Regulations 

Dysarthria with spastic form of cerebral palsy. Forms of children's cerebral palsy. Atonic-astatic form (at an early age, hypotonic form)

Infantile paralysis of the central nervous system or cerebral palsy is formed against the background of damage to various parts of the brain and causes a disorder of motor functions in a child. Atonic-astatic form of cerebral palsy is one of the most severe types of the disease. Today, doctors do not have effective remedies for the treatment of serious disorders in the functioning of the nursery, but some techniques can reduce negative manifestations. These include medical treatment.

The importance of exercise therapy in cerebral palsy

  1. The child goes down into the pool, takes his hands overboard. The legs are alternately laid back (5 times each). Then leg extensions are made to the sides 10 times.
  2. Turning his back to the side, the baby clings to him with his hands, lifts his legs up and spreads them to the sides. Do this 10 times.
  3. Having laid the patient with his back on the water, it is necessary to let him grab the side. Mom puts her hands behind the baby's back. Starts lifting both legs up (10 times), spreading them to the sides (10 times), crossing the legs (“scissors” 10 times).
  4. Turn the patient over on his stomach, let him hold his hands over the side, and you support him by the stomach. Do alternating leg raises 5 times, then parting to the sides 10 times, and bending at the knees of each limb 5 times.
  5. Having pressed the child with his back to the pool, ask him to take a sitting position. Then he must twist the “bicycle” with his legs in the water.

Additional simulators

To harmonize the intellectual and physical development of children with cerebral palsy, it is necessary to use, which you can buy or do it yourself. The bumpy rug is perfect for therapeutic massage and physical education, it will improve blood circulation in the limbs. In specialized pharmacies, rugs of different sizes are sold: separately for the foot, for the entire body. A rug can be placed near the baby's crib so that in the morning he can walk on it.

To eliminate spasticity of the fingers, which is often observed in patients with cerebral palsy, sew a bag and fill it with cereals (rice, buckwheat). Such a homemade expander will prepare your hands for grasping and manipulating objects. So you get a great expander. Useful for the limbs of the baby and classes with jumpers and walkers.

Note!

You should not buy a plastic walker for a patient with cerebral palsy, they are unstable and can harm the child.

Brain diseases that develop in babies require patience and perseverance from parents so that the life of the child is happy and rich. Of course, there can be no question of a complete cure, but the exercise therapy complexes that are created for such children can achieve a lot. They increase the physical abilities of children and make life easier for parents. Class programs are compiled individually, but with their regular implementation, they provide a common success for all.

Video - An unusual exercise for children with cerebral palsy

Collection output:

ATONIC-ASTATIC FORM OF CHILDHOOD CEREBRAL PALSY. CORRECTION OF MOTOR AND SPEECH DISORDERS

Dementieva Elena Valerievna

neurologist, CJSC STK Reacenter, Samara

Ukhanova Tatyana Alekseevna

cand. honey. Sci., Leading Neurologist, CJSC STK Reacenter, Samara

In the atonic-astatic form of infantile cerebral palsy (ICP), muscle tone, unlike other forms of this disease, is classified as hypotension, but their characteristic static and dynamic ataxia, hypermetry and intentional tremor significantly complicate the acquisition of new motor skills. Patients with atonic-astatic form of cerebral palsy initially find it difficult to maintain balance and master the creation and inclusion of physiological synergies in the process of movement. In most cases, morphological studies indicate underdevelopment of the cerebellum, its atrophy or dysplasia in patients with this group of cerebral palsy. However, vestibular functions, and above all, the sphere of coordination of movements and maintaining a posture, are subject to positive changes as a result of targeted training and comprehensive rehabilitation. With the localization of the pathological process in the frontal lobes of the brain in the clinical picture, mental retardation prevails over delayed motor development with pronounced motor demotivation. In these cases, an integrated approach is required in the treatment and rehabilitation of patients in order to improve vestibular functions and increase the functional activity of motor zones located in the frontal sections of the cerebral cortex. In recent years, in the rehabilitation of patients suffering from atonic-astatic form of cerebral palsy, modern methods of treatment have been used that not only correct muscle tone and reflex activity, but also have a direct impact on the restoration of neurophysiological functions of the brain due to the normalizing effect on cerebral metabolism and fine neurochemical regulation. To correct motor and speech disorders, the effect of microcurrent reflex therapy (MTRT) on the muscles of the musculoskeletal and articulatory apparatus, which are in a state of hypotonicity, is actively used. Exposure to a stimulating alternating current allows you to activate trophic processes and start the mechanism of reinnervation of the hypotonic muscles of the musculoskeletal system. The impact on the zones of craniotherapy with a current of the microampere range improves the functional activity of the frontal cortex affected by hypoxia. Providing a therapeutic effect on corporal biologically active points (BAP) of the craniospinal region contributes to the stabilization of the reflex activity of the cerebellum.

