Forms of cerebral palsy and their clinical manifestations. Symptoms and treatment of cerebral palsy (CP) Cerebral palsy symptoms

With a diagnosis of cerebral palsy (infantile cerebral palsy), I have been living since birth. More precisely, from the age of one (around then, the doctors finally determined the name of what is happening to me). I graduated from a special school for children with cerebral palsy, and after 11 years I came to work there. Since then, 20 years have already passed ... According to the most conservative estimates, I know more or less close, more than half a thousand cerebral palsy. I think this is enough to dispel the myths that those who are faced with this diagnosis for the first time tend to believe.

Myth one: cerebral palsy is a serious disease

It is no secret that many parents, having heard this diagnosis from a doctor, are shocked. Especially in recent years, when the media more and more often talk about people with severe cerebral palsy - about wheelchair users with damage to the arms and legs, slurred speech and constant violent movements (hyperkinesis). They are not aware that many people with cerebral palsy speak normally and walk confidently, and in mild forms they do not stand out among healthy people at all. Where does this myth come from?

Like many other diseases, cerebral palsy varies from mild to severe. In fact, it is not even a disease, but a common cause of a number of disorders. Its essence is that during pregnancy or childbirth, the infant is affected by certain parts of the cerebral cortex, mainly those that are responsible for motor functions and coordination of movements. This causes cerebral palsy - a violation of the proper functioning of individual muscles, up to the complete inability to control them. Doctors have more than 1000 factors that can trigger this process. Obviously, different factors cause different effects.

Traditionally, there are 5 main forms of cerebral palsy, plus mixed forms:

Spastic tetraplegia- the most severe form, when the patient, due to excessive muscle tension, is not able to control either his arms or legs and often experiences severe pain. Only 2% of people with cerebral palsy suffer from it (hereinafter, the statistics are taken from the Internet), but they are most often talked about in the media.

Spastic diplegia- a form in which either the upper or lower limbs are severely affected. Legs suffer more often - a person walks with half-bent knees. Little's disease, on the contrary, is characterized by severe damage to the hands and speech with relatively healthy legs. Consequences of spastic diplegia have 40% of cerebral palsy.

At hemiplegic form motor functions of the arm and leg on one side of the body are affected. 32% have its signs.

In 10% of people with cerebral palsy, the main form is dyskinetic or hyperkinetic. It is characterized by strong involuntary movements - hyperkinesis - in all limbs, as well as in the muscles of the face and neck. Hyperkinesias are often found in other forms of cerebral palsy.

For ataxic form characterized by reduced muscle tone, sluggish slow movements, a strong imbalance. It is observed in 15% of patients.

So, the baby was born with one of the forms of cerebral palsy. And then other factors are included - the factors of life, which, as you know, everyone has their own. Therefore, what happens to him after a year, it is more correct to call the consequences of cerebral palsy. They can be completely different even within the same form. I know a person with spastic diplegia of the legs and rather strong hyperkinesis, who graduated from the Mechanics and Mathematics Department of Moscow State University, teaches at the institute and goes on hikes with healthy people.

According to various sources, 3-8 babies out of 1000 are born with cerebral palsy. Most (up to 85%) have a mild and moderate severity of the disease. This means that many people simply do not associate the peculiarities of their gait or speech with a “terrible” diagnosis and believe that there are no cerebral palsy in their environment. Therefore, the only source of information for them is publications in the media, which by no means strive for objectivity ...

Myth two: cerebral palsy is curable

For most parents of children with cerebral palsy, this myth is extremely attractive. Not thinking about the fact that brain disorders today cannot be corrected by any means, they neglect the “ineffective” advice of ordinary doctors, spending all their savings and collecting huge sums with the help of charitable funds to pay for an expensive course at the next popular center. Meanwhile, the secret of alleviating the consequences of cerebral palsy is by no means so much in fashionable procedures as in constant work with the baby from the first weeks of life. Baths, ordinary massages, games with straightening the legs and arms, turning the head and developing the accuracy of movements, communication - this is the base that in most cases helps the child's body to partially compensate for violations. After all, the main task of early treatment of the consequences of cerebral palsy is not to correct the defect itself, but to prevent the abnormal development of muscles and joints. And this can only be achieved by daily work.

Myth three: cerebral palsy does not progress

This is how those who are faced with mild consequences of the disease console themselves. Formally, this is true - the state of the brain does not really change. However, even a mild form of hemiplegia, almost invisible to others, by the age of 18 inevitably causes a curvature of the spine, which, if not dealt with, is a direct path to early osteochondrosis or intervertebral hernia. And this is severe pain and limited mobility up to the inability to walk. Each form of cerebral palsy has similar typical consequences. The only trouble is that in Russia these data are practically not generalized, and therefore no one warns growing cerebral palsy and their relatives about the dangers that lie in wait in the future.

Parents know much better that the affected areas of the brain become sensitive to the general state of the body. A temporary increase in spasticity or hyperkinesia can cause even a banal flu or a pressure surge. In rare cases, a nervous shock or a serious illness causes a sharp long-term increase in all the consequences of cerebral palsy and even the appearance of new ones.

Of course, this does not mean that people with cerebral palsy should be kept in greenhouse conditions. On the contrary: the stronger the human body, the easier it adapts to adverse factors. However, if a procedure or physical exercise regularly causes, for example, an increase in spasticity, they should be abandoned. In no case should you do anything through "I can not"!

Parents should pay special attention to the condition of the child from 12 to 18 years old. At this time, even healthy children experience serious overload due to the peculiarities of the restructuring of the body. (One of the problems of this age is the growth of the skeleton, which outstrips the development of muscle tissue.) I know several cases when walking children, due to problems with the knee and hip joints at this age, sat in a stroller, and forever. That is why Western doctors do not recommend putting children of 12-18 years old on their feet if they have not walked before.

Myth four: everything from cerebral palsy

The consequences of cerebral palsy are very different, and yet their list is limited. However, relatives of people with this diagnosis sometimes consider cerebral palsy to be the cause of not only impaired motor functions, as well as vision and hearing, but also such phenomena as autism or hyperactivity syndrome. And most importantly, they believe: it is worth curing cerebral palsy - and all other problems will be solved by themselves. Meanwhile, even if cerebral palsy really became the cause of the disease, it is necessary to treat not only it, but also a specific disease.

During childbirth, Sylvester Stallone's facial nerve endings were partially damaged - part of the actor's cheeks, lips and tongue remained paralyzed, however, slurred speech, a smirk and big sad eyes later became a hallmark.

Especially funny is the phrase “You have cerebral palsy, what do you want!” sounds in the mouths of doctors. More than once or twice I heard it from doctors of various specialties. In this case, I have to patiently and persistently explain that I want the same thing as any other person - to alleviate my own condition. As a rule, the doctor gives up and prescribes the procedures that I need. In extreme cases, a trip to the manager helps. But in any case, faced with this or that disease, a person with cerebral palsy has to be especially attentive to himself and sometimes prompt doctors for the necessary treatment in order to minimize the negative impact of the procedures.

Myth 5: People with cerebral palsy are not taken anywhere

Here it is extremely difficult to assert anything based on statistics, because there are simply no reliable data. However, judging by the graduates of the mass classes of the special boarding school No. 17 in Moscow, where I work, only a few stay at home after school. Approximately half enter specialized colleges or departments of universities, a third go to ordinary universities and colleges, some immediately go to work. In the future, at least half of the graduates are employed. Sometimes girls quickly get married after graduation and start “working” as a mother. With graduates of classes for children with mental retardation, the situation is more complicated, but even there, about half of the graduates continue their studies in specialized colleges.

This myth is spread mainly by those who are not able to soberly assess their abilities and want to study or work where they are unlikely to be able to meet the requirements. Receiving a refusal, such people and their parents often turn to the media, trying to get their way by force. If a person knows how to measure desires with opportunities, he finds his way without showdowns and scandals.

An illustrative example is our graduate Ekaterina K., a girl with a severe form of Little's disease. Katya walks, but can work on the computer with just one finger of her left hand, and only very close people understand her speech. The first attempt to enter a university as a psychologist failed - after looking at an unusual applicant, several teachers said they refused to teach her. A year later, the girl entered the Academy of Printing at the editorial department, where there was a distance learning. The study went so well that Katya began to earn extra money by passing tests for her classmates. She failed to get a permanent job after graduation (one of the reasons is the lack of an ITU labor recommendation). However, from time to time she works as a moderator of educational sites in a number of universities in the capital (an employment contract is drawn up for another person). And in his free time he writes poetry and prose, posting works on his own website.

Dry residue

What can I advise parents who found out that their baby has cerebral palsy?

First of all, calm down and try to give him as much attention as possible, surrounding him (especially at an early age!) with only positive emotions. At the same time, try to live as if an ordinary child is growing in your family - walk with him in the yard, dig in the sandbox, helping your child to establish contact with peers. There is no need to once again remind him of the disease - the child himself must come to an understanding of his own characteristics.

