Signs and causes of cerebral palsy in a child, methods of treatment of 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, for many years the search and development of an optimal classification of this suffering has been underway. 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 for the first time made it possible to single out the types of cerebral palsy, which later became 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, pathogenetic features. In domestic clinical practice, the classification of K.A. Semenova (65), which includes the author's own data and elements of the classification by D.S. Footer (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 with significant brain damage in the period of intrauterine life. All clinical manifestations are associated with pronounced destructive-atrophic changes, expansion of the subarach-

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

Movement disorders are detected already in the neonatal period, as a rule, there is no protective reflex, all tonic reflexes are sharply expressed: labyrinthine, cervical, reflex from the head to the body and from the pelvis to the body. Chain setting reflexes do not develop; the child cannot learn to sit, stand and walk independently.

The functions of the hands, like the legs, are practically absent. Rigidity of the muscles always predominates, aggravated under the influence of persistent intense topical reflexes (cervical and labyrinthine). Due to the increased activity of tonic reflexes, the child in the position on the stomach or back has a pronounced flexion or extension posture (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 sharply impaired. Voluntary motor skills are completely or almost not developed.

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

No speech: anartria or severe dysarthria.

The prognosis for the further development of motor, speech and mental functions is extremely unfavorable. The diagnosis of "double hemiplegia" indicates the 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. arms and legs are affected), but the lower limbs are affected in a much greater steppe.

In children with spastic diplegia, secondary mental retardation is often observed, which can be eliminated by the age of 6-8 with early and properly administered treatment. 30-35% of children with spastic diplegia suffer from mild mental retardation. In 70% - there are speech disorders 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 action of harmful factors. Depending on the severity of the brain damage, already in the neonatal period, congenital motor reflexes are weakly expressed or do not appear at all: protective, crawling, supports, stepping movements of the newborn, etc., i.e., the basis is violated, on the basis of which the installation reflexes are formed. The grasping reflex, on the contrary, is most often strengthened, as well as tonic reflexes: cervical, labyrinth; and the degree of their severity can increase by 2-4 months. life.

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

With a pronounced symmetrical tonic neck reflex, when the head is flexed, a flexion posture occurs in the arms and an extensor posture in the legs, and when the head is extended, on the contrary, extension of the arms and flexion of the legs occur. This rigid connection of tonic reflexes with muscles by 2-3 years leads to the formation of persistent pathological synergies and, as a result, to persistent vicious postures and attitudes.

The most characteristic postures of children with spastic diplegia are shown in fig. 2.

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

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

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

Children with mild severity motor lesion, awkwardness and slowness of the pace of movements in the hands, a relatively slight limitation of the volume of active movements in the legs, mainly in the ankle joints, a slight increase in muscle tone are noted. 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 formation of locomotion.

A child suffering from spastic diplegia can learn to serve himself, write, master a number of labor skills (25, 82).

Hemiparetic form

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

Brain. With this form, one side of the body is affected: the left with a right-sided brain lesion, and the right, with a left-sided one. With this form of cerebral palsy, the upper limb is usually more severely affected. Right-sided hemiparesis is more common than left-sided. Apparently, the left hemisphere, when exposed to harmful factors, suffers primarily as a younger phylogenetically, the functions of which 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 by the type of pseudobulbar dysarthria, less often by motor alalia.

After the birth of a child with this form of cerebral palsy, all innate 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, crawling are worse expressed 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, while the posture is asymmetrical, which can lead to scoliosis.

Manifestations of hemiparesis are formed, as a rule, by 6-10 months. child's life, 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 ongoing therapy.

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

With a severe degree lesions in the upper and lower limbs, there are pronounced violations of muscle tone by the type of spasticity and rigidity. The volume of active movements, especially Fig. 3. Hemiparetic form in the forearm, hand, fingers and

Stop, 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 hypotrophy and a slowdown in bone growth are noted. Children begin to walk on their own only from 3-3.5 years, while there is a gross violation of posture, scoliosis of the spinal column and pelvic tilt are formed. In 25-35% of children, mental retardation is detected, in 55-60% - speech disorders, in 40-50% - convulsive syndrome.

