What is cerebral palsy in a child. Signs of cerebral palsy in a child depending on age. Causes of cerebral palsy in newborns

Cerebral palsy (CP) is a pathology of a child’s motor activity that appears due to 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 nervous system in children (24%) it is 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. The development of cerebral palsy can be affected by:

fetal asphyxia (umbilical cord entanglement, protracted labor and so on.);
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 enough oxygen;
carcinogens enter the baby’s body;
head injuries;
past infections.

How to recognize cerebral palsy in a child after 1 year

Normal by 12 months of age developing child already knows 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, 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: optic nerve atrophy 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 cranial nerves are affected, the child may experience mild 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 is often not associated with motor 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.” A person walks on tiptoes, moving his straight leg forward, and the arm on the affected 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 bodies 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. A characteristic feature of the 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 a slight or moderate degree of mental retardation.

Mixed or combined forms

Mixed forms of cerebral palsy are a combination of different forms of the disease. This happens because for some reason the child has damage to various brain structures.

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, as a rule, are used to confirm the diagnosis, exclude diseases with a similar clinical picture, and clarify the form of the disease. However, making an accurate diagnosis of a baby can be difficult.

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 best 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. To support the nervous system, glutamic acid, drugs Nootropil, Aminalon can be prescribed. If the child is different increased excitability, 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.

If there is a 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 it will never be possible to assume the pose of a healthy person. 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 tires, rollers, verticalizers and other devices.

In extreme cases, they resort to surgical treatment: tendon plastic surgery, removal of joint contractures, and 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, and positive communication with animals are used.

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.

Doctors call cerebral palsy one of the most terrible diagnoses that can be given to a newborn - the causes of this disease in various forms doctors continue to discuss them, as well as treatment methods. The only thing that experts say with confidence is that cerebral palsy is not a hereditary disease. Who is at risk and is it possible to reduce the likelihood of this disorder occurring in the fetus?

What is cerebral palsy

Experts assigned the abbreviation cerebral palsy to a group of symptom complexes that arise from movement disorders that do not tend to progress. However, this does not detract from the need for treatment of cerebral palsy, since a child who has been diagnosed with this condition will show delays or other symptoms of mental and physical development disorders as they grow older. To the term " infantile paralysis"associated with polio, this disease has nothing to do with it. It will manifest itself in the following moments:

intelligence develops behind the norm;
problems with muscle tone that cause childhood disability;
disturbances of the emotional-volitional sphere;
epilepsy attacks.

According to ICD-10, cerebral palsy is coded G-80 (neurological disease) and is divided into several forms. Based on them, it is convenient for specialists to group all the causes of cerebral palsy and select treatment methods for cerebral palsy. According to the international classification, the following forms are distinguished:

80.0 – tetraplegia (in clinical manifestations indicates an increase in muscle tone in the arms).
80.1 – diplegia (among the main symptoms is hypertonicity of the leg muscles).
80.2 – hemiplegic (spastic syndrome).
80.3 – dyskinetic (hyperkinetic).
80.4 – ataxic (atonic-astatic).
80.8 – mixed.
80.9 – unspecified.

Why does cerebral palsy occur in children?

With cerebral palsy, brain disorders are observed affecting the cortex, subcortical zones, capsules and trunk separately or together (determined by the form of the disease). Due to brain damage, there are also lesions of the nervous system, in which neuronal pathology appears (up to diffuse necrosis). What complications will follow depends on the form of cerebral palsy.

Causes of cerebral palsy in newborns

At the end of the 19th century, the main prerequisite for cerebral palsy was considered to be fetal asphyxia during childbirth, and doctors adhered to this theory for almost a century. The only one who spoke about risk factors during the prenatal period was Sigmund Freud. However, even in modern medicine there are difficulties in understanding cerebral palsy - the causes of this disease continue to be discussed by doctors. Doctors divide them into 3 categories:

Pathologies of fetal development during pregnancy (the influence of intrauterine infections, chronic diseases of the mother, etc.)
Damage to the cerebral hemispheres during difficult childbirth (birth injuries, asphyxia, early birth).
External factors in postpartum period(toxic damage or physical trauma to the brain).

Is it possible to detect cerebral palsy during pregnancy?

