Signs and causes of cerebral palsy in a child, methods of treating cerebral palsy. Cerebral palsy - causes, symptoms, treatment The most common form of cerebral palsy is

2.3.

Clinical forms of cerebral palsy

Since the term cerebral palsy cannot include all the variety of pathological changes that occur with this disease, the search and development of an optimal classification of this suffering has been ongoing for many years. The first clearly defined classification of cerebral palsy belongs toS. Freud(96). It is based on clinical criteria.

Classification of cerebral palsy(96)

Hemiplegia

Cerebral diplegia (bilateral cerebral palsy)

Generalized rigidity

Paraplegic rigidity

Bilateral paraplegia

Generalized chorea

Double athetosis

This classification made it possible for the first time to identify types of cerebral palsy, which were then used as the basis for all subsequent classifications.

More than twenty classifications of cerebral palsy have been proposed in the world literature. They are based on etiological signs, the nature of clinical manifestations, and pathogenetic features. In domestic clinical practice, the classification of K.A. is most often used. Semenova (65), which includes the author’s own data and elements of the classification of D.S. Futer (76) and M.B. Zucker (80). According to this classification, there are five main forms of cerebral palsy:

Double hemiplegia;

Spastic diplegia;

Hemiparetic form;

Hyperkinetic form;

Atonic-astatic form.

In practice, a mixed form of cerebral palsy is also distinguished. Let us dwell on a brief description of the clinical forms of cerebral palsy.

Double hemiplegia - The most severe form of cerebral palsy occurs when there is significant damage to the brain during intrauterine life. All clinical manifestations are associated with pronounced destructive-atrophic changes, expansion of the subarachnoid

Noidal spaces and ventricular system of the brain. There is a pseudobulbar symptom, drooling, etc. All the most important human functions are severely impaired: motor, mental, speech (82).

Motor disturbances are detected already in the neonatal period; as a rule, there is no protective reflex; all tonic reflexes are clearly expressed: labyrinthine, cervical, reflex from the head to the torso and from the pelvis to the torso. Chain adjustment reflexes do not develop, i.e. the child cannot learn to sit, stand and walk independently.

The functions of the arms, as well as the legs, are practically absent. Muscle rigidity always predominates, increasing under the influence of persistent intense topical reflexes (cervical and labyrinthine). Due to the increased activity of tonic reflexes, a child in a position on his stomach or back has pronounced flexion or extension postures (Fig. 1). When supported in an upright position, as a rule, an extension posture is observed with the head hanging down. All tendon reflexes are very high, muscle tone in the arms and legs is severely impaired. Voluntary motor skills are completely or almost not developed.

The mental development of children is usually at the level of moderate or severe mental retardation.

No speech: anarthria or severe dysarthria.

The prognosis for further development of motor, speech and mental functions is extremely unfavorable. The diagnosis of “double hemiplegia” indicates a complete disability of the child.

Spastic diplegia

This is the most common form of cerebral palsy, known as Little's disease or syndrome. In terms of the prevalence of motor disorders, spastic diplegia is tetraparesis (i.e., the arms and legs are affected), but the lower extremities are affected to a much greater extent.

Children with spastic diplegia often experience secondary mental retardation, which, with early and correct treatment, can be eliminated by the age of 6-8 years. 30-35% of children with spastic diplegia suffer from mild mental retardation. In 70%, speech disorders are observed in the form of dysarthria, much less often - in the form of motor alalia.

The severity of speech, mental and motor disorders varies widely. This is due to the time and strength of the harmful factors. Depending on the severity of brain damage, already in the neonatal period, innate motor reflexes are weakly expressed or do not arise at all: protective, crawling, supporting, stepping movements of the newborn, etc., i.e. the basis on which the installation reflexes are formed is disrupted. The grasping reflex, on the contrary, is most often strengthened, as well as tonic reflexes: cervical, labyrinthine; Moreover, the degree of their severity can increase by 2-4 months. life.

The muscle tone of the tongue is sharply increased, so that it is brought to the root, and its mobility is sharply limited. The child's eyes look up. Thus, the functions of vision and speech are drawn into a vicious circle.

When the symmetrical cervical-tonic reflex is expressed, when the head is flexed, a flexion position occurs in the arms and an extension position in the legs, and when the head is extended, on the contrary, there is an extension of the arms and flexion of the legs. This rigid connection of tonic reflexes with muscles by the age of 2-3 years leads to the formation of persistent pathological synergies and, as a consequence, to persistent vicious postures and attitudes.

The most typical postures of children with spastic diplegia are presented in Fig. 2.

By the age of 2-3 years, vicious postures and attitudes become persistent, and from this time, depending on the severity of motor disorders, severe, moderate and mild degrees of spastic diplegia are distinguished.