Second - do not rely on the fact that sooner or later your child will be healthy. Accept him for who he is. One should not think that in the first years of life all forces should be thrown into treatment, leaving the development of the intellect “for later”. The development of the mind, soul and body are interconnected. A lot in overcoming the consequences of cerebral palsy depends on the desire of the child to overcome them, and without the development of intelligence, it simply will not arise. If the baby does not understand why it is necessary to endure the discomfort and difficulties associated with treatment, there will be little benefit from such procedures.

Third, be lenient with those who ask tactless questions and give “stupid” advice. Remember: recently you yourself knew no more about cerebral palsy than they did. Try to calmly conduct such conversations, because how you communicate with others depends on their attitude towards your child.

And most importantly - believe: your child will be fine if he grows up an open and friendly person.

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Anastasia

I read the article. My theme:)
32 years old, right-sided hemiparesis (mild cerebral palsy). An ordinary kindergarten, an ordinary school, a university, independent job searches (in fact, I am currently in it), travel, friends, ordinary life ....
And through the "lame-footed" she went through, and through the "clubfoot", and through God knows what. And there will be many more, I'm sure!
BUT! The main thing is a positive attitude and strength of character, optimism!!

Nana

Does it really get worse with age? I have a mild degree, spasticity in the legs

Angela

And the attitude of people, unfavorable living conditions broke me. At 36, I have no education, no job, no family, although a mild form (right-sided hemiparesis).

Natasha

After vaccinations, a lot of "dtsp" appeared. Although the children are not cerebral palsy at all. There is nothing congenital and intrauterine. But they attribute to cerebral palsy and, accordingly, incorrectly "heal". As a result, they really get a kind of paralysis.
Often the cause of "congenital" cerebral palsy is not an injury at all, but an intrauterine infection.

Elena

A wonderful article that raises a huge problem - how to live with it. It is well shown that it is equally bad to ignore the presence of disease-related limitations and give them excessive importance. Don't focus on what you can't, but focus on what is available.
And it is really very important to pay attention to intellectual development. We even injected Cerebrocurin, it gave us a huge boost in development, after all, embryonic neuropeptides really help to use the available capabilities of the brain. My opinion is that you don’t need to wait for a miracle, but you shouldn’t give up either. The author is right: “this can only be achieved by the daily work” of the parents themselves, and the sooner they do this, the more productive. It’s too late to start “prevention of abnormal development of muscles and joints” after a year and a half of age - “the locomotive is gone.” I know from personal experience and from the experience of other parents.
Ekaterina, all the best to you.

* Kinesthesia (ancient Greek κινέω - “I move, touch” + αἴσθησις - “feeling, sensation”) - the so-called “muscular feeling”, a sense of the position and movement of both individual members and the entire human body. (Wikipedia)

Olga

I completely disagree with the author. firstly, why, when considering the forms of cerebral palsy, did they say nothing about double hemiplegia? it differs from ordinary hemiplegia and from spastic tetraparesis. secondly, cerebral palsy is really curable. if we mean the development of the compensatory capabilities of the brain and the improvement of the patient's condition. thirdly, did the author see heavy children in the eyes ??? those about which there is no question of making play in the sandbox. when you almost look at the child and he is shaking from convulsions. and the screaming doesn't stop. and he arches in such a way that the bruises on the hands of my mother when she tries to hold him. when not only to sit - the child cannot lie down. fourthly. the form of cerebral palsy is nothing at all. the main thing is the severity of the disease. I saw spastic diplegia in two children - one almost does not differ from his peers, the other is all crooked and with convulsions, of course, he cannot even sit upright in a stroller. there is only one diagnosis.

Elena

I do not quite agree with the article as the mother of a child with cerebral palsy - spastic diplegia, of moderate severity. As a mother, it is easier for me to live and fight, thinking that if it is incurable, then it is fixable, it is possible to bring the child as close as possible to "norms." social life. for 5 years we managed to hear enough that it’s better to send your son to a boarding school, and give birth to a healthy one yourself ... and this is from two different orthopedic doctors! it was said in front of a child who has a preserved intellect and he heard everything ... of course, he closed himself, began to shun strangers .... but we have a huge leap - our son walks on his own, though it’s bad with balance and his knees are bent ... but we fight. we started quite late, from 10 months , before that they treated other consequences of premature birth and indifference of doctors ...

Cerebral palsy is a group of diseases in which there is a violation of motor functions and posture.

This is due to a brain injury or a violation of the formation of the brain. This disease is one of the most common causes of permanent disability in children. Cerebral palsy occurs in about 2 cases for every thousand people.

Cerebral palsy causes reflex movements that a person cannot control and thickening of a muscle that can affect part or all of the body. These impairments can range from moderate to severe. There may also be intellectual disability, convulsive seizures, impaired vision and hearing. Sometimes it is a difficult task for parents to accept the diagnosis of cerebral palsy.

Cerebral palsy (CP) is one of the most common diseases in children today. In Russia, according to official statistics alone, more than 120,000 people are diagnosed with cerebral palsy.

Where does this diagnosis come from? Inherited or acquired? A sentence for life or can everything be fixed? Why childish? After all, not only children suffer from it? And what is cerebral palsy anyway?

Cerebral palsy is a disease of the central nervous system in which one (or several) parts of the brain are affected, resulting in non-progressive disorders of motor and muscle activity, coordination of movements, functions of vision, hearing, as well as speech and psyche. Cerebral palsy is caused by damage to the child's brain. The word "cerebral" (from the Latin word "cerebrum" - "brain") means "cerebral", and the word "paralysis" (from the Greek "paralysis" - "relaxation") defines insufficient (low) physical activity.

There is no clear and complete set of data on the causes of this disease. Cerebral palsy cannot be contracted and become ill.

The reasons

Cerebral palsy (CP) is the result of an injury or abnormal development of the brain. In many cases, the exact cause of cerebral palsy is not known. Damage or impaired brain development can occur during pregnancy, birth, and even during the first 2 to 3 years after birth.

Symptoms

Even when the disease is present at birth, the symptoms of cerebral palsy (CP) may not be noticed until the child is 1 to 3 years old. This is due to the growth of the child. Neither doctors nor parents may not pay attention to violations of the child's motor sphere until these violations become apparent. Children may retain the reflex movements of newborns without age-appropriate development of movement skills. And sometimes the first to pay attention to the underdevelopment of the child are nannies. If cerebral palsy has a severe form, then the symptoms of this disease are already found in the newborn. But the appearance of symptoms depends on the type of cerebral palsy.

The most common symptoms of severe cerebral palsy are

• Swallowing and sucking disorders
• Weak cry
• Seizures.
• Unusual postures of the child. The body can be very relaxed or very strong hyperextension with spread of the arms and legs. These postures are significantly different from those that occur with colic in newborns.

Some problems associated with cerebral palsy become more apparent over time or develop as the child grows. They may include:

• Muscle wasting in injured arms or legs. Problems in the nervous system impair movement in the affected arms and legs, and muscle stiffness affects muscle growth.
• Pathological sensations and perception. Some patients with cerebral palsy are very sensitive to pain. Even normal daily activities, such as brushing your teeth, can be painful. Pathological sensations can also affect the ability to identify objects by touch (for example, to distinguish between a soft ball and a hard one).
• Skin irritation. Drooling, which is common, can irritate the skin around the mouth, chin, and chest.
• Problems with teeth. Children who have difficulty brushing their teeth are at risk for gum disease and tooth decay. Anti-seizure medications can also contribute to gum disease.
• Accidents. Falls and other accidents are risks associated with impaired coordination of movements, as well as in the presence of convulsive attacks.
• Infections and somatic diseases. Adults with cerebral palsy are at high risk for heart and lung diseases. For example, in severe cerebral palsy, there are problems with swallowing and when choking, part of the food enters the trachea, which contributes to lung diseases. (pneumonia)

All patients with cerebral palsy have certain problems with body movement and posture, but many babies do not show signs of cerebral palsy at birth, and sometimes only nannies or nurses are the first to pay attention to deviations in the child's movements that contradict age criteria. The signs of cerebral palsy may become more apparent as the child grows. Some developing disorders may not become apparent until after the child's first year. The brain injury that causes cerebral palsy does not show up for a long time, but the effects may appear, change, or become more severe as the child gets older.

Certain effects of cerebral palsy depend on its type and severity, the level of mental development and the presence of other complications and diseases.

1. The type of cerebral palsy determines the movement disorders in a child.

Most patients with cerebral palsy have spastic cerebral palsy. Its presence can affect both in all parts of the body, and in individual parts. For example, a child with spastic cerebral palsy may develop symptoms mainly in one leg or one half of the body. Most children usually try to adjust to motor impairments. Some patients can even live independently and work, needing only occasional assistance. In cases where there are disorders in both legs, patients require a wheelchair or other devices to compensate for motor functions.

Complete cerebral palsy causes the most severe problems. Severe spastic cerebral palsy and choreoathetoid cerebral palsy are types of complete paralysis. Many of these patients are unable to care for themselves due to both motor and intellectual impairments and require constant care. Complications such as seizures and other long-term physical effects of cerebral palsy are difficult to predict until a child is 1 to 3 years old. But sometimes such predictions are not possible until the child reaches school age, and in the process of learning, communicative intellectual and other abilities can be analyzed.