In conditions of oxygen and energy deficiency that occurs with cerebrovascular lesions, the drug Actovegin is of particular value - an antioxidant, a deproteinized extract of the blood of young calves. Its main action is to improve the utilization of oxygen and glucose. Under the influence of the drug, oxygen diffusion in neuronal structures is significantly improved, which makes it possible to reduce the severity of secondary trophic disorders, cerebral and peripheral microcirculation is significantly improved against the background of improved aerobic energy exchange of vascular walls and the release of prostacyclin and nitric oxide. The use of Actovegin also contributes to an increase in the concentration of acetylcholine in the structures of the brain, which is a necessary factor for improving neuromuscular transmission. Thus, the use of the drug Actovegin will also increase the effectiveness of stimulation of hypotonic muscles using MTRT by restoring the balance of the neurotransmitter acetylcholine in the body.

However, to date, no clinical trials have been conducted to evaluate the effectiveness of Actovegin in the complex treatment of patients with atonic-astatic form of cerebral palsy.

To study the effectiveness of complex treatment in the form of a combination of Actovegin with MTRT in patients with a diagnosis of cerebral palsy, atonic-astatic form, chronic residual stage, 46 children aged 3 to 7 years were examined and treated. The treatment was carried out on an outpatient basis at the Children's Department of Neurology and Reflexology of the Samara Therapeutic Complex "Reacenter".

All 46 patients underwent preliminary magnetic resonance imaging (MRI) of the brain and electroencephalogram (EEG). MRI revealed signs of organic brain damage in the form of combined hydrocephalus with a predominance of the external form, with a characteristic expansion of the subarachnoid cerebrospinal fluid spaces along the convex, up to atrophy of the frontal lobes; identified areas of demyelination and/or cystic changes in the white matter of the frontal regions of the cerebral hemispheres of the cortex; hypo- or dysplasia of the vermis and cerebellar hemispheres, expansion of the large occipital cistern or the presence of a retrocerebellar cyst. The EEG revealed signs of disorganization of the cortical rhythm, a slowdown in the development of the bioelectrical activity of the brain, the presence of dysfunction of the mid-stem structures of the brain, and, in some cases, a decrease in the threshold of convulsive readiness.

All patients in the study of neurological status underwent palpation examination of muscle tone, as well as observation of the motor activity of the child in a familiar environment to assess the volume of active movements in the limbs. In all 46 patients, neurological examination revealed signs of static and dynamic ataxia, dysmetria, intentional tremor, severe hypotension of the muscles of the upper and lower extremities. In 18 patients, signs of static ataxia predominated - balancing movements of the head and torso were noted, the children did not sit or stand on their own, when they were deprived of support, the protective reaction of the hands and compensatory movements of the torso aimed at maintaining balance were absent. In 16 patients, motor skills were formed - the children held their heads, sat independently and stood at the support, however, they had signs of dynamic ataxia (shaky gait, legs wide apart, jerky, excessive, awkward movements). In 12 patients with a predominance of organic damage to the frontal parts of the cerebral hemispheres, a sharp decrease in motor, mental and speech initiatives was also noted. In all patients, during a standard speech therapy examination, a general speech underdevelopment with elements of cerebellar dysarthria was revealed: asynergy of the muscles of the speech apparatus with characteristic signs - a weak air stream, chanted speech, and in severe cases, pronunciation of only the first syllable from the word. All 46 patients received basic treatment: MTRT, repeated courses of manual limb massage with elements of exercise therapy. They were randomized into 2 groups. The first group included 24 patients who received, against the background of the basic treatment, repeated course treatment with Actovegin according to the method described below. In the second - 22 patients who received basic treatment.

To conduct microcurrent reflexology, we used a device approved for serial production and use in medical practice “Microcurrent electroacupuncture computer stimulator “MEKS”, which allows you to use the required number of acupuncture points per treatment session, since when an acupuncture point is exposed to a constant alternating current of microampere range, there is no destruction of the structures of biologically active points (BAP), which is characteristic of acupuncture. The use of MTRT allows you to control the location of the BAP. As a monitoring of the treatment process, electropuncture diagnostics according to I. Nakatani is used, with the help of which the state of acupuncture meridians is assessed and control points are selected based on objective data on the state of the patient's autonomic nervous system.