Children with severe cannot move independently or move with the help of crutches. The manipulative activity of their hands is significantly reduced. These children do not provide for themselves or only partially provide for themselves. They relatively quickly develop contractures and deformities in all joints of the lower extremities. 70-80% of children have speech disorders, 50-60% have mental retardation, and 25-35% have mental retardation. In these children, for 3-7 or more years, tonic reflexes are not reduced and righting reflexes are difficult to form.

Children with moderate severity motor lesions move independently, although with defective posture. They have well-developed manipulative activity of their hands. Tonic reflexes are slightly expressed. Contractures and deformities develop to a lesser extent. Speech disorders are observed in 65-75% of children, mental retardation in 45-55%, and mental retardation in 15-25%.

Children with mild severity motor damage is noted by awkwardness and slowness of the pace of movements in the arms, a relatively slight limitation in the range of active movements in the legs, mainly in the ankle joints, and a slight increase in muscle tone. Children move independently, but their gait remains somewhat defective. Speech disorders are observed in 40-50% of children, mental retardation - in 20-30%, mental retardation - in 5%.

Prognostically, spastic diplegia is a favorable form of the disease in relation to/overcoming mental and speech disorders and less favorable in relation to the development of locomotion.

A child suffering from spastic diplegia can learn to care for himself, write, and master a number of work skills (25, 82).

Hemiparetic form

This form of the disease is characterized by damage to the arms and legs of the same name (82). In 80% of cases, it develops in a child in the early postnatal period, when, due to injuries, infections, etc., the developing pyramidal tracts of the brain are affected.

Brain. In this form, one side of the body is affected: the left with right-sided brain damage, and the right with left-sided brain damage. With this form of cerebral palsy, the upper limb is usually more severely affected. Right-sided hemiparesis is more common than left-sided hemiparesis. Apparently, the left hemisphere, when exposed to harmful factors, suffers primarily as it is phylogenetically younger, whose functions are the most complex and diverse. 25-35% of children have a mild degree of mental retardation, 45-50% have secondary mental retardation, which can be overcome with timely rehabilitation therapy. Speech disorders are observed in 20-35% of children, more often of the pseudobulbar dysarthria type, less often of motor alalia.

After the birth of a child with this form of cerebral palsy, all congenital motor reflexes are formed. However, already in the first weeks of life, limitation of spontaneous movements and high tendon reflexes in the affected limbs can be detected; the support reflex, stepping movements, and crawling are less pronounced in the paretic leg. The grasp reflex is less pronounced in the affected hand. The child begins to sit on time or with a slight delay, and the posture turns out to be asymmetrical, which can lead to scoliosis.

Manifestations of hemiparesis usually develop by 6-10 months. life of the child, which gradually increase (Fig. 3).

Starting from 2-3 years, the main symptoms of the disease do not progress; they are in many ways similar to those observed in adults. Movement disorders are persistent, despite the therapy.

There are 3 degrees of severity of hemiparetic forms of cerebral palsy: severe, moderate and mild.

In severe cases lesions in the upper and lower extremities, pronounced disturbances in muscle tone such as spasticity and rigidity are observed. The volume of active movements, especially Fig. 3. Hemiparetic form in the forearm, hand, fingers and

Wait, minimal. Manipulative activity of the upper limb is practically absent. The hand, the length of all phalanges of the fingers, the shoulder blade, and the foot are reduced.

In the paretic arm and leg, muscle wasting and slow bone growth are noted. Children begin to walk independently only at the age of 3-3.5 years, and a severe violation of posture is observed, scoliosis of the spinal column and pelvic distortion are formed. In 25-35% of children mental retardation is detected, in 55-60% - speech disorders, 40-50% have convulsive syndrome.

For moderate severity damage to motor functions, muscle tone disorders, trophic disorders, limitation of the range of active movements are less pronounced. The function of the upper limb is significantly impaired, but the patient can grasp objects with his hand. Children begin to walk independently at the age of 1.5-2.5 years, limping on the affected leg, with support on the forefoot. 20-30% of children have mental retardation, 15-20% have mental retardation, 40-50% have speech disorders, and 20-30% have convulsive syndrome.

For mild cases lesions, disturbances in muscle tone and trophism are insignificant, the range of active movements in the hand is preserved, but awkwardness of movements is noted. Children begin to walk independently from 1 year 1 month to 1 year 3 months. without rolling the foot in the affected leg. 25-30% of children have mental retardation, 5% have mental retardation, and 25-30% have speech disorders.