Most parents want to know before the child is born that he will be completely healthy, but with cerebral palsy this is difficult. The main cause of this disease is prenatal in nature, so special concern should be exercised during childbirth and in preparation for it. When carrying a fetus, a woman can only try to prevent pathologies as much as possible with timely treatment, however, even in the absence of therapy, these are not the key reasons for the birth of children with cerebral palsy.

Diagnosis of cerebral palsy in newborns

Children with paralysis at the age of 3-4 years can be recognized even from a photo, but at the moment of birth only through a series of checks. The first is whether the baby has enough oxygen: if there is a deficiency, this can be considered a consequence of brain abnormalities and a symptom of cerebral palsy. The key symptom of cerebral palsy is considered to be a disorder of muscle coordination, which manifests itself in the first days after birth. However, to diagnose the disease you will need to pay attention to a few more points:

problem with muscle tone;
thrown back head, flaccid or strongly bent limbs;
impaired reflexes of the newborn.

Causes of cerebral palsy during pregnancy

According to statistics, 60% of children born with cerebral palsy received it during the formation of the body in the womb. However, this is not enough for a child to develop cerebral palsy - the causes of the prenatal occurrence of the disease must be combined with factors that arise during childbirth, or with postnatal ones. If we consider situations of cerebral palsy associated with pathologies intrauterine development, they may arise due to:

chronic maternal diseases;
infections suffered during pregnancy;
genetic factors;
complications during pregnancy.

The mother has chronic diseases

Doctors advise women planning a pregnancy to treat everything that can be treated in advance, for good reason: chronic diseases of the mother can negatively affect the formation and development of the fetus. Not only diabetes mellitus and diseases of the endocrine system pose a danger - doctors also list hypertension as a risk factor for the occurrence of this type of cerebral palsy. chronic form, heart disease (especially congenital defects), anemia, excess weight. However, this reason alone does not provoke the birth of a child with cerebral palsy.

Disorders of pregnancy

Toxicosis, gestosis and other problems that a woman may encounter are not only problems with well-being - each of them is accompanied by a disturbance in the oxygen exchange of tissues, as a result of which fetal hypoxia develops, or may be a prerequisite for placental insufficiency or placental abruption. These factors increase the risk of cerebral palsy - the causes will lie in encephalopathy: a hypoxic-ischemic disorder occurring in the fetal brain.

Lifestyle of an expectant mother

Taking medications, alcoholism, frequent stress, nicotine abuse, difficult working conditions and even physical injuries are things that a pregnant woman should be protected from. These factors are included among the causes of cerebral palsy, although they increase the risk of this pathology by only 10%. They are directly related to the above-mentioned complication of pregnancy, which results in disruption of the placental blood flow to the fetus and the risk of perinatal hypoxia.

Hereditary predisposition

You cannot get cerebral palsy from close relatives - the causes of its occurrence are not hereditary, but doctors do not rule out genetic factors. According to medical theory, the presence of defects in the chromosomes of the parents can affect the activation of pathological proteins, resulting in morphological changes in organism. However, doctors consider this cause of cerebral palsy to be the most controversial.

Breech presentation of the fetus

Normally, the baby should come out of the uterus head first, but this is not the only option for its position in the mother’s womb. According to statistics, every 20th woman experiences a breech presentation of the fetus: this can be diagnosed after the 36th week. The increased risk of having a child with cerebral palsy with this diagnosis is caused by 2 factors:

During childbirth, moving the buttocks forward does not expand the woman’s bone ring, therefore, with a narrow pelvis, this creates the precondition for birth trauma due to deformation of the skull and cervical spine.
If the cause of breech presentation is hydrocephalus and other developmental abnormalities, they increase the risk of brain disorders.

Prenatal factors for the occurrence of cerebral palsy

According to medical assumptions, the majority of patients with cerebral palsy - the causes of which are unclear due to the absence of problems with intrauterine development - owe the disease to birth injuries: they occupy a leading position among the prerequisites for acquired cerebral palsy. Brain damage in this situation occurs due to:

violations labor activity(including early birth);
asphyxia of the child;
spinal/skull deformities.

Premature birth

According to statistics, in premature babies, the frequency of the diagnosis of “cerebral palsy” is significantly higher than in those born at term, which is explained by the imperfection of the vessels located in the fetal brain. Their increased fragility leads to an increased likelihood of damage, and if birth trauma is added to this, brain pathology is almost inevitable. However, not every premature baby will have even a mild form of cerebral palsy - the causes of its occurrence in the prenatal period are more serious and are mainly associated with injuries.