MTRT was carried out in 3 courses, consisting of 15 procedures, the duration of each procedure was 40-50 minutes. The courses of treatment were carried out intermittently: 1 month after the 1st course and 2 months after the 2nd course of treatment. The method of treatment was as follows: the impact was carried out sequentially on the BAP of the craniospinal region, on the zones of cranioacupuncture, on the BAP over the hypotonic muscles. The impact was carried out in two modes: braking mode - a constant negative current, with a power of 80 μA; excitation mode - alternating current, with a polarity reversal frequency of 0.5 Hz, with a power of 80 μA. The exposure time for each BAT is 60 sec. The inhibition mode was applied when the corporal BAPs were exposed to the classical meridians (English abbreviation) of the craniospinal region: GB20, GB21, GB12, BL11, LI15. The excitation mode was used when acting on the zones of cranioacupuncture and when acting on local BAP located in the center of the projections of the paretic muscles on the skin. During the MRI procedures, the patients were in a state of calm wakefulness, in the supine position.

Actovegin (Nycomed, Austria, 2 ml ampoules, 200 mg tablets) was used as intramuscular injections at a dose of 0.2 ml/kg/day, but not more than 5 ml once. The treatment course consisted of 10 injections once every other day in the morning. Drug treatment was carried out in 2 courses, after the completion of the 1st and 3rd courses of MTRT.

During the study, all patients with atonic-astatic form of cerebral palsy showed the following positive dynamics: a decrease in the phenomena of static and dynamic ataxia in the form of a decrease in the amplitude of balancing movements of the head and trunk, elements of overshooting and intentional tremor was noted in all 24 patients of group I and 22 patients of group II groups. At the same time, some patients developed new motor skills: 18 people (75%) from group I and 13 people (59%) from group II learned to hold their heads and sit independently, and 16 people (67% ) from group I and 12 people from group II (55%). Patients also noted an improvement in speech function: an increase in the air stream, an increase in the volume of speech and the appearance of the skill of continuous pronunciation of words, an expansion of vocabulary and the development of the skill of constructing phrases and simple sentences of 2-3 words. Thus, in group I, positive dynamics in the form of a decrease in the degree of speech underdevelopment was observed in 18 patients (75%), and in group II, in 11 patients (61%). A decrease in the degree of dysarthria, taking into account the severity of neurological dysfunction, was noted in group I from 21 ± 3 points to 7 ± 2 points, in group II from 22 ± 3 points to 17 ± 2 points.

The results of the study demonstrated the high efficiency of the combined use of actovegin and MTRT in patients with atonic-astatic form of cerebral palsy due to the correction of hypotonic muscle tone, cerebellar reflex activity, and an increase in the functional activity of the motor areas of the frontal parts of the brain.

Thus, the combined use of Actovegin with MTRT is advisable to use in the complex rehabilitation of patients with atonic-astatic form of cerebral palsy.

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The atonic-astatic form is manifested by muscular hypotension, dynamic and static ataxia, cerebellar dysarthria, and, as a rule, preserved or slightly impaired intelligence.

The atonic-astatic form occurs as a result of either gross violations of the fronto-bridge-cerebellar pathway, or an intrauterine brain disease with a predominant lesion of the cerebellum. In children with this form of cerebral palsy in the initial residual stage, against the background of general muscular hypotension, the pronatoric position of the forearms and hands gradually develops, the tension of the adductors of the thighs and arch supports of the feet increases. At the same time, there may be a delay in the reduction of the cervical tonic and labyrinth reflexes, only by the age of 1.5-3 years the adjusting reflexes begin to develop. Tendon and periosteal reflexes are always high. Cerebellar disorders are manifested from an early age - at first there is ataxia and tremor of the hands, then, when the child begins to stand, trunk ataxia develops, as well as dys- and hypermetry. This explains the atactic gait. Mental and speech development with lesions predominantly of the cerebellum can be delayed to one degree or another. Cerebellar dysarthria is revealed.

In case of damage to the entire fronto-bridge-cerebellar tract or predominantly to the frontal lobes of the brain, head control, the functions of sitting, standing and walking practically do not develop (astasia, abasia) or are formed very slowly. Locomotor ataxia, although present, is not the dominant syndrome. Another indispensable clinical sign is a deep mental and speech development delay, or oligophrenia, more often in the degree of imbecility. Convulsive and hypertensive syndrome are observed in 15-20% of children.



The prognosis of motor development and social adaptation in most patients with cerebellar cerebral palsy is favorable. Children study in special boarding schools or mass schools and later master professions that do not require fine differentiation of hand movements. The prognosis for motor abilities and social adaptation in case of damage to the fronto-bridge-cerebellar pathway is unfavorable.

