Cerebral palsy (infantile cerebral palsy) is the name of a whole group of neurological disorders that occur as a result of damage to brain structures in a child during pregnancy and in the first weeks of life. An obligatory clinical component is movement disorders, in addition to which there are often speech and mental disorders, epileptic seizures and violations of the emotional-volitional sphere. Cerebral palsy is not progressive in nature, however, its symptoms often remain with a person for life and become the cause of disability. From this article you will learn about the causes, clinical manifestations and methods of treatment of cerebral palsy.
In cerebral palsy, there is always a structural and morphological lesion of the brain, that is, a clear anatomical basis clinical symptoms. Such a zone arises as a result of the action of any causative factor and does not extend to other parts of the brain (therefore, in the case of cerebral palsy, they speak of a non-progressive nature of the course). Since a certain function is assigned to each area of the brain, this function is lost in cerebral palsy.
Despite modern achievements in the field of medicine, the prevalence of cerebral palsy continues to be high at 1.5-5.9 per 1000 newborns. The frequency of cerebral palsy among boys is slightly higher than among girls. The ratio is 1.33:1.
Causes of cerebral palsy
At the heart of any case of cerebral palsy is the pathology of neurons, when they have structural disorders that are incompatible with normal functioning.
Cerebral palsy can be caused by the action of adverse factors in a variety of periods of brain formation - from the very first day of pregnancy, during all 38-40 weeks of pregnancy and the first weeks of life, when the child's brain is very vulnerable. According to statistics, in 80% of cases, the cause acted in the prenatal period and in childbirth, the remaining 20% occur in the period after childbirth.
So what can cause cerebral palsy? The most common reasons are:
- violation of the development of brain structures (as a result of genetic disorders transmitted from generation to generation, spontaneous gene mutations);
- lack of oxygen (cerebral hypoxia): acute (asphyxia during childbirth, premature detachment of the placenta, rapid delivery, cord entanglement) or chronic (insufficient blood flow in the vessels of the placenta due to placental insufficiency);
- transferred in utero and in the first months of life infectious diseases(intrauterine infections, especially the TORCH group, meningoencephalitis, arachnoiditis);
- toxic effects on the child (alcohol, smoking, drugs, potent medicines, occupational hazards, radiation);
- mechanical injuries (intracranial trauma during childbirth);
- maternal and fetal incompatibility various reasons(Rhesus conflict, conflict in blood type with the development of hemolytic disease);
- chronic diseases of the mother (diabetes mellitus, bronchial asthma, heart defects).
Babies born prematurely are at particular risk. Among them, the prevalence of cerebral palsy is significantly higher compared with full-term children. Also, the risk is higher in children with birth weight less than 2000, in children from multiple pregnancies (twins, triplets).
None of the above reasons is 100% it as such. This means that, for example, the presence of diabetes in a pregnant woman or the flu will not necessarily lead to the development of cerebral palsy in a child. The risk of having a child with cerebral palsy in this case is higher than in healthy woman, but no more than that. Of course, a combination of several factors significantly increases the risk of pathology. In each individual case with cerebral palsy, it is rarely possible to catch the presence of only one significant reason, more often several factors are found in the anamnesis.
Based on the main causes of cerebral palsy, the following prevention of this condition is recommended: planning pregnancy with the rehabilitation of chronic foci of infection, competent management of pregnancy with a thorough and timely examination, and, if necessary, treatment, individual tactics for childbirth. These factors are the most effective measures prevention of cerebral palsy.
Symptoms
Children with cerebral palsy are characterized by a delay in motor development. Symptoms of cerebral palsy are mainly movement disorders. Moreover, the type of such violations and severity vary depending on the age of the child. In this regard, it is customary to distinguish the following stages of the disease:
- early - up to 5 months of life;
- initial residual - from 6 months to 3 years;
- late residual - after 3 years.
IN early stage the diagnosis is rarely made because there are very few motor skills as such at this age. But, nevertheless, there are certain signs that may be the first symptoms:
- delay in motor development: there are average terms for the appearance of certain skills (the ability to hold the head, roll over from the stomach to the back, purposefully reach for a toy, sit, crawl, walk). The absence of these skills in the appropriate time period should alert the doctor;
- children have unconditioned reflexes, which fade away at a certain age. The existence of these reflexes after reaching this age is a sign of pathology. For example, a grasping reflex (pressing a child's palm with a finger causes the capture of this finger, squeezing the palm) normally does not occur after 4-5 months. If it is nevertheless detected, this is an occasion for a more thorough examination;
- violation of muscle tone: increased or decreased tone can be determined by a neurologist during examination. The result of changes in muscle tone may be excessive, aimless, sudden or slow, worm-like movements in the limbs;
- the predominant use of one limb for the implementation of actions. For example, a normal child reaches for a toy with both hands with the same zeal. Moreover, this does not depend on whether the child will be right-handed or left-handed in the future. If he constantly uses only one hand, this should be alarming.
