Cerebral palsy is the cause of various degrees of cerebral palsy in children. Cerebral palsy (CP) Why cerebral palsy occurs in children

cerebral palsy (children) cerebral paralysis) is a set of neurological abnormalities that arise as a result of damage to brain structures in the first weeks of a child’s life or in the womb. The main component of the clinical picture is movement disorders. In addition to them, there may be speech and mental disabilities, disturbances in the functioning of the emotional-volitional area, epileptic seizures may be observed.

Cerebral palsy is not a progressive disease, but most often the symptoms of this disease persist throughout a person’s life and make them disabled. As people get older, many people believe that the symptoms of the disease progress, but this is not the case. You can simply not notice many deviations while the child is still very small and cannot, for example, eat or move on his own, does not yet speak his first words, etc.

With cerebral palsy, various types of motor impairments are observed. The structure of the muscular system is most affected, and coordination of movement suffers. The structure, nature and neglect of muscle disorders can be determined based on the concentration of brain lesions and the volume of their damage. In addition, visual, auditory and speech pathologies are observed. Subsequently, the child may experience disturbances in sensations and cognition, urinary and defecation incontinence, difficulty breathing and the process of absorbing food, the formation of bedsores from constantly being in a lying state, and so on.

Although modern medicine is developing more and more effectively, the statistics on the prevalence of cerebral palsy is not decreasing and is about 1.6 per 1000 children. It should be noted that boys suffer from this disorder much more often than girls.

Cerebral palsy and the causes of its occurrence can be divided into 6 groups:

1. Physical pathologies.
2. Genetic.
3. Mechanical.
4. Ischemic.
5. Intoxicating.
6. Infectious.

The physical causes of cerebral palsy appear due to various influences: X-ray exposure, magnetic field, radiation damage.

The genetic origin of cerebral palsy has not been reliably established, but experts talk about the likelihood of hereditary disorders in chromosomes. Genetic causes are various chromosomal abnormalities that provoke the development of paralysis; it is possible to establish the likelihood of such an outcome even in the womb using genetic mapping.

Mechanical changes in children's body may appear as a result of injury, which entails disturbances in the functioning of the brain. After the baby is born, the likelihood of any motor impairments needs to be assessed. As early as possible, it is necessary to diagnose the child’s motor skills, the presence of defects in cerebral tissues and evaluate how the child moves his limbs, what position he takes, whether he can roll over on his own, etc.

The ischemic etiology of cerebral palsy is fetal hypoxia, fetoplacental insufficiency, lack of oxygen due to toxicosis and diseases of internal organs.

Intoxication causes are the result of poisoning, the consequences of the action of toxins. If any complications arise during a woman's pregnancy, this can lead to the accumulation of toxic substances that affect the fetus and its development. A similar situation can be provoked by drug treatment of female toxicosis.

Infectious causes in newly born children can occur due to the presence of diseases such as meningitis, meningoencephalitis and encephalitis. The brain tissue becomes inflamed, which can lead to atrophy. Infectious diseases are accompanied by high fever, an increase in the number of leukocytes in the blood plasma and the presence cerebrospinal fluid. All these factors affect the subsequent motor instability of the child.

Risk factors

There is a list of factors that can provoke the appearance of a terrible disease in an unborn child:

• age of the child's mother. There is a risk for mothers under 18 and 30 years and older who give birth for the first time, have late toxicosis and do not comply healthy image life;
• infectious diseases. The highest percentage of risk is congenital rubella, which can harm the fetus in 16 - 50% of cases out of 100. Other children whose mothers suffered from congenital toxoplasmosis, meningitis, and cytomegaly can also receive congenital brain damage. Equally dangerous viral diseases, herpes, coli etc.;
• constant stress during pregnancy. When stressed, a whole portion of hormones is released into the body; their excess can develop spasm of the umbilical cord and uterine vessels;
• threat of miscarriage: placental abruption and intrauterine bleeding;
• maternal endocrine diseases. This may be hypertension, arterial hypertension, diabetes. All this can lead to the threat of miscarriage;
• poor nutrition, smoking and alcohol abuse;
• harm from medications;
• toxicosis in the later stages;
• intracranial trauma during childbirth, asphyxia;
• incompatibility of erythrocyte antigens.