Asphyxia of the newborn

Mostly, suffocation in a child during childbirth is preceded by early diagnosis chronic failure oxygen in the fetus, but this can also include problems with the placenta, cardiovascular and endocrine diseases of the mother. Often, fetal asphyxia has its causes in the prenatal period and is one of the main answers to the question of what causes cerebral palsy in newborns. However, its occurrence cannot be ruled out even after the normal course of pregnancy during childbirth, which is facilitated by:

entanglement of the umbilical cord around the fetal neck;
breech presentation;
labor dysfunction;
Pregnant age – women over 30 years of age are at risk.

Birth injuries

If the doctor excludes congenital cerebral palsy, noting the normal course of pregnancy and fetal development, the problem may lie in birth injuries, which give both light form illness, as well as a more serious condition. In a situation where the child comes out with his legs forward, the doctor, even with careful actions, can provoke a stretch of the cervical spine and deformation of the skull, which will lead to brain damage and acquired diseases of the nervous system. A similar scheme is possible with:

disruption of labor;
rapid/protracted labor;
waterless birth.

Causes of cerebral palsy in children in the postpartum period

If you can figure out the question of why children with cerebral palsy are born relatively quickly - disorders of intrauterine development and negative impact While birth injuries to the brain speak for themselves, acquired cerebral palsy is absolutely unclear as a phenomenon for most parents. Here doctors highlight several of the most obvious reasons:

inflammation of the subarachnoid zone of the brain;
physical/mechanical impact (injury);
intoxication.

Toxic brain damage during hemolytic pregnancy

Rh conflict can make itself felt already in the first days of a baby’s life. Against this background, newborn jaundice develops and bilirubin accumulates, the danger of which is toxic damage to the nuclei of the brain. If the disease is recognized at an early stage, it is reversible, but later the affected areas die, which becomes the cause of cerebral palsy.

Mechanical head injuries

The acquired causes of cerebral palsy necessarily include any trauma to newborns (even a light blow) affecting the head in the first days of life. Against their background, due to deterioration of blood circulation (in severe situations - hemorrhages), oxygen deficiency occurs, the functioning of the affected area of the brain decreases, and motor and mental disorders appear.

Poisoning with drugs and toxic substances

In the first 4 weeks the newborn is especially vulnerable, so taking medications (especially tranquilizers) by the mother breast-feeding, is prohibited due to the risk of brain damage, especially if the pregnancy was difficult. No less dangerous for the baby are sepsis, alcohol and nicotine addiction mothers, lead poisoning.

Video

Cerebral palsy is one of the most severe consequences of perinatal damage to the nervous system.

Cerebral palsy is the result of brain damage sustained during pregnancy, childbirth, and the first 28 days of a baby's life. The disease is manifested by motor disturbances, disorders of speech, psyche and perception of the surrounding world, which do not progress, but can only be partially corrected and restored.

For modern medicine, cerebral palsy is a complex disease that is difficult to treat, despite its scientific and practical achievements.

Manifestations of cerebral palsy have been known for a long time, since 1843, when they were first described by Little. In those days it was called Little's disease. The modern name was proposed by Sigmund Freud, and it quite accurately characterizes the manifestations of the disease.

Factors contributing to the development of cerebral palsy

Impact on the fetus during pregnancy:

the mother has serious illnesses that may adversely affect the development of the unborn child;
complications of pregnancy;
hypoxia, infections, toxins and other factors that can cause abnormal development of the child.

Factors affecting the baby at the time of birth:

asphyxia that occurred during childbirth;
birth injury.

Impact on a child in the neonatal period:

various injuries;
poisoning of the body;
infections;
lack of oxygen in the child's body.

Types of cerebral palsy

Forms of cerebral palsy according to clinical manifestations:

Double hemiplegia.
Spastic diplegia, also called Little's syndrome.
Hemiparetic or spastic hemiplegia.
Hyperkinetic.
Atonic-astatic.

According to the course of the disease:

Early stage. Develops in the first four months of life. Characterized by severe general condition baby, disruption of the functioning of internal organs caused by a failure of nervous regulation (sending signals to action from the nervous system to the organs), increased blood pressure, nystagmus (involuntary eye movement), convulsions and motor disorders.
Initial stage (chronically residual). Starts at 5 months and lasts until 4 years of age. It occurs against the background of residual effects after the pathology with the formation of persistent neurological disorders.
Late residual stage (final). The stage when incorrect motor stereotypes with contractures and deformities are finally formed.