1. The severity of mental impairment, if any, is a strong indicator of daily functioning. Slightly more than half of patients who have cerebral palsy have some degree of intellectual disability. Children with spastic quadriplegia usually have severe mental impairments.
2. Other conditions, such as hearing impairment or problems, often occur with cerebral palsy. Sometimes these disorders are noted immediately; in other cases, they are not detected until the child is older.

In addition, just like people with normal physical development, people with cerebral palsy experience social and emotional problems during their lives. Since their physical defects exacerbate problems, patients with cerebral palsy need the attention and understanding of other people.

Most patients with cerebral palsy survive to adulthood, but their life expectancy is somewhat shorter. Much depends on how severe the form of cerebral palsy is and the presence of complications. Some patients with cerebral palsy even have the opportunity to work, especially with the development of computer technology, such opportunities have increased significantly.

Cerebral palsy is classified according to the type of body movement and postural problems.

Spastic (pyramidal) cerebral palsy

Spastic cerebral palsy is the most common type. A patient with spastic cerebral palsy develops muscle stiffness in parts of the body that are unable to relax. In damaged joints, contractures occur, and the range of motion in them is sharply limited. In addition, patients with spastic cerebral palsy have problems with coordination of movements, speech disorders and swallowing disorders.

There are four types of spastic cerebral palsy, grouped according to how many limbs are involved. Hemiplegia - one arm and one leg on one side of the body, or both legs (diplegia or paraplegia). They are the most common types of spastic cerebral palsy.

• Monoplegia: Only one arm or leg is impaired.
• Quadriplegia: Both arms and both legs are involved. Usually in such cases it happens, and damage to the brain stem and, accordingly, this is manifested by swallowing disorders. Newborns with quadriplegia may have problems with sucking, swallowing, weak crying, the body may be cottony or vice versa tense. Often, when in contact with a child, hypertonicity of the body appears. The child may sleep a lot and not show interest in the environment.
• Triplegia: Either both arms and one leg or both legs and one arm are called.

Non-spastic (extrapyramidal) cerebral palsy

Nonspastic forms of cerebral palsy include dyskinetic cerebral palsy (subdivided into athetoid and dystonic forms) and ataxic cerebral palsy.

• Dyskinetic cerebral palsy is associated with muscle tone that ranges from moderate to severe. In some cases, there are uncontrollable jerky twitches or involuntary slow movements. These movements most often involve the muscles of the face and neck, arms, legs, and sometimes the lower back. The athetoid type (hyperkinetic) type of cerebral palsy is characterized by relaxed muscles during sleep with slight twitches and grimaces. When the muscles of the face and mouth are involved, there may be disturbances in the process of eating, salivation, choking on food (water) and the appearance of inadequate facial expressions.
• Ataxic cerebral palsy is the rarest type of cerebral palsy and affects the entire body. Pathological movements occur in the torso, arms, legs.

Ataxic cerebral palsy is manifested by the following problems:

• Body imbalance
• Violation of precise movements. For example, the patient is unable to place their hand on the desired object or perform even simple movements (for example, bring the cup exactly to the mouth). Often only one hand is able to reach the object; the other hand may tremble from trying to move that object. The patient is often unable to fasten clothing, write, or use scissors.
• Movement coordination. A person with ataxic cerebral palsy may walk with too large steps or legs wide apart.
• Mixed cerebral palsy
• Some children have symptoms of more than one type of cerebral palsy. For example, spastic legs (symptoms of spastic cerebral palsy related to diplegia) and problems with facial muscle control (symptoms of dyskinetic CP).
• Total (complete) cerebral palsy of the body affects the entire body to one degree or another. Complications of cerebral palsy and other health problems are most likely to develop when the whole body is involved rather than isolated parts.

There are several forms of this disease. Basically, spastic diplegia, double hemiplegia, hyperkinetic, atonic-ataxic and hemiplegic forms are diagnosed.

Spastic diplegia or Little's disease

This is the most common (40% of all cases of cerebral palsy) form of the disease, clearly manifested by the end of the first year of life. It occurs mainly in premature babies. They develop spastic tetraparesis (paresis of the arms and legs), and the paresis of the legs is more pronounced. In such children, the legs and arms are in a forced position due to the constant tone of both the flexor and extensor muscles. The arms are pressed to the body and bent at the elbows, and the legs are unnaturally straightened and pressed against each other or even crossed. Feet often deform during growth.

Also, these children often have speech and hearing impairments. Their intelligence and memory are reduced, it is difficult for them to concentrate on any activity.

Seizures are less common than in other types of cerebral palsy.

double hemiplegia

This is one of the most severe forms of the disease. It is diagnosed in 2% of cases. It occurs due to prolonged prenatal hypoxia, in which the brain is damaged. The disease manifests itself in the first months of a child's life. With this form, paresis of the arms and legs is observed with a predominant lesion of the arms and an uneven lesion of the sides of the body. At the same time, the arms are bent at the elbows and pressed to the body, the legs are bent at the knees and hip joints, but can also be unbent.

The speech of such children is slurred, poorly understood. They speak in a nasal way, either too quickly and loudly, or too slowly and quietly. They have a very small vocabulary.

The intelligence and memory of such children are reduced. Children are often euphoric or apathetic.

With this form of cerebral palsy, convulsions are also possible, and the more often and stronger they are, the worse the prognosis of the disease.

This form of cerebral palsy, which occurs in 10% of cases, is characterized by involuntary movements and speech disorders. The disease manifests itself at the end of the first - beginning of the second year of a child's life. Arms and legs, facial muscles, neck can move involuntarily, and movements are intensified during experiences.

Such children begin to speak late, their speech is slow, slurred, monotonous, articulation is impaired.

Intellect rarely suffers in this form. Often such children successfully graduate not only from school, but also from a higher educational institution.

Convulsions in the hyperkinetic form are rare.

Atonic-astatic form

In children suffering from this form of cerebral palsy, the muscles are relaxed, and hypotension is observed from birth. This form is observed in 15% of children with cerebral palsy. They begin to sit, stand and walk late. Their coordination is disturbed, and there is often a tremor (trembling of the hands, feet, head).

Intelligence in this form suffers slightly.

Hemiplegic form

With this form, which occurs in 32% of cases, the child has unilateral paresis, that is, one arm and one leg on one side of the body are affected, and the arm suffers more. This form is often diagnosed already at birth. Speech impairment is characteristic of this form - the child cannot pronounce words normally. Intelligence, memory and attention are reduced. In 40-50% of cases, convulsions are recorded, and the more often they occur, the worse the prognosis of the disease. There is also a mixed form (1% of cases), in which various forms of the disease are combined.

There are three stages of cerebral palsy:

• early;
• initial chronically residual;
• final residual.

In the final stage, there are two degrees - I, in which the child masters self-care skills, and II, in which this is impossible due to severe mental and motor disorders.

Diagnostics

Symptoms of cerebral palsy may not be present or detected at birth. Therefore, the attending physician observing the newborn needs to carefully monitor the child so as not to miss the symptoms. Nevertheless, it is not worth overdiagnosing cerebral palsy, since many motor disorders in children of this age are transient. Often the diagnosis can be made only a few years after the birth of the child, when it is possible to notice movement disorders. Diagnosis of cerebral palsy is based on monitoring the physical development of the child with the presence of various deviations in physical and intellectual development, analysis data and instrumental research methods such as MRI.

How to diagnose cerebral palsy in newborns: symptoms

If the baby sharply pulls up the legs or, on the contrary, stretches them at the moment when he is taken under the tummy, there is no lower thoracic and lumbar lordosis (bend) in his spine, the folds on the buttocks are weakly expressed and at the same time asymmetrical, the heels are pulled up, then parents should suspect the development of cerebral palsy.

The final diagnosis is established as a result of observing how the child develops. As a rule, in children with a disturbing obstetric history, control over the sequence of formation of reactions, the dynamics of general development and the state of muscle tone is carried out. If there are noticeable deviations or obvious symptoms of cerebral palsy, then an additional consultation with a psychoneurologist is required.

How cerebral palsy manifests itself in children under one year old

If the child was born prematurely or had a low body weight, if pregnancy or childbirth had any complications, parents should be extremely attentive to the baby's condition so as not to miss the warning signs of developing paralysis.

True, the symptoms of cerebral palsy up to a year are not very noticeable, they become expressive only at an older age, but still some of them should alert parents:

• the newborn has difficulty sucking and swallowing food;
• at the age of one month, he does not blink in response to a loud sound;
• at 4 months does not turn his head in the direction of the sound, does not reach for the toy;
• if the baby freezes in any position or he has repetitive movements (for example, nodding his head), this may be a sign of cerebral palsy in newborns;
• the symptoms of the pathology are also expressed in the fact that the mother can hardly spread the legs of the newborn or turn his head in the other direction;
• the child lies in obviously uncomfortable positions;
• The baby does not like being turned over on his tummy.