Signs of cerebral palsy - symptoms of the disease

There are three stages of the disease:

1. Early (from 0 to 5 months)
2. Initial stage (from 5 months to 3 years).
3. Late (from 3 years and older).

As a result of studying the stages, early manifestations of cerebral palsy and their late symptoms are distinguished. TO early signs illness can be attributed to:

• children's reflexes, for example, grasping, which persist after six months;
• developmental delay, for example, the child cannot crawl, walk, roll over, sit, etc.;
• using only one hand.

Early symptoms may be completely invisible until a certain age, or they may be very pronounced depending on the degree of damage to the brain tissue. If a child has unhealthy muscle tone, for example, this may manifest itself as either excessive relaxation or resistance. If the tone is relaxed, i.e. Decreased, limbs dangle, the child cannot hold the position. If the tension is increased, then the limbs take a forced, not always comfortable position. Due to this pathology of muscle tone, cerebral palsy has the following character:

• suddenness of movements;
• slow and worm-like;
• excessive dynamics;
• aimlessness;
• uncontrolled motor reflexes.

All other symptoms of cerebral palsy are correlated with late symptoms. These include:

• skeletal deformation. The affected side in this case has a shortened limb. Subsequently, if the problem is ignored, poor posture, scoliosis, and curvature of the pelvic bones may develop;
• hearing impairment. The child is unable to recognize the sounds around him, which threatens the late development of speech and other skills;
• speech apparatus disorder. It is expressed in the inability to form sounds by coordinating the lips, larynx and tongue. This occurs as a result of damage to muscle tone. At the same time, speech is incoherent and difficult;
• visual problems. Myopia, farsightedness or strabismus develops;
• swallowing disorder. There is no interaction between the muscles responsible for the swallowing process, which creates great difficulties with the process of eating and drinking, and salivation;
• violation anatomical structure jaws - these are pathological problems in the structure of the dentition, tooth damage by caries, weakness of the enamel;
• urinary incontinence and defecation. When muscle function is uncontrolled, the execution of these processes becomes problematic;
• convulsions. This symptom can be observed immediately after the birth of a child or some time after the development of cerebral palsy;
• delay in mental development. This symptom appears only in some sick children;
• impaired coordination and muscle tone. The child's movements and motor skills are loose, clumsy, and uncoordinated. Cerebral palsy is manifested by the following disorders:
• excessive muscle strain;
• involuntary contraction of muscle tissue;
• no reaction to loud sound;
• strabismus, myopathy;
• does not reach an object with his hand after 4 months;
• does not sit independently after 7 months;
• cannot pronounce words after one year;
• only uses one of the two upper limbs after 12 years;
• walking on your toes rather than on your full foot;
• difficulty in gait, stiffness.

Forms

Forms of cerebral palsy are classified according to many criteria proposed by various scientists and consisting of various factors. Currently, only one classification of cerebral palsy is used, which was proposed by Semenova K.A.

Let's consider all forms of cerebral palsy separately:

• Spastic diplegia cerebral palsy is the most common form. These types of cerebral palsy are characterized by a curved spine, impaired functioning of the leg muscles, while the arms and face are almost unaffected, and deformed joints. In addition to physical development, mental development also suffers. Pseudobulbar dysarthria syndrome may develop. Characteristics of the disease: speech, hearing, and intellect are impaired. The diagnosis - a spastic form of cerebral palsy - is very severe and may not lead to the most pleasant consequences, but it can help with this social adaptation child.
• Double hemiplegia is another type of cerebral palsy. It is extremely severe and is accompanied by complete impairment of motor skills, both in the legs and arms. The child cannot fully bend or straighten the limbs, the muscles are constantly in good shape, and asymmetry of movements is observed. In more than half of the cases, mental retardation is observed. These children are completely bedridden and cannot stand or sit. Such patients are not trainable, which cannot be said about the next form of the disease.
• The hyperkinetic form of cerebral palsy (also called the dyskinetic form) is a change in muscle tone that causes impulsive automatic twitching and movements that increase with emotional overexcitation. During sleep, muscle activity stops; during wakefulness, muscle tone constantly changes. Such patients begin to sit late, but do not walk for the rest of their lives. They are characterized by unintelligible speech and hearing impairments, but at the same time retain their intelligence. If spastic symptoms are added to these symptoms, then the disease is diagnosed as spastic hyperkinetic cerebral palsy.
• The atactic form of cerebral palsy is the dominance of motor disorders and imbalance of balance. On early years life, you can only notice muscle hypotonia. Ataxia becomes more distinct as functions develop, motor activity upper limbs.