According to the severity of the process

Mild degree. At this level, independent movement and self-care skills are possible.
Average degree. Children require partial assistance with mobility and self-care.
Heavy. Children are completely dependent on the people around them.

There is another classification for assessing motor disorders that occur with cerebral palsy. This is an international classification of motor functions, a global standard used throughout the world to assess the level of movement disorders in children, taking into account their capabilities and needs for devices that help them move.

This classification includes 5 levels:

The child moves without assistance and has no restrictions.
Can move without assistance within a room.
The child moves using assistive devices (walkers, crutches).
Moves in a wheelchair. Independent movements are limited.
Movement is severely limited.

Children and teenagers of the second level cannot run and jump like children of the first level. They need special devices to help them move when they go a long way when going outside (strollers, railings for going down or going up stairs).

Children of the third level need special devices both for moving around the house and for moving on the street and in public places.

Level 4 children can sit if supported and move around in an electronically controlled stroller.

Children at level five cannot sit or move without assistance or special technology.

In addition to motor disorders, children with cerebral palsy in 90% of cases have changes in the structure of the brain.

There are two groups of changes.

Death and destruction of brain cells.
Disorder, abnormal brain development.

For prognosis and development of a rehabilitation program, early detection of the disease is especially important. In most children with cerebral palsy, the diagnosis can be made within the first year of life.

Early manifestations of cerebral palsy

The first signs that allow one to suspect the development of cerebral palsy in a child can be noticed in the first year of life.

Slow development of the baby’s motor sphere, speech and psyche.
Delayed or complete absence of extinction of innate reflexes.
Developmental delay or complete absence of reflexes, which should be formed together with the motor development of the baby in the first year of life.
Impaired muscle tone.
Enhanced tendon reflexes.
The appearance of unnecessary involuntary movements and muscle contractions (syncinesia).
Formation of incorrect limb positions.

In order to make a diagnosis as early as possible, a pediatrician and a neurologist must clearly know the sequence and be able to competently assess the neurological mental development baby's first year of life.

This form accounts for 15 - 18% of all cases of cerebral palsy.

A common cause of development is birth trauma. The hemiparetic form often develops in full-term and post-term infants.

The main manifestations of the hemiparetic form of cerebral palsy are given below.

Unevenly dilated lateral ventricles, atrophy of cells of the cerebral hemispheres.
Spastic hemiparesis. Muscle tone and tendon reflexes are enhanced on one side only.
The arm suffers more than the leg.
The arm and leg on the affected side are shorter and thinner (thinner) than the healthy ones.
Gait disturbance, in which the leg on the affected side seems to describe a semicircle when moving a step, at which time the affected arm is bent at the elbow and pressed to the body. This gait is called a hemiparetic or Wernicke-Mann gait.
Curvature of the feet and contractures on the affected side.
35% of patients develop epilepsy (seizures) due to brain damage.

This form most often develops as a result of damage to the brain by excess bilirubin, which is often formed when there is a Rh conflict between the blood of the mother and the fetus (the mother is Rh negative, and the fetus is Rh positive). In full-term infants, the brain is affected when the blood level reaches 428 µmol/l and above, in premature infants - 171 µmol/l and above.

Also, the cause of the development of this form can be hypoxia (prolonged lack of oxygen in the fetus) as a result of ischemia (impaired blood circulation in the brain).

The main manifestations of the hyperkinetic form of cerebral palsy are as follows.

Hyperkinesis or involuntary movements and body positions. Impaired muscle tone: increased or decreased tone in all muscles, or dystonia (different tone in different groups muscles).
At first, hyperkinesis appears in the tongue at the age of 2 - 3 months, then appears on the face at 6 - 8 months, and after two years they are already well expressed. Such children have chorea (the child appears to be grimacing and making faces) and athetosis or slow convulsion. All these manifestations intensify when the child is worried and disappear during sleep.
The presence of pathological and high tendon reflexes.
Violation autonomic system, which is manifested by vegetative crises (incomprehensible, unreasonable attacks of panic and fear), increased temperature.
Speech is impaired in 90% of patients. She is inarticulate, illegible, expressionless.
Hearing problems in the form of sensorineural hearing loss are observed in 30–80% of patients.