True, parents need to remember that the severity of symptoms will greatly depend on how deeply the baby's brain is affected. And in the future, they can manifest as a slight clumsiness when walking, as well as severe paresis and mental retardation.

How does cerebral palsy manifest itself in children at 6 months?

With cerebral palsy, symptoms at 6 months are more pronounced than in the infant period.

So, if the unconditioned reflexes characteristic of newborns have not disappeared in a baby before the age of six months - palmar-oral (when pressing on the palm, the baby opens his mouth and tilts his head), automatic walking (raised by the armpits, the baby puts bent legs on a full foot, imitating walking) is a warning sign. But parents should pay attention to such deviations:

• periodically, the baby has convulsions, which can be disguised as pathological voluntary movements (the so-called hyperkinesis);
• the child later than his peers begins to crawl and walk;
• the symptoms of cerebral palsy are also manifested in the fact that the baby often uses one side of the body (pronounced right-handedness or left-handedness may indicate muscle weakness or their increased tone on the opposite side), and his movements look awkward (uncoordinated, jerky);
• the baby has strabismus, as well as hypertonicity or lack of tone in the muscles;
• a baby at 7 months is not able to sit on its own;
• trying to bring something to his mouth, he turns his head away;
• at the age of one, the child does not speak, walks with difficulty, leaning on his fingers, or does not walk at all.

Diagnosis of cerebral palsy includes:

• Gathering information about the child's medical history, including details about the pregnancy. Quite often, the presence of a developmental delay is reported by the parents themselves or it is detected during professional examinations in children's institutions.
• A physical examination is necessary to look for signs of cerebral palsy. During a physical examination, the doctor evaluates how long the reflexes of newborns in a child last compared to normal periods. In addition, an assessment of muscle function, posture, hearing function, vision is performed.
• Tests to detect a latent form of the disease. Developmental questionnaires and other tests help determine the extent of developmental delays.
• Magnetic resonance imaging (MRI) of the head, which may be done to identify abnormalities in the brain.

The combination of these diagnostic approaches allows you to make a diagnosis.

If the diagnosis is unclear, additional tests may be ordered to assess the state of the brain and to rule out possible other diseases. Analyzes may include:

• Additional questionnaires.
• Computed tomography (CT) of the head.
• Ultrasound examination of the brain.

Evaluation and control of cerebral palsy
After cerebral palsy is diagnosed, the child must be further examined and other diseases that may be simultaneously with cerebral palsy should be identified.

• Other developmental delays in addition to those already identified. Developing abilities need to be assessed periodically to see if new symptoms appear, such as speech delay, as the child's nervous system is in continuous development.
• Intellectual lag can be detected through certain tests.
• Convulsive episodes. Electroencephalography (EEG) is used to detect abnormal activity in the brain if the child has a history of seizures.
• Problems with feeding and swallowing.
• Vision or hearing problems.
• Behavior problems.

Most often, a doctor can predict many of the long-term physical aspects of cerebral palsy when a child is 1 to 3 years old. But sometimes such predictions are not possible until the child reaches school age, when deviations can be detected in the course of learning and development of communication capabilities.

Some children need to be retested which may include:

• X-rays to look for dislocations (subluxations) of the hip. Children with cerebral palsy usually have several X-rays between the ages of 2 and 5 years. In addition, x-rays may be ordered if there is pain in the hips or if there are signs of hip dislocation. It is also possible to prescribe an x-ray of the spine to detect deformities in the spine.
• Gait analysis, which helps to identify violations and adjust treatment tactics.

Additional examination methods are prescribed if necessary and if there are indications.

Treatment

Cerebral palsy is an incurable disease. But a variety of treatments help patients with cerebral palsy minimize motor and other impairments and thus improve their quality of life. Brain injury or other factors leading to cerebral palsy do not progress, but new symptoms may appear or progress as the child grows and develops.

Initial (initial) treatment

exercise therapy is an important part of treatment that begins shortly after a child is diagnosed and often continues throughout his or her life. This type of treatment may also be given before a diagnosis is made, depending on the child's symptoms.

Despite the fact that cerebral palsy cannot be completely cured, it must be treated to make life easier for the child.

Treatment of this disease comprehensive, includes:

• massage to normalize muscle tone;
• therapeutic exercises to develop movements and improve coordination (should be done constantly);
• physiotherapy(electrophoresis, myostimulation) only if there are no seizures;
• electroreflexotherapy to restore the activity of motor neurons of the cerebral cortex, resulting in reduced muscle tone, improved coordination, speech, improved diction;
• load suits for correcting posture and body movements, as well as for stimulating the central nervous system;
• therapy with animals hippotherapy , canistherapy ;
• work with a speech therapist;
• development of motor skills of the child;
• prescribing drugs that improve brain function
• classes on special simulators such as loktomat.

If necessary, surgical intervention is performed - tendon-muscle plastic, elimination of contractures, myotomy (incision or division of the muscle).

It is possible that after some time a method of treatment with stem cells will appear, but so far there are no scientifically proven methods of treating this disease with their use.

Complex orthotics in the rehabilitation of patients with cerebral palsy

The characteristic signs of cerebral palsy are a violation of motor activity with the subsequent development of vicious attitudes, and later contractures and deformities of large joints of the limbs and spine, so timely and adequate orthotics is an important, if not a determining condition for the successful rehabilitation of patients with cerebral palsy.

When prescribing rehabilitation measures, it should be borne in mind that in its development, a sick child must consistently go through all the stages inherent in a healthy child, namely: sit (with and without support on hands), get up and sit down, stand with support, and only after that walk: first with support, and then without it.

It is unacceptable to skip any of these stages, as well as to carry out rehabilitation activities without orthopedic support. This leads to an increase in orthopedic deformities, the patient develops a stable vicious posture and movement stereotype, which contributes to the development of concomitant orthopedic pathologies.

At the same time, orthotics at all stages of the patient's development not only protects him from the formation or progression of vicious attitudes and ensures the safety of large joints, but also contributes to a faster and better passage of the current stage.

It should be noted that the upper limbs, which, as a rule, receive little attention during rehabilitation, also play an important role in the life support of the patient, since they perform supporting and balancing functions. Therefore, orthotics of the upper extremities are no less important than orthoses of the lower and spine.

When prescribing orthopedic products, it should be borne in mind that the orthopedic product shown must perform the task. In particular, the S.W.A.S.H. cannot be used for walking. this design does not allow you to do it correctly and without harm to the hip joints. Also, for walking, you should not use devices for the lower limb with locking hinges in the hip and knee joints at the same time. The use of various load devices without orthotics of large joints is also unacceptable, because. in this case, a muscular frame occurs with vicious joints, which further exacerbates orthopedic pathologies.

Dynamic orthotics

This type of orthotics is used when it is necessary to replace the function of damaged muscles, tendons and nerves of the limbs.

A dynamic orthosis is made for a specific patient, is a removable device and allows you to minimize the consequences of injuries / operations / diseases associated with movement disorders in the limbs, and also, in some cases, has a therapeutic effect.

Medications can help manage some of the symptoms of cerebral palsy and prevent complications. For example, antispasmodics and muscle relaxants help relax spasmodic (spastic) muscles and increase range of motion. Anticholinergics help improve limb movement or reduce salivation. Other drugs may be used as symptomatic treatment (eg, anticonvulsants, if seizures are present)

Permanent treatment

Permanent treatment for cerebral palsy (CP) focuses on continuing and adjusting existing treatments and adding new treatments as needed. Permanent treatment for cerebral palsy may include:

• Exercise therapy that can help a child become as mobile as possible. It may also help prevent the need for surgery. If the child underwent surgical treatment, then intensive exercise therapy may be necessary for 6 or more months. Drug treatment should be constantly monitored in order to avoid possible side effects of drugs.
• Orthopedic surgery (for muscles, tendons, and joints) or dorsal rhizotomy (excision of the nerves of injured limbs), if there are severe problems with bones and muscles, ligaments, and tendons.
• Special orthopedic devices (braces, splints, orthoses).
• Behavioral therapy, in which the psychologist helps the child find ways to communicate with peers, is also part of the treatment.
• Massage, manual therapy can also be used in the treatment of both the main symptoms of cerebral palsy and complications associated with impaired movement biomechanics.
• Social adaptation. Modern technologies (computers) have made it possible to employ many patients with the consequences of cerebral palsy.

Prevention

The cause of cerebral palsy (CP) is often unknown. But certain risk factors have been identified and proven to be associated with the incidence of cerebral palsy. Some of these risk factors can be avoided. Fulfilling certain conditions during pregnancy helps reduce the risk of brain damage in the fetus. These recommendations include:

• Complete nutrition.
• Do not smoke.
• Do not come into contact with toxic substances
• See your doctor regularly.

• Minimize injury from accidents
• Determine neonatal jaundice
• Do not use substances containing heavy metals (lead)
• Isolate the child from patients with infectious diseases (especially meningitis)
• Promptly immunize your child.