HYPERKINETIC FORM

Hyperkinesis is often observed in various forms of cerebral palsy. However, in some cases they are clinically leading and then they speak of a hyperkinetic form of cerebral palsy. The hyperkinetic form is characterized by the presence of hyperkinesis (choreoathetosis, choreic, torsion dystonia, etc.), extrapyramidal (hyperkinetic or spastic-hyperkinetic) dysarthria, with usually preserved intelligence.

Pathological anatomical changes are found in the striopallidary system, the cause of which may be incompatibility of the blood of the mother and fetus for Rh or ABO factors, intracranial birth trauma, etc.

The clinical picture consists of hyperkinesis and impaired muscle tone, more often in the direction of its diffuse increase (extrapyramidal rigidity). In some cases, at rest, muscle tone is normal or even reduced, but it rises sharply during active movements. In children in the initial residual stage of the disease, hypotonia of the muscles of the trunk and limbs can be observed already in the first months of life, later dystonia. In the muscles of the tongue, hyperkinesis usually appears at the 4-5th month of life. After 6-12 months, involuntary movements also occur in other muscles of the face, trunk and limbs. The most common form of children's cerebral hyperkinesis is double athetosis, in which hyperkinesis of an athetotic (worm-like) nature is localized in the mimic muscles of the face, upper and lower extremities, mainly in the distal sections, often capturing the torso. Choreic or choreoathetoid, hyperkinesis manifests itself in the form of faster, more widespread, proximal, high-amplitude, non-stereotypical movements. Torsion dystonia - hyperkinesis in the form of a slow contraction of the muscles of the body, leading to its rotation, head turn and other changes in posture. Hyperkinesis is minimal at rest, disappears during sleep, increases with voluntary movements, is provoked by emotions, and is more pronounced in the supine and standing position. Hyperkinesis and muscular dystonia destabilize the posture. Voluntary movements are discoordinated, spasmodic, sweeping.

In 60-70% of cases, pseudobulbar symptoms are detected (salivation, difficulty chewing, swallowing), in 10-15% convulsions. The formation of the reactions of rectification and balance is sharply delayed and defective. On the part of the intellect, changes are detected much less frequently (5-8%) than in other forms of cerebral palsy. In most patients, speech is impaired by the type of extrapyramidal dysarthria.

The prognosis for the development of motor functions and social adaptation depends on the severity of the damage to the nervous system. In 60-70% of cases, children learn to walk independently, however, voluntary motor activity, especially fine motor skills, is largely impaired. With moderate motor impairment, children can learn to write and draw. Patients with security intelligence graduate from general education schools, specialized secondary schools, and sometimes higher educational institutions.

DIAGNOSTICS

Cerebral palsy in the chronic residual and late residual stages is diagnosed based on the detection of:

1) pathologies of intrauterine development and childbirth, or diseases of the central nervous system in the first days or weeks of life, before the main structures, paths and centers of the brain have yet been formed;

2) characteristic movement disorders;

3) violations of speech and intelligence.

A list of pathological signs indicating the threat of cerebral palsy in infants.

I. Anamnesis:

1. Parents' complaints about developmental delay.

2. A large number of risk factors in the prenatal and intranatal periods.

3. Neurological disorders in the neonatal period.

II. Neurological examination:

1. Violation of muscle tone: hypertension, hypotension, dystonia.

2. Congenital reflex reactions:

a) the presence of unconditioned reflexes after 3-4 months. (normally should be inhibited),

b) activation of tonic neck and labyrinth reflexes in all positions.

3. Violation of posture and voluntary movements:

a) head: tilting in the supine position, constant turning to one side, excessive tilting in the prone position, difficulty holding with traction, upright, prone, sitting,

b) pressed to the body, not brought to the midline, the child does not pull them into the mouth, does not take them to the sides, does not reach for the toy, the hands are clenched into a fist, there is no optical support of the hands,

c) legs: excessive extension and adduction in the position on the back, vertically on the support, walking on toes, poor support, bending in the knee joints,

d) delay in global motor reactions: the child does not turn on his side, does not turn on his stomach, turns sideways, does not sit on his own, does not lean on his hands in a position on his stomach, does not get on all fours, does not sit down and does not stand up on his own, does not stand on his own, stands on bent and adducted legs, does not walk, walks on toes, asymmetry of posture and voluntary movements.

4. Delay in speech and mental development.

5. Neurosonography data: ventriculomegaly, periventricular leukomalacia, intra- and periventricular hemorrhages, polycystic disease, porencephaly, etc.

TREATMENT

The allocation of cerebral palsy to a separate group is due to the immaturity of the brain of the newborn, both anatomically and functionally. During this period, various harmful causes can produce similar clinical changes in the nervous system. With cerebral palsy, the immature, developing brain is affected, which has great compensatory capabilities.