At an early age it is 10 - 12%, at an older age it occurs in 0.5 - 2%.

In this form, the frontal lobes and cerebellum are affected.

The main manifestations of the atonic-astatic form of cerebral palsy are expressed in the symptoms indicated below.

Decreased muscle tone. Characterized by widespread from birth.
Poor coordination of movements (ataxia), inability to determine range of motion (hypermetry), trembling of the limbs or tremor.
Disturbed balance.
Paresis.
The range of motion in the joints is increased, hyperextension is typical.
Tendon reflexes are increased.
Speech impairment is observed in 65 - 70% of patients.

Double hemiplegia

This form is the most severe variant of cerebral palsy with an unfavorable prognosis. With it, brain changes are clearly expressed, as are the main manifestations.

Severe tetraparesis: both arms and legs are affected, with the arms being more affected.
Severe, gross motor disorders. The child is unable to hold his head up, fix his gaze, roll over, or sit; his arms and legs practically do not move.
Tendon and tonic reflexes are sharply strengthened, there is no protective reflex. The connection between the brain and the muscles of the pharynx, tongue, soft palate and vocal cords is disrupted, which is manifested by impaired speech, swallowing and voice. All these are manifestations of the so-called bulbar pseudosyndrome. Patients are also bothered by constant drooling.
Mental development and intelligence suffer. Children have moderate to severe mental retardation.
Speech is absent or significantly underdeveloped.

With cerebral palsy, in addition to motor disorders, complications associated with disruption of the functioning of other organs and systems quite often develop.

Complications of cerebral palsy

1) Orthopedic and surgical complications. These include violations hip joints, curvature of the feet, forearms and knee joints.

2) Epileptic syndrome, manifested by attacks of various types, is especially often observed in the hemiparetic form.

A pressing problem for children with cerebral palsy is the presence of (convulsive seizures), which significantly complicate their already difficult life. Convulsions aggravate the course of cerebral palsy, cause certain difficulties with rehabilitation and, in addition, pose a danger to life. Among patients with cerebral palsy, there are different forms of epilepsy, both extremely severe and benign with a favorable prognosis.

3) Cognitive disorders. These include impaired memory, attention, intelligence and speech.

The main speech disorders in cerebral palsy are impaired pronunciation or dysarthria, stuttering, lack of speech with preserved hearing and intelligence (alalia), delayed speech development. Motor and speech disorders are interrelated, so each form of the disease is characterized by specific speech disorders.

4) Visual and hearing impairment.

Treatment and rehabilitation of the consequences of cerebral palsy

Cerebral palsy is difficult to treat and the later the diagnosis is made, the less chance there is for recovery and correction of disorders. The most favorable range for complex treatment and correction is considered to be the age period from one month to three years, and it is very important to make a diagnosis and begin treatment in this period.

Treatment of cerebral palsy is a long process. The treatment method is developed by a group of doctors working together. The group includes a pediatric neurologist, a doctor physical therapy, orthopedic doctor, speech pathologist-defectologist, teacher-educator and psychologist. When drawing up the methodology, the child’s age, form and severity of the disease are taken into account. Each child with cerebral palsy requires an individual approach.

The main complex of rehabilitation treatment for cerebral palsy consists of three components.

Medical rehabilitation, which includes the prescription of medications, physical therapy and massage, the use of special therapeutic-load suits and pneumatic suits, physiotherapy, orthopedic and surgical treatment, treatment using orthoses - devices that help make correct movements in the joints.
Adaptations in the social environment. Teaches children to navigate, adapt and behave adequately in society.
Psychological, pedagogical and speech therapy correction, which consists of classes with a psychologist, teacher, speech therapist, occupational therapy, training in simple skills and activities with the family.

Among the methods of medical rehabilitation, kinesiotherapy or movement therapy, medications and physical therapy are most often used.

Kinesiotherapy

This is a method of correcting movement disorders and reducing or eliminating the consequences of a sedentary lifestyle.

Types of exercises used in kinesiotherapy.

Gymnastic. These are exercises that help develop muscle strength, restore joint mobility, and also develop coordination of movements. They are divided into active and passive; static and dynamic.
Sports and applied. This type of exercise is used to restore complex motor skills.
Physiotherapy. Teaches you to voluntarily and measuredly tense and relax muscles, maintain balance, normalizes muscle tone and helps get rid of synkinesis, increases muscle strength and restores motor skills.
Mechanotherapy. Various exercises using simulators and specially designed devices.