Children who, during a routine examination by a doctor, have revealed any even minor violations, must be examined every 2-3 weeks. During repeated examinations, attention is paid to the dynamics of the identified changes (whether the violations persist, increase or decrease), whether all motor skills are formed with a delay, or the delay in one of them was a variant of individual development.
Most of the symptoms of cerebral palsy appear in the initial residual period i.e. after six months of life. These symptoms include disturbances in movement and muscle tone, speech, mental development, hearing and vision, swallowing, urination and defecation, the formation of contractures and skeletal deformities, convulsions. Which symptoms come to the fore depends on clinical form diseases. Let's get acquainted with the existing clinical forms of cerebral palsy.
There are 4 forms in total:
- spastic (spastic diplegia, spastic tetraplegia (double hemiplegia), hemiplegia);
- dyskinetic (hyperkinetic);
- ataxic (atonic-astatic);
- mixed.
spastic form
This is the most common form. The main signs are a violation of muscle strength and tone in the limbs. Depending on the number of limbs involved, it is divided into several subtypes.
Spastic diplegia (Little's disease)- characterized by the defeat of all four limbs, with the greatest severity of the process in the legs, mental, mental and speech disorders. Most clearly, the symptoms declare themselves by the end of the first year of life. Muscle tone is increased in all limbs, but more in the legs (mainly in the flexors of the arms and extensors of the legs). This leads to restriction of movements, to the formation of a forced position of the limbs. When trying to stand up, the legs do not rest with the whole foot on the surface, but stand on their toes, sometimes crossing. Constant muscle tension over time leads to the formation of contractures, as a result of which the joints change their configuration. This makes it even more difficult voluntary movements. The calcaneal tendon is shortened, the feet are deformed.
Tendon reflexes increase, pathological foot and hand signs (Babinsky, Gordon, Zhukovsky and others) are revealed.
Perhaps the appearance of involuntary movements (hyperkinesis) in the limbs, and more often they develop in the muscles of the face and hands. Sometimes this causes a negative reaction from others, because, for example, hyperkinesis in the face can look like grimacing, teasing. Hyperkinesis is aggravated by excitement, decreases during sleep.
Speech disorders are expressed in blurring, fuzziness, speech therapy defects. Moreover, with age, without appropriate treatment, this does not go away.
Mental and mental problems are manifested by impaired concentration, poor memory, emotional instability. Usually mental disorders are not pronounced. Therefore, with good functioning of the upper limbs, such people are fully adapted in society, acquire a profession and serve themselves.
Spastic tetraplegia or double hemiplegia characterized by a uniform lesion of all four limbs or a more pronounced violation of movements in the hands. This is the most severe form of cerebral palsy, because, as a rule, it is accompanied by severe mental, mental, speech disorders, convulsive syndrome. Mental disorders reach the degree of oligophrenia, speech can generally take the form of inarticulate lowing. Along with this, visual impairment is observed due to atrophy of the optic nerves (which cannot be corrected by wearing glasses or lenses), strabismus, and hearing impairment. Symptoms of this form of the disease are noticeable already in the first months of life. Tendon reflexes are very high, many pathological signs from feet and hands. Such children do not know how to sit, let alone walk. Pronounced movement disorders lead to early formation of contractures of many joints, spinal deformities. Patients require constant, lifelong outside care.
hemiplegia means that the patient has muscle weakness on one side - left or right. That is, paresis captures the arm and leg of the same name, and often in the arm it is more pronounced than in the leg. Children with this form learn to sit and walk, master self-care skills, but much later than their peers. From birth, the lag of the affected limbs from healthy ones is noticeable. When the child is already walking, a characteristic posture is striking - the affected arm is bent and pressed to the body (the asking hand), and the leg is straightened and does not bend when moving. In addition to motor disorders in hemiplegia, convulsive seizures, moderate or minor mental impairment are found. If seizures occur frequently, they can cause a significant decrease in intelligence.