Cerebral palsy is actually the residual effects of an already transferred pathological process, while motor and other disorders tend to reverse development. The goal of the doctor is to direct this spontaneous regression of symptoms along the right path, to control it, to prevent contractures, various vicious postures and movements from developing.

Due to the complexity of the pathogenesis and the variety of clinical forms of cerebral palsy, it is necessary to participate in the treatment process of such specialists as a neuropathologist, psychiatrist, orthopedist, physiotherapist, speech therapist, etc.

In order to properly plan the treatment of a patient with cerebral palsy, it is necessary to first determine: 1) what indicators of motor development (head control, turning, sitting, standing up, standing, walking, manipulating the arm and hand) are relatively normal, but lag behind chronological age; 2) what period do certain static and locomotor functions correspond to, are they mosaic; 3) why the child performs some movements and cannot perform others; 4) what elements of movement are absent in each skill and hinder its development; 5) whether tonic reflex activity has an effect on posture and movement; 6) the degree of spasticity at rest, when trying to move, in what positions it is more pronounced; 7) the presence of contractures and deformities or their early signs; 8) the level of mental and speech development, the nature of combined disorders.

Objectives of treatment: 1) develop in the child patterns of movements that contribute to the normalization of muscle tone, counteract gravity, maintain balance, and create the possibility of independent movement, acquire self-service skills; 2) to prevent the formation of pathological postures, abnormal muscle tone and movements, the development of contractures and deformities; 3) educate parents on methods of curative care and available curative and corrective measures.

The main directions of corrective work on the formation of motor functions involve a complex, systemic effect, including medication, physiotherapy, orthopedic treatment, various massages, physiotherapy exercises, directly related to the conduct of physical education lessons, labor, with the development and correction of movements at all regime moments.

The construction of a rehabilitation program should proceed from the basic principles:

1. Rehabilitation measures begin from the first days of the disease and are carried out continuously, subject to the phased construction of the program.

2. Rehabilitation measures should be comprehensive, versatile, but unidirectional (meaning the unity of biological and psychosocial methods of influence).

3. The rehabilitation program should be individual for each child, depending on the nosological form, the nature of the course of the disease, age, etc.

4. The final stage of the rehabilitation program should be the most complete social adaptation possible.

The first stage of rehabilitation is rehabilitation treatment in a hospital. Depending on the nature of the pathological process, its duration is different.

The second stage is readaptation, i.e. adaptation of the patient to the conditions of existence at one level or another in accordance with the degree of restoration and compensation of functions. It is better to start this stage of baking in a local sanatorium. Especially effective is the treatment of children with the consequences of diseases of the nervous system at balneological and mud resorts. Natural factors - radon, sulfide waters, therapeutic mud - cause humoral and hemodynamic changes in the body, affect the state of the nervous and endocrine systems, metabolism, improve the trophic functions of the body. The use of spa treatment at the second stage of rehabilitation, which has a long aftereffect, significantly increases the volume of the child's recovery reactions.

The third stage is the actual rehabilitation, the return to normal activities, to their former duties. In children, this stage pursues the complete elimination of the defect, the return to the environment of peers. At this stage, a significant place in the rehabilitation program is given to social, psychological, educational and educational influences.

PHYSIOTHERAPY

Therapeutic physical culture is one of the leading components of the complex treatment of patients with disorders of the musculoskeletal system.

The main tasks of physical therapy in cerebral palsy are as follows: 1) normalization of the unconditional reflex basis for the formation of voluntary movements; 2) the development of the patient's sensorimotor capabilities based on the restructuring of vicious compensations and stimulation of the coordinated functions of the analyzer systems; 3) teaching vital motor skills and elements of sports exercises based on the development of the general mobility of the patient; 4) special versatile training of coordination of movements.

Proper protective and stimulating motor regimen and physical exercises contribute to the overall strengthening of the body, restoration of the function of various systems, development of coordination links and favorable compensatory reactions. Therapeutic gymnastics is aimed at: 1. normalization of muscle tone; 2. normalization or formation of weakened or absent congenital motor reflexes (stepping, protective, crawling, reflex from head to body, from body to head, support reflex, Perez, Robinson, etc.); 3. suppression of primitive tonic reflexes that were not reduced to the term, but, on the contrary, growing (asymmetric and symmetrical cervical, labyrinthine, grasping, etc.); 4. stimulation from the 3rd-4th week of life of the development of the reflex from the head to the neck (the first adjusting reflex, indicating the development of adequate activity of antigravitational mechanisms), as well as mechanical, then optical reactions of the support of the upper limbs, the correct grip of objects, visual-motor coordination ; 5. correcting the position of the fingers; prevention of muscle atrophy, limited mobility in the joints; 6. restoration of active and passive movements and general statics and kinematics of the patient.

