The term infantile cerebral palsy is usually used to refer to a group of symptom complexes that are manifested by disorders in the motor sphere. These disorders result from damage to the central nervous system. Cerebral Palsy may occur in mild, subtle form or have a severe course requiring continuous treatment.
cerebral palsy refers to diseases of the nervous system and according to the ICD 10 the disease is assigned code G80, there are also subparagraphs indicating the form of paralysis. Cerebral Palsy refers to non-progressive diseases of the nervous system, but in the absence of treatment, the child will lag behind in development both mentally and physically from his peers.
Causes of cerebral palsy
According to statistics, 6 to 12 children per thousand newborns are born with the diagnosis of cerebral palsy and many think that this disease is inherited, but the direct cause of cerebral palsy in the fetus is pathological disruption of brain structures leading to this state of insufficientoxygen supply. The risk of developing cerebral palsy increases due to the following provoking factors:
- Infectious diseases of the mother throughout the entire pregnancy, primarily the herpes virus, cytomegalovirus, toxoplasmosis.
- Misalignment of the brain regions during intrauterine development of the fetus.
- Incompatibility of blood of mother and child - rhesus - a conflict leading to hemolytic disease of newborns.
- Chronic hypoxia of the fetus during pregnancy and delivery itself.
- Endocrinological and acute physical illnesses of the mother .
- Heavy births , prolonged labor activity, traumas of the child, obtained during passage through the birth canal.
- In the early perinatal period, cerebral palsy can be caused by toxic damage to the body by heavy poisons, infectious diseases, which seize the parts and cortex of the brain.
A large role in the development of cerebral palsy is attributed to the oxygen starvation of the brain, which occurs when the fetus is in a wrong position in the uterus, prolonged labor, cervical cord embryos. The majority of children reveal the influence of several factors at once, one of which is considered the leading one, while others increase its negative impact.
Forms of cerebral palsy and their characteristics
The severity of motor disorders in children with cerebral palsy may be completely different and therefore the disease is divided into forms.
- The hyperkinetic form of is exhibited in the event that the baby has a change in muscle tone, on different days it may be elevated, normal or decreased. Ordinary movements are awkward, sweeping, involuntary movements of limbs, hyperkinesis of facial muscles are observed. Violations in the motor sphere are often accompanied by pathologies of speech and hearing, while the mental activity of such children is at an average level.
- The atonic-astatic form of develops predominantly in the defeat of the cerebellum and frontal lobes. Characterized by extremely low muscle tone, which prevents the child from holding in a vertical position. Mental development proceeds with a slight delay, but in some cases, oligophrenia is determined in children.
- Spastic diplegia is the most common form. The functions of the muscles are broken on both sides, with the lower limbs more affected. In children from an early age, the formation of contractures is formed, the deformation of many joints and the spine is revealed. Mental and speech development is delayed, often strabismus, speech pathologies, a child with a given form becomes socially adapted with appropriate rehabilitation measures. Spasmodic tetraparesis ( tetraplegia) is one of the most severe forms of cerebral palsy, the disease is caused by significant anomalies in the defeat of most parts of the brain. Paresis is observed in all the limbs, neck muscles can be constantly relaxed, in such children, mental development is often below average. Almost half of the cases of tetraparesis are accompanied by epileptic seizures. Children with this form can rarely move independently, understanding the world around them is difficult due to problems with speech and hearing.
- The ataxic form of is rare, with its development there are violations in the coordination of all movements and keeping the balance. The child often has a tremor of the hands, because of what can not perform the usual actions. The delay in the development of mental activity in most cases is moderate.
- The spastic-hyperkinetic form ( dyskinetic form) reveals a combination of involuntary movements, increased muscle tone and paresis with paralysis. Mental development at an appropriate age level, such children successfully complete not only the school, but also the institutions.
- Right-sided hemiparesis refers to a hemiplegic form in which one side of the hemisphere is affected. Increased muscle tone of the limbs on the one hand, develops paresis and contracture. The muscles of the hand suffer most, the involuntary movements of the upper limb are noted. With this form, there may be symptomatic epilepsy, mental development disorders.
