The most serious disease that destroys the life of a child is cerebral palsy. This neurological disease associated with brain damage develops into a disability for the baby. But with timely and proper treatment, the disease stops progressing, some symptoms disappear.
To the most common reasons development of cerebral palsy include the following manifestations:
- (lack of oxygen while the mother is carrying a child);
- Infections during pregnancy;
- Failures in the formation of brain structures;
- Conflict of Rh factor between mother and baby;
- Brain injuries during pregnancy and childbirth;
- Toxic poisoning;
- Disturbances during childbirth.
The occurrence of symptoms of cerebral palsy in newborns is often not associated with any one cause, but is caused by a complex of factors, and determining the exact cause is not always possible.
The most common factor in the manifestation of cerebral palsy is hypoxia, accompanied by early placental abruption and abnormal fetal position. This is followed by a conflict between the Rh factor and infection, and genetic predisposition by one of the parents.
It is customary to group reasons occurrence of cerebral palsy according to their main factors:
- Genetic. Damage to the parents' chromosomes stimulates the occurrence of cerebral palsy in their child.
- Hypoxia. Lack of oxygen supply to the fetus, both during pregnancy and at the time of birth.
- Infections. Having suffered from meningitis, encephalitis, arachnoiditis before the age of one year, increases the risk of cerebral palsy, especially in severe forms.
- Poisoning. Damage to the body of a pregnant woman or baby toxic poisons or medicines lead to disease. Harmful production, contact with toxic substances, potent medical supplies– sources of risk for pregnant women.
- Physical. Various radiations and electromagnetic fields cause damage to the child in the prenatal period; these same sources of risk include radiation.
- Mechanical. Mechanical damage a child receives during childbirth - these are birth injuries.
The most accurate determination of the cause of cerebral palsy will help identify the main pain points and prescribe appropriate treatment.
Forms
There are different forms of cerebral palsy according to the generally accepted system.
Spastic tetraplegia
The cause of spastic tetraplegia is oxygen starvation of the fetus during the intrauterine period or at the time of birth. Due to hypoxia, neurons in the baby’s brain die, and the nervous tissue loses the necessary characteristics. Brain lesions reveal such signs of cerebral palsy in a child as strabismus, speech impairment, decreased hearing and vision up to blindness, possible impaired mental abilities and developmental delays.
With an unexpressed impairment of hand activity, a patient with cerebral palsy with spastic syndromes can find his place in society, doing feasible work.
Dyskinetic
The dyskinetic form is also called the hyperkinetic form of cerebral palsy. The causes of this symptom are the transfer of hemolytic disease to the newborn. In the dyskinetic form there are following signs diseases:
- Uncontrolled movements not only of the limbs, but also of any part of the body;
- Possible frequent seizures and paralysis;
- The vocal cords are affected by paresis, which leads to problems with sound production;
- Posture is impaired.
The development of children with dyskinetic type cerebral palsy can take place in general institutions, since this form of cerebral palsy does not affect mental abilities. The intellectual capabilities of children allow them to enter universities and successfully obtain a diploma, while continuing their activities in work groups.
Ataxic
In the ataxic form, a decrease in muscle tone is observed, tendon reflexes are actively manifested, and disturbances of the speech apparatus may occur. Arises this type Cerebral palsy due to hypoxia and injury (most often due to injury) frontal lobes brain Symptoms of cerebral palsy in the ataxic form include the following manifestations:
- Muscle tone is reduced;
- There is trembling of the arms and legs;
- Mental retardation;
- Speech disorders.
Mixed
Damage to the baby's brain structures occurs as a result of a complex of the above forms in various combinations.
Symptoms
Symptoms of cerebral palsy may appear immediately after the birth of a child or in the first months of life. Parents and doctors should be attentive to absolute reflexes and, if their manifestation fades, urgently carry out a full diagnosis.
It is important to monitor the timeliness of the development of gaming skills and speech development; a lack of contact with the mother can be a signal of alarm.
Cerebral palsy is not the main diagnosis for developmental disorders in a child under one year of age, but if after this period the child cannot sit, does not show speech skills, or exhibits mental disorders, then the likelihood of diagnosing this disease increases.
Symptoms of cerebral palsy include visual and hearing impairment, epileptic seizures, developmental delays and problems with the urinary system.
Treatment
Treatment for cerebral palsy is prescribed by a neurologist after identifying the causes of the disease and making a diagnosis. During diagnosis, electroencephalography and electroneuromyography are performed to study in more detail the functioning of the child’s brain and muscles. Based on the data received, the treatment process begins immediately in order to avoid more severe consequences, and, as a maximum, to get rid of the disease itself.