To solve these problems, domestic and foreign researchers have developed a number of methods, among which in the first place should be called the method of K.I. tonic and formation of congenital motor reflexes. I. Voit (1970), S. A. Bortfeld (1986). K.A. Semenova (1979) improved the system of K. and B. Bobat and offered their own methods.

The process of physiotherapy exercises should be theoretically substantiated, built in coordination with other methods of treatment. To select training methods, a preliminary thorough examination of the patient, a detailed clarification of the nature of the lesion, the state of the joints and the muscular system, the degree of loss of functionality and the prognosis of the disease are necessary.

Since the physiological meaning of physical therapy is the development of new conditioned reflex connections and mechanisms in the process of corrective work, both the demonstration and the verbal explanation of the complex of physical exercises are of equal importance. The main form of their organization is individual lessons. It is necessary to periodically determine changes in the state of functions with the help of special tests, and, if possible, physiological studies. Such examinations make it possible to timely identify the need to change the methodology and at the same time reflect the dynamics of the functional state of the patient, the effectiveness of his treatment at each stage.

The ultimate goal of exercise therapy is the development of new motor acts, teaching the child self-service and independent movement.

MASSAGE

Massage is widely used for disorders of the musculoskeletal system. Mechanically acting on tissues, it causes a reaction primarily from the vascular and nervous systems. Under the influence of massage, lymph and blood circulation, gas exchange between blood and tissues is enhanced. Afferent impulses arising in the skin and deeper tissues have a stimulating effect on the activity of the central nervous system. Regular massage helps to increase the contractility of muscles, their elasticity and accelerates their recovery after fatigue or prolonged immobilization. Since orthopedic patients require prolonged use of massage, it is advisable to teach the basic techniques of massage to parents and relatives of the ballroom.

A complex of physiotherapy exercises begins with a massage. Conventional physiological massage is in most cases not suitable, since work with each muscle group should be approached selectively, taking into account its tone, as well as its effect on a synergistic muscle group, so as not to cause a pathological increase in their tone. . K.A. Semenova (1974) developed a special systemic acupressure, which can be used to take into account the characteristics of physiological and pathological synergies.

MEDICAL THERAPY

Drug treatment depends on the stage of the course of the disease, the structure of the defect, the mental and somatic status of the child and is aimed at:

1. termination of intrauterine inflammatory primary and secondary autoimmune processes, if any;

2. prevention of cicatricial adhesions resulting from inflammation, mechanical birth trauma and hemorrhages; consequences of asphyxia, including chronic metabolic acidosis;

3. intensification of metabolic processes in the nervous tissue, primarily redox and protein metabolism;

4. providing energy processes in the brain;

5. elimination of primary or secondary hypertensive and convulsive syndromes;

6. normalization of muscle tone, reduction of violent movements, increased activity of compensatory processes in the nervous system;

7. stimulation of mental and speech development.

The use of drugs in children with cerebral palsy aims to create favorable conditions for a more successful exercise therapy. Drug therapy in the residual period includes the appointment of drugs that lower muscle tone, improve the conduction of nerve impulses in synapses, reduce hyperkinesis, normalize the course of metabolic processes in the nervous tissue, as well as anticonvulsants (in the presence of seizures), dehydrating (with hypertension-hydrocephalic syndrome) and fortifying agents.

Drugs that reduce muscle tone (inhibit cells of the reticular formation, block mono- and postsynaptic spinal reflexes, have a central and peripheral anticholinergic effect): mydocalm, baclofen, surdolit, amedin, norakin, cyclodol, tropacin, scutamil C, levodopa, nakom, sinimet, etc. These drugs are prescribed in a gradually increasing dosage. It has been established that 40-60 minutes after taking one of the listed drugs, a decrease in muscle tone occurs and at this time it is recommended to carry out exercise therapy.

Drugs that improve neuromuscular conduction: prozerin, galantamine, nivalin, kalimin, oksazil dibazol. They do not act on dead nerve cells, but only on those parts of the nervous tissue that have been in a state of oppression for a long time. It must be remembered that with regard to neuromuscular transmission of excitation, prozerin and its analogues are antagonists of tropacin and other drugs from the atropine group, so they cannot be administered simultaneously.