With moderate severity lesions of motor functions, violations of muscle tone, trophic disorders, limitation of the volume of active movements are less pronounced. The function of the upper limb is significantly impaired, but the patient can take objects with his hand. Children begin to walk independently from 1.5-2.5 years old, limping on a sore leg, relying 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.

With mild degree lesions of violation of muscle tone and trophism are insignificant, the volume of active movements in the hand is preserved, but awkwardness of movements is noted. Children begin to walk independently from 1 year. 1 month - 1 year. 3 months. without rolling the foot in the affected leg. In 25-30% of children, mental retardation is noted, in 5% - mental retardation, in 25-30% - 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 there is a rupture of the arteries that supply blood to the subcortical nuclei.

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

After the birth of such a child, congenital motor reflexes are disturbed: congenital movements are sluggish and limited. The sucking reflex is weakened, coordination of sucking, swallowing, breathing is disturbed. In some cases, muscle tone is reduced. At 2-3 months, sudden muscle spasms may occur. Reduced tone is replaced by dystonia. Adjusting chain reflexes are significantly late in their form.

Mirirovaniye. The delay in the formation of adjusting reflexes, muscular 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 from 2-3 years old, most often independent movement becomes possible at 4-7 years old, sometimes only at 9-12 years old.

In the hyperkinetic form of cerebral palsy, hyperkinesis of a different nature can be observed, they are most often polymorphic, there are types of hyperkinesis: choreiform, athetoid, choreatetosis, parkinson-like tremor. Choreiform hyperkinesis is characterized by fast and jerky movements, most often it is more pronounced in the proximal limbs (Fig. 4).

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

Violation of muscle tone is manifested by dystonia. Often, many children have ataxia, which is masked by hyperkinesis and is detected during its reduction. Many children have a decrease in facial expressions, paralysis of the abducens and facial nerves. Almost all children have expressed vegetative disorders, significantly reduced body weight.

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

Intelligence in most cases develops quite satisfactorily, and unlearned children may be due to severe disorders of speech and voluntary motor skills due to hyperkinesis.

Prognostically, this is a completely favorable form in terms of learning and social adaptation. The prognosis of the disease depends on the nature and intensity of hyperkinesis: in choreic - 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 occurs much less frequently than other forms, it is characterized by paresis, low muscle tone in the presence of pathological tonic reflexes, impaired coordination of movements, balance (25, 82).

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

By the age of 3-5, with systematic, directed treatment, children, as a rule, master the possibility of voluntary movements. Speech disorders in the form of cerebellar or pseudobulbar dysarthria are observed in 60-75% of children, there is a mental retardation.

As a rule, with this form of cerebral palsy, the fronto-cerebellopontine path, the frontal lobes and the cerebellum are affected. Characteristic symptoms are ataxia, hypermetry, intentional tremor.

In those cases where there is a pronounced immaturity of the brain as a whole and the pathological process extends mainly to its anterior sections, mental retardation is detected more often. in mild, less often - moderately pronounced, there is euphoria, fussiness, disinhibition.

This form is prognostically severe.

mixed form

The most common form of cerebral palsy. With it, there are combinations of all the forms listed above: spastic-hyperkinedic, hyperkinetic-cerebellar, and so on. Violations of speech and intelligence occur with the same frequency. Sometimes the disease proceeds as a spastic form, and later hyperkinesis appears and manifests itself more and more clearly.

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

Easy - a physical defect allows you to move around, use public transport, have self-service skills.

Medium - children need partial help from others when moving and self-service.

Severe - children are entirely dependent on others.

The presence of hypertensive, hydrocephalic, convulsive syndromes in patients significantly worsens the course of cerebral palsy; 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 impaired motor function and coordination.

Cerebral palsy occurs due to damage to the area of \u200b\u200bthe brain responsible for muscle activity. The cause of the disease may be a violation of the development of the brain or its trauma before, during or shortly after childbirth.

The cause of cerebral palsy in most cases is laid during the intrauterine development of the baby and is associated with diseases of a pregnant woman, pregnancy pathology or mutations. And in rare cases - with problems in 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 cerebral palsy is the most common pathology in this group. Approximately 1 out of 400-500 people in Russia has cerebral palsy.