Drugs
To relieve convulsions and epileptic seizures, anticonvulsant medications are prescribed, to improve blood circulation - nootropic medications, and in the case of muscle hypertonicity - muscle relaxants. When manifested pain symptoms antispasmodics are prescribed.
In the most serious cases of brain damage, surgery is prescribed.
Massage
Massage for cerebral palsy is used when the child reaches the age of 1.5 months. Massage should be performed only by an experienced specialist who can assess muscle tone. All types of massage are used: classical, segmental, acupressure, according to Manakov.
Parents should not perform these procedures on their own, since only a specialist can correctly calculate the required load and frequency of sessions.
Exercises
Examples of training and exercises to develop muscle groups and joints:
Development of motor skills
- The baby is squatting, the adult is also squatting in front of the child. Holding the baby by the belt and placing his hands on his shoulders, the adult pushes the child to make such a movement so that the baby kneels;
- From the position of the child on his knees, holding him under the armpits, the adult tilts him to the right and left;
- When holding the child, it is necessary to give him the opportunity to stand on one or the other leg.
Development of joint functions
- From a position lying on your back, keeping one leg straight, the other should be bent towards the tummy and returned back, changing legs;
- From a position lying on your back, raise and lower your legs alternately, bending them at the knees.
Abdominal muscle development
- From a position sitting on a chair, the child should be helped to lean forward, and he should perform extension to the initial position independently;
- From a position sitting on the floor, the child should reach his toes. An adult helps;
- From a lying position, the child raises his legs and throws them behind his head, with the help of an adult.
Removing hypertension
- Develop the baby's hand by moving it in different sides, shake the pen slightly at short intervals, relaxing the muscles.
Leg muscle training
- From a position lying on his back, the adult helps the baby perform flexion and extension movements in the hip joint.
Exercises in water will help relieve muscle tension and increase their tone. A baby swimming in the central pool or even in the bathtub becomes much more energetic and better fights stress and depression. Finding a sick child in a dolphinarium has an amazing effect and helps greatly advance the treatment process.
Child development
The symptoms of cerebral palsy can be overcome by additional development of the child using play manipulations. Fine motor skills, involved in playing with pyramids and cubes, rolling a ball, holding and releasing objects, affects the development of both the baby’s mental abilities and his speech apparatus.
As a result of these activities, the child learns to quickly memorize various objects, which leads to more intensive development and smoothing, or complete disappearance of the symptoms of cerebral palsy.
Prevention
You can prevent the occurrence of cerebral palsy in an infant by following certain rules:
- Pregnancy should be planned;
- The expectant mother should stop smoking and drinking alcohol;
- Needs to be organized proper nutrition during pregnancy and breastfeeding;
- Immediately treat all types of infectious and viral lesions of the body;
- Establish regular monitoring of hemoglobin levels in the blood of a pregnant woman;
- Childbirth should only take place in a clinical setting;
- Viral and infectious diseases in the infant should be avoided.
Often in early childhood the symptoms of cerebral palsy are almost invisible, but they become more pronounced as the child grows older. Children suffering from this disease begin to hold their head up, roll over, sit, crawl and walk later than others. But “baby” reflexes, which normally disappear at 6-8 months, persist longer. Often, by the age of one and a half years, such children control one hand much better than the other, since the other half of their body is too weak.
However, the muscles of a child suffering from cerebral palsy may not only be too relaxed. They may also be too tense. Both are called pathological muscle tone. Because of it, the child's arms and legs can take unnatural positions.
The movements of a person suffering from cerebral palsy are too sharp or, conversely, too slow. Quite often the child cannot control them.
Often those suffering from this disease experience skeletal deformities. Typically, the arm and leg on the affected side are somewhat shorter than on the healthy side. If this difference is not corrected, scoliosis may develop.
Many children suffering from cerebral palsy have mental development delays. However, if a child does not respond to his name, he may have problems not with mental development, but with hearing. This is also a common pathology in cerebral palsy.
Some children are unable to speak normally due to an inability to move their lips and tongue correctly. They may also have problems initially with sucking and later with swallowing. These children often drool because they cannot swallow saliva. In this case, parents need to closely monitor the child while eating - there is a danger of suffocation due to the fact that food can get into the respiratory tract.