What parents need to know

Parents should be very attentive to the condition of their child, so as not to miss the signs of cerebral palsy in newborns. The symptoms of this pathology should be taken into account especially if there are grounds for alarm in the form of a problematic pregnancy, childbirth, or diseases suffered by the mother.

If you start treating a baby before the age of three, then cerebral palsy in 75% of cases is reversible. But with older children, recovery is highly dependent on the state of mental development of the child.

Cerebral palsy does not tend to progress, therefore, in the case when the pathology has affected only the patient's motor system, and there are no organic damages in the brain, good results can be achieved.

Attention! the information on the site is not a medical diagnosis, or a guide to action and is for informational purposes only.

Sometimes the pregnancy does not end as expected, the baby is born with a developmental pathology, for example, cerebral palsy (cerebral palsy). It should be noted that the disease is not inherited, but occurs during childbearing or during childbirth. Cerebral palsy is a disease that is a series of syndromes that have arisen due to brain damage, the signs of the disease are associated with a violation of the human motor sphere.

History of disease detection

Cerebral palsy was identified and studied in the early 19th century by the British physician Little, which is why cerebral palsy is also called "Little's disease." The British scientist and physician believed that the main cause of cerebral palsy is pathological labor activity, during which the child experiences severe oxygen starvation (hypoxia). Sigmund Freud also studied cerebral palsy at one time. He suggested that the cause of the disease is damage to the central nervous system of the child during fetal development. This assumption was proven in 1980. But subsequent studies have revealed that complicated labor activity is the most common cause of cerebral palsy.

General characteristics of the state

Currently, doctors say that cerebral palsy occurs immediately after birth or during pregnancy. The causes of illness are many. But mainly it is damage to the central nervous system and related neurological problems. With the disease, a wide variety of disorders of motor functions are observed. Muscle structures are most affected, this manifests itself in impaired coordination. Motor activity is impaired due to damage to brain structures. The localization and volume of these lesions determine the form, nature and severity of muscle disorders, which can be single or combined. Options for major muscle disorders:

• Muscle tension.
• Movements of involuntary chaotic character.
• Various gait disorders.
• Limited mobility.
• Muscle contractions.

In addition to impaired motor function, cerebral palsy may be accompanied by hearing and speech impairment. In addition, very often the disease is accompanied by epilepsy, deviations in psychological and mental development. Children have disturbances in the sphere of sensations and perception.

Cerebral palsy does not progress, since brain damage is point, it does not spread and does not capture new areas.

The reasons

Cerebral palsy is caused by damage to certain parts of the brain that are developing. This damage can occur during pregnancy, when the baby's brain is just beginning to form, during childbirth, in the first years of life. In most cases, the exact cause is very difficult to establish. In the scientific literature, the causes of cerebral palsy are divided into several groups:

• Genetic causes (damage to the chromosomes of the mother or father, may occur due to aging of the body).
• Oxygen starvation of the brain (placental insufficiency both during childbirth and during the period of bearing a baby). Factors in the development of oxygen deficiency: placental abruption, long or, conversely, rapid labor, cord entanglement, abnormal fetal presentation.
• Infectious diseases, for example, encephalitis, meningitis cause cerebral palsy. It is especially dangerous if the infection occurs with a high temperature.
• Toxic effects on the child (work in hazardous industries, smoking, drugs, alcohol).
• Physical impact (if the child was exposed to x-rays or radiation).
• Mechanical causes, a consequence of birth trauma.

Also, the factors that give rise to cerebral palsy are:

• premature birth.
• Small birth weight.
• Large baby weight or large fetus.
• Chronic diseases of women.
• Multiple pregnancy.

The risk of developing the disease increases if several factors that affect the baby's brain and nervous system act at once.

Factors in the development of the disease in the first days of life can be:

• Hemolytic disease (a congenital ailment that develops due to the incompatibility of the blood of the mother and child).
• Asphyxia of the child during labor.
• Entry of amniotic fluid into the respiratory tract of the fetus.
• Defects in the development of the respiratory system.

Children's cerebral palsy is a consequence of the influence of various factors that lead to disruption of the normal functioning of the child's brain. The greatest influence is oxygen starvation, which develops due to premature detachment of the placenta, the gluteal position of the fetus, rapid or prolonged labor, entanglement of the umbilical cord. Risk factors are Rh-conflict of mother and baby, infections.

Sometimes the cause of the development of cerebral palsy is considered various pathologies of the vascular system. This is an erroneous opinion, since the child's vessels are elastic and soft, they cannot burst without a reason. That is why vascular damage in a child can occur only as a result of a severe injury.

It is important to timely establish the cause of the development of cerebral palsy, as this determines the further tactics of working with the child and his treatment.

signs

Symptoms of cerebral palsy are divided into late and early. Early scholars include:

• Lagging behind the child in physical development (does not hold his head, does not crawl, does not sit, does not walk by the due date).
• The reflexes that are characteristic of infants are preserved with the growing up of the child (limb movements are chaotic for a long time, grasping reflex, stepping reflex).
• The child uses only one hand, this is clearly noticeable during the game or at home.
• The child is not interested in toys.
• If you put the child on his feet, he gets up only on his toes.

Late signs of cerebral palsy are:

• Deformation of the skeleton, in the affected area the limb is much shorter.
• Impaired coordination, low mobility of the child.
• Frequent spasms of the limbs.
• Gait is difficult, mostly on toes.
• Swallowing problems.
• Salivation.
• Problems with speech.
• Myopia, strabismus.
• Disease of the gastrointestinal tract.
• Involuntary defecation and urination.
• Emotional and psychological problems.
• It is difficult for children to write, read, count.

The degree of disability depends on the level of development of the child and the efforts of relatives. The higher the level of intelligence, the less violations of motor functions in the baby.

Forms

There are two classifications of the disease - the first is based on the age of the baby, the second on the form of the disorder.

By age, the disease is divided into:

• Early - symptoms appear before 6 months of a baby's life.
• Residual initial - the disease is detected from 6 months to 2 years.
• Residual later - after 2 years.

Regarding the forms of cerebral palsy classify:

• Spastic tetraplegia - areas of the brain that are responsible for motor function are affected. This happens, as a rule, in the prenatal period of a child's development due to oxygen deficiency. This type of cerebral palsy is one of the most severe and serious forms of the disease. The disease manifests itself in the form of problems with swallowing, impaired formation of sounds and their reproduction, paresis of the muscles of the limbs, problems with attention, visual impairment, strabismus, mental retardation.
• Spastic diplegia is the most common form of the disease, accounting for about 75% of all cases. As a rule, it is detected in children who were born as a result of premature birth. The disease manifests itself in the form of damage to the lower extremities, delayed mental and mental development, problems with speech. But, despite all the manifestations of the disease, patients with cerebral palsy of this type successfully study at school, are adapted in society. They do certain types of work.
• Hemiplegic form is more often seen violations in the movement of the upper limbs. The cause of this form of cerebral palsy is cerebral hemorrhage or heart attacks in the brain. Such children have good learning abilities, they can learn a number of actions, but their speed will not be great. Children who suffer from this form of the disease often have mental retardation, lag in speech development, mental problems, and frequent epileptic seizures.
• The dyskinetic form is the cause of hemolytic disease (a congenital disease that develops during the Rhesus conflict of the blood of the mother and baby). Such children have involuntary body movements, paresis and paralysis appear in all parts of the body. The positions of the limbs are not normal. At the same time, this type of cerebral palsy is considered the mildest form. Children can study at school, not be inferior in intellectual abilities to their peers, they can graduate from a higher educational institution, live a normal life in society.
• Ataxic form - the main causes of the disease are fetal hypoxia or trauma to the frontal lobes of the brain. A sign of this form is paresis of the vocal cords and muscles of the larynx, trembling of the limbs, and involuntary movements. As a rule, children suffer from mental retardation. With proper work with the child, he can learn to stand and even walk.
• Mixed form - when the patient has symptoms of several forms of the disease.

It should be noted that in newborns it is difficult to reliably diagnose the form of cerebral palsy, characteristic signs are detected by 6 months of a baby's life.

Condition Diagnostics

The disease is diagnosed on the basis of the identified characteristic signs. Conditioned reflexes and muscle tone are checked, in addition, an MRI of the brain is done. If there is a suspicion of brain damage, an EEG and ultrasound are performed.

Timely diagnosis is very important for a small patient. It is important to recognize the disorder. Children should be examined even in the maternity hospital, doctors pay special attention to children:

• With little weight.
• Born prematurely.
• Having defects and anomalies of development.
• Diagnosed with neonatal jaundice.
• Born as a result of difficult and prolonged childbirth.
• with infectious diseases.

Cerebral palsy is diagnosed by a neurologist, but he can additionally prescribe other tests to clarify the diagnosis.

Features of children with cerebral palsy

The main cause of cerebral palsy is a change in the structure of the brain, and the main symptoms are impaired motor activity. Movement disorders occur due to a disruption in the transmission of signals from the brain to the muscles. ICP is characterized by the presence of speech, motor, emotional, mental disorders. They are associated with damage to different muscle groups and brain tissues.