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

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

Early residual stage of cerebral palsy starts at 2-4 months of age. In parallel with the growing up of the child, disorders are manifested, determined by the place and volume of brain damage. There is a developmental delay, such children begin to sit, crawl, walk, talk late, stiffness and unnatural movements of the damaged part of the body become clearly visible. For example, a child can perform all movements with only one hand, and press the other to the body, walk on toes, and so on.

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

There are various methods of treatment that can reduce the manifestations of cerebral palsy and increase the independence of the child. 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

As a rule, the 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 her, the muscles are in constant tension, so the child does not succeed in fast and accurate movements. The arms are bent at the elbows, the legs are often brought together or crossed, which makes it difficult to swaddle the baby. The degree of cerebral palsy damage can be different - from severe paralysis to slight awkwardness in movements, which are noticeable only when performing complex manipulations.
Dyskinetic. It can be manifested by both tension and flaccidity of the muscles. As a rule, newborn children with dyskinetic form of cerebral palsy behave sluggishly, almost do not 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, bright lights. 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 muscles of the body, which lead to its rotation, head turns and other changes in posture (torsion movements). Hyperkinesias usually do not appear at rest and disappear when the child is sleeping. Children with this form of cerebral palsy often have a decrease in hearing and speech, as well as difficulty with eating. At the same time, mental development suffers less frequently than in other forms of the disease.
Ataxic. With this form of cerebral palsy, balance and coordination disorders come to the fore, because of which movements become convulsive and awkward. Children start standing and walking at the age of 1.5–2 years, but these functions have to be brought to automatism for a long time. Tremors (involuntary trembling) of the hands and head may also be observed. Possible decrease in intelligence.
Mixed. With it, patients have signs of more than one of the forms of cerebral palsy described above.

The severity of symptoms can vary greatly from person to person. In some, the symptoms are expressed in a mild form, while in others the disease turns into invalids.

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. Depending on which part of the brain is damaged, cerebral palsy can be accompanied by a violation of not only motor, but also other body functions. Therefore, children with cerebral palsy may experience the following symptoms:

recurring seizures or seizures (epilepsy);
salivation and difficulty swallowing (dysphagia);
gastroesophageal reflux disease (GERD);
skeletal abnormalities or abnormalities, especially hip dislocation or spinal curvature (scoliosis);
problems with bladder control (urinary incontinence);
speech disorder (dysarthria);
visual impairment;
difficulties with learning (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 proved 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 infectious disease (such as meningitis), very low blood sugar, a severe head injury, or a stroke.

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

Reason number 1 - periventricular leukomalacia. This is a lesion of the white matter of the brain. White matter is a set of nerve fibers that connect the nerve cells responsible for mental activity with the rest of the body. When white matter is damaged, the connection between the brain and organs and parts of the body is disrupted.

It is believed that the defeat leads to a reduction in the volume of blood flowing to the head of the fetus, 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 the transmission of 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 can be:

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

Reason number 2 - a violation of the development of the brain. 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 the development of the brain:

changes (mutations) in genes that affect the development of the brain;
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, because with a lack of blood, parts of the brain can die, and the accumulation of blood itself can damage surrounding tissues. Usually, intracranial hemorrhage occurs in premature babies, but it can also happen after a stroke in a child in the womb.

Factors that increase the risk of stroke in the fetus:

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 to, who will check the baby's reflexes, his posture, muscle tone and movements. If the diagnosis is confirmed, you will undergo an additional examination by an orthopedist, who will prescribe treatment and develop a habilitation program (adaptation to life). Depending on the age of the child, they may also be referred to a psychologist for an assessment of intellectual development.

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

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

Sometimes the diagnosis of cerebral palsy is established to the child in the hospital. However, in most cases, it is possible to assume this disease only after several months or years of observation of the baby. It is possible to finally 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 the symptoms and help the child be as independent as possible.

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

Help for patients with cerebral palsy is provided in and specialized children's sanatoriums and boarding schools. Some of the main treatments are described below.