There are also mixed forms, because It is not always possible to diagnose one of them due to the diffuse nature of the disease. With this form, there is a mixture of symptoms of several types of cerebral palsy.

During the newborn period, it is sometimes difficult to diagnose and determine cerebral palsy, the form of which is not clear. Therefore, this classification contains clarifying data taking into account the age range of a person. For younger ages, spastic forms of paralysis are characteristic, for older ones - spastic, atactic, hyperkinetic, mixed.

Diagnosis and treatment

Diagnosis of cerebral palsy covers the following stages of analysis:

• Ultrasound of the brain;
• CT and MRI;
• Electroencephalogram.

The main goal of treatment for cerebral palsy is to eliminate malfunctions in the motor system, speech barriers, and correct mental development. Treatment is selected individually, taking into account all the characteristics of each individual organism, because there is no universal treatment today. Methods that accompany positive results:

• physiotherapy;
• medications that normalize muscle tone;
• massage.

The following methods are also effective:

• Voight method;
• Atlant pneumatic suit;
• load suits;
• classes with a speech therapist;
• walkers, bicycles and other exercise equipment.

If the methods do not produce changes, a surgical operation is performed, plastic surgery of the muscle structure and tendons is performed, and the tissues are given the correct shape. In this way, contractures and damaged areas are removed and the spinal cord is stimulated.

Analyzing cerebral palsy, the causes of which can be different, it can be noted that a very effective non-traditional method is animal-assisted therapy - treatment using positive emotions from communication with animals (horses and dolphins).

Cerebral palsy is a group of diseases in which motor functions and posture are impaired.

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

Cerebral palsy causes reflex movements that a person cannot control and tightness of the muscle, which can affect part or all of the body. These disorders can range from moderate to severe. There may also be intellectual disability, seizures, visual and hearing impairment. Accepting the diagnosis of cerebral palsy can sometimes be a difficult task for parents.

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 children's? 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 damaged, resulting in the development of non-progressive disorders of motor and muscle activity, coordination of movements, functions of vision, hearing, as well as speech and psyche. The cause of cerebral palsy is 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. You cannot catch or get sick with cerebral palsy.

Causes

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

Symptoms

Even when the condition is present at birth, symptoms of cerebral palsy (CP) may not be noticed until the child is 1 to 3 years old. This happens due to the growth characteristics of the child. Neither doctors nor parents may pay attention to disturbances in the child’s motor sphere until these disturbances become obvious. Children may retain newborn reflex movements without age-appropriate development of movement skills. And sometimes the first to pay attention to a child’s underdevelopment are nannies. If cerebral palsy is severe, then the symptoms of this disease are already detected 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 problems
• Faint scream
• Cramps.
• Unusual child poses. The body can be very relaxed or very strong hyperextension with arms and legs spread out. These positions are significantly different from those that occur with colic in newborns.

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

• Muscle wasting in injured arms or legs. Problems in the nervous system impair movement in the injured arms and legs, and muscle inactivity affects muscle growth.
• Pathological sensations and perceptions. Some patients with cerebral palsy are very sensitive to pain. Even normal everyday activities such as brushing your teeth can be painful. Pathological sensations may also affect the ability to identify objects by touch (for example, distinguish a soft ball from a hard one).
• Skin irritation. Drooling, which is common, can lead to irritation of the skin around the mouth, chin and chest.
• Dental problems. Children who have difficulty brushing their teeth are at risk for gum disease and tooth decay. Medicines used to prevent seizures may also contribute to the development of 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 in the zone high risk heart and lung diseases. For example, in severe cases of cerebral palsy, problems arise with swallowing and when choking, some of the food enters the trachea, which contributes to lung diseases (pneumonia).

All patients with cerebral palsy (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 caregivers are the first to pay attention to deviations in the child’s movements that contradict age criteria. Signs of cerebral palsy may become more obvious 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 appear 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, level mental development and the presence of other complications and diseases.

