end moves upward. The spinal canal of a newborn in relation to the spinal cord is large, but by the age of 5-6 years, the ratio of the spinal cord to the spinal canal becomes the same as in an adult. The growth of the spinal cord continues until about 20 years of age, the weight of the spinal cord increases by about 8 times compared with the neonatal period.

The blood supply to the spinal cord is provided by the anterior and posterior spinal arteries and spinal branches extending from the segmental branches of the descending aorta (intercostal and lumbar arteries).

Rice. 1-6. Cross sections of the spinal cord various levels(semi-schematic). Rice. 1. Transition of the I cervical segment to the medulla oblongata. Rice. 2. I cervical segment. Rice. 3. VII cervical segment. Rice. 4. X thoracic segment. Rice. 5. III lumbar segment. Rice. 6. I sacral segment.

Ascending (blue) and descending (red) paths and their further connections: 1 - tractus corticospinalis ant .; 2 and 3 - tractus corticospinalis lat. (fibers after decussatio pyramidum); 4 - nucleus fasciculi gracilis (Goll); 5, 6 and 8 - motor nuclei cranial nerves; 7 - lemniscus medlalis; 9 - tractus corticospinalis; 10 - tractus corticonuclearis; 11 - capsula interna; 12 and 19 - pyramidal cells of the lower parts of the precentral gyrus; 13 - nucleus lentiformis; 14 - fasciculus thalamocorticalis; 15 - corpus callosum; 16 - nucleus caudatus; 17 - ventrlculus tertius; 18 - nucleus ventralls thalami; 20 - nucleus lat. thalami; 21 - crossed fibers of the tractus corticonuclearis; 22 - tractus nucleothalamlcus; 23 - tractus bulbothalamicus; 24 - nodes of the brain stem; 25 - sensitive peripheral fibers of the nodes of the trunk; 26 - sensitive cores of the trunk; 27 - tractus bulbocerebellaris; 28 - nucleus fasciculi cuneati; 29 - fasciculus cuneatus; 30 - ganglion splnale; 31 - peripheral sensory fibers of the spinal cord; 32 - fasciculus gracilis; 33 - tractus spinothalamicus lat.; 34 - cells of the posterior horn of the spinal cord; 35 - tractus spinothalamicus lat., its decussation in the white commissure of the spinal cord.

Thank you

The nervous system is responsible for all processes in the human body. Thanks to the nervous system in the human body, metabolic processes are combined, which proceed according to different patterns in different tissues, and relationships with the external environment. It is necessary to understand the fact that the development of the nervous system, in particular the brain, does not come to an end at the birth of a child.

brain mass

The mass of the child's brain relative to the mass of his body is large. For clarity, we can compare the mass newborn and an adult. In a newborn, about 100-110 g of brain is accounted for 1 kg of mass, in an adult this mass is 5 times less.

Spinal cord

The spinal cord by the birth of a child is more developed than the brain. Gradually, as you grow and child development the composition of the brain and spinal cord changes. In the brain, the amount of water decreases, the protein substance accumulates. It also changes its structure. The differentiation of nerve cells reaches the structure of an adult by about 8 years.

From the very beginning, the child indicates his ability to move. Turns of the head, torso, repulsion by the legs - all this feels future mother. The movements of the child reflect the level of development of his reflex activity.

Thanks to the movements of the child, and his adaptability, the process of childbirth is facilitated.

Motor development of the newborn

The movements of the newborn are distinguished by their randomness and lack of coordination, which develops in stages after birth.

Gradually, with the overall development of the child, the movements become more coordinated and purposeful. The process of development of motor activity is very complex, and is of a phased nature:

2-3 weeks. At this stage, the eye muscles develop, thanks to which the child can fix his gaze on an object (at the beginning - brighter), then the child can observe the object in motion due to the development of the neck muscles. He can observe a highly raised object and turn his head in the direction where, for example, a toy is located.
Age 1 - 1.5 months. At this stage, the child makes coordinated movements with his hands, namely, he studies his face. Later, he raises his arms above his head in order to examine himself. Also at this age, the child can hold his head.
Age 3-3.5 months. The child learns his position and the place where he sleeps. At this stage, purposeful movements are formed. The child studies the fingers and toys that hang over his bed. Moreover, the smaller the toy, the faster the development process will go.
Age 12-13 weeks. During this period, the child holds objects with both hands, namely a blanket, toys and other soft objects that surround him.

Beginning with 5 months grasping movements resemble those of an adult. Of course, they are accompanied by many other accompanying extra movements. As a rule, the child mainly takes objects with his palm - fingers play a smaller role, they are an auxiliary link to bring the toy closer to the palm. In addition, other muscle groups are often involved in the act of grasping. At this age, the baby rolls from back to stomach, at 6 months - from stomach to back. Such new movements for the child are formed due to the development of the back muscles, and their coordinated contraction.

On 6-7 month the child is able to sit without the support of an adult, due to the development of leg muscles.
At the age of 7-8 months there is a coordinated work between the visual and motor analyzer. Thanks to this, the actions and movements of the child become more coordinated and purposeful.
By 9-10 months grasping is done by closing the larger, second and third fingers of the hand. Later, at the age of 1 year, the child is able to use distal phalanges index and larger fingers, due to which more complex movements involving small parts are made.