Physiotherapy for cerebral palsy

As a rule, physical therapy is started immediately after the diagnosis of cerebral palsy, as this is one of the most important ways to help the child manage the disease.

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

prevent weakening of muscles that your child does not normally use;
prevent muscles from contracting and losing their normal range of motion (a phenomenon called muscle contracture).

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

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

Development of speech in children with cerebral palsy

Salivary Control and Nutritional Problems in Cerebral Palsy

Children who cannot control their mouth muscles often find it difficult to swallow food and control salivation. This can lead to serious consequences, so nutritional problems with cerebral palsy require treatment.

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

If the dysphagia is mild, your doctor may teach your child how to deal with it. A diet consisting of soft foods is also recommended. For more severe dysphagia, tube feeding may be required. 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).

Salivation irritates the skin around the mouth, chin, and neck, which increases the risk of inflammation in these areas. There are a number of methods to combat salivation in cerebral palsy:

an anticholinergic medicine in the form of a tablet or patch that reduces saliva production;
injections of botulinum toxin into the salivary glands (although this is only a temporary solution);
moving the ducts of the salivary gland with the help of a surgical operation, as a result of which saliva is secreted deep into the oral cavity and is easier to swallow;
a special device placed in the oral cavity, which contributes to the correct position of the tongue and the regular swallowing of saliva;
teaching the skills of self-control over the physiological state of the body, during which the child is taught to recognize when his saliva flows and swallow it in time.

Surgery for cerebral palsy

Sometimes, to correct deformities of bones and joints, an operation is prescribed to lengthen too short muscles and tendons that cause inconvenience. This type of surgery is called orthopedic surgery and is indicated if a child with cerebral palsy experiences pain when moving. Surgery can also correct posture and ease 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 physiotherapy.

Surgery may be done to correct a curvature of the spine (scoliosis) or urinary incontinence. The condition of the child will be carefully monitored in order to timely identify those violations that can be effectively corrected with the help of surgery. As an examination, a regular x-ray of the hip joint or spine may be prescribed.

Selective dorsal rhizotomy (SRD) is a surgical operation that is prescribed to improve gait in children with high muscle rigidity (increased muscle 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 stiffness have not helped.

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

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

There are other methods of surgical correction of cerebral palsy. Intervention depends on the severity and prevalence of paralysis, the nature of disorders of the musculoskeletal system, 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, together with the child (if the child is able to understand the consequences of the procedure).

Complications of cerebral palsy

The brain damage that causes cerebral palsy does not worsen with age, but as a person with the condition grows older, physical and psychological difficulties may arise.

So, 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 the pathology of muscles and bones inherent in cerebral palsy, and creating a great burden on the body. Therefore, people with cerebral palsy can take much more energy to perform ordinary tasks than those who do not suffer from this disease.

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

Charitable Educational Foundation for Assistance in the Habilitation of Children with Developmental Disabilities;

You can easily find doctors who are involved in the diagnosis and treatment of cerebral palsy using the NaPopravku service. The "Who treats this" section on our website will help you decide on the choice of a suitable doctor. If in doubt, contact your pediatrician. He will conduct an initial diagnosis and direct you to a consultation with a doctor of the desired profile.

Cerebral palsy is one of the most difficult diagnoses that parents of a baby can hear from doctors. If you want to understand what this disease is, what are the symptoms and treatment, check out 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 even during the period of intrauterine development of the baby. The exact causes that eventually lead to cerebral palsy in newborns are still being investigated 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 limitation of motor functions do not change. As the child grows, 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 in the 19th century. Then the British surgeon John Little took up the study of birth injuries. It took him exactly 30 years to formulate and present to the public the idea that the oxygen deficiency that the fetus experiences at the time of its birth can result in paresis of the limbs.

At the end of the 19th century, the Canadian doctor Osler came to the conclusion that cerebral disorders are still associated with the hemispheres of the brain, and not with the spinal cord, as the Briton Little had argued before him. However, Osler's arguments were not too convincing to medicine, and Little's theory was officially supported for a very long time, and birth trauma and acute asphyxia were called 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 make a clear classification of different forms of this disease.