Signs and symptoms
Symptoms of muscle pathologies in cerebral palsy depend on the area and degree of brain damage.
The main symptoms are as follows:
- Strain of different muscle groups.
- With spastic involuntary contractions of the muscles in the limbs and in the entire body.
- Pathological disorders in walking.
- Restriction of general mobility.
In addition to these signs in children, pathology of visual, auditory and speech function, mental and mental disorders are revealed. Signs of the disease depend on the age of the baby. Cerebral palsy does not progress, as the lesion is punctual and, as the child grows up, new areas of the nervous tissue are not captured.
Consider the signs of infantile cerebral palsy:
- Newborns with cerebral palsy can pay attention to the fact that the baby moves only the limbs of one side of the body, the opposite ones are usually pressed to the body. A newborn child with infantile cerebral palsy when trying to get a clenched fist in his mouth turns his head in the opposite direction. Also, there are difficulties in trying to push the legs apart or turn the baby's head.
- One month .In one month, you can pay attention to the fact that the baby still does not smile, can not hold even the head for a few seconds, there is no focusing of the look at a certain object. The kid is restless, the sucking and swallowing reflex is often difficult, often there are convulsions and involuntary jerks.
- 3 months .In children with cerebral palsy in three months, the absolute reflexes can be preserved, that is, those that are at birth, but normally should disappear by three months. This is a stepping motion, when the kid, leaning on the legs, is able to take several steps. Also palmar reflex - when you press your fingers on the palm of your hand, the child involuntarily opens his mouth. In three months, the baby also tries to turn over under normal development, and in the prone position holds the head firmly.
- 4 months .The kid at 4 months should already consciously react to his mother, pronounce the sounds, smile, actively move the handles and legs, take the toy and consider the nearby objects. The child with cerebral palsy will be sluggish, with crying, can arch the body with an arc, objects take only with one hand.
- 6 months .In half a year of their lives, most babies say individual syllables, can turn over themselves, hold a head well, swallow with a spoon or mugs, try to crawl. The child reacts differently to mother and relatives. On the presence of any violations says not only hypertension of the muscles, but also their weakness, the constant worry of the baby, bad sleep.
- 9 months .At 9 months, a child with cerebral palsy does not show interest in walking, does not sit well, falls on his side, is unable to hold objects for a long time. At normal development at this age the kid already should rise, move on a bed or with support of adults on a room. The child is already recognizing favorite toys, trying to name them, uttering individual sounds or syllables.
Of course, not all signs of developmental delay are symptoms of infantile cerebral palsy. But parents should remember that it depends on them how the child will live in the future life - according to statistical data, more than half of the children diagnosed and treated with cerebral palsy in the first year of life in the future only a few violations differ from their peers.
Diagnosis
When diagnosing a doctor, you need not only to examine the child and perform a number of diagnostic procedures, but you also need to find out how pregnancy and childbirth took place. Cerebral Palsy should be differentiated from other diseases, often if there is a worsening of the already mastered skills, this indicates quite different pathologies. During the examination they rely on MRI data, computed tomography.
During pregnancy, it is possible to detect abnormalities of brain development with ultrasound, but to state that the child will have cerebral palsy because of cerebral palsy. According to the revealed violations, one can only assume the appearance of developmental delay in the baby after birth and, on the basis of this, conduct an appropriate examination. Caution should also be the presence of herpes and cytomegalovirus infection.
Treatment of
It is necessary to be treated immediately after the diagnosis is established and it is best if the whole complex of therapeutic measures is implemented in the first year of life. Nerve cells of the child in the first year of life can be fully restored, in the older age only rehabilitation and adaptation of the child to public life are possible.
LFK with cerebral palsy
A special group of physical exercises is necessary for the child every day. Under the influence of training, muscular contractures decrease, the stability of the psychoemotional sphere is formed, the muscular corset is strengthened.
The child from the prone position should be encouraged to rely on a firm support with the feet.
From the prone position on the abdomen, you need to pull the baby by the handles upwards, making springy movements in all directions.
The child on his knees, the mother should stand behind and fix the legs of the baby, try to make sure that he moved forward.