Crawling and walking

At the age of 6 months the first attempts begin, which may not end very well.

More mature crawling involving arms and legs appears during 7-9 months. By the end of 9 months, the child learns the pose on all fours.

At the same age, newer movements and experiments for the child begin, namely the beginning of walking. This process is as complicated as it is interesting, so most children begin to quickly get used to walking. The most difficult element is the first step, so children start their journey either in a playpen or crib, or with the help of adults.

At the age of 8-9 months the child, holding on to the crib, begins to get up and slowly, holding on to the support, moves along its perimeter. Then the child begins to step over with the help of an adult, namely holding with both hands, after a while - with one hand.

The timing of the development of walking may vary. Some children may start their journey at the age of 1 year. Other, calmer children begin to walk at the age of 1.5 years. Of course, the gait is different from that of older children. Legs bent at the hips and knee joints, spin in upper section tilted forward, in the lower section - on the contrary. In addition, the baby instinctively holds the handles to the chest, thus providing insurance in case of a possible fall. The first attempts may fail, but nothing happens without errors. The gait is characterized by a lack of balance when moving, the legs are widely spaced, the feet are directed to the sides.

Walking, moving with hands and learning more complex processes.

Confident walking is established at the age of 4-5 years. At the same time, everything is individual, and may differ from any norms, since each child is unique. Every year walking becomes more and more like an adult.

The mechanism of development is helped by the participation of parents and their emotional support, since the child feels the psychological atmosphere in the family best of all.

Development of communication and emotional status.
Development of conditioned reflex activity

driving force

At the age of 2 years, the child reaches general development and perfection.

The emotional background of the child is closer to negative character, since all emotions are a signal for parents. So, if the baby is cold, or he is hungry, or he has abdominal pain, he draws attention to himself with the help of a cry. Such a manifestation of feelings is the first step in communicating with adults.

The relationship between mother and child is established very early and grows stronger every day.

Development of communication, emotions and conditioned reflexes takes place in several periods:

The first days of a baby's life are only interested in feeding him. Therefore, in the first days the child only sleeps and eats, and this continues for a long time.
Beginning with 2-3 weeks, after feeding, the child stops and examines the face of his mother - sort of like making an acquaintance with the one who feeds, dresses and cares for him.
On 1-2 month life, the child already gets acquainted not only after eating, and not only with his mother, but also with the people around him. Focuses on strangers.
On 6-7 weeks the child greets his mother with the first smile. Gradually, his revival will be more obvious, as the hands and feet will take part in the greeting.
Beginning with 9-12 weeks the child becomes more liberated, physical activity accompanied by laughter and squealing.
Recognition of relatives and strangers installed aged 4 months. Among all, the child singles out his mother, and therefore, in some situations, he may react negatively to the fact that someone else took him in his arms. Reaction to stranger some children have a positive one, that is, the child smiles, laughs, but more often even such a reaction turns into a negative one. As a rule, this element is self-defense against danger. After some time, this attitude disappears, especially if he sees an adult more often.
At the age of 6-7 months there is an interest in objects, especially in toys that surround him. At the same time, interest in adults, namely in their speech, increases. The child tries to repeat any sounds after them, and the first speech of the child is babbling.
Sensory speech is key point the child's contact with the outside world. The kid understands what adults are talking about, and shows it by moving his head or stretching his arms towards the subject that was discussed.
At the age of 9 months the stock of emotion increases. They can be completely different and different people The child reacts differently. Elements of shyness appear in his behavior - he understands what is possible and what is not. In the future, sensory speech is replaced by motor speech.

Speech development

1. Initial (preparatory) stage.

positive emotions

2. The origin of sensory speech. The term "sensory speech" refers to babbling, which is combined with an understanding of the meaning of words that a child hears from an adult. At this stage, the child responds to questions. As a rule, he visually observes the subject that is being talked about around. At the age of one year, the vocabulary increases, babble is enriched every day. At this age, the stock of understood words is close to 20. The child obeys, distinguishes between the concepts of "possible" and "impossible." There is also an interest in communicating with adults. The child gesticulates, waves his arms, greets strangers at the request of the parents.

3. Formation of motor speech. All children have a stage when they do not just understand words, but when they want to be understood. At the age of 11 months, the child pronounces a few words (15-20), understands their meaning, and further develops this gift more and more. Girls begin to speak much faster than boys. The first words of all children are simple words, consisting of the same syllables, for example: mom, dad, willow, uncle. By the second year of life, the stock doubles. This period is considered one of the brightest and most memorable in the life of a child. The kid understands the connection between sentences, and freely perceives fairy tales from the words of an adult. Also during this period, auditory memory develops very well. By the end of the second year, the child pronounces words better, and the vocabulary increases to 300 words.

It should be noted that the successful development of motor speech of the child is helped by communication with parents. If problems arise at one of the stages of the formation of speech, and parents are not able to cope on their own, then it is necessary to think about the help of a speech therapist. In any situation, you need to remember that only care and affection help normal development, A negative emotions can only slow down and scare the baby. Therefore, the main task of parents is to preserve and ensure the family atmosphere.

Before use, you should consult with a specialist.