Causes

Modern doctors believe that cerebral palsy cannot be considered a hereditary disease. Damage to the motor apparatus and problems with mental development become possible in case of improper development of the baby's brain during the mother's pregnancy, as well as banal underdevelopment of the brain.

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

However, prematurity itself is not terrible, it only creates the prerequisites for the development of disorders.

The likelihood of cerebral palsy is usually influenced by other factors that, 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;
a severe form of Rh-conflict between the mother and fetus (occurs with a negative Rh of the mother and a positive Rh of the child), as well as severe hemolytic disease of the child immediately after birth;
brain injury during childbirth and immediately after them;
infection of the brain immediately after birth;
toxic effects on the brain of a child with salts of heavy metals, poisons - both during pregnancy and immediately after birth.

However, it is not always possible to establish the true cause of the onset 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, as well as to prove that brain damage is the result of a conflict of Rh factors. Some children with cerebral palsy have not one, but several reasons 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 attack of antibodies associated with Rh conflict in utero. When they are born, the development of hemolytic disease of the newborn (HDN) plays a role, its nuclear icteric form is especially dangerous. This affects the subcortex of the brain, as well as auditory analyzers.

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

With all this, the intellect suffers to a lesser extent than with some other types of cerebral palsy. Such children (with due efforts on the part of parents and teachers) are perfectly socialized, they are able to study at school, many then 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 the result of chronic severe fetal hypoxia, an anomaly in the development of these brain structures. Birth trauma to the frontal lobes is often cited as a likely cause.

With this form, the child's muscle tone is reduced. When moving, the muscles do not coordinate with each other, so the child is not able to make purposeful movements. It is practically impossible to maintain balance due to reduced muscle tone. There may be trembling (tremor) of the limbs.

Such children are most prone to epileptic seizures. At an early age there are problems with the development of vision and speech. With proper care, systematic studies, adequate therapy, children with an athanic-astatic form of cerebral palsy can demonstrate certain low intellectual abilities that allow them to only slightly master the basics of speech and realize 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 hypoxia of the fetus, mechanical asphyxia when the neck is wrapped around the umbilical cord, hemorrhage in the brain (when affected by toxins, for example, or when the brain is infected). Often, a birth injury is considered as the cause, in which the cervical spine was affected.

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

The child experiences muscle and joint pain, he 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 noted - 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 serve themselves. There are also big problems with learning, since the intellect and psyche suffer to a large extent, and the child not only does not have the opportunity to take something with his hands, he does not have a 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. With an illness, 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 is deformed very quickly, the mobility of the joints is limited. Muscles contract uncontrollably.

The intellect, mental development and development of speech suffer quite pronouncedly. 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 commonly affects the arm rather than the leg. This condition becomes possible as a result of hemorrhage in one hemisphere of the brain.

The socialization of such children is possible if their intellectual capabilities are sufficiently large. Such babies develop with a large lag behind their peers. They are characterized by a delay in mental and mental development, problems with speech. Sometimes epileptic seizures 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 apparatus is quite real. Most often, a combination of a spastic form and a dyskinetic form is detected.

unspecified

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

Symptoms and signs

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

There are alarming symptoms that should make parents wary and see a doctor. These symptoms are not always signs of cerebral palsy, quite often they indicate neurological disorders that are not related to cerebral palsy in any way.

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 muscles of the crumbs 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 eyes on the 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 should normally disappear by six months), continue to persist after 6 months;
the limbs are spastically tense and do not relax, sometimes spasms occur in “attacks”;
the child has convulsions;
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).

The most difficult to determine the signs of cerebral palsy in children under the age of 5 months. 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. For one or more symptoms from the above list, it is impossible to suspect cerebral palsy, as well as mistakenly take the symptoms of some similar diseases for cerebral palsy.

Parents should be very careful, because if the treatment of some forms of pathology is started early, before the age of 3, then the results will be excellent, and the child will be able to lead a completely fulfilling life.

Stages of the disease

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

The smaller the stage, the more favorable the prognosis for a cure. Even if the child cannot be completely cured, it is quite possible to minimize the negative manifestations. The child's brain (even those affected by trauma or malformations) has a high ability to compensate, and this can and should be used to correct disorders.