1. The type of cerebral palsy determines the child's motor impairment.

Most patients with cerebral palsy have spastic cerebral palsy. Its presence can affect both all parts of the body and individual parts. For example, a child with spastic cerebral palsy may have symptoms primarily in one leg or one side of the body. Most children usually try to adapt to impaired motor functions. Some patients can even live independently and work, requiring only occasional assistance from others. In cases where there are impairments in both legs, patients require a wheelchair or other devices that 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 consequences of cerebral palsy are difficult to predict until the 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 studying, communicative intellectual and other abilities can be analyzed

1. The severity of mental impairment, if any, is a strong predictor 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 violations mental abilities.
2. Other conditions, such as hearing impairments or problems, often occur with cerebral palsy. Sometimes these disorders are noticed immediately; in other cases they are not discovered until the child gets older.

In addition, just like people with normal physical development, people with cerebral palsy experience social and emotional problems throughout 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 posture problem.

Spastic (pyramidal) cerebral palsy

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

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 there is damage to the brain stem and, accordingly, this is manifested by swallowing disorders. In newborns with quadriplegia, there may be disturbances in sucking, swallowing, weak crying, and the body may be weak or, on the contrary, tense. Often, upon contact with a child, hypertonicity of the torso appears. The child may sleep a lot and not show interest in his surroundings.
• Triplegia: Either both arms and one leg or both legs and one arm are caused.

Non-spastic (extrapyramidal) cerebral palsy

Non-spastic forms of cerebral palsy include dyskinetic cerebral palsy (divided 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 jerks 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 minor twitching and grimacing. If the muscles of the face and mouth are involved, there may be disturbances in the process of eating, drooling, choking on food (water) and the appearance of inappropriate facial expressions.
• Ataxic cerebral palsy is the rarest type of cerebral palsy and affects the entire body. Pathological movements occur in the torso, arms and legs.

Ataxic cerebral palsy is manifested by the following problems:

• Body imbalance
• Impaired precise movements. For example, the patient cannot reach the desired object with his hand or perform even simple movements (for example, bringing a cup directly to the mouth). Often only one hand is able to reach the object; the other hand may shake as it tries to move the object. The patient is often unable to button clothes, write, or use scissors.
• Coordination of movements. A person with ataxic cerebral palsy may walk with too long steps or with their feet spread 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 body cerebral palsy affects the entire body to varying degrees. Complications from cerebral palsy and other health problems are most likely to develop when the entire body is involved rather than isolated parts.

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

Spastic diplegia or Little's disease

This is the most common (40% of all cases of cerebral palsy) form of the disease, clearly manifesting itself 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 together or even crossed. Feet often become deformed as they grow.

These children also often have speech and hearing impairments. Their intelligence and memory are reduced, and they find it difficult to concentrate on any activity.

Convulsions occur less frequently than with 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, which damages the brain. The disease manifests itself already in the first months of a child’s life. With this form, paresis of the arms and legs is observed with predominant damage to the arms and uneven damage to 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 straightened.

The speech of such children is slurred and difficult to understand. They speak nasally, 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, seizures are also possible, and the more frequent and severe they are, the worse the prognosis of the disease.

Hyperkinetic form

This form of cerebral palsy, which occurs in 10% of cases, is not characterized by: voluntary 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, and neck may move involuntarily, and movements intensify with anxiety.

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

Intelligence is rarely affected in this form. Often such children successfully graduate not only from school, but also from higher education.

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 up, stand and walk late. Their coordination is impaired, and there is often tremor (trembling of the arms, legs, head).

Intellect 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 at birth. This form is characterized by speech impairment - the child cannot pronounce words normally. Intelligence, memory and attention are reduced. In 40-50% of cases, seizures are recorded, and the more frequent they are, 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 chronic-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 impairments.

Diagnostics

Symptoms of cerebral palsy may not be present or detected at birth. Therefore, the attending physician observing the newborn must carefully monitor the child so as not to miss symptoms. However, you should not over-diagnose cerebral palsy, since many motor disorders in children of this age are transient. Often, the diagnosis can only be made several years after the birth of the child, when movement disorders can be noticed. Diagnosis of cerebral palsy is based on monitoring the physical development of the child, the presence of various deviations in physical and intellectual development, test data and instrumental methods studies such as MRI.

How to diagnose cerebral palsy in newborns: symptoms

If a baby sharply pulls up his legs or, conversely, stretches them out at the moment when he is taken under the tummy, the lower thoracic and lumbar lordosis(bend), 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 made by observing how the child develops. As a rule, in children with an alarming obstetric history, control is carried out over the sequence of reactions, dynamics general development and state of muscle tone. If noticeable deviations or obvious symptoms of cerebral palsy are observed, then it is required additional consultation from a neuropsychiatrist.