To reduce hyperkinesis, tranquilizers are most often used (elenium, amizil, phenibut, noofen, relanium, phenazepam, etc.), neuroleptics, less often - atropine-containing drugs (cyclodol, ortan, tropacin), as well as pyridoxine. In some cases, when conservative treatment is ineffective, so-called stereotoxic operations on the basal ganglia of the brain are resorted to. At the same time, a neurolytic mixture (usually alcohol with mayodil) is injected into the region of the pale ball or some nuclei of the thalamus. According to the literature data, hyperkinesis stops in 70% of cases and muscle tone decreases in 80% of cases. Chemopallidectomy is performed only by neurosurgeons in specialized departments.

In cerebellar forms of cerebral palsy, when muscle tone is reduced, duplex, securinin, echinopsin, mediator stimulants are prescribed.

Drugs that stimulate metabolic processes in the nervous system (activate protein and carbohydrate metabolism, while removing toxic decay products, increase respiratory activity, energy processes in brain tissue, improve blood circulation, promote differentiation of nerve cells, myelination of pathways, improve brain functionality): glutamic acid , aminalon, nootropil, piracetam, encephabol, cerebrolysin, diavitol, lipoic acid, cogitum, prefison, carnitine, pantogam, pyridoxine, cyanocobolamin, neuromedin, etc. In convulsions, stimulant drugs should be administered carefully, gradually increasing the dose, in combination with anticonvulsants and sedatives.

Drugs that improve microcirculation (increase cerebral and peripheral blood circulation, improve the rheological properties of blood, activate metabolic processes): teonikol, xanthinol, trental, cavinton, actovegin, emoxipin.

Preparations that have a resolving effect and stimulate regeneration (reduce productive and stimulate regenerative processes in the nervous system, increase tissue permeability and improve their trophism): aloe, lidase, pyrogenal, propermil.

Dehydrating drugs (increase diuresis, reduce CSF production): magnesium sulfate, diacarb, triampur, hypothiazitis, furosemide, lasix, glycerin, etc.

The presence of epileptic seizures without fail requires the appointment of anticonvulsants (phenobarbital, difenin, antelepsin, carbamazepine, valproic acid derivatives - depakine, convulsofin, etc.). Anticonvulsant therapy for patients with cerebral palsy is prescribed individually, taking into account the characteristics of the underlying disease, the nature of epileptic paroxysms, their frequency, and the time of occurrence during the day. Anticonvulsants must be taken continuously, for a long time (3-5 years of effective therapy), followed by gradual withdrawal.

In addition to such a differentiated drug treatment, it is recommended to periodically take pharmacological agents that regulate the metabolism in the nervous tissue and increase the body's resistance to adverse external influences. These are preparations of phosphorus and calcium, ATP, vitamins of groups B, E, C, thymalin, etc.

PHYSICAL THERAPIES

In the complex therapy of cerebral palsy, a significant place is occupied by physical methods of treatment (electrophototherapy, hydrotherapy, electrophoresis, ultrasound, magnetotherapy, electrical stimulation of muscles and nerves, mud therapy, paraffin-iozokerite therapy, IRT, etc.). ), aimed at reducing spasticity, improving blood circulation in the muscles .

Below is a brief description of some of the physiotherapy procedures.

So, for therapeutic purposes, you can use galvanic current. Various methods of its application have been proposed (galvanic collar according to A.E. Shcherbak, galvanization of cervical sympathetic nodes, transcerebral galvanization, etc.). During the procedure, the patient should not experience discomfort (the initial current strength is 4-5 mA, gradually increased to 10-12 mA), the treatment is carried out daily or every other day, in total 20-25 sessions. With the help of galvanic current, various medicinal substances (electrophoresis) can be administered, which create a long-acting depot in the deep layers of the skin. In children with cerebral palsy, a galvanic collar with calcium chloride, potassium iodide, magnesium sulfate, novocaine, bromine is most often used. At the same time, trophic and blood supply to the muscles improves, their tone decreases, the activity of higher vegetative centers normalizes, and hyperkinesis decreases. In order to resolve gliosis scars in the central nervous system, transcerebral Bourguignon electrophoresis with potassium iodide can be used. To reduce muscle tone in the same way, you can enter an extract from belladonna root (1-2 ml of a 0.2% aqueous solution of belladonna root is taken, dissolved in 100 ml of water and two pads are moistened, which are applied to closed eyelids), to improve metabolism - glutamic acid, to relieve arousal - GHB.

With increased muscle tone, it is recommended to prescribe paravertebral ultraviolet irradiation, the so-called "creeping" DUV and KuV erythema. You can also apply local electrothermal procedures (irradiation with a "Solux" lamp, diathermy, inductothermy). After such procedures, which contribute to the expansion of blood vessels and a decrease in muscle tone, rational electrical muscle stimulation can be applied using the ACM-2 or ACM-3 devices. According to I.M. Levin, in this way, you can start teaching the child active muscle contraction.