Dyskinetic (hyperkinetic) form
It is characterized by the presence of involuntary movements - hyperkinesis. Usually these symptoms appear after a year. Movements can be very diverse: worm-like movements in the fingers, swings and imitation of throws with hands, twisting of the body around its axis, grimacing. Involuntary contraction of the muscles of the larynx can lead to the appearance of uncontrollable sounds and cries. With emotional overstrain, hyperkinesis intensifies, disappears at rest and sleep.
Hyperkinesis is accompanied by a decrease in muscle tone. Periodically there are episodes of a sudden increase in tone, in children of the first months of life this is called dystonic attacks.
There is a delay in the formation of motor skills: holding the head, turning over, sitting, crawling, walking become possible later than among peers. However, such children eventually master the skills of self-care and do not need outside help.
With the dyskinetic form, speech may be impaired. Usually the words are pronounced slowly, not quite clearly, with a violation of articulation.
Intelligence practically does not suffer.
Ataxic form
This form occurs with a predominant lesion of the connections of the cerebellum or frontal lobes. Since birth, muscle tone has been reduced. All motor skills are formed with a significant delay. Violated coordination and accuracy of movements. The gait is staggering, attempts to take something end in a miss and a miss. There may be trembling in the limbs. Sometimes with this form hyperkinesis occurs. Mental abilities may not be disturbed, but may reach varying degrees of oligophrenia.
mixed form
This form is diagnosed in the presence of symptoms characteristic of two or more clinical forms (described above).
Treatment
Classes physical therapy an important component of the treatment of cerebral palsy. Treatment of cerebral palsy is a complex and very long process. The effect depends on the severity of the damage to the nervous system (the clinical form of the disease), the period of diagnosis of the disease, the complexity of the methods of treatment, the perseverance and perseverance of the parents of the sick child.
With cerebral palsy, the main role is given to non-drug methods of treatment, which are based on the establishment of a muscle stereotype, the correct posture by stimulating the remaining intact nerve structures of the brain.
By itself, the state of cerebral palsy is not curable, that is, it is impossible to restore destroyed neurons today. But it is possible to “teach” the remaining intact neurons to function in such a way that a person can live fully in society without feeling his inferiority.
Among all the methods of treatment, the following should be noted:
- massage;
- physiotherapy;
- Voight therapy, Bobath therapy;
- the use of load (training) suits - "Adeli", "Gravistat" and others;
- classes with a speech therapist and psychologist;
- drug treatment;
- operational orthopedic care;
- symptomatic neurosurgical intervention.
You can learn about the methods of massage, the features of its use in cerebral palsy from the article of the same name.
Therapeutic gymnastics is used both independently and in combination with Voight and Bobath therapy. Exercise therapy complexes are developed individually, aimed at relieving muscle tension, teaching coordination and maintaining balance, and eliminating muscle weakness. The condition for achieving the effect is the regularity and systematic training.
Voight and Bobath therapy are also types of therapeutic exercises. At the origins of these techniques lies the stimulation of movements based on existing innate reflexes. That is, learning new motor skills occurs due to the reflexes that this patient has. The goal of therapy is to bring the patient's motor activity as close as possible to the norm, to form a motor stereotype, even if based on pathological reflexes.
The use of training suits "Adeli", "Gravistat" allows you to eliminate vicious positions various parts body, normalize muscle tone by stretching the muscles. With the help of clamps, shock absorbers, special clothing, the limbs and torso are given the correct position of the body, in which the child stays for some time and even performs individual movements. Treatment is carried out in courses, gradually increasing the time spent in the suit.
Classes with a speech therapist and psychologist allow you to correct communication with others, socially adapt the child, expand the scope of his life.
From medications the main attention is paid to the use of drugs that reduce muscle tone - Baclofen, Mydocalm, Sirdalud. For the same purpose, injections of botulinum toxin (Botox, Dysport) into the muscles are used.
It is possible to use drugs that improve brain metabolism and blood circulation, but some doctors are skeptical about such measures, not seeing the results of such treatment.
Operative orthopedic care consists in eliminating deformities of the limbs and joints in order to facilitate movement and self-care. For example, the plastic of the Achilles tendon contributes to the correct supporting position of the foot.
Neurosurgical intervention involves the elimination of pathological impulses in the brain, which underlies spasticity and hyperkinesis. Operations consist either in the destruction of individual brain structures (responsible for the production of "incorrect" signals), or in the implantation of devices that suppress pathological impulses.