Massage

Massage normalizes body functions, improves blood and lymph circulation, and also optimizes oxidation and recovery processes in muscles. Various massage techniques are used in patients with cerebral palsy. The best effect is observed after classical therapeutic massage, segmental massage and massage of the cervical-collar area, circular trophic and acupressure massage, sedative and tonic massage, as well as massage carried out according to the Monakov system.

Dynamic proprioceptive correction (DPC)

The method is based on the use of a modified penguin space suit for the treatment of patients with cerebral palsy over the age of three. The treatment-loading suits Adele, Regent and Spiral are used for treatment. The duration of the course is 10 - 20 days, the duration of one lesson is 1.5 hours per day. In general, it is necessary to conduct 3 - 4 courses per year.

The duodenum method eliminates pathological (incorrect) position, improves vertical support and motor functions. DPC is contraindicated for up to three years in case of diseases of the spine, hip joints and during periods of exacerbation of diseases.

This is a necessary component of rehabilitation treatment for cerebral palsy.

Several groups of drugs are used for treatment.

Neurotrophic and nootropic drugs (Cortexin, Pantogam, Phenibut, Picamilon).
Drugs that improve blood circulation and microcirculation of the brain (Actovegin, Trental).
Drugs that improve metabolism in nervous tissue, have a resolving effect and restore damaged cells (Lidase).
Drugs that reduce intracranial pressure (Diacarb).
Anticonvulsants (Depakine).
Drugs that normalize muscle tone (Mydocalm, Prozerin).
B vitamins and Aevit.

Since 2004, in Russia, botulinum toxin A has been successfully used to treat spastic and distant forms of cerebral palsy, which relieves spasticity and muscle stiffness, increases joint movement and improves the child’s mobility, and also eliminates pain. In general, the use of botulinum toxin improves the patient’s quality of life and makes it easier to care for him.

The effect of botulinum toxin treatment is more pronounced when started early. The most optimal age for botulinum therapy is considered to be from 2 to 7 years.

Physiotherapy

The goal of physiotherapy is to increase the performance of cells of the nervous and muscular systems that are not destroyed by damaging factors, and to reduce pain and swelling.

Types of physiotherapy used for cerebral palsy:

electrotherapy;

Electrophoresis with various medications that decrease or increase muscle tone, depending on the situation.
Electrical stimulation of muscle groups. A relaxing or stimulating technique is used.
Magnetic fields.

Electrical procedures are not prescribed for patients who have seizures.

thermal, warming procedures (applications of paraffin and ozokerite);
mud therapy (wraps and mud baths);
hydrotherapy (swimming pools, bubble baths, water massage);
acupuncture;
treatment natural factors. This is a sanatorium-resort treatment prescribed to children over three years of age, subject to 2 conditions: absence of seizures and increased intracranial pressure.

Surgical treatment in patients with cerebral palsy is often used to eliminate contractures, curvature of the feet and upper limbs.

Neurosurgical treatment is usually used to correct spasticity or high tone in cerebral palsy.

Orthosis therapy

This is treatment using special devices - orthoses, designed to give the correct position to the musculoskeletal system and correct disorders and curvatures. Examples of orthoses are splints and corsets.

An important component of the complex of rehabilitation for the consequences of cerebral palsy is psychological and pedagogical correction.

Basic principles of psychological and pedagogical correction.

Complex nature, simultaneous correction of speech, mental and movement disorders.
Early start of correction.
Logically consistent principle of correctional work.
Individual approach to the child's personality.
Observation and control of the dynamics of psychospeech development.
Collaboration and unity of the correction carried out with the child and his immediate environment, that is, with the family.

Important importance in correctional work is given to sensory education, which develops the child’s full perception of the surrounding reality. It develops all types of perception (visual, auditory, tactile-motor), forming in the child a complete understanding of the properties of the things and objects around him.

The main tasks of speech therapists in working with children with cerebral palsy

Development verbal communication and improving the intelligibility of spoken words.
Restoration of normal tone and movements of the speech apparatus.
Development of voice and speech breathing.
Synchronization of breathing, voice and speech.
Correction of incorrect pronunciation.