Diagnostics

Quite often, genetic diseases are mistaken for cerebral palsy, which are completely independent diseases, 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 are still not well understood.

It is usually possible to determine the disease closer to 1 year. If a child at this age does not sit, does not crawl, shows other progressive signs of disorders of the nervous system, then the doctor prescribes an MRI.

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

For small children, the procedure is carried out under general anesthesia, since in the capsule for taking pictures you have to lie still and for a long time. Children can't do that.

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

If the child has convulsions, 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 intrauterine infection, the use of special forceps by obstetricians during childbirth, hemolytic disease, low Apgar score of the newborn (if the child "scored" at birth no more than 5 points) .

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

Treatment

Treatment does not aim to restore the functioning of the affected parts of the brain, since this is almost 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, serve himself independently.

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

Massage and Bobath Therapy

Motor functions are restored sequentially, for this, therapeutic massage and Bobath therapy are used. This method was founded by a British couple, therapists Berta and Carl Bobath. They proposed to influence not only the damaged limbs, but also the child's psyche. In a complex psychophysical impact gives excellent results.

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

The exercise therapy specialist selects an individual program for each baby, since Bobath therapy, in principle, does not provide for a single approach and a specific scheme. Depending on how and how the limbs are affected, at the first stage, the doctor does everything to ensure that the body “forgets” the wrong position. For this, relaxing technologies and exercises, massaging 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 to go through all the natural stages of development, albeit later, - standing on all fours, crawling, sitting, grasping with hands, resting on legs. With due diligence in classes, parents and doctors achieve excellent results - the “correct” positions are perceived by the child’s body as familiar and become an unconditioned reflex.

Food

Proper nutrition is very important for a child with cerebral palsy, since many babies with this diagnosis have concomitant pathologies of internal organs and the oral cavity. The digestive system is the most commonly 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” in the process of eating - sheds, cannot swallow, burps.

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

Formulas are encouraged (regardless of age) as they provide a more balanced diet. If the child refuses to eat or cannot do so due to the lack of a swallowing reflex, a special probe can be installed for him.

Vojta therapy

The method, which bears the name of its creator - the Czech doctor Vojt. It is based on the formation in children of motor skills characteristic of their age. For 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 lesions of motor skills and the central nervous system, they have to be formed "manually" so that later they become a habit and give rise to new movements - sitting, standing and walking.

The Vojta therapist can teach the technique to parents. All exercises are carried out independently, at home. The clinical effectiveness of this type of impact (as well as Bobot therapy) has not been proven to date, but this does not prevent medical statistics from being regularly updated with positive numbers of improved conditions in children with cerebral palsy.

Medicines

There is no special bet on pills and injections, since there is no such medication that would help cure cerebral palsy completely. However, some drugs significantly alleviate the condition of the child and help him to actively rehabilitate. Not every baby with such a pathology needs their use, the expediency of using drugs is determined by the attending physician.

Often prescribed to reduce muscle tone Baclofen, "Tolperison". Reduce muscle spasticity and botulinum toxin preparations - "Botox", "Xeomin". After the introduction of "Botox" into a spasmodic muscle, visible muscle relaxation appears already on the 5-6th day.

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, so botulinum toxins are included in the Russian standard for the treatment of cerebral palsy - as a means of complex therapy.

With epileptic seizures, the child is prescribed anticonvulsant drugs, to improve cerebral circulation, nootropic drugs are sometimes prescribed.

Some disorders in cerebral palsy are quite successfully corrected surgically. Tense ligaments and tendons are operated on, muscle-tendon plasty is performed, surgeons are excellent at eliminating ossification and limited movement of the joints, which accompany some forms of the disease.

Other Methods

Very good results are shown by the treatment of children with cerebral palsy with the help of pets. Animal therapy (this is the international name of the method, not always used in Russia) allows the child to socialize faster, stimulates intellectual and mental functions. Most often, parents of a child with such a diagnosis are advised to get a dog or cat. At the same time, the child should communicate and be close to 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 kids with cerebral disorders go in for horseback riding under the supervision of experienced hippotherapists.