The developmental difficulties of such children are due to the enormous difficulties during the execution of complex or coordinated movements. Such children have limited independence, the ability to move freely, and only a partial ability to self-service.

Any movements of children are slow, which is why there is a disproportion between thinking and understanding of the surrounding reality. Logical thinking and abstract knowledge in such children are perfectly formed, and the idea of ​​the world around them is formed only in the conditions of constant movement of the child, as a result of which muscle memory is developed.

Children with cerebral palsy are not able to study for a long time, they learn a smaller amount of information compared to their peers. These children have difficulty with counting, it is very difficult for them to learn mathematical operations.

Emotionally, they are vulnerable, impressionable, very attached to their parents and guardians.

They, as a rule, have a speech disorder, which is why the circle of communication with peers is always limited.

Treatment and rehabilitation of cerebral palsy

The goal and main task of all therapeutic measures is to reduce the manifestations of the signs and symptoms of the disease. It is impossible to completely cure the disease, but it is possible, with the right method, to ensure that the child acquires the necessary skills and abilities for life.

To choose the nature of treatment, the doctor needs to know the form of cerebral palsy, concomitant diseases and the severity of the disease.

As medicines, as a rule, anticonvulsants are prescribed, relaxing.

Currently, there are no universal methods for the treatment of cerebral palsy. The following methods have worked well:

• Massage.
• Physiotherapy.
• Medical drugs that are aimed at normalizing muscle tone (Dysport, Mydocalm, Baclofen).

The following methods and techniques have a positive effect in the treatment of the disease:

• Bobath-tarapiya.
• Voight method.
• Load suit "Gravistat" or "Adeli".
• Pneumosuit "Atlant".
• Logopedic classes.
• Auxiliary devices (chair, walker, standers, exercise machines, bicycles).

Successfully used balneotherapy, hydrotherapy in the pool. It is easier for a child to move in the water, he first learns to walk in the water, after that it is easier for him to perform the same actions on the ground. Water procedures are completed with hydromassage.

Mud therapy has a good effect, which has a stimulating effect on nerve cells and relieves muscle tone. In addition, hypertonicity is well normalized with the help of electrophoresis, magnetotherapy, paraffin therapy.

If the changes in the structure of the muscles could not be corrected, then they resort to surgical treatment of cerebral palsy. Operations are aimed at performing plastic surgery of muscles and tendons. If it is possible to correct disorders in the tissues of the nervous system, then neurosurgical interventions, spinal cord stimulation, and removal of damaged areas are performed.

According to reviews, cerebral palsy should be treated as early as possible, as the condition may worsen due to the gradual development of an orthopedic problem. It can be curvature of the spine, flat feet, clubfoot, hip dysplasia, and others. If you miss the time, you will have to treat not only cerebral palsy, but also correct orthopedic disorders by putting on spacers, splints, splints.

Principles of working with children

With children who suffer from cerebral palsy, it is necessary to deal with both doctors and teachers. It is better to start working from an early age of children - from 1 to 3 years old. It is necessary to take them to classes where they will be taught to speak, perform daily activities, and teach self-care skills. Such training centers for cerebral palsy develop the ability to interact and communicate with peers.

In working with such children, much attention is paid to the development of speech and behavior in society. Each child has an individual approach that takes into account the age, form of pathology. Education of children, as a rule, is carried out in groups in the form of a game, which is led by a competent specialist. The movements of each child are carefully observed, incorrect movements are corrected, and correct ones are encouraged.

To develop the correct movement skills, special devices and devices are used to support the head, limbs, and torso in the desired position. The child trains and explores the surrounding space.

Exercise therapy and massage

Massage with cerebral palsy begins to be carried out from 1.5 months. The course is conducted only by a specialist who can assess muscle tone, the frequency of sessions, the degree of impact. It is not recommended to massage yourself.

Physiotherapy exercises include a complex of therapy, classes should be regular. The complexity of the exercises is set for each child individually, taking into account age, abilities, level of mental and emotional development. The load should increase gradually, as the child's condition improves.

As a rule, with cerebral palsy perform the following exercises:

• Stretching.
• Decreased muscle tone.
• Strengthening individual muscle groups.
• Endurance exercises.
• For balance.
• To increase muscle strength.

Complications

Cerebral palsy does not progress over time. But the danger of the disease is that additional pathologies develop against its background. Complications of cerebral palsy:

• Disability.
• Eating problems.
• Epilepsy.
• Delayed growth and development.
• Scoliosis.
• Incontinence.
• Salivation.
• Psychological and mental disorders.

Prevention of cerebral palsy

During pregnancy, you must strictly monitor your health. It is important to eliminate bad habits, regularly go to appointments with your doctor, strictly follow his recommendations. Timely diagnose conditions dangerous to the fetus, for example, hypoxia. The doctor should correctly assess the condition of the mother and choose the right way of delivery.

Disability

Disability in cerebral palsy is assigned depending on the severity and forms of the disease. Children can receive the status of "child with cerebral palsy", and after 18 years - the first, second or third group.

To obtain a disability, it is necessary to undergo a medical and social examination, as a result of which it is established:

• The degree and form of the disease.
• The nature of the lesion of the musculoskeletal system.
• The nature of speech disorders.
• Degree and expressiveness of mental defeats.
• degree of mental retardation.
• The presence of epilepsy.
• The degree of loss of vision, hearing.

Parents of a disabled child can receive the necessary means of rehabilitation and vouchers to a sanatorium at the expense of the state budget.

Special tools that make life easier for a child

Such devices and special equipment can be obtained at the expense of the state budget. This is only possible if the doctor has entered a list of them in a special rehabilitation card, and the ITU commission, when confirming disability, has recorded all the funds as necessary for the rehabilitation of the child.

Such devices are divided into 3 groups:

• Hygienic purposes: toilet chairs, bathing chairs. These devices are equipped with special seats, comfortable belts for fixing the child.
• Devices intended for movement: wheelchairs for children with cerebral palsy, parapodium, walkers, standers. All these devices allow the child to move in space and explore it. A child who is not able to walk on his own will need a stroller (cerebral palsy is the diagnosis in which this item is often extremely necessary), and more than one. For moving around the house - a home option, and for walking along the street, respectively, a street one. A stroller (cerebral palsy), for example, "Stingray" is the most lightweight, equipped with a removable table. There are very convenient and comfortable strollers, with electric drive, but their price is quite high. If your child can walk but cannot balance, he will need a walker. They train coordination of movements well.
• Devices for the development of the child, medical procedures, training: splints, tables, exercise equipment, bicycles, special toys, soft rollers, balls.

In addition, a child with cerebral palsy will need special furniture, shoes, clothes, dishes.

live fully

Many children with cerebral palsy successfully adapt in society, some manifest themselves in creativity. So, for example, a seven-year-old boy with cerebral palsy (severe form), who cannot walk at all, but loves to sing very much, has become a real star. The Internet literally blew up the video where he made a cover of the track "Minimal" by rapper LJ. Cerebral palsy-diagnosis does not interfere with creativity and self-realization at all. This talented child was visited by the rapper himself, their joint picture is very popular among fans of both LJ and the boy Sergei.

The term cerebral palsy is used to designate a group of symptom complexes, manifested by disorders in the motor sphere. These disorders result from damage to the central nervous system. Cerebral palsy can occur in a mild, subtle form or have a severe course that requires ongoing treatment.

Cerebral palsy refers to diseases of the nervous system and according to ICD 10, the disease is assigned the code G80, there are also subparagraphs indicating the form of paralysis. Cerebral palsy refers to non-progressive diseases of the nervous system, but if left untreated, the child will lag far behind in development, both mentally and physically, from their peers.

Rehabilitation measures started in early childhood can achieve excellent results, of course, everything depends on the form of the disease. Children with cerebral palsy generally live to old age and can have children of their own.

Causes of cerebral palsy

According to statistics, from 6 to 12 children for every thousand newborns are born with a diagnosis of cerebral palsy and many people think that this disease is inherited, however, the direct cause of the development of cerebral palsy in the fetus is a pathological disorder of the brain structures, which leads to this condition is insufficient oxygen supply. The risk of developing cerebral palsy increases under the influence of the following provoking factors:

• Infectious diseases of the mother throughout pregnancy, these primarily include the herpes virus, cytomegalovirus, toxoplasmosis.
• Incorrect development of brain regions during fetal development.
• Blood incompatibility between mother and child- Rhesus - a conflict leading to hemolytic disease of the newborn.
• Chronic fetal hypoxia during pregnancy and childbirth.
• Endocrinological and acute somatic diseases of the mother.
• Difficult delivery, protracted labor, trauma to the child received during the passage through the birth canal.
• In the early perinatal period, cerebral palsy can be caused by toxic damage to the body with heavy poisons, infectious diseases that affect the brain regions and cortex.

A large role in the development of cerebral palsy is given to oxygen starvation of the brain, which occurs when the uterus is improperly located in the body of the fetus, protracted labor, entanglement of the neck with the umbilical cord. In most children, the influence of several factors at once is revealed, one of which is considered the leading one, while others increase its negative influence.