Approximately 30% of these children experience seizures. They can begin immediately after birth, or maybe after a few years. Often, cramps are not noticed, considering that they are simply involuntary movements of the arms or legs.
Approximately 75% of people with cerebral palsy have vision problems. Most often this is strabismus, which occurs due to weakness of the muscles that control eye movements. They often also have myopia.
Many people with cerebral palsy have dental caries. This occurs due to the inability to brush your teeth properly. Also plays a role in the occurrence of this disease. congenital deficiency tooth enamel.
Some children may have problems with urination and bowel movements because they cannot control the related muscles.
Description
For every 1000 children, approximately 2-3 children suffer from cerebral palsy. However, more of them are born - approximately 1.7-5.9 per 1000 births. It was previously thought that cerebral palsy developed due to problems during childbirth. Now it is known that improper childbirth, of course, plays a role in the development of this disease, but not the first one - in almost 80% of cases the disease begins in the prenatal period (before the birth of the child). There are many risk factors for this disease:
- premature birth;
- complications during childbirth;
- tight umbilical cord entanglement;
- the fruit is too large;
- narrow pelvis;
- low birth weight, especially if body weight is less than 1 kg;
- multiple fetuses (twins, triplets and more);
- congenital pathologies of the structure of the brain and spinal cord;
- cerebral circulatory disorders in the fetus;
- infectious diseases suffered by the mother during pregnancy;
- diseases thyroid gland and diabetes mellitus in the mother;
- hypertension, coronary heart disease, heart defects in the mother;
- smoking and drinking alcohol during pregnancy;
- Rh conflict between mother and fetus;
- hypo- and vitamin deficiencies in the mother;
- hemolytic disease newborn;
- poor environmental situation.
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 defeat hands 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, occurring 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, 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 shapes diseases.
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
You should contact a neurologist with suspected cerebral palsy if:
- at the age of 1 month, the child does not blink his eyes in response to a loud sound;
- at the age of 4 months the child does not turn his head towards the sound;
- at the age of 4 months the child does not reach for a toy;
- at the age of 7 months the child does not sit without support;
- at the age of 12 months the child does not speak words;
- at the age of 12 months the child does everything mainly with one hand;
- the child has seizures;
- the child has strabismus;
- the child’s movements are too sudden or too smooth;
- the child does not walk or walks incorrectly, for example, on tiptoes.
The doctor makes a diagnosis based on a thorough examination of the child, parental complaints, family history, as well as the course of pregnancy and childbirth. (electrophoresis, myostimulation) only if there are no seizures;
If necessary, carry out surgery- 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.
Cerebral palsy (CP) is a collective term that unites a group neurological diseases that cause disruption motor function and coordination.
Cerebral palsy occurs due to damage to the part of the brain responsible for muscle activity. The disease may be caused by abnormal brain development or injury to the brain before, during, or shortly after childbirth.
The cause of cerebral palsy in most cases begins during the fetal development of the baby and is associated with diseases of the pregnant woman, pregnancy pathology or mutations. And in rare cases - with problems during childbirth and injuries received after birth.
According to statistics, the main cause of disability in children is damage to the nervous system (47.9%), and the most common pathology in this group is cerebral palsy. Approximately 1 in 400–500 people in Russia has cerebral palsy.
Typically, symptoms of cerebral palsy appear within first three years of a child's life.
Initial stage of cerebral palsy appears immediately after birth. Changes in the child’s behavior are associated with disruption of signal transmission from damaged parts of the brain. The baby’s movements are constrained due to constant muscle tension or, on the contrary, muscle weakness and lethargy. The child may shudder periodically, convulsions and trembling in the body are possible. Parents can pay attention to the fact that the baby cannot fix his gaze and sucks poorly. All these changes often occur against the background of severe general condition child: problems with breathing, heartbeat, intracranial pressure, etc.
Early residual stage of cerebral palsy begins at 2–4 months of age. In parallel with the child growing up, disorders appear, determined by the location and extent of brain damage. Developmental delay is observed, such children begin to sit, crawl, walk, talk late, and stiffness and unnatural movements of the damaged part of the body become clearly noticeable. For example, a child can perform all movements with only one hand, and tuck the other one towards the body, walk on tiptoes, and so on.
Late residual stage of cerebral palsy occurs in older children. No new symptoms appear. Due to the lack of full movements, the development of irreversible body deformations, muscle atrophy, and the formation of a specific gait are observed.