Early diagnosis of cerebral palsy, adequate and timely medical and social rehabilitation and psychological and pedagogical correction significantly increases the effectiveness of the rehabilitation therapy complex. The result of this is a reduction in disability, successful social adaptation and improvement in the lives of patients with cerebral palsy.

An adult with cerebral palsy has difficulty moving due to weight. As a result, an adult has to move in a wheelchair. With cerebral palsy in an adult (in ICD-10 code G80), the motor skills of the limbs are impaired. This makes it difficult to move and make sudden movements, making it difficult to take care of yourself. Even cooking poses a lot of challenges.

Peculiarities

It is impossible for such people to work, especially with physical labor. Adults with cerebral palsy have developmental delays or mental disorders due to damaged brain structures responsible for reason. It is difficult for such people to talk, as muscle function is impaired. As a result, difficulties arise with eating and unnatural facial expressions appear on the face.

An adult patient often begins to develop epilepsy. There is an abnormal perception of the surrounding world, again associated with damage to the patient’s brain. In addition, often a person with this diagnosis begins to experience rapid decline in vision and hearing.

In addition to the physical consequences, there are psychological consequences for the adult patient. The patient begins to develop a mental disorder. This is neurosis or depression. Consciousness also changes for the worse.

With cerebral palsy in adulthood, women do not have difficulties with pregnancy and childbirth. Sick pregnant women bear a child without any difficulty. Doctors often advise pregnant women with cerebral palsy to do C-section, but this is done only in severe cases. Sick pregnant women require close monitoring by a gynecologist. Women with cerebral palsy can give birth to twins or triplets without complications. Cerebral palsy is not passed on to children from adult parents. Adults are almost always born healthy babies.

Symptoms

A smooth course of cerebral palsy in adults is typical. Over the years, the childhood disease outgrows; congenital or acquired pathologies accompany the patient throughout his life. With minor brain damage and timely diagnosis followed by symptomatic treatment, a decrease in cognitive and motor impairment is possible. Symptoms of cerebral palsy in adults:

General muscle weakness. Often found in patients, it is accompanied by pain caused by bone deformation.
Arthrosis and arthritis. Occurring in childhood, disorders of the motor system, accompanied by improper interaction of the joints, begin to cause inconvenience over time.
Painful sensations. Sudden, acute or chronic pain worries the patient. The most commonly affected areas are the knees, upper or lower back. A person suffering from these pains cannot independently determine their strength and source of distribution.
Premature aging. Signs accompanying this symptom begin to appear when the patient reaches the age of 40 years. The reason for this is the forced work of weakened, poorly developed organs at full strength along with completely healthy ones to maintain the patient’s body. In this connection, early wear and tear of some systems (cardiovascular, respiratory) occurs.

Consequences

Consequences of cerebral palsy in adults:

Basically, with cerebral palsy, the patient is not able to move normally on his or her legs. Due to lack of coordination, in addition to difficulty walking, it is even more difficult for him to maintain balance, so the patient needs constant help from loved ones.
The patient loses the ability to perform certain types of motor skills, because of this he is unable to take care of himself, and work, especially physical work, is out of the question.
Many patients have damage to the structure responsible for their mental state, so they are developmentally delayed or have psychological disorders.
The patient's speech deteriorates, as there is a disturbance in the contractions of the facial muscles. Difficulties with eating and unnatural facial expressions also appear.
Often the patient begins to develop epilepsy.
Sometimes there is an abnormal perception of the world around us due to brain damage.
The patient's hearing and vision begin to rapidly decline.
Psychological disorders appear. This, in turn, is expressed in phobias or depression.
It is difficult for the patient to communicate with other people due to a secluded lifestyle.

Surgery

Surgical treatment of cerebral palsy certainly involves a comprehensive medical diagnosis of the patient’s health condition. The complex includes:

electromyography;
ENG et al.

In addition to the listed diagnostic complex, the patient undergoes consultations with an ophthalmologist, orthopedist, epileptologist, psychiatrist, in exceptional cases even a speech therapist, as well as other specialists, each of whom must provide his or her medical permission for surgical treatment of the patient’s pathology in the anatomical area related to their specialization.

Neurosurgery in the treatment of disabled adults with cerebral palsy is a serious and radical method of therapy. Therefore, it is necessary to use it after carefully weighing everything and get advice from different specialists. When adaptive treatment does not provide the expected and visible improvements in treatment, and turns into convulsions or hyperkinesis, which increasingly constrain the person, and movements cause pain, neurosurgery will help. Otherwise, deterioration in health is inevitable.