A special role in the treatment of cerebral palsy is played by the use accessories(technical means of rehabilitation), which not only make life as easy as possible for the patient, but also carry out muscle training. Such means include wheelchairs, walkers, verticalizers (a device for giving the body a vertical position), bath chairs, toilet chairs, special bicycles and exercise equipment for patients with cerebral palsy, orthoses, splints to give the correct position to the joints and much more.
Most of the methods are used both in special medical institutions for patients with cerebral palsy, and at home. A favorable effect is provided by sanatorium-resort treatment. Special sanatoriums focused on patients with cerebral palsy are equipped with a large number of necessary devices and allow for a complex effect on the pathological process. A combination of physiotherapy techniques with massage, exercise therapy, water procedures has a significant healing effect.
From non-traditional methods treatment in patients with cerebral palsy use animal therapy - treatment with the help of animals. More often, horses and dolphins are used for this purpose.
The effectiveness of stem cell therapy for cerebral palsy has not yet been proven.
Cerebral palsy is a complex of various neurological symptoms, headed by movement disorders. May be accompanied by mental and speech disorders. It can be very difficult, but this is not always a sentence. The complex application of various treatment methods contributes to the formation of motor skills, the patient's adaptation to existence in society, provides an opportunity for learning and acquiring professional skills, and therefore makes life full.
TVC, program “Doctors” on the topic “Infantile cerebral palsy: about symptoms and prevention”
Cerebral palsy (CP) - common medical term, which is used to refer to a group of motor disorders that progress in infants due to trauma to various areas of the brain in the perinatal period. The first symptoms of cerebral palsy can sometimes be detected after the birth of a child. But usually the signs of the disease appear in infants in infancy (up to 1 year).
Etiology
Cerebral palsy in a child progresses due to the fact that certain parts of his central nervous system were damaged directly in the prenatal period of development, during the birth process, or in the first months of his life (usually up to 1 year). In fact, the causes of cerebral palsy are quite diverse. But they all lead to one thing - some areas of the brain begin to function incompletely or completely die.
Causes of cerebral palsy in a child in the prenatal period:
- toxicosis;
- untimely detachment of the "children's place" (placenta);
- risk of miscarriage;
- nephropathy of pregnant women;
- trauma during childbearing;
- fetal hypoxia;
- fetoplacental insufficiency;
- the presence of somatic ailments in the mother of the child;
- rhesus conflict. This pathological condition develops due to the fact that the mother and child have different Rh factors, so her body rejects the fetus;
- ailments of an infectious nature that the expectant mother suffered during the gestation of the fetus. The most potentially dangerous pathologies include,;
- fetal hypoxia.
Causes that provoke cerebral palsy in the process of labor:
- narrow pelvis (injury to the child's head during its passage through the mother's birth canal);
- birth injury;
- violation of labor activity;
- childbirth before the due date;
- large weight of the newborn;
- rapid childbirth - pose the greatest danger to the baby;
- breech presentation of the child.
The reasons for the progression of the disease in the first months of a newborn's life:
- defects in the development of elements of the respiratory system;
- asphyxia of newborns;
- aspiration of amniotic fluid;
- hemolytic disease.
Varieties
There are 5 forms of cerebral palsy, which differ from each other by the zone of brain damage:
- spastic diplegia. This form of cerebral palsy is diagnosed in newborns more often than others. The main reason for its progression is the traumatization of brain areas that are “responsible” for the motor activity of the limbs. A characteristic sign of the development of the disease in a child under one year old is partial or complete paralysis of the legs and arms;
- atonic-astatic form of cerebral palsy. In this case, there is damage to the cerebellum. Signs of cerebral palsy of this type - the patient cannot keep balance, coordination is impaired, muscle atony. All these symptoms appear in a baby under the age of one year;
- hemiparetic form. The “target” areas of the brain are the subcortical and cortical structures of one of the hemispheres responsible for motor activity;
- double hemiplegia. In this case, two hemispheres are affected at once. This form of cerebral palsy is the most severe;
- hyperkinetic form of cerebral palsy. In most clinical situations, it is combined with spastic diplegia. It develops due to damage to the subcortical centers. characteristic symptom hyperkinetic form of cerebral palsy - the commission of involuntary and uncontrolled movements. It is noteworthy that such pathological activity can increase if a child less than a year old or older is worried or tired.
Classification based on the age of the child:
- early form. In this case, the symptoms of cerebral palsy are observed in a newborn in the period from birth to six months;
- initial residual form. The period of its manifestation is from 6 months to 2 years;
- late residual- from 24 months.