Hyperkinetic form

The cause of this form of cerebral palsy is most often bilirubin encephalopathy as a result of hemolytic disease of the newborn. Less commonly, the cause may be prematurity followed by traumatic brain injury during childbirth, in which the arteries supplying blood to the subcortical nuclei are ruptured.

In the neurological status of these patients, hyperkinesis (violent movements), muscle rigidity of the neck, torso, and legs are observed. Despite the severe motor defect and limited ability to self-care, the level of intellectual development in this form of cerebral palsy is higher than in previous ones.

After birth, such a child’s congenital motor reflexes are impaired: congenital movements are sluggish and limited. The sucking reflex is weakened, coordination of sucking, swallowing, and breathing is impaired. In some cases, muscle tone is reduced. Sudden muscle spasms may occur at 2-3 months. Decreased tone is replaced by dystonia. Installation chain reflexes are significantly delayed in their formation.

Mirovaniye. Delayed formation of righting reflexes, muscle dystonia, and subsequently hyperkinesis disrupt the formation of normal postures and lead to the fact that the child cannot learn to sit, stand and walk independently for a long time. Very rarely, a child begins to walk independently at 2-3 years of age; most often, independent movement becomes possible at 4-7 years of age, sometimes only at 9-12 years of age.

In the hyperkinetic form of cerebral palsy, hyperkinesis of various types can be observed; they are most often polymorphic; types of hyperkinesis are distinguished: choreiform, athetoid, choreathetosis, Parkinson-like tremor. Choreiform hyperkinesis is characterized by fast and jerky movements, most often it is more pronounced in the proximal limbs (Fig. 4). Athetosis is characterized by slow, worm-like movements simultaneously occurring in the flexors and extensors, observed mainly in the distal limbs (Fig. 5)

Hyperkinesis occurs from 3-4 months of a child’s life in the muscles of the tongue and only by 10-18 months does it appear in other parts of the body, reaching its maximum development by 2-3 years of life. The intensity of hyperkinesis increases under the influence of exteroceptive, proprioceptive and especially emotional stimuli. At rest, hyperkinesis decreases significantly and almost completely disappears during sleep.

Impaired muscle tone is manifested by dystonia. Often, many children experience ataxia, which is masked by hyperkinesis and is revealed when it is reduced. Many children experience decreased facial expressions and paralysis of the abducens and facial nerves. Almost all children have pronounced autonomic disorders and significantly reduced body weight.

Speech dysfunction occurs in 90% of patients, most often in the form of hyperkinetic dysarthria, mental retardation in 50%, hearing impairment in 25-30%.

In most cases, intelligence develops quite satisfactorily, but children may become unteachable due to severe disorders of speech and voluntary motor skills due to hyperkinesis.

Prognostically, this is a completely favorable form with regard to learning and social adaptation. The prognosis of the disease depends on the nature and intensity of hyperkinesis: with choreic hyperkinesis, children, as a rule, master independent movement by 2-3 years; With double athetosis, the prognosis is extremely unfavorable.

Atonic-astatic form

This form of cerebral palsy is much less common than other forms and is characterized by paresis, low muscle tone in the presence of pathological tonic reflexes, and impaired coordination of movements and balance (25, 82).

From the moment of birth, the failure of congenital motor reflexes is revealed: there are no reflexes of support, automatic gait, crawling, weakly expressed or absent, protective and grasping reflexes (Fig. 6) Reduced muscle tone (hypotonia). Chain adjustment reflexes are significantly delayed in development. Such patients begin to sit independently by 1-2 years, and walk by 6 years.

By the age of 3-5 years, with systematic, targeted treatment, children, as a rule, master the ability to make voluntary movements. Speech disorders in the form of cerebellar or pseudobulbar dysarthria are observed in 60-75% of children, and mental retardation occurs.

Typically, this form of cerebral palsy affects the frontocerebellar tract, frontal lobes and cerebellum. Characteristic symptoms are ataxia, hypermetria, and intention tremor.

In cases where there is pronounced immaturity of the brain as a whole and the pathological process spreads mainly to its anterior parts, mental retardation is detected more often V mild, less often - moderately expressed, euphoria, fussiness, disinhibition are observed.

This form is prognostically severe.

Mixed form

The most common form of cerebral palsy. With it, there are combinations of all the above forms: spastic-hyperkinetic, hyperkinetic-cerebellar, and so on. Speech and intellectual impairments occur with the same frequency. Sometimes the disease occurs as a spastic form, and later hyperkinesis appears and becomes more pronounced.

According to the motor defect, there are three degrees of severity of cerebral palsy for all of the listed forms of the disease:

Mild - a physical defect allows you to move around, use public transport, and have self-care skills.

Average - children need partial help from others when moving and self-care.

Difficult - children are completely dependent on those around them.