Exist various methods treatments to reduce the manifestations of cerebral palsy and increase the child’s independence. These include physical therapy, occupational therapy, and medications to relieve muscle tension and spasms. In some cases, surgery may be required.
Symptoms of cerebral palsy in a child
Typically, symptoms of cerebral palsy appear during the first three years of life. A child with cerebral palsy may be slower to achieve important stages development, such as the ability to crawl, walk and talk.
There are four main forms of cerebral palsy:
- Spastic. This is the most common form of the disease. With it, the muscles are in constant voltage, so the child is not good at making quick and precise movements. The arms are bent at the elbows, the legs are often brought together or crossed, which makes swaddling the baby difficult. The degree of damage to cerebral palsy can vary - from severe paralysis to slight awkwardness in movements, which are noticeable only when performing complex manipulations.
- Dyskinetic. It can manifest itself as either muscle tension or flaccidity. As a rule, newborn children with a dyskinetic form of cerebral palsy behave sluggishly and hardly move. Seizures appear at 2–3 months of age sudden increase muscle tone (sharp muscle tension) in response to strong emotions, loud sounds, bright light. After 1–1.5 years, hyperkinesis appears - slow worm-like movements of the arms and legs (athetosis), fast and jerky movements (choreic cerebral palsy) or contractions of the trunk muscles, which lead to its rotation, head turns and other changes in posture (torsion movements). Hyperkinesis usually does not appear at rest and disappears when the child sleeps. Children with this form of cerebral palsy often experience decreased hearing and speech, as well as difficulty eating. At the same time, mental development suffers less frequently than in other forms of the disease.
- Ataxic. With this form of cerebral palsy, imbalances and coordination come to the fore, causing movements to become jerky and awkward. Children begin to stand and walk at the age of 1.5–2 years, but these functions still have to be brought to automaticity for a long time. Tremor (involuntary shaking) of the hands and head may also be observed. Possible decrease in intelligence.
- Mixed. With it, patients exhibit signs of more than one of the forms of cerebral palsy described above.
The severity of symptoms in different people can vary greatly. For some, the symptoms are mild, while for others the disease turns them into disabled people.
Cerebral palsy can also affect different parts of the body. In some, the right or left-hand side body, in others the legs are primarily affected, and in others both the legs and arms are affected. Depending on which part of the brain is damaged, cerebral palsy may be accompanied by a violation of not only motor, but also other functions of the body. Therefore, children with cerebral palsy may experience the following symptoms:
- repeated convulsions or seizures (epilepsy);
- drooling and difficulty swallowing (dysphagia);
- gastroesophageal reflux disease (GERD);
- skeletal disorders or abnormalities, especially hip dislocation or spinal curvature (scoliosis);
- problems with bowel control Bladder(urinary incontinence);
- speech disorder (dysarthria);
- visual impairment;
- learning difficulties (although mental abilities are often not impaired).
Causes of cerebral palsy
In the recent past, doctors believed that the cause of cerebral palsy was damage to the brain during childbirth due to a temporary lack of oxygen (hypoxia). However, in the 1980s. A large study was conducted, during which it was proven that hypoxia during childbirth causes cerebral palsy in no more than 10% of cases. Also, sometimes brain damage can occur during the first few months of a child's life. The cause of this condition may be an infectious disease (for example, meningitis), very low level blood sugar, severe head injury or stroke.
Much more often, the disease develops due to brain damage that occurs before the birth of the child. Researchers believe that damage to the baby's brain in the womb, leading to cerebral palsy, occurs for three main reasons.
Cause No. 1 - periventricular leukomalacia. This is a lesion of the white matter of the brain. White matter is a collection of nerve fibers that connect nerve cells responsible for mental activity, with the rest of the body. When white matter is damaged, the connection between the brain and organs and parts of the body is disrupted.
It is believed that the damage is caused by a reduction in the volume of blood flowing to the fetal head, or a lack of oxygen. In the future, this is fraught with serious consequences for muscular system child, since the white matter is responsible, among other things, for transmitting signals from the brain to the muscles of the body.
The exact cause of periventricular leukomalacia is unclear. But it is believed that risk factors may include:
- very low blood pressure mothers - for example, due to caesarean section;
- premature birth, especially before the 32nd week of pregnancy.
Reason number 2 is a violation of brain development. Any damage to the brain can disrupt the transmission of signals from nerve cells to muscles and other parts of the body, and therefore can cause cerebral palsy in children.
The following factors can affect brain development:
- changes (mutations) in genes affecting brain development;
- an infectious disease suffered by a woman during pregnancy;
- fetal head injury.