While riding in the saddle, all muscle groups are involved in a person, and attempts to maintain balance are reflexive, that is, a signal from the brain to set the muscles in motion is not at all necessary. 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 the saddle, pulled along the horse's spine, seated, trying to load all the "problem" parts of the body and limbs.

Emotionally, children perceive a live horse much better, emotional contact is exactly the factor that allows you to form motivation in a child with cerebral palsy.

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

Methods with unproven effectiveness

Quite often, children are prescribed vascular drugs "Cerebrolysin", "Actovegin" and others, classed as nootropics. Although their use is widespread, it raises great 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 defeat a terrible disease stumble upon modern homeopathic remedies, which promise "improvement of brain activity". None of these funds 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 for manufacturers of drugs with unproven action. Clinical trials have shown that stem cells cannot restore movement disorders, since they do not have any effect on the connection between the psyche and motor skills.

Experts believe there is little benefit in cerebral palsy and from manual therapy. No one detracts from its significance, with 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, the diagnosis of cerebral palsy is not a sentence. Certain forms of the disease lend themselves to complex therapy, which includes the use of medications, massage, rehabilitation techniques, and work with a psychologist and a correctional teacher. Even some 50-60 years ago, children with cerebral palsy rarely lived to adulthood. Now life expectancy has changed in a big way.

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. It is rather difficult to answer the question of how long they 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 prone to premature aging, his actual age is always lower than his biological age, because deformed joints and muscles wear out faster, creating prerequisites for early aging.

Disability

Disability in children with cerebral palsy is issued based on the form and severity of the course of the disease. Children can count on the status of a “child with a disability”, and after they come of age, they can receive the first, second or third group of disability.

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

form and degree of cerebral palsy;
the nature of the lesion of the motor function (on one or both sides, whether there are skills in holding objects, leaning on the legs);
the severity and nature of speech disorders;
the severity and degree of mental damage and mental retardation;
the presence of epileptic seizures;
the presence, as well as the degree of hearing loss, vision.

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

Development Features

In infants, cerebral palsy has almost no clear manifestations (in any case, up to 3-4 months). After that, the baby begins to rapidly lag behind in development from his healthy peers.

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

Children with a light children with cerebral palsy are rarely aggressive and angry. On the contrary, they have an incredible attachment to their parents or guardians. She can reach panic if the baby is afraid to be alone.

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

At the physical level, in children with cerebral palsy, the lack of understanding of what the correct position of the body in space should be comes first. 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 often persist, 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 features of development are determined by a single factor - the preservation of intellectual potential. If it is, then a lot can be adjusted and corrected.

Means of rehabilitation

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

All devices are divided into three large groups:

hygienic devices;
devices that make it possible to move;
devices for the development of the child, training and medical procedures.

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

Hygiene

These facilities include toilet chairs and bathing chairs. 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 for secure fixation of the child.

The bath chair has an aluminum frame and a waterproof seat. On it, parents will be able to place the child comfortably and calmly bathe him. The tilt adjustment allows you to change the angle to change the position of the body, and the seat belts securely hold the child in the bath.

Mobility

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

If a child has learned to walk, but cannot (or cannot always) keep his balance, he needs a walker. A well-fitted walker can also help in the process of learning to walk. In addition, they train coordination of movements. Walkers usually look like a frame with four wheels and a safety device. The wheels cannot roll back, this completely eliminates tipping.

A more complex version of the walker is the parapodium. This is a dynamic stander 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 suitable only for children who have retained their intellectual functions, for everyone else it is better to use a regular static stand.

The verticalizers fix the child in the region of the popliteal space, as well as the feet, on the hips and on the belt. It can lean slightly forward. If the model is equipped with a table, then the child will even be able to play there.

Devices for the development of the child

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

Such a bike is equipped with mounts for the hands, legs and feet, as well as a cane that allows parents to push the device with the child forward if the child cannot pedal on his own.