The course of cerebral palsy is significantly worsened by the presence of hypertensive, hydrocephalic, and convulsive syndromes in patients; dysfunction of the hypothalamus, the entire hypothalamic-pituitary-adrenal system, which adapts the role to the external environment.

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 fits (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, communication 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 a curvature of the spine (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 burden 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.

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 brain lesions.

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 impaired motor functions, 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 time of 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 impairment 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 injuries to the frontal lobes are 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 exposure).

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 to correct 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 performed 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 factors such as prematurity and low birth weight of the child, the established fact of an intrauterine infection, the use of special forceps by obstetricians during childbirth, hemolytic disease, a low Apgar score for the newborn (if the child “scores” 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.

A vojta therapist can teach parents the technique. 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 drugs 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 plasty, 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; 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. Exercises in such a suit allow 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, rings for hands that the child will 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.

Cerebral palsy or cerebral palsy is a congenital disease of parts of the brain during intrauterine development. Acquired cerebral palsy is extremely rare, due to traumatic brain injury or infection.

Cerebral palsy is the most common cause of childhood disability, affecting nine out of a thousand children.

In many ways, these statistics are explained by insufficient knowledge, complexity and unpredictability of this disease.

Causes of cerebral palsy

The main cause of cerebral palsy is considered to be brain hypoxia. Hypoxia can occur due to rapid or protracted labor, when oxygen reaches the baby's brain in very small quantities.

Contact with radiation and chemicals literally “poisons” the fetus, so it is not surprising that a woman working in a hazardous industry will give birth to a child diagnosed with cerebral palsy. No less than chemical substances, the disease is provoked by x-ray radiation and exposure to electromagnetic fields. Bad habits of the mother and pathology of thyroid function also have a significant influence on the formation of cerebral palsy in a child.

Trauma sustained during or before childbirth is another factor influencing the development of cerebral palsy. Trauma sustained during childbirth can seriously damage the unborn baby's intact brain. Most often in such cases, hemorrhage occurs, followed by death of parts of the brain. It is worth noting that children born by cesarean section are practically not diagnosed with cerebral palsy.

Infectious diseases such as meningitis or encephalitis can also cause cerebral palsy.

The newborn's brain can also be paralyzed and intellectually disabled without any birth trauma. It is smaller than the healthy brain of children of this age and is affected by profound genetic disorders. These children, as a rule, rarely survive: only 10% of them. In this case, the main cause of the disease is a hereditary factor.

Symptoms of cerebral palsy

At an early age, when the child’s central nervous system is not fully formed, children with cerebral palsy are almost no different from others.

Over time, it becomes more noticeable that the baby is significantly behind his peers in development. He begins to hold his head up and roll over late, cannot sit for a long time without support, and does not crawl. The symptoms of cerebral palsy become even more obvious when the child is already a year old, and there are no hints of the first steps. An unhealthy child also has problems with hearing and speech: he does not react to sharp sounds by blinking, and begins to talk at 2-3 years. At about the same age, you can notice that the child uses mainly one hand (right-handed or left-handed).

The movements of a child diagnosed with cerebral palsy are abrupt and uncontrolled or, conversely, sluggish, most often aimless. Cramps of the arms and legs, as well as the lower jaw, may begin when crying.

A child aged 5-6 years may have a number of uncontrollable habits, for example, lip biting, nail biting. He is hyperactive and disobedient. He speaks poorly because he cannot control his lips and tongue. The child begins to drool, caused by an inability to control the work of many muscle groups responsible for swallowing. A patient with cerebral palsy develops strabismus, caused by weakness of the muscles responsible for the movements of the eyeball. The gait is most often tense, the child literally walks “on his toes,” with his legs somewhat crossed and pressed against one another.

Treatment of cerebral palsy

The best effect on the health of a child diagnosed with cerebral palsy is physical activity, of course, if it is permitted by a doctor. Therapeutic exercises with specialists, massage, warm baths - this is exactly what is needed for the rehabilitation of the patient.

Treatment of cerebral palsy involves the use of drugs aimed at improving brain function. The Voight method can also be used, the essence of which is to restore natural patterns of human movement, as well as to form motor skills. The child must learn to control balance, make grasping and stepping movements of the limbs.

It is also advisable to wear orthopedic shoes to avoid foot deformation.

A patient with cerebral palsy should be taught to walk normally and regularly and methodically develop each muscle group through training and exercises. Exercises for muscle stretching, endurance and stress relief will very soon give positive results, and with a long course of treatment, a child diagnosed with cerebral palsy will be practically no different from a healthy peer.

Remember that for a child diagnosed with cerebral palsy, the best treatment is a friendly atmosphere in the family, love and sincere hope from relatives for recovery.

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