The development of extensive muscle paralysis gradually turns into inflammation of the epidural tissue, which, in turn, affects blood circulation and metabolic processes in the body. These violations inevitably lead to outflow failure venous blood from the cervical spine, which can lead to disruption of the spinal cord.

As a way to solve the problem, you can use at least 2 botulinum toxin blockades, and when they do not give an effect, then there are no more options.

Exercise therapy classes

General instructions for all exercise therapy exercises:

Systematicity.
Regularity.
Determination.
Individuality (directly dependent on the age, diagnosis, condition and psyche of the rehabilitated patient).
Gradual increase in physical activity.

Types of exercises

The main types of exercise therapy for cerebral palsy:

Stretching exercises aimed at reducing and removing excessive muscle tone.
Exercises to develop muscle sensitivity and strength, including those that allow you to adjust a specific muscle group.
Recovery activities functional state muscle tissue by restoring and developing the sensitivity of nerve endings.
Exercises aimed at developing leading and antagonistic muscles.
Endurance loads to improve organ function.
Exercises that relieve cramps and muscle spasms.
Walking aimed at developing gait and posture.
Exercises to develop the organs of perception of the surrounding world (visual and tactile).
Exercises that develop the vestibular apparatus.

Often, patients with cerebral palsy are prescribed to develop the muscles of the body by performing a series of exercises with gradually increasing intensity and load. If it is not used, then after a certain period of time, musculoskeletal functions may not be realized and may be depressed. In this connection, for adults suffering from the consequences of cerebral palsy, exercise therapy is important, given that with age, it takes much more time to bring the muscles to the desired tone than for children.

Massage

Stroking during massage has a relaxing effect. The massage therapist's hand movements should be slow and soft. When rubbing and kneading, the specialist helps you relax; these techniques are best done gently, gently and more slowly than usual.

Shaking - special and effective technique, which can be used to reduce muscle tone in the limbs.

Warm-up

First of all, the back muscles are warmed up:

Hand movements follow from the lumbar region to the neck (paravertebral areas are carefully massaged using segmental and acupressure).
Preparatory massage (rubbing, stroking, shallow massaging of problematic muscle areas).
Massage that projects the weak painful sensations to areas of the body remote from the source of pain.
Stroking completes the back muscle massage procedure. This is followed by treatment of the muscles of the legs and buttocks.

Upper shoulder massage

Next stage. Upper massage shoulder girdle, thoracic and abdominal muscles. When massaging the chest muscles, techniques to activate breathing help. In the process, you should apply a set of muscle stretching exercises.

In case of cerebral palsy, it is strictly forbidden to use squeezing, chopping, and beating techniques. The duration of the session should be no more than 20 minutes. The average number of massage procedures for cerebral palsy is approximately 2-3 times every six months.

Drug treatment

Drug treatment of cerebral palsy in adults allows to maintain and restore motor and sensory functions. It is impossible to completely defeat the disease with medications, but you can make the patient’s life normal and joyful for him. Applicable drug treatment often with severe damage to the brain structure.

To treat seizures in adults with cerebral palsy, two types of drugs are used. Various anticonvulsants are used to control seizures. They differ in the mechanism of action on the human body.

Benzodiazepines are used only in extreme cases to stop the patient's frequent seizures. They act on intracellular processes in human brain.

What do doctors prescribe?

"Diazepam." This drug is used against frequent seizures. The dosage is prescribed by the attending physician, based on the EEG result and the type of seizure. There is no general remedy for all types of seizures. Sometimes doctors have to prescribe complex drug therapy.

For a relaxant, Lioresal and Diazepam are used. Together they are able to block signals from the brain aimed at muscle contraction.

The drug "Dantrolene" is used to improve control over muscle contractions. These medications help reduce muscle tone during the treatment period.

To ensure long-term results, you need to use physiotherapy. The drugs also have side effects. They can cause drowsiness and an allergic rash in an adult.

Doctors also prescribe a dehydrating drug for sick adults. It is aimed at increasing diuresis and reducing liquor products. Patients with cerebral palsy also need to take medications aimed at improving blood circulation in the brain. Such medications can improve blood quality. These drugs include Emoxipin.