Symptoms
Cerebral palsy has many manifestations. The symptoms of the disease directly depend on the degree of damage to the structures of the brain, as well as on the location of the focus in this organ. You can notice the progression of cerebral palsy after birth, but more often it is detected after a couple of months, when it becomes clearly visible that the newborn is lagging behind in development.
Signs of cerebral palsy in a newborn:
- the baby is not at all interested in toys;
- the newborn does not roll over on its own for a long time and does not hold its head;
- if you try to put the baby, then he will not stand on the foot, but only on the toes;
- limb movements are chaotic.
Symptoms of cerebral palsy:
- paresis. Usually only half of the body, but sometimes they spread to the legs and arms. The affected limbs change - they shorten and become thinner. Characteristic deformations of the skeleton in children with cerebral palsy - deformity of the sternum;
- violation of the tone of muscle structures. A sick child has either spastic tension or complete hypotension. If there is hypertonicity, then the limbs take an unnatural position for them. With hypotension, the child is weak, there is a tremor, he can often fall, since the muscle structures of the legs do not support his body;
- pronounced pain syndrome. In children with cerebral palsy, it develops due to various bone deformities. The pain has a clear localization. It most commonly occurs in the shoulders, back, and neck;
- violation of the physiological process of swallowing food. This sign of cerebral palsy can be detected immediately after birth. Babies cannot fully suckle their mother's breasts, and babies do not drink from a bottle. This symptom occurs due to paresis of the muscular structures of the pharynx. It also causes salivation;
- violation of speech function. It occurs due to paresis of the vocal cords, throat, lips. Sometimes these elements are affected simultaneously;
- convulsive syndrome. Seizures occur at any time and at any age;
- chaotic pathological movements. The child makes sudden movements, can grimace, take certain poses, and so on;
- articular contractures;
- significant or moderate decrease in hearing function;
- developmental delay. This symptom of cerebral palsy does not occur in all sick children;
- decreased visual function. Often there is also strabismus;
- malfunction of the digestive tract;
- the patient involuntarily excretes excrement and urine;
- progression of endocrine diseases. Children with such a diagnosis are often diagnosed with dystrophy, growth retardation,.
Complications
Cerebral palsy is a chronic disease, but over time it does not progress. The patient's condition may worsen if secondary pathologies occur, such as hemorrhages, somatic ailments.
Complications of cerebral palsy:
- disability;
- violation of adaptation in society;
- the occurrence of muscle contractures;
- violation of food intake, as the paresis affected the muscles of the pharynx.
Diagnostic measures
The diagnosis of the disease is carried out by a neurologist. The standard diagnostic plan includes the following examination methods:
- careful inspection. A medical specialist evaluates reflexes, visual and hearing acuity, muscle function;
- electroencephalography;
- electroneurography;
- electromyography;
Additionally, the patient can be referred for consultations to narrow specialists:
- speech therapist;
- ophthalmologist;
- psychiatrist;
- epileptologist.
Therapeutic measures
It should be said right away that such a pathology cannot be completely cured. Therefore, the treatment of cerebral palsy is primarily aimed at reducing the manifestation of symptoms. Special rehabilitation complexes provide an opportunity to gradually develop speech, intellectual and motor skills.
Rehabilitation therapy consists of the following activities:
- sessions with a speech therapist. It is necessary for a sick child to normalize speech function;
- exercise therapy. A set of exercises is developed only by a specialist strictly individually for each patient. They must be performed daily in order for them to have the desired effect;
- massage for cerebral palsy is a very effective method of rehabilitation. Doctors resort to segmental, point and classical types. Massage with cerebral palsy should be carried out only by a highly qualified specialist;
- use of technical means. These include crutches, special inserts placed in shoes, walkers, and more.
Physiotherapeutic methods and animal therapy are also actively used in the treatment of cerebral palsy:
- hydrotherapy;
- oxygen barotherapy;
- mud treatment;
- electrical stimulation;
- warming up the body;
- electrophoresis with pharmaceuticals;
- dolphin therapy;
- hippotherapy. This is a modern method of treatment based on the patient's communication with horses.
Medical therapy:
- if a child has epileptic seizures of varying degrees of intensity, then he must be prescribed anticonvulsant drugs to stop the seizures;
- nootropic pharmaceuticals. The main purpose of their appointment is the normalization of blood circulation in the brain;
- muscle relaxants. These pharmaceuticals are prescribed to patients if they have hypertonicity of muscle structures;
- metabolic agents;
- antiparkinsonian drugs;
- antidepressants;
- neuroleptics;
- antispasmodics. These drugs are prescribed to the patient with a strong pain syndrome;
- analgesics;
- tranquilizers.