How does cerebral palsy manifest in children under one year of age?

If the child was born premature or had 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 alarming signs of developing paralysis.

True, the symptoms of cerebral palsy before one year are little noticeable, they become expressive only at an older age, but still some of them should alert parents:

• the newborn has noticeable difficulties with sucking and swallowing food;
• V one month old it 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 exhibits repetitive movements (for example, nodding his head), this may be a sign of cerebral palsy in newborns;
• symptoms of the pathology are also expressed in the fact that the mother can hardly spread the newborn’s legs or turn his head in the other direction;
• the child lies in clearly uncomfortable positions;
• The baby doesn't 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 themselves as slight clumsiness when walking, or severe paresis and mental retardation.

How does cerebral palsy manifest in children at 6 months?

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

So, if the baby has not lost the unconditioned reflexes characteristic of newborns 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 his bent legs on a full foot, imitating walking) - this is an alarming sign. But parents should pay attention to the following deviations:

• periodically the baby experiences convulsions, which can be disguised as pathological voluntary movements (so-called hyperkinesis);
• the child begins to crawl and walk later than his peers;
• symptoms of cerebral palsy also manifest themselves in the fact that the baby more often uses one side of the body (pronounced right-handedness or left-handedness may indicate muscle weakness or 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 independently;
• 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, relying on his fingers, or does not walk at all.

Diagnosis of cerebral palsy includes:

• Gathering information about the baby's medical history, including details about the pregnancy. Quite often, the presence of developmental delay is reported by parents themselves or it is revealed during professional examinations in children's institutions.
• A physical examination is necessary to identify signs of cerebral palsy. During a physical examination, the doctor evaluates how long the baby's newborn reflexes last compared to normal periods. In addition, muscle function, posture, hearing function, and vision are assessed.
• 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 complex of these diagnostic approaches makes it possible to make a diagnosis.

If the diagnosis is unclear, additional tests may be prescribed to assess the condition of the brain and to exclude possible other diseases. Tests may include:

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

Assessment and management of cerebral palsy
After cerebral palsy is diagnosed, the child must be further examined and other diseases that may be present simultaneously with cerebral palsy be identified.

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

More often than not, the doctor can predict many of the long-term physical aspects Cerebral palsy, when the child is already 1 - 3 years old. But sometimes such predictions are not possible until the child reaches school age, when deviations can be detected during learning and the development of communication abilities.

Some children need to be retested which may include:

• X-rays to detect hip dislocations (subluxations). Children with cerebral palsy usually undergo 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 order a spinal x-ray to identify deformities in the spine.
• Gait analysis, which helps identify disorders and adjust treatment tactics.

Additional examination methods are prescribed if necessary and indicated.

Treatment

Cerebral palsy is an incurable disease. But a variety of treatment methods help patients with cerebral palsy to minimize motor and other disorders and, thus, improve their quality of life. The brain injury or other factors that lead 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 soon after a child is diagnosed and often continues throughout his or her life. This type of treatment may also be prescribed before diagnosis, depending on the child's symptoms.

Despite the fact that cerebral palsy cannot be completely cured, it needs to 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 (must be carried out constantly);
• physiotherapy(electrophoresis, myostimulation) only if there are no seizures;
• electroreflexotherapy to restore the activity of motor neurons in the cerebral cortex, resulting in decreased muscle tone, improved coordination, speech, and improved diction;
• load suits for correcting body posture and movements, as well as for stimulating the central nervous system;
• therapy with animals – hippotherapy , canistherapy ;
• working with a speech therapist;
• development of the child’s motor skills;
• prescription of drugs that improve brain function
• classes on special simulators such as loktomat.

If necessary, surgical intervention is performed - tendon-muscle plasty, elimination of contractures, myotomy (incision or separation 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 using them.

Complex orthosis for the rehabilitation of patients with cerebral palsy

Characteristic signs of cerebral palsy are impaired motor activity with the subsequent development of vicious attitudes, and subsequently contractures and deformations of large joints of the limbs and spine, therefore timely and adequate orthosis is an important, if not the 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 sequentially go through all the stages inherent in a healthy child, namely: sitting (with and without support on the hands), getting up and sitting down, standing 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 measures 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 usually receive little attention during rehabilitation, also play important role in the life support of the patient, since they perform supporting and balancing functions. Therefore, orthotics of the upper extremities is no less important than orthotics of the lower extremities and the spine.