Reason number 3 - intracranial hemorrhage and stroke. Intracranial hemorrhage is bleeding in the brain. This is potentially dangerous, since if there is a lack of blood, parts of the brain can die, and the accumulation of blood itself can damage surrounding tissue. Intracranial hemorrhage usually occurs in premature babies, but can also occur after a stroke in a child in the womb.
Factors that increase the risk of fetal stroke:
- initial weakness or pathology blood vessels fetus or maternal placenta;
- maternal high blood pressure;
- an infectious disease in a woman during pregnancy, especially chlamydia, trichomoniasis and other sexually transmitted diseases.
Diagnosis of cerebral palsy
If you notice signs of cerebral palsy in a child, contact your pediatrician. If a disease is suspected, he will write out a referral for a consultation with a pediatric neurologist, who will check the baby’s reflexes, posture, muscle tone and movements. If the diagnosis is confirmed, you will undergo additional examination by an orthopedist, who will prescribe treatment and develop a habilitation (adaptation to life) program. Depending on the child's age, they may also be referred to a psychologist to evaluate their intellectual development.
To exclude similar diseases and confirm the diagnosis of cerebral palsy, the doctor may prescribe additional examination, for example:
- magnetic resonance imaging (MRI) - creating a detailed image of the brain using magnetic fields and radio waves;
- ultrasonography(ultrasound) - creating images of brain tissue using sound waves;
- CT scan(CT) - creating a series of x-rays that are assembled by a computer into a detailed three-dimensional image of the child’s brain;
- electroencephalogram (EEG) - monitoring brain activity using small electrodes attached to the head;
- electromyogram (EMG) - test muscle activity and function peripheral nerves(network of nerves running from the brain and spinal cord to other parts of the body);
- blood tests.
Sometimes the diagnosis of cerebral palsy is made for a child while still in the maternity hospital. However, in most cases, this disease can be suspected only after several months or years of monitoring the baby. It is possible to definitively determine the degree and type of paralysis only at the age of 4–5 years.
Treatment of cerebral palsy
There is no cure for cerebral palsy, but there are approaches to relieve symptoms and help your child be as independent as possible.
Rehabilitation treatment must begin early, since the children's brain has great compensatory capabilities. In the first years of life, children are prescribed therapeutic measures, helping proper development various parts of the nervous system. In the future, to improve motor function, children with cerebral palsy may be recommended surgical treatment in combination with conservative therapy.
Help for patients with cerebral palsy is provided in neurological and orthopedic departments, specialized children's sanatoriums and boarding schools. Some basic treatment methods are described below.
Physiotherapy for cerebral palsy
Typically, physical therapy begins immediately after a diagnosis of cerebral palsy is made, as it is one of the most important ways to help a child manage the condition.
The two main goals of physical therapy for cerebral palsy are:
- prevent weakening of muscles that your child does not usually use;
- prevent muscles from contracting and losing their normal range of motion (this is called muscle contracture).
The risk of developing contractures is increased in children who find it difficult to stretch their muscles due to their stiffness. If muscles cannot stretch, they cannot grow as quickly as bones. This can lead to curvature of the body, causing pain and discomfort to the child.
A physiotherapist teaches a child a row physical exercise to strengthen and stretch muscles that need to be done every day. Also, special orthopedic attachments for arms or legs can be used to stretch muscles and correct posture.
Speech development in children with cerebral palsy
Salivation control and nutritional problems in cerebral palsy
Children who cannot control their mouth muscles often have difficulty swallowing food and maintaining saliva flow. This may lead to severe consequences, therefore, nutritional problems in cerebral palsy require treatment.
With difficulty swallowing (dysphagia), tiny particles of food can enter the lungs, which is accompanied by the development of dangerous disease- aspiration pneumonia.
If dysphagia is mild, the doctor can teach the child how to cope with it. A diet consisting of soft foods is also recommended. More severe dysphagia may require tube feeding. This is a tube that is passed into the stomach through the nose or mouth (nasogastric tube) or directly through abdominal wall(gastrostomy tube).
Drooling causes irritation of the skin around the mouth, chin and neck, increasing the risk of inflammation in these areas. There are a number of methods to combat drooling in cerebral palsy:
- an anticholinergic medicine in tablet or patch form that reduces saliva production;
- botulinum toxin injections into the salivary glands (although this is only a temporary solution);
- movement of ducts salivary gland with help surgery, as a result of which saliva is secreted deeper into the oral cavity and is easier to swallow;
- a special device placed in the oral cavity, which promotes the correct position of the tongue and regular swallowing of saliva;
- training in self-monitoring skills for the physiological state of the body, during which the child is taught to recognize when he is salivating and swallow it in time.