Complexes of exercises need to be selected conscientiously with the doctor, their effectiveness depends largely on the insistence of the parents.
The video shows a set of exercise exercises for children with cerebral palsy:
Massage
Massage in cerebral palsy is not recommended to begin earlier than one and a half months and should be performed only by a specialist. Incorrect choice of massage techniques can lead to an increase in muscle tone. Correctly conducted by the course massages allow to facilitate the restoration of functions, have a general strengthening and health-improving effect.
Medical treatment
From drugs prescribe neuroprotectors - Cortesin, Actovegin, muscle relaxants. Vitamin complexes and preparations improving metabolic processes in the body are widely used. In some cases, sedation is prescribed.
Botulinum toxin preparations are administered locally in muscles with increased tone to children with spastic disorders. Toxins relax the muscles and expand the range of their movement. The drugs are active for three months and then they need to be re-injected. Use botulinum toxins is recommended for the treatment of those children who have a limited group of disorders. To botulinum toxins are Botox, Dysport
Logopedic work with cerebral palsy
Lesson with a speech therapist for children with cerebral palsy is very important. Correct statement of speech is the key to his further successful learning and communication with peers. Classes are selected based on the form of speech impairment in cerebral palsy.
Operations with cerebral palsy
Surgical intervention in cerebral palsy is carried out for older children in the absence of the effect of the therapy. Operative interventions are most often aimed at treating contractures, which helps the child become more active in movement.
Tapping
Tapping is the fixation for a few days on a specific area of the body of a special plaster. Its purpose is to reduce pain and increase the mobility of the affected area of the body. With the help of kinesiotheypes, the directions of movements are corrected, blood circulation is improved, muscle endurance is increased.
New and non-standard methods of treatment
With each year, new methods of treatment of infantile cerebral palsy appear, some of them are really effective, others only help a limited number of patients.
Osteopathy
This is a manual effect on various parts of the body in order to restore motor disorders. Osteopathy improves blood circulation in the brain, restores the natural connections between the nerve endings and the muscles regulated with their help.
Treatment with stem cells.
Transplantation of stem cells into the child's body allows to stimulate the restoration of the nervous tissue and thus begin to function in the normal mode of the damaged parts of the brain. The introduction of stem cells is effective, even if such treatment is started only in adolescence.
Hippotherapy
Medical horse riding.ЛВЕ helps to strengthen physical activity of the child, promotes restoration of motor functions, forms new skills. Communication with horses is also useful for the psychoemotional state of a child - babies with cerebral palsy who have undergone a course of hypothermia become much calmer, less worried about their condition, learn to adapt in society.
Achilloplasty
Focuses on reducing muscle contractures. After the operation, the volume of movements is expanded, surgical intervention is performed no earlier than 4-5 years.
Equipment for children with cerebral palsy
Depending on the degree of impairment of motor functions, children with cerebral palsy need special adaptations that help them move around and restore impaired functions.
- strollers are necessary for children who can not move by themselves. Special wheelchairs for the house and walks are designed, modern models have an electric drive, which ensures the convenience of their use. The PLIKO stroller refers to walking, it is light in weight and also just folds. The stroller is designed taking into account the normal physiological position of the child with cerebral palsy. The "Lisa" stroller, thanks to its design features, can also be used for teenage children.
- walkers are required if the child walks, but can not keep his balance. With the help of walkers, children not only learn to walk, but also learn to coordinate their movements.
- Simulators - for this group can be attributed any device that helps a child develop their activity and learn certain skills.
- Bicycles with cerebral palsy of three-wheeled design and with a rudder not connected to the pedals. The bike should have a mount for the body, shins and hands, a pushing handle is required. Fastening on the pedals of the legs allows you to develop movements in the legs, strengthens the muscles.
- Exercise bikes strengthen the muscles of the legs, contribute to the consolidation of motor skills, form endurance. Classes on the exercise bike helps and strengthen the immunity of
- Ipotrenazhery - devices that simulate all the movements of a horse during its walking or running. That is, on the hippotherapy the child's body swings back, forward and sideways. Ipotrenazhery allow you to strengthen the muscles of the back, form a beautiful posture, improve flexibility in the joints.