Medical specialists resort to operable treatment of infantile cerebral palsy only in severe clinical situations, when conservative therapy does not have the desired effect. They resort to the following types of interventions:
- brain surgery. Doctors carry out the destruction of structures that are the cause of the progression of neurological disorders;
- spinal rhizotomy. Doctors resort to this operable intervention in case of severe muscle hypertonicity and severe pain syndrome. Its essence lies in the interruption of pathological impulses that come from the spinal cord;
- tenotomy. The essence of the operation is to create a support position for the affected limb. It is prescribed if the patient develops contractures;
- sometimes specialists perform tendon or bone grafts to stabilize the skeleton a little.
CEREBRAL PALSY.
The term cerebral palsy combines a number of syndromes that occur in connection with brain damage.
Cerebral palsy occurs as a result of an organic lesion, underdevelopment or damage to the brain in early ontogenesis (intrauterine development, the moment of childbirth or the early postnatal period). At the same time, phylogenetically “young” parts of the brain and the cerebral cortex are especially affected. Cerebral palsy can manifest itself as a whole complex of motor, mental and speech disorders, combined with disorders of vision, hearing, and various types of sensitivity. The main clinical syndrome of cerebral palsy is movement disorders.
The severity of movement disorders can vary from minimal to very gross, severe.
The first clinical description of cerebral palsy was made by V. LITTLE in 1853. For almost 100 years, cerebral palsy was called LITTLE's disease. The term cerebral palsy was coined by Sigmund Freud in 1893. Since 1958, this term has been officially adopted by the WHO (World Health Organization).
The WHO approved the following definition: “Cerebral palsy is a non-progressive disease of the brain that affects its departments that control movements and body position, the disease is acquired in the early stages of brain development”
Currently, cerebral palsy is considered as a disease resulting from brain damage suffered in the prenatal period or during the period of the incomplete formation of the main brain structures, which causes a complex combined structure of neurological and mental disorders.
Etiology and pathogenesis of cerebral palsy.
The causes of cerebral palsy are varied. It is customary to single out:
prenatal (before the birth of the child, during the mother's pregnancy)
natal (during childbirth)
postnatal (after the birth of a child).
Most often, the causes are prenatal from 37% to 60% of cases.
Natal from 27% to 40% of cases.
Postnatal - from 3 to 25%.
prenatal factors.
The state of health of the mother (somatic, endocrine, infectious diseases of the mother), for example, diseases of the cardiovascular system in the mother, cause oxygen deficiency in the fetus in 45% of cases.
mother's bad habits;
taking various medications by a pregnant woman.
deviations and complications of the course of pregnancy;
The risk factor is the small weight of the fetus, early delivery, incorrect position of the fetus. It was found that a high percentage of children with cerebral palsy had low birth weight. The genetic factor is important, i.e. inheritance of congenital pathology of development.
natal factors.
Asphyxia in childbirth, birth trauma. Asphyxia during childbirth leads to the expansion of the vessels of the brain of the fetus, the occurrence of hemorrhages. Birth trauma is associated with mechanical damage or compression of the baby's head during childbirth.
postnatal factors.
Occur in the early stages of a child's life, even before the motor system is formed.
Skull injuries, neuroinfections (meningitis, encephalitis), drug intoxication (some antibiotics, etc.). Injury due to suffocation or drowning. Brain tumors, hydrocephalus.
In some cases, the etiology remains unclear, unknown.
The pathogenesis of cerebral palsy.
Cerebral palsy is a consequence of changes in brain cells or brain development disorders. Pathological changes in the brain in children with cerebral palsy can be established using computed tomography.
CLINICAL FORMS of cerebral palsy.
Currently, there are more than 20 different classifications of cerebral palsy. In domestic practice, the classification of SEMENOVA K.A. is most often used.
According to this classification, there are five main forms of cerebral palsy:
DOUBLE HEMIPLEGIA;
SPASTIC DIPLEGIA;
HEMIPARETIC FORM
HYPERKINETIC FORM
ATONIC - ASTATIC FORM
In practice, mixed forms of cerebral palsy are distinguished.
DOUBLE HEMIPLEGIA.
The most severe form of cerebral palsy. Occurs as a result of significant brain damage at the stage prenatal development. There is a pseudobulbar syndrome.
The term hemiparesis or hemiplegia means that one half of the body is affected (face, arm, leg on one side).
Clinical manifestations: Rigidity of the muscles (Rigidity - inflexibility, inflexibility, numbness due to muscle tension).