Surgery for cerebral palsy
Sometimes, to correct bone and joint deformities, surgery is prescribed to lengthen muscles and tendons that are too short and cause discomfort. This type of surgery is called orthopedic surgery and is prescribed if a child with cerebral palsy experiences pain when moving. Surgery can also improve posture and ease of movement, as well as improve a child's self-esteem.
However, it is not possible to feel all the benefits of the operation immediately after the intervention. Sometimes this takes several years, during which the child needs repeated courses of physical therapy.
Surgery may be performed to correct spinal curvature (scoliosis) or urinary incontinence. The child’s condition will be carefully monitored in order to promptly identify those disorders that can be effectively corrected with surgical intervention. Regular radiography may be prescribed as an examination. hip joint or spine.
Selective dorsal rhizotomy (SDR) is a surgical operation that is prescribed to improve the gait of children with high rigidity ( increased tone) muscles. As a rule, it is recommended only in cases where examinations have shown that the child has damage to the white matter of the brain (periventricular leukomalacia) and other methods of treating rigidity have not helped.
During the operation, the surgeon cuts some of the nerve fibers in the lower spine to relieve tension in the leg muscles. However, after surgery, several months of intensive physical therapy are required to re-teach the child to control his movements.
Like any other surgery, SRD has a risk of complications, including temporary problems emptying the bladder (urinary incontinence), scoliosis, and changes in sensation in the legs.
There are other methods of surgical correction of cerebral palsy. The intervention depends on the severity and prevalence of paralysis, the nature of the musculoskeletal system disorders, the age of the patient and his mental state. The optimal age for surgery is 8–16 years.
Discuss the potential benefits and risks of surgery with the surgeon, along with your child (if he is able to understand the consequences of the procedure).
Complications of cerebral palsy
The brain disorder that causes cerebral palsy does not get worse with age, but a person with the condition may experience physical and psychological difficulties as they get older.
Thus, many adults, under the influence of cerebral palsy, develop additional diseases(eg osteoarthritis) that cause pain, fatigue and weakness. Basically, these diseases are associated with the pathology of muscles and bones inherent in cerebral palsy, and creating heavy load on the body. Therefore, people with cerebral palsy may take much more effort to carry out ordinary activities than those who do not suffer from this disease.
Additional physical therapy sessions and the use of mobility aids, such as a wheelchair for cerebral palsy or special walkers, can help alleviate the physical difficulties that develop over time as a result of the disease.
Charitable educational foundation for promoting habilitation of children with special needs;
You can easily find doctors who diagnose and treat cerebral palsy using the NaPopravka service. The “Who Treats It” section on our website will help you decide on the right doctor. If in doubt, consult your pediatrician. He will conduct an initial diagnosis and refer you for a consultation with a doctor of the required profile.
Cerebral palsy (CP) is a pathology motor activity child caused by brain damage during pregnancy, childbirth or infancy. The perception of the outside world, the ability to communicate, and in most cases the psyche are impaired. The disease is difficult to treat, but does not progress. There are different types Cerebral palsy, in which the disease occurs with characteristic features.
Most often, the symptoms of the disease make themselves felt during the first months of life.
How common is cerebral palsy?
According to world statistics, almost a quarter of cases of pathology of the nervous system in children (24%) are due to cerebral palsy. Despite the development of medicine, pregnant women and newborn children continue to be the most vulnerable group of the population, subject to increased exposure to any stress factors.
Reasons for the development of cerebral palsy
The cause of cerebral palsy is a violation of the transmission of brain impulses to the muscles. It develops when brain cells are damaged in the early stages of development. This can happen both in utero, during childbirth or after birth.
During pregnancy
A woman’s body during pregnancy requires a gentle regimen and more careful attention. Adverse factors can be detrimental to a child’s development:
- exposure to radiation, toxic substances, drugs, alcohol, and certain medications;
- severe illness of the expectant mother;
- infections suffered during pregnancy;
- oxygen starvation;
- pregnancy with complications;
- incompatibility of the Rh factor of the blood of mother and baby.
During childbirth
Childbirth does not always go smoothly; doctors sometimes have to quickly respond to unforeseen situations. On development of cerebral palsy may affect:
- fetal asphyxia (umbilical cord entanglement, prolonged labor, etc.);
- birth injury.