- Costumes for treatment of cerebral palsy are designed as space suits, that is, the body in them is in weightlessness. The material used for the costume helps to tighten the body and simultaneously relax the muscles, which allows the child to take the first steps. Pneumatic chambers in a suit inflate and stimulate the work of different muscle groups, transferring impulses from them to the cerebral cortex.
- Orthopedic shoes and orthoses are necessary to suppress hyperkinesis and develop contractures. Fixed in the right position, the limbs learn to function properly and at the same time reduce the risk of deformity of the skeleton. Shoes and orthoses for each child are selected individually.
- Verticalizers and platforms .Verticalizer is a special device that allows the child to keep the body in a vertical position without outside help. The verticalizer has fixators for the back, feet, knee joints. Verticalizers allow to establish the correct work of internal organs, promote mental development and adaptation.
Rehabilitation
Rehabilitation for cerebral palsy is necessary for better physical activity of the child, his adaptation in the social sphere, for mastering all necessary skills. Activities that contribute to rehabilitation are selected based on the age of the baby, the degree of disruption of his motor activity, hypotension or hypertonic muscle.
- The method of Lashutovoy is based on the restoration of respiratory breathing and on the conduct of various movements, which removes the internal tension, increases the elasticity of muscles and joints.
- The Vojta method is based on activating the brain by performing reflex movements. Classes are conducted jointly with parents, their task is to perform up to 4 times a day with the child the proposed exercises. The aim of the technique is to consolidate every movement, from simple to complex.
Rehabilitation centers and specialized sanatoriums
It is best to begin treatment of a child with cerebral palsy by visiting specialized centers where they will not only correctly diagnose, but will also conduct rehabilitation activities. Such centers are enough today both in our country and abroad.
In Russia
In Moscow - GAU "MSPT Rehabilitation of the disabled with cerebral palsy" - tel.(499) 179-14-99.The center's services include the implementation of rehabilitation measures on domestic technologies. Center "Preodolenie" is engaged in physical, medicamental and social rehabilitation of adolescents, from the age of 14, you can get advice by phone.+7( 495) 789-49-09.
In St. Petersburg - Center for Complex Rehabilitation and Development of Children ул.Opochinina, 6, tel.+7( 812) 939-26-56."Dynamics" - school-center № 616, rehabilitation of disabled children with cerebral palsy, Kurlyandskaya ul., D. 29A, +7( 812) 251-12-91.
In Samara - Samara therapeutic complex "Reacenter" 443052, Zavodskoye sh., 31, tel.(846) 205-03-43.
In Ryazan, is the GKUZ Ryazan Center for Rehabilitation and Rehabilitation for Children with Organic Nervous System Damage and Children's Cerebral Palsy. Ryazan, Uritsky, d.7k.1, 8-( 4912) 44-36-46.
Novosibirsk - Novosibirsk Research Institute of Traumatology and Orthopedics, ul. Frunze, 17, tel.8( 383) 363-31-31, 8( 383) 363-32-46.
In Anapa - branch of MC CORTEX, tel.+7( 86133) 2-45-48, +7( 928) 206-25-26.Sanatorium "Anapa" of the Krasnodar Territory. Tel.8( 86133) 5-68-52, 5-67-31, 5-63-75, 5-65-81.
In Kazan - Alan Klinik, tel.843-555-6-333.
in Tyumen - Regional rehabilitation center for children and adolescents with disabilities "Rodnik", tel.8( 3452) 77-21-17, 8( 3452) 77-20-48
In Evpatoria - Evpatoria Children's Clinical Sanatorium( EDKS), tel.+3( 06569) 3-05-64,( 06569) 3-14-00.
Abroad
In China, is the Heilongjiang University of Chinese Medicine. In Harbin the center of the "Datun" CCP, the state military hospital - tel.8( 1086) -1524-2626-706.
In Germany is the rehabilitation center "IMC Kliniken Koln GmbH", tel.+49( 228) 377-36-90.
In the Czech Republic mainly children with cerebral palsy are treated in the resort of Toplitsa. You can find out all information by phone.8-10-420 775 034 589.
In Israel - Hadassa Clinic, tel.+7 499 299 3698.