When prescribing orthopedic products, it should be kept in mind that the orthopedic product shown must perform the intended task. In particular, the S.W.A.S.H. hip extension apparatus. cannot be used for walking, because this design does not allow you to do it correctly and without harm to the hip joints. Also, for walking, you should not use lower limb devices with locking joints in the hip and knee joints simultaneously. The use of various loading devices without orthotics of large joints is also unacceptable, because in this case, the muscular frame develops with vicious joint alignments, which further aggravates orthopedic pathologies.

Dynamic orthosis

This type of orthosis 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 impaired movement in the limbs, and also, in some cases, has a therapeutic effect.

Medications can help treat some of the symptoms of cerebral palsy and prevent complications. For example, antispasmodics and muscle relaxants help relax tight (spastic) muscles and increase range of motion. Anticholinergics can help improve limb movement or reduce drooling. Other medicines may be used as symptomatic treatment(for example, the use of anticonvulsants in the presence of seizures)

Permanent treatment

Permanent treatment for cerebral palsy (CP) focuses on continuing and adjusting existing treatment 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. This may also help prevent the need for surgical intervention. If the child was given surgical treatment, then intense exercise therapy classes may be needed for 6 months or more. Drug treatment should be under constant monitoring in order to avoid possible side effects of medications.
• Orthopedic surgery (for muscles, tendons, and joints) or dorsal rhizotomy (excision of nerves of damaged limbs), in the presence of severe problems with bones and muscles, ligaments, and tendons.
• Special orthopedic devices (braces, splints, orthoses).
• Behavioral therapy, in which a psychologist helps a child find ways to communicate with peers and this is also part of the treatment.
• Massage and manual therapy can also be used in the treatment of both the main symptoms of cerebral palsy and complications associated with impaired biomechanics of movement.
• Social adaptation. Modern technologies(computers) have made it possible to employ many patients with consequences of cerebral palsy.

Prevention

The cause of cerebral palsy (CP) is sometimes unknown. But certain risk factors have been identified and their relationship with the incidence of cerebral palsy has been proven. Some of these risk factors can be avoided. Following certain conditions during pregnancy can help reduce the risk of brain damage to the fetus. These recommendations include:

• Complete nutrition.
• No smoking.
• Do not come into contact with toxic substances
• Regularly see your doctor.

• Minimize injury from accidents
• Determine neonatal jaundice
• Do not use substances containing heavy metals (lead)
• Isolate the child from sick people infectious diseases(especially meningitis)
• Immunize the child in a timely manner.

What is important for parents to know

Parents should be very attentive to the condition of their child so as not to miss 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 illnesses suffered by the mother.

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

Cerebral palsy does not have a tendency to progress, therefore, in cases where the pathology affects only the patient’s motor system, and there is no organic damage in the brain, good results can be achieved.

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

I have been diagnosed with cerebral palsy (cerebral palsy) since birth. More precisely, from the age of one (about then the doctors finally determined the name of what was happening to me). I graduated from a special school for children with cerebral palsy, and 11 years later I came to work there. 20 years have passed since then... According to the most conservative estimates, I know, more or less close, more than half a thousand people with 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 illness

It is no secret that many parents, upon hearing this diagnosis from a doctor, experience shock. Especially in recent years, when the media are increasingly talking about people with severe cerebral palsy - wheelchair users with damage to their arms and legs, slurred speech and constant violent movements (hyperkinesis). They don’t even know that many people with cerebral palsy speak normally and walk confidently, and with mild forms they do not stand out among healthy people at all. Where does this myth come from?

Like many other diseases, cerebral palsy ranges 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, certain areas of the cerebral cortex are affected in the baby, mainly those responsible for motor functions and coordination of movements. This causes cerebral palsy - disruption of the correct functioning of individual muscles, up to the complete inability to control them. Doctors count more than 1000 factors that can trigger this process. It's obvious that various factors cause different consequences.

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 unable to control either his arms or legs and often experiences severe pain. Only 2% of people with cerebral palsy suffer from it (hereinafter statistics are taken from the Internet), but they are the ones most often talked about in the media.