After the baby is born
After the birth of a child, the living conditions of mother and baby have a decisive influence on his body. The following situations are dangerous for brain damage:
- the child's brain does not receive sufficient quantity oxygen;
- carcinogens enter the baby’s body;
- head injuries;
- past infections.
How to recognize cerebral palsy in a child after 1 year
By 12 months of age, a normally developing child can already do a lot. He turns over, sits down, stands up on his legs, tries to walk, pronounces individual words. The baby responds to his name, reacts emotionally to the world around him, and communicates.
Of course, each baby has an individual pace of development. One child can walk with his own legs or start talking earlier, another later. However, CNS pathologies usually appear in aggregate.
Parents should be wary if, at the age of 1 year and older:
- does not crawl and does not try to walk (some children do one thing: either crawl for a long time, or immediately walk);
- cannot stand independently without support;
- does not speak individual short words(“mom”, “dad”, “woof”, etc.);
- does not try to find a toy hidden in front of his eyes, does not reach for flashy things that interest him;
- the baby’s limbs on one side of the body are more active than on the other;
- The child has seizures.
Types of cerebral palsy
In world practice, there are several types (forms) of this disease. The differences between them are in the symptoms, degree and localization of central nervous system damage.
Spastic tetraplegia
This is a severe form of cerebral palsy that develops due to a critical lack of oxygen. Because of this, partial death of brain neurons occurs, liquefaction of the structure of nervous tissue. In half of the cases epilepsy is observed. Other possible symptoms– disturbances of attention, speech, swallowing, intelligence, paresis of the muscles of the arms and legs. Visual impairment: atrophy optic nerve up to blindness, strabismus. Microcephaly (reduction in skull size) is possible. With this form of the disease, a person may become disabled and unable to perform basic self-care.
Spastic diplegia (Little's disease)
It is diagnosed most often - in 75% of cases, cerebral palsy. Predominant in children born prematurely. Causes: hemorrhages in the ventricles of the brain, changes in the structure of brain tissue.
The muscles of the legs are predominantly affected, and bilateral paresis develops. Already in early age Joint contractures may form, resulting in a change in the shape of the spine and joints, impairing their mobility.
This form of cerebral palsy is accompanied by delayed mental development, speech and psyche. If affected cranial nerves, the child may experience mild degree mental retardation. However, children with Little's disease are able to learn. If the arm muscles can function normally, a person is able to adapt to life, partially take care of himself in everyday life, and even perform feasible work.
With this type of disease, the muscles of the limbs (usually the arms) are affected on only one side. The causes of hemiplegic cerebral palsy are usually hemorrhages and cerebral infarctions. A child with this form of the disease can learn to perform movements no worse than a healthy one, but it will take him much longer to acquire such skills. The disease may varying degrees affect the intellect. This determines how much the child will be able to learn and live among other people. Moreover mental development often not associated with movement disorders, despite the fact that the illness of such a person is revealed by his gait. This is the so-called Wernicke-Mann pose, about which they say: “The leg is mowing, the hand is asking.” The man is walking on tiptoes, moving the straight leg forward, and the arm on the sore side is extended into the characteristic pose of a begging person.
In the hemiplegic form of cerebral palsy, mental development, psyche, and speech may be impaired. Some patients suffer from epileptic seizures.
Dyskinetic (hyperkinetic) form
The cause of this type of cerebral palsy is hemolytic disease of the newborn. The name comes from hyperkinesis (dyskinesis) - involuntary muscle movements in different parts of the body, characteristic of sick people. They are slow, stringy movements that may be accompanied by muscle spasms. In the hyperkinetic form of cerebral palsy, paralysis and paresis are observed, including those of the vocal cords, disturbances in the normal posture of the torso and limbs, and difficulties in pronouncing sounds. At the same time, the intelligence of sick children is normal, they are able to learn and develop normally. People with this form of cerebral palsy successfully graduate from school, even universities, find work, and fully adapt to life in society. Their only feature compared to other people is their gait and spoken speech.
It occurs due to severe fetal hypoxia during childbirth, as well as injury to the frontal lobes of the brain. Feature manifestations is associated with decreased muscle tone and strong tendon reflexes. Speech disturbances are often observed. Patients often experience tremors in their arms and legs. All this is associated with paresis of muscles in various parts of the body. Characterized by small or average degree mental retardation.