Tonic reflexes that have persisted for many years. Voluntary motor skills are absent or poorly developed. Children do not sit, do not stand, do not walk. Gross speech disorders, severe dysarthria up to anartria. Most children have severe mental retardation, which hinders the development of the child and aggravates the condition.
The absence of an inhibitory effect of the higher parts of the nervous system on the reflex mechanisms of the brain stem or spinal cord contributes to the release of primitive reflexes, as a result, muscle tone changes, and pathological postures appear. There is a delay or impossibility of the gradual development of chain setting reflexes, which normally contribute to the fact that the child gradually learns to raise and hold his head, sit, stand, then walk.
SPASTIC DIPLEGIA.
Known as LITTLE's disease or syndrome. The most common form of cerebral palsy. Spastic diplegia is characterized by tetraparesis when the arms and legs of both sides of the body are affected. The legs are more affected than the arms. The main clinical symptom is increased muscle tone, spasticity. There is a crossing of the legs during support. Limbs can freeze in the wrong position. In 70 - 80% of children, pronounced speech disorders in the form of spastic - paretic (pseudobulbar) dysarthria, sometimes motor alalia, delay speech development. Early speech therapy significantly improves the state of speech. Psychiatric disorders manifest as a delay mental development, which can be compensated with a corrective action. Children can study in special boarding schools for children with disorders of the musculoskeletal system or in general education schools. Some of the children have mental retardation, in which case they study according to the program of the VIII type school. This form of cerebral palsy is prognostically more favorable than double hemiplegia. 20 - 25% of children begin to sit, walk, but with a significant delay (by 2 - 3 years). The rest learn to move around using crutches or in a wheelchair. The child can learn to write, perform some self-service functions.
HEMIPARETIC FORM of cerebral palsy.
This form is characterized by damage to the limb (arm and leg) on one side of the body. The arm is usually more affected than the leg. Right-sided hemiparesis associated with damage to the left hemisphere is observed more often than left-sided. Children acquire motor skills later than healthy children. Already in the first year of life, limitation of movements in the affected limbs is revealed, the child begins to sit on time or with a slight delay, but the posture is asymmetrical, with a bias in one direction. The child learns to walk by giving a healthy hand. Over time, a persistent pathological posture is formed. Adduction of the shoulder, flexion of the arm and hand, scoliosis of the spine. The child brings forward a healthy part of the body. The affected limbs are retarded in growth, shortening of the affected limbs occurs.
There are speech disorders in the form of motor alalia, dysgraphia, dyslexia, and counting disorders. Children have spastic-paretic (pseudobulbar) dysarthria.
Intellectual disabilities range from mild mental retardation to mental retardation.
The prognosis of motor development is favorable, children walk independently, master self-service skills.
HYPERKINETIC FORM of cerebral palsy.
Associated with damage to the subcortical regions of the brain. The cause of this form of cerebral palsy may be the incompatibility of the blood of the mother and fetus according to Rh factor or hemorrhages in the region of the caudate body as a result of birth trauma. Motor disorders are manifested in the form of involuntary violent movements - hyperkinesis. The first hyperkinesias appear at 4-6 months more often in the muscles of the tongue, then by 10-18 months in other parts of the body. During the neonatal period, there is a reduced muscle tone, hypotension and dystonia. Hyperkinesis occurs involuntarily, intensifies with movement and excitement, with an attempt to move. At rest, hyperkinesis decreases and disappears during sleep.
In the hyperkinetic form, voluntary motor skills develop with great difficulty. Children can not learn to sit, stand, walk on their own for a long time. They begin to move independently only by 4-7 years. The gait is jerky, asymmetrical. Walking balance is easily disturbed, but standing is harder than walking. Difficulty automating motor skills, writing. Speech disorders in the form of hyperkinetic dysarthria (extrapyramidal, subcortical). Mental and intellectual disorders are manifested to a lesser extent than in other forms of cerebral palsy. Most children learn to walk independently, but voluntary movements, especially fine motor skills, are largely impaired. Children are educated either in a special school for children with NOD or in a public school. They can later study at a technical school or university. An insignificant part of the children study according to the program of the auxiliary school.
ATONIC - ASTATIC FORM of cerebral palsy.
With this form of cerebral palsy, there is damage to the cerebellum, sometimes combined with damage to the frontal parts of the brain. There is a low muscle tone, imbalance of the body at rest and when walking, imbalance and coordination of movements, tremor, hypermetry (excessive movements).