Spastic diplegia- a form in which either the upper or lower limbs. The legs are more often affected - a person walks with 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 occur in 40% of cerebral palsy patients.

At hemiplegic form motor functions of the arms and legs on one side of the body are affected. 32% have signs of it.

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

For ataxic form characterized by decreased muscle tone, sluggish slow movements, severe violation balance. 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 - factors of life, which, as you know, is different for everyone. Therefore, what happens to him after a year is more correctly called the consequences of cerebral palsy. They can be completely different even within the same form. I know a man with spastic diplegia of the legs and quite strong hyperkinesis, who graduated from the Faculty of Mechanics and Mathematics 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. The majority (up to 85%) have mild to moderate severity of the disease. This means that many people simply do not associate the peculiarities of their gait or speech with the “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 do not at all strive for objectivity...

Myth two: Cerebral palsy is curable

For most parents of children with cerebral palsy, this myth is extremely attractive. Without thinking about the fact that disorders in the functioning of the brain 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 foundations to pay for an expensive course at the next popular center. Meanwhile, the secret to alleviating the consequences of cerebral palsy is not so much in fashionable procedures, but in constant work with the baby, starting from the first weeks of life. Baths, regular massages, games with straightening the legs and arms, turning the head and developing precision of movements, communication - this is the basis that in most cases helps the child’s body partially compensate for the disorders. After all, the main task of early treatment of the consequences of cerebral palsy is not the correction of the defect itself, but the prevention of improper development of muscles and joints. And this can only be achieved through 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, practically unnoticeable to others, by the age of 18 inevitably causes curvature of the spine, which, if not addressed, is a direct path to early osteochondrosis or intervertebral hernias. And this means 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 this data is practically not generalized, and therefore no one warns growing children with cerebral palsy and their relatives about the dangers that await them in the future.

Parents know much better that the affected areas of the brain become sensitive to the general condition of the body. A temporary increase in spasticity or hyperkinesis can be caused even by a common flu or a surge in blood pressure. In rare cases, nervous shock or serious illness cause 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 more easily it adapts to unfavorable factors. However, if the procedure or physical exercise regularly cause, for example, increased spasticity, they should be abandoned. Under no circumstances should you do anything through “I can’t”!

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

Myth four: everything comes 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 not only of impaired motor functions, as well as vision and hearing, but also of such phenomena as autism or hyperactivity syndrome. And most importantly, they believe that if cerebral palsy is cured, all other problems will be solved on their own. Meanwhile, even if the cause of the disease is indeed cerebral palsy, it is necessary to treat not only it, but also the specific disease.

During the birth process, Sylvester Stallone's facial nerve endings were partially damaged - part of the actor's cheeks, lips and tongue remained paralyzed, however, slurred speech, a grin and large sad eyes later became his calling card.

The phrase “You have cerebral palsy, what do you want!” is especially funny! sounds in the mouths of doctors. I heard it more than once or twice from doctors of different specialties. In this case, I have to patiently and persistently explain that I want the same thing as any other person - relief from my own condition. As a rule, the doctor gives in and prescribes the procedures that I need. As a last resort, going to the manager helps. But in any case, when faced with a particular disease, a person with cerebral palsy has to be especially attentive to himself and sometimes tell doctors necessary treatment to minimize negative impact procedures.

Myth five: people with cerebral palsy don’t get hired anywhere

It is extremely difficult to say anything based on statistics here, because there is simply no reliable data. However, judging by the graduates of the mass classes of special boarding school No. 17 in Moscow, where I work, only a few remain at home after school. About half go to specialized colleges or departments of universities, a third go to regular universities and colleges, and some go straight to work. At least half of the graduates are subsequently employed. Sometimes girls quickly get married after finishing school and begin to “work” as a mother. The situation is more complicated with graduates of classes for children with mental retardation, however, even there, about half of the graduates continue their studies in specialized colleges.

This myth is spread mainly by those who are unable to soberly assess their abilities and want to study or work where they are unlikely to meet the requirements. Having received a refusal, such people and their parents often turn to the media, trying to force their way. If a person knows how to balance desires with possibilities, he finds his way without showdowns and scandals.