Mixed or combined forms
Mixed forms of cerebral palsy are a combination different forms diseases. This happens because the child, for some reason, is affected various structures brain.
Most often, a combination of spastic and dyskinetic forms of cerebral palsy, as well as hemiplegic and spastic diplegia, is observed.
In addition, depending on the age at which the child was diagnosed with the disease, cerebral palsy is divided into stages:
- from birth to 6 months – early form;
- from 6 to 2 years – initial residual form;
- after 2 years – late residual form.
Diagnosis of cerebral palsy after a year
By the age of one year, a child with cerebral palsy usually has all the signs of the disease: non-progressive motor impairment, uncoordinated movements, and developmental delays. Diagnostic methods are usually used to confirm the diagnosis, exclude diseases with a similar clinical picture, and clarify the form of the disease. However, put accurate diagnosis It can be difficult for a baby.
The child is examined by a neurologist who will prescribe an MRI - magnetic resonance imaging of the brain. The purpose of this procedure is to identify affected areas of the brain. In addition, MRI helps to determine the presence of changes in the substance of the cortex and subcortex of the brain, as well as to determine their type. This could be, for example, a decrease in white matter density.
Treatment of cerebral palsy
There is no universal treatment method for cerebral palsy. Therapy for cerebral palsy is aimed at improving motor activity, speech development and correction of the child’s psyche.
The earlier cerebral palsy is detected, the better results can be achieved when treating a child. The emotional and mental state of the baby’s mother plays an important role.
Drug treatment
Treatment of cerebral palsy is strictly individual. Medicines are recommended according to the symptoms of the disease. Can be prescribed to support the nervous system glutamic acid, drugs Nootropil, Aminalon. If the child is highly excitable, sedatives are indicated. Children with cerebral palsy are often recommended B vitamins, which improve metabolism in the brain.
In some cases it is necessary to reduce intracranial pressure, for which intravenous magnesium is prescribed. For this purpose, there are also mixtures containing diacarb and citral.
In the presence of convulsive syndrome The doctor will prescribe medications for the baby such as Luminal, Chlorocan, Benzonal. Normalization of muscle tone occurs due to the intake of Mydocalm, Biclofen and other drugs.
But cerebral palsy cannot be cured with medications alone. Treatment of the disease must be comprehensive. It is imperative to treat not only the symptoms, but also the disease that became the root cause of paralysis.
Massage and physical therapy
Therapeutic gymnastics and physiotherapy are a mandatory component of the treatment of cerebral palsy. To develop muscles, electrophoresis, mud and heat baths, magneto-, balneo-, and acupuncture are used.
With small children, exercise therapy, massage, or any other procedure can be done as a game. It is important to praise your child for the slightest achievements. This will help create a friendly, relaxing atmosphere, which will only contribute to successful treatment.
Correction of incorrect postures
If you allow a child with cerebral palsy to remain in an uncharacteristic position, then over time he will perceive it as normal. In this case, a violation of the mobility of joints and muscles may occur, in which the pose healthy person will never be possible. The correct muscle stereotype is gradually established for a child with cerebral palsy, fixing normal postures in his memory. For this purpose, special corrective overalls are used (for example, a “spiral” suit). Correct postures are fixed using splints, rollers, verticalizers and other devices.
IN extreme cases resort to surgical treatment: tendon plastic surgery, removal of joint contractures, neurosurgical operations.
Other corrective treatments
A child with cerebral palsy most often has speech impairment. To correct it, classes are held with a speech therapist. It is important to follow all the doctor's recommendations.
Animal-assisted therapy—treatment with the help of animals—has become widespread. For the treatment of children with cerebral palsy, horseback riding, swimming with dolphins, positive communication with animals.
Difficult, but important question – social adaptation baby with cerebral palsy. Among other things, communication with both healthy and similar children is required. For parents and loved ones of the child, working with a psychologist is also useful: after all, a lifelong ill child in the family is extremely stressful. Parents must prepare themselves for the fact that when the child grows up, it will be important for him to learn to accept himself and the world around him.
Complications
If you do not treat and rehabilitate the child, orthopedic complications of cerebral palsy may appear: scoliosis, kyphosis, stiffness of the joints and spine, pathological flexion of the limbs up to dislocations, foot deformity. This occurs due to the body being in incorrect postures.
As for the child’s speech and psyche, their condition may worsen due to a life isolated from society. If there is no communication with peers, no one to talk to, then speech becomes “not needed.” And rejection by society can cause depression and a feeling of rejection, which will only strengthen the picture of the disease.
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