Forms of cerebral palsy and their characteristics

The severity of motor disorders in children with cerebral palsy can be completely different and therefore the disease is usually divided into forms.

• Hyperkinetic form exhibited in the event that the baby has an unstable muscle tone, on different days it can be increased, normal or reduced. Ordinary movements are awkward, sweeping, involuntary movements of the limbs, hyperkinesis of the muscles of the face are observed. Disturbances in the motor sphere are often accompanied by pathologies of speech and hearing, while the mental activity of such children is at an average level.
• Atonic-astatic form develops mainly with damage to the cerebellum and frontal lobes. It is characterized by extremely low muscle tone, which prevents the child from holding a vertical position. Mental development proceeds with a slight delay, but in some cases oligophrenia is determined in children.
• Spastic diplegia is the most common form. Muscle functions are impaired on both sides, with the lower limbs being more affected. In children from an early age, the formation of contractures is formed, deformation of many joints and the spine is detected. Mental and speech development is delayed, strabismus, speech pathologies are often detected, a child with this form, with appropriate rehabilitation measures, becomes socially adapted.
• Spastic tetraparesis(tetraplegia) is one of the most severe forms of cerebral palsy, the disease is caused by significant anomalies in the lesions of most parts of the brain. Paresis is observed in all limbs, the muscles of the neck can be constantly relaxed, in such children mental development is often below average. In almost half of the cases, tetraparesis is accompanied by seizures of epilepsy. Children with this form can rarely move independently, understanding the world around them is difficult due to problems with speech and hearing.
• Atactic form- rare, with its development, there are violations in the coordination of all movements and maintaining balance. The child often has a tremor of the hands, because of which he cannot perform normal activities. The delay in the development of mental activity in most cases is moderate.
• Spastic-hyperkinetic form(dyskinetic form) a combination of involuntary movements, increased muscle tone and paresis with paralysis is revealed. Mental development at the age-appropriate level, such children successfully graduate not only from school, but also from institutes.
• Right-sided hemiparesis refers to the hemiplegic form, in which one of the sides of the hemisphere is affected. The muscle tone of the limbs is increased on the one hand, paresis and contractures develop. The muscles of the hand suffer the most, involuntary movements of the upper limb are noted. With this form, there may be symptomatic epilepsy, disturbances in mental development.

Signs and symptoms

Symptoms of muscle pathologies in cerebral palsy depend on the area and degree of brain damage.

The main signs are represented by the following violations:

• Tension of different muscle groups.
• Spasmodic involuntary muscle contractions in the limbs and throughout the body.
• Pathological disorders when walking.
• Limitation of general mobility.

In addition to these signs, pathologies of visual, auditory and speech functions, disorders of mental and mental activity are detected in children. Symptoms of the disease also depend on the age of the baby. Cerebral palsy does not progress, since the lesion is point-like and, as the child grows older, does not capture new areas of the nervous tissue.

The appearance of a deterioration in the course of the disease is explained by the fact that the symptoms are less noticeable at a time when the baby is not yet walking and does not attend preschool institutions.

Consider the signs of cerebral palsy in an infant:

• In newborns with cerebral palsy you can pay attention to the fact that the baby moves only the limbs of one side of the body, the opposite ones are usually pressed to the body. A newborn child with cerebral palsy, when trying to get a clenched fist into his mouth, turns his head in the opposite direction. Difficulties also arise when the mother tries to push the legs apart or turn the baby's head.
• One month. In one month, you can pay attention to the fact that the baby still does not smile, cannot hold his head even for a few seconds, there is no focus on a specific object. The baby is restless, the sucking and swallowing reflex is often difficult, there are often convulsions and involuntary shudders.
• 3 months. In children with cerebral palsy at three months, the preservation of absolute reflexes can be observed, that is, those that are present at birth, but should normally disappear by three months. These are stepping movements, when the baby, leaning on the legs, is able to take several steps. Also palmar reflex - when you press your fingers on the palm of your hand, the child involuntarily opens his mouth. At three months, the baby, also with normal development, is already trying to roll over, and in the prone position he confidently holds his head.
• 4 months. A baby at 4 months old should already consciously respond to his mother, make sounds, smile, actively move his arms and legs, take a toy and examine nearby objects. A child with cerebral palsy will be lethargic, when crying, he can arch his body in an arc, he takes objects with only one hand.
• 6 months. At six months of their lives, most babies pronounce individual syllables, can roll over on their own, hold their heads well, swallow from a spoon or mug, and try to crawl. The child reacts differently to mother and relatives. The presence of any violations is indicated not only by muscle hypertonicity, but also by their weakness, constant anxiety of the baby, and poor sleep.
• 9 months. At 9 months, a child with cerebral palsy does not show interest in walking, does not sit well, falls on his side, and is not able to hold objects for a long time. With normal development at this age, the baby should already rise, move around the crib or with the support of adults around the room. The child already recognizes his favorite toys, tries to name them, pronouncing individual sounds or syllables.

Of course, not all signs of developmental delay are symptoms of cerebral palsy. But parents should remember that it depends only on them how the child will live in later life - according to statistics, more than half of the identified and treated children with cerebral palsy in the first year of life in the future differ from their peers in only a few violations.

Diagnostics

When diagnosing, the doctor needs not only to examine the child and carry out a number of diagnostic procedures, but also to find out how the pregnancy and childbirth proceeded. Cerebral palsy must be differentiated from other diseases, often if there is a deterioration in already mastered skills, then this indicates completely different pathologies. The examination is based on the data of MRI, computed tomography.

During pregnancy, anomalies in the development of the brain can be detected using ultrasound, but doctors will not claim that the child will have cerebral palsy. According to the identified violations, one can only assume the appearance of a developmental delay in the baby after birth and, on the basis of this, conduct an appropriate examination. The presence of herpes and cytomegalovirus infection should also alert.

Treatment

It is necessary to be treated immediately after the diagnosis is established, and it is best if the entire complex of therapeutic measures is carried out in the first year of life. The nerve cells of a child in the first year of life are able to fully recover, at an older age only rehabilitation and adaptation of the child to social life is possible.

Exercise therapy for cerebral palsy

A special group of physical exercises is necessary for the child every day. Under the influence of classes, muscle contractures decrease, the stability of the psycho-emotional sphere is formed, and the muscle corset is strengthened.

The child from a prone position should be stimulated to lean on a solid support with his feet.

From a position lying on your stomach, you need to pull the baby by the handles up, making springy movements in all directions.

The child is on her knees, the mother should stand behind and, fixing the baby's legs, try to ensure that he moves forward.

Complexes of exercises should be selected in conscience with the doctor, their effectiveness depends largely on the perseverance of the parents.

The video shows a set of exercise therapy exercises for children with cerebral palsy:

Massage

Massage with cerebral palsy is not recommended to start earlier than one and a half months and only a specialist should perform it. The wrong choice of massage technique can lead to increased muscle tone. Correctly carried out by the course of massages can facilitate the restoration of functions, have a general strengthening and healing effect.

Medical treatment

Of the drugs, neuroprotectors are prescribed - Cortesin, Actovegin, muscle relaxants. Vitamin complexes and preparations that improve metabolic processes in the body are widely used. In some cases, sedative therapy is prescribed.

Botulinum toxin preparations are injected locally into the muscles with increased tone in children with spastic disorders. The toxins relax the muscles and increase their range of motion. The drugs act for three months and then they need to be re-injected. The use of botulinum toxins is recommended for the treatment of those children who have a limited group of disorders. Botulinum toxins include Botox, Dysport

Logopedic work with cerebral palsy

Classes with a speech therapist for children with cerebral palsy are very important. Proper staging of speech is the key to his further successful learning and communication with peers. Classes are selected based on the form of speech impairment in cerebral palsy.

Operations for cerebral palsy

Surgical intervention for cerebral palsy is performed in older children in the absence of the effect of the therapy. Surgical interventions are most often aimed at treating contractures, which helps the child become more active with movements.

Taping

Taping is fixing a special plaster on a certain area of ​​the body for several days. Its purpose is to reduce pain and increase the mobility of the affected area of ​​the body. With the help of kinesio tapes, the directions of movements are corrected, blood circulation improves, and muscle endurance increases.

New and non-standard methods of treatment

Every year, new methods of treating cerebral palsy appear, some of them really turn out to be effective, others help only a limited number of patients.

Osteopathy

This is a manual impact on various parts of the body in order to restore movement disorders. Osteopathy improves blood circulation in the brain, restores the natural connections between the nerve endings and the muscles regulated with their help.

Only a qualified specialist knows the technique of osteopathy, so you need to consider all the options for clinics before making a decision on the treatment of osteopathic cerebral palsy in your child.

Stem cell treatment.