A good example is our graduate Ekaterina K., a girl with a severe form of Little’s disease. Katya walks, but can work on a computer with just one finger of her left hand, and her speech is understood only by very close people. The first attempt to enroll in a university as a psychologist failed - after looking at the unusual applicant, several teachers declared that they refused to teach her. A year later, the girl entered the Academy of Printing in the editorial department, where there was a distance learning option. Her studies went so well that Katya began earning extra money by taking tests for her classmates. After graduating from university, she was unable to find a permanent job (one of the reasons was the lack of a work recommendation from ITU). However, from time to time she works as a moderator of educational websites in a number of universities in the capital (the employment contract is drawn up in the name of another person). And in free time writes poetry and prose, posting works on his own website.

Dry residue

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

First of all, calm down and try to pay 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 up in your family - walk with him in the yard, dig in the sandbox, helping your baby establish contact with peers. There is no need to remind him about the disease once again - the child himself must come to an understanding of his characteristics.

Secondly, 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 efforts should be devoted to treatment, leaving the development of intelligence “for later.” The development of mind, soul and body are interconnected. Much in overcoming the consequences of cerebral palsy depends on the child’s desire to overcome them, and without the development of intelligence it simply will not arise. If the baby does not understand why he needs 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 their attitude towards your child depends on how you communicate with others.

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

<\>code for a website or blog

No related articles yet.

Anastasia

I read the article. My theme:)
32 years old, right-sided hemiparesis (mild form of cerebral palsy). An ordinary kindergarten, an ordinary school, a university, an independent search for a job (in fact, that’s where I am now), travel, friends, ordinary life….
And I went through the “lame-footed” one, and through the “club-footed” one, and through God knows what. And there will be much more, I'm sure!
BUT! The main thing is a positive attitude and strength of character, optimism!!

Nana

Should we really expect things to get worse with age? I have mild spasticity in my legs

Angela

But people’s attitude and unfavorable living conditions broke me. At 36 years old, I have no education, no job, no family, although it is a mild form (right-sided hemiparesis).

Natasha

After vaccinations, a lot of “cerebral palsy” appeared. Although the children do not have cerebral palsy at all. There is nothing congenital or intrauterine there. But they attribute it to cerebral palsy and, accordingly, incorrectly “heal” it. As a result, they actually get a type of paralysis.
Often the cause of “congenital” cerebral palsy is not trauma at all, but an intrauterine infection.

Elena

A wonderful article that raises a huge problem - how to live “with it”. It has been well shown that it is equally bad not to take into account the presence of limitations associated with the disease and to attach excessive importance to them. You shouldn't focus on what you can't do, but rather focus on what you can.
And it is indeed 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 existing capabilities of the brain. My opinion is that you shouldn’t wait for a miracle, but you shouldn’t give up either. The author is right: “this can only be achieved through the daily work” of the parents themselves, and the sooner they do this, the more productive it will be. It’s too late to start “preventing improper development of muscles and joints” after one and a half years of age - “the locomotive has left.” I know on personal experience and from the experiences of other parents.
Ekaterina, all the best to you.

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

Olga

I completely disagree with the author. firstly, why didn’t they say anything about double hemiplegia when considering the forms of cerebral palsy? it differs from ordinary hemiplegia and from spastic tetraparesis. secondly, cerebral palsy is truly curable. if we mean the development of compensatory capabilities of the brain and improvement of the patient’s condition. thirdly, the author has seen heavy children in the eyes??? those that are out of the question to bear playing in the sandbox. when you look at a child almost in the wrong way and he shakes with convulsions. and the screaming doesn't stop. and he arches in such a way that there are bruises on mom’s arms when she tries to hold him. when the child cannot only sit or 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 is almost no different from his peers, the other is all crooked and with convulsions, of course, he cannot even sit upright in a stroller. but there is only one diagnosis.

Elena

I don’t quite agree with the article as a mother of a child with cerebral palsy - spastic diplegia, moderate severity. As a mother, it’s easier for me to live and fight thinking that if this is incurable, then it’s fixable—it’s possible to bring the child as close as possible to “norms.” social life. For 5 years we have heard enough that it is better to send our son to a boarding school and give birth to a healthy one ourselves... and this is from two different orthopedic doctors! It was said in front of a child whose intellect was preserved and he heard everything... of course he closed himself off, began to avoid strangers... but we have a huge leap - our son walks on his own, although he has poor balance and his knees are bent... but we are fighting. We started quite late - from 10 months , before this they treated other consequences of premature birth and doctors’ indifference...