Using a bicycle allows you to prepare your child well for learning to walk, trains leg muscles, alternating movements.

simulators

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

The most popular in Russia is the so-called Adele costume. This is a whole system of support and load flexible elements. Classes in such a suit allow the child to correct the posture, the position of the limbs, which ultimately has a good effect on other body functions. The kid begins to speak better, draw, 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, the child (from 3 years old) will have to walk, bend and unbend, squat (if possible) in this suit for 3-4 hours a day.

After such courses, which can be taken on the basis of a rehabilitation center, children feel more confident, they control their own hands and feet more easily, their arches are strengthened, a wider step appears, they master new skills. Doctors say that the risk of developing "fossil" joints is reduced several times.

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

And at home, in a rehabilitation center, you can use the Gross simulator. It is very easy to fix it in the country, and in the apartment, and on the street, and even in the pool, so that the child can practice in the water. The simulator is a movable block with a stretched cable, elastic rods, hand rings, for which the child will hold on. 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 baby with cerebral palsy develops the skills of independent movement with legs, about a third of children with this diagnosis, after systematic classes, were able to attend specialized schools and study.

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

To fix the joints in the correct position, orthoses, splints and splints are often used. The most popular manufacturing companies - 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 the medical rehabilitation of such children is carried out in St. Petersburg, they are produced under the brand name "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 serious illness of the child. Many rehabilitation means cannot be purchased at the expense of the budget, and incomes do not allow them to be bought on their own. 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 foundations describing the problem, confirming the diagnosis, and wait for the necessary support.

If you do not 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 fund has been operating throughout the country since 1998.
Charitable Foundation "Creation" (Moscow, Magnitogorskaya st., 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.
Spread Your Wings Charitable Foundation (Moscow, Bolshoy Kharitonevsky lane, 24, building 11, office 22). The Foundation has been operating since 2000 and provides support to disabled children.
Kindness Foundation (Moscow, Skatertny lane, 8/1, building 1, office 3). She has been working only with children with cerebral palsy since 2008.
Charitable Foundation "Children of Russia" (Ekaterinburg, 8 March 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 the brain during fetal 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 respects, such statistics are explained by insufficient knowledge, complexity and unpredictability of this disease.

Causes of cerebral palsy

Cerebral hypoxia is considered to be the main cause of cerebral palsy. Hypoxia can occur due to rapid or prolonged labor, when oxygen enters 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 chemicals, the disease is provoked by X-rays and exposure to electromagnetic fields. Not a small influence on the formation of cerebral palsy in a child is also exerted by the bad habits of the mother, the pathology of the thyroid gland function.

Injury received during or before childbirth is another factor influencing the development of cerebral palsy. An injury sustained during childbirth can seriously damage the full-fledged brain of an unborn child. Most often in such cases, hemorrhage occurs, followed by the death of parts of the brain. It is worth noting that children born by caesarean section practically do not have a diagnosis of cerebral palsy.

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

The brain of a newborn can also be paralyzed, intellectually disabled without any birth trauma. It is smaller than the healthy brain of children of this age and is afflicted with deep 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 central nervous system of the child 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 and roll over late, cannot sit without support for a long time, 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 the age of 2-3 years. At about the same age, you can notice that the child uses mainly one hand (right-handedness or left-handedness).

The movements of a child diagnosed with cerebral palsy are abrupt and uncontrollable, 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, such as lip biting, nail biting. He is hyperactive, disobedient. He doesn't speak well because he can't control his lips and tongue. The child begins to salivate, caused by the 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 movement of the eyeball. The gait is most often tense, the child literally walks “on his toes”, while the legs are somewhat crossed and pressed one to the other.

Treatment of cerebral palsy

The best way for the health of a child diagnosed with cerebral palsy is physical activity, of course, if it is allowed by a doctor. Remedial gymnastics 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 the functioning of the brain. The Voight method can also be applied, the essence of which is to restore the 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 advisable to wear orthopedic shoes to avoid foot deformity.

A patient with cerebral palsy should be taught normal walking, regularly and methodically develop each muscle group through training and exercises. Exercises for stretching muscles, for endurance and stress relief will very soon give positive results, and with a long course of treatment, a child diagnosed with cerebral palsy will practically not differ 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 of relatives for recovery.

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