Transplantation of stem cells into a child's body allows stimulating the restoration of nervous tissue and thus the damaged areas of the brain begin to function normally. The introduction of stem cells is effective, even if such treatment is started only in adolescence.

hippotherapy

Therapeutic riding. LVE helps to increase the child's physical activity, helps to restore motor functions, and forms new skills. Communication with horses is also useful for the psycho-emotional state of the child - kids with cerebral palsy who have completed a course of hypothermia become much calmer, worry less about their condition, learn to adapt in society.

Achilloplasty

Designed to reduce muscle contractures. After the operation, the range of motion expands, surgical intervention is carried out no earlier than 4-5 years.

Equipment for children with cerebral palsy

Depending on the degree of impairment of motor functions, children with cerebral palsy need special devices that help them move around and restore impaired functions.

• strollers necessary for children who cannot move independently. Special strollers have been developed for home and walks, modern models have an electric drive, which ensures the convenience of their use. The PLIKO stroller belongs to the walking stroller, it is light in weight and also easy to fold. The stroller is designed taking into account the normal physiological position of a child with cerebral palsy. The stroller "Lisa" due to its design features can also be used for children - teenagers.
• Walkers are required if the child walks, but cannot maintain balance. With the help of walkers, children not only learn to walk, but also learn to coordinate their movements.
• simulators- this group includes any device that helps the baby develop his activity and learn certain skills.
• Bicycles with cerebral palsy of a three-wheeled design and with a steering wheel not connected to the pedals. The bike must have a mount for the body, shins and hands, a push handle is required. Fastening on the foot pedals allows you to develop movements in the legs, strengthens the muscles.
• Exercise bikes strengthen the muscles of the legs, contribute to the consolidation of motor skills, form endurance. Exercise bike helps and strengthen the immune system
• hippotrainers- devices that imitate all the movements of a horse during its walking or running. That is, on the hippo simulator, the child's body sways back, forward and to the sides. Hippo-simulators allow you to strengthen your back muscles, form a beautiful posture, and improve flexibility in the joints.
• Suits for the treatment of cerebral palsy are designed as space suits, that is, the body in them is in weightlessness. The material used for the costumes promotes a tight fixation of the body and simultaneous relaxation of the muscles, which allows the child to take the first steps. The pneumatic chambers in the suit inflate and stimulate the work of different muscle groups, transmitting impulses from them to the cerebral cortex.

• Orthopedic shoes and orthoses are necessary to suppress hyperkinesis and the development of contractures. Fixed in the right position, the limbs learn to function correctly and at the same time the risk of developing skeletal deformities is reduced. Shoes and orthoses for each child are selected individually.
• Verticalizers and platforms. The stander is a special device that allows the child to hold the body in an upright position without assistance. The stander has fixators for the back, feet, knee joints. Verticalizers allow you to establish the correct functioning of internal organs, contribute to mental development and adaptation.

Rehabilitation

Rehabilitation for cerebral palsy is necessary for better physical activity of the child, his adaptation in the social sphere, to master all the necessary skills. Activities that contribute to rehabilitation are selected based on the age of the baby, the degree of impairment of his motor activity, hypotonia or hypertonicity of the muscles.

• The Loskutova method is based on the restoration of respiratory breathing and on carrying out a variety of movements, which relieves internal tension, increases the elasticity of muscles and joints.
• Voigt's method is based on activating the work of the brain by making reflex movements. Classes are held jointly with parents, their task is to perform the proposed exercises with the child up to 4 times a day. The purpose of the technique is to consolidate each movement, from simple to complex.

Rehabilitation centers and specialized sanatoriums

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

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

more details in the article "The evolution of ideas about infantile cerebral palsy" Osokin V.V., Autonomous non-profit organization "Institute for Medical Correction, Recovery and Support", Irkutsk (magazine "Modern Science: Actual Problems and Ways to Solve Them" No. 9, 2014) [ read ]

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

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

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

Since the classification of motor disorders in infants according to the traditional categories of cerebral palsy is difficult, L.O. Badalyan et al. in 1988 suggested that this classification be adjusted to reflect the age of the patients. This classification distinguishes [ 1 ] forms of infantile cerebral palsy - spastic, dystonic and hypotonic, and [ 2 ] older forms - spastic (hemiplegia, diplegia, bilateral hemiplegia), hyperkinetic, atactic, atonic-astatic and mixed forms of cerebral palsy (spastic-atactic, spastic-hyperkinetic, atactic-hyperkinetic).

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

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

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

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

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

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

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

Postnatal factors. About 15% of cases of cirrhosis in children are caused by causes that affect the child's body after birth. Incompatibility between mother and child in terms of blood type or Rh factor can lead to fetal bilirubin encephalopathy (the so-called "nuclear jaundice"), which is fraught with the formation of hyperkinetic or dyskinetic syndromes. Serious infections that affect the brain directly, such as meningitis and encephalitis, can also cause permanent brain damage resulting in permanent, disabling motor and mental deficits. Neonatal convulsions can either directly cause damage to the central nervous system, or be the result of other hidden pathological factors (encephalitis, stroke, metabolic defect), which will also contribute to the formation of a persistent deficit in motor skills and the psyche. Speaking about the postnatal causes of LC, it is necessary to recall once again that in most foreign countries (D) LC is considered a symptom complex of persistent disabling motor disorders that have arisen as a result of exposure to the CNS of the fetus and child of pathological factors antenatally, intranatally or postnatally before the child reaches the age of 3 - 4 years old. Thus, according to foreign standards, the category of patients with (D)LC can include patients with the consequences of physical injuries, drowning, suffocation, intoxication, which led to persistent neurological disorders.

Symptoms. Clinical manifestations of cirrhosis (respectively, classifications) are diverse, they depend on the nature, degree of developmental disorders and the pathological state of the brain:

The following are the accompanying neurological manifestations of cirrhosis, which are not related to the motor sphere (but are also a consequence of CNS damage, often, but not necessarily, accompanying cirrhosis): [ 1 ] intellectual (cognitive) disorders and behavioral disorders; [ 2 ] epilepsy and other paroxysmal disorders; [ 3 ] impaired vision and hearing; [ 4 ] speech disorders (dysarthria) and nutrition.

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

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

Diagnostics. The diagnosis of CP is based on clinical manifestations. Among the anamnestic data, one should take into account the course of pregnancy, childbirth, assessment of the child's condition after childbirth [Apgar scale, resuscitation, video analysis of generalized movements according to Prechtl (GMS)]. Most often, the diagnosis is determined by the end of the first 6 - 12 (18) months of a child's life, when, compared with healthy peers, the pathology of the motor system becomes apparent. To confirm the pathology of the central nervous system, neuroimaging methods are used: ultrasound diagnostics (neurosonography), magnetic resonance and computed tomography (detection of periventricular leukomalacia, ventriculomegaly, foci of ischemia or hemorrhages or structural anomalies of the central nervous system, etc.).

Neurophysiological studies (electroencephalography, electromyography, registration of evoked potentials) and laboratory studies (biochemical analyzes, genetic tests), as a rule, are used to identify pathological conditions often associated with cirrhosis (optic nerve atrophy, hearing loss, epileptic syndromes) and differential diagnosis of cirrhosis with many hereditary and metabolic diseases that debut in the first year of a child's life.

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

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

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

more details in the article "Infantile cerebral palsy: clinical recommendations for treatment and prognosis" N.L. Tonkonozhenko, G.V. Klitochenko, P.S. Krivonozhkina, N.V. Malyuzhinskaya; Department of Children's Diseases of the Pediatric Faculty of the VolgGMU (magazine "Medicinal Bulletin" No. 1 (57), 2015) [read]

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

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

Immediate Causes of Cerebral Palsy:

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

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

When evaluating the likely cause of cerebral palsy, consider that damage to the basal ganglia or deep gray matter is mainly due to dyskinetic cerebral palsy.

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

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

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

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

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

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

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

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

The following motor features in the early period of a child's life should be alert for cerebral palsy: [ 1 ] unusual fussy movements or other movement anomalies, including asymmetry of movements or hypokinesis; [ 2 ] tone abnormalities, including hypotension, spasticity (stiffness) or dystonia; [ 3 ] abnormal development of motor skills (including delayed development of head holding, rolling and crawling skills); [ 4 ] feeding difficulties.

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

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

All children with motor delays need specialist advice for further evaluation and correction of management tactics. Children who constantly walk on tiptoe (on the toes of the foot) should be consulted by a specialist.

If there is concern that the child may have cerebral palsy, but there is not enough data to establish a definitive diagnosis (diagnosis is doubtful), discuss this with the child's parents or guardians and explain that additional investigations and monitoring will be required to establish a definitive diagnosis.

Red flags for other neurological disorders:

If the child's condition was assessed as cerebral palsy, but the clinical signs or development of the child do not correspond to the expected symptoms of cerebral palsy, re-diagnose the differential diagnosis, taking into account that the functional and neurological manifestations of cerebral palsy change over time.

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

Principles of treatment:

All children with suspected cerebral palsy should be referred immediately to an appropriate specialized institution for multidisciplinary evaluation for early diagnosis and treatment. Parents or guardians of children and adolescents with cerebral palsy play a central role in decision making and care planning.

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

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