In the first year of life, hypotension, delayed psychomotor development are detected, i.e. the functions of sitting, standing, walking do not develop. The child finds it difficult to grasp and play with objects, toys. The child learns to sit by the age of 1-2, stand and walk by the age of 6-8. The child stands and walks with his legs wide apart, his gait is unsteady, his arms are spread out to the sides, he makes many excessive, rocking movements. Hand tremor and coordination disorder of fine movements make it difficult to master the skills of writing, drawing, self-service. Speech disorders in the form of delayed speech development, cerebellar dysarthria, alalia. There may be intellectual impairment of varying severity in 55% of cases. Learning is difficult.
MIXED FORM of cerebral palsy.
With this form, there are combinations of various clinical manifestations characteristic of the above listed forms: SPASTICO - HYPERKINETIC, HYPERKINETIC - CEREBELLAR, etc.
According to the severity of motor disorders, there are three degrees of severity of cerebral palsy.
Easy - a physical defect allows you to move around, have self-service skills.
Medium - children need the help of others.
Severe - children are entirely dependent on others.
cerebral palsy () - a disease, disturbing in the work of the motor system, which arise as a result of damage to areas of the brain or their incomplete development.
Back in 1860, Dr. William Little took up the description of this disease, which was called Little's disease. Even then, it was revealed that the cause is oxygen starvation fetus at the time of birth.
Later, in 1897, the psychiatrist Sigmund Freud suggested that the source of the problem could be a violation of the development of the brain of a child in the womb. Freud's idea was not supported.
And only in 1980 it was found that only in 10% of cases of cerebral palsy occurs due to birth injuries. Since that moment, experts began to pay closer attention to the causes of brain damage and, as a result, the appearance of cerebral palsy.
Provoking intrauterine factors
Currently, more than 400 causes of cerebral palsy are known. The causes of the disease are correlated with the period of gestation, childbirth and in the first four weeks after (in some cases, the period of the possibility of manifestation of the disease is extended to the age of three years).
It is very important how the pregnancy progresses. According to studies, it is during fetal development that in most cases violations of the fetal brain activity are observed.
The key reasons that can cause dysfunction in the work of the developing child's brain, and the occurrence of cerebral palsy during pregnancy:
Postnatal factors
In the postpartum period, the risk of occurrence decreases. But he also exists. If the fetus was born with a very low body weight, then this can pose a danger to the health of the child - especially if the weight is up to 1 kg.
Twins and triplets are more at risk. In situations where the child is early age receives, this is fraught with unpleasant consequences.
These factors are not the only ones. Experts do not hide the fact that in every third case it is not possible to identify the cause of cerebral palsy. Therefore, the main points that you should pay attention to first of all were listed.
A curious observation is the fact that boys are 1.3 times more likely to be affected by this disease. And in males, the course of the disease manifests itself in a more severe form than in girls.
Scientific research
There is evidence that particular importance in considering the risk of occurrence should be given to the genetic issue.
Norwegian doctors from the field of pediatrics and neurology conducted a major study, as a result of which they revealed a close relationship between the development of cerebral palsy and genetics.
According to the observations of qualified specialists, if parents already have a child suffering from this disease, then the possibility of having another child in this family with cerebral palsy increases by 9 times.
The research team led by Professor Peter Rosenbaum came to these conclusions as a result of studying data on more than two million Norwegian babies who were born between 1967 and 2002. 3649 babies were diagnosed with cerebral palsy.
Cases with twins were considered, situations with relatives of the first, second and third degree of kinship were analyzed. Based on these criteria, the incidence of cerebral palsy in infants belonging to different categories of kinship was revealed.
As a result, the following data was provided:
- if a twin is ill with cerebral palsy, then the probability of having another twin is 15.6 times higher;
- if sick brother or a sister, then the risk of having another child suffering from cerebral palsy increases 9 times; if single-uterine - 3 times.
- in the presence of cousins and sisters with a diagnosis of cerebral palsy, the risk of the baby having the same problem increases by 1.5 times.
- parents with this disease increase the likelihood of having a child with the same diagnosis by 6.5 times.
It is necessary to know the causes and risk factors for cerebral palsy, since its development can be prevented, 
if prematurely take care of the health of the mother and fetus.
To do this, it is worth not only visiting a doctor regularly, but also observing healthy lifestyle life, avoid injury, viral diseases, use of toxic substances, conduct treatment in advance and do not forget to consult on the safety of the drugs used.
Understanding the importance of precautions is the best prevention infantile cerebral palsy.