In 1957, K.A. Semenova proposed the treatment of cerebral palsy with low-frequency pulsed current, the source of which is the ASU-2, ASM-3 apparatus. The technique of this procedure is as follows: narrow electrodes are applied to the distal parts of the hands and feet. The strength of the current, the duration of the pulse should be individually selected depending on the age of the child, his tolerance to the current and the clinical manifestations of the disease. The time of current exposure is 5-8 minutes, followed by a change in the polarity of the current for the same time. The course of treatment is 20-25 sessions. You can conduct up to 10 courses with a break of 1.5-3 months. According to K.A. Semenova, these procedures improve the general condition of the child, reduce muscle tone, and increase the range of active movements. I.M. Levin suggests that with the distal location of the electrodes on the limbs, electrophoresis of novocaine with adrenaline is performed (8 drops of a 0.1% solution of adrenaline are added to 40 ml of a 2% solution of novocaine). Napkins moistened with such a solution are applied to the distal sections of the hands or feet and attached to the bifurcated anode. The cathode is superimposed on the middle third of the forearm or lower leg. In total, the course of treatment is 10-20 procedures.

In order to influence the general condition of the body, as well as to reduce muscle tone, water procedures are widely used: general warm baths, salt baths (1-2 kg of table salt per 200 liters of water), pine baths (50-60 grams of liquid extract per bath needles), as well as brine and sea baths. Water temperature 35-38 °, every other day for 10-15 minutes, for a course of treatment 10-15 baths. Water procedures must be combined with therapeutic exercises. With high muscle tone, selective underwater shower-massage can be carried out.

In the complex treatment of cerebral palsy, organic and inorganic mud and mud-like substances can be widely used: sapropels, clay, sand, peat, ozocerite and paraffin. Mud procedures are carried out mainly in the form of an application ("collar", "panties", "harem pants", etc.) at a temperature of 40-42 ° every other day for 15-20 minutes. In total, there are 15-20 procedures for the course of treatment. When treating with paraffin and ozocerite, the duration of the procedure increases to 30-40 minutes. At home, it is also possible to carry out treatment with sifted river sand, which, at a temperature of 45-50 °, is poured into wooden boxes or linen bags, and the affected limb is placed there. In summer, you can cover the upper and lower limbs of the patient with a layer of sand 5-6 cm thick and use natural solar heating. All these thermal procedures cause hyperemia and improve muscle nutrition, reduce muscle tone, and reduce contractures.

Climatotherapy - the impact on the body of natural factors - air, solar radiation, water. They are especially successfully used in specialized climatic resorts - in the Crimea, the Caucasus, Central Asia, and the Baltic states.

ORTHOPEDIC TREATMENT

Orthopedic baking is aimed at preventing and correcting deformities, restoring support and active mobility of the affected limbs and their appearance. In traumatology and orthopedics, both a variety of conservative and surgical methods of treatment are used. Orthopedic products that can be used to give parts of the body a physiological position include splints, shank-panties, splints, splints, collars, rollers. The orthopedic regimen should be developed for each patient individually and strictly observed.

Orthopedic methods for the treatment of cerebral palsy (both conservative and surgical) are subject to the competence of orthopedists, surgeons, and therefore are not considered in this brochure.

UPBRINGING

Along with carrying out the necessary treatment for patients with cerebral palsy, the correct organization of educational work is no less important. It should be borne in mind that 70-80% of these patients have mental disorders. Mental disability should not be regarded as something static, permanent, but as a situation that, in principle, can be changed in order to carry out appropriate educational and therapeutic measures. In the presence of severe mental retardation, patients must be placed in homes for the disabled. Children with moderate mental retardation should attend special kindergartens and schools. With the preservation of intelligence or a slight delay in mental development, patients can attend general schools or (better) specialized kindergartens and boarding schools, where the necessary conditions for educational work are created. These conditions determine the originality of the methodological approach to education:

1. creation of small groups, taking into account the level of development;

2. for each group, a plan is drawn up for one week, with the development of an individual activation plan for each child;

3. you should reduce the duration of classes so as not to overload the ability to concentrate;

4. more frequent exercises are needed to consolidate knowledge and special time for repetition;

5. rest time should be longer than in healthy children;

6. an important element of education is the development of hygiene skills and training in certain social duties;

7. special attention should be paid to the development of motor skills and speech with the participation of a physiotherapist and a speech therapist;

8. due to increased distractibility, it is necessary to more strictly manage the game, reveal the possibilities of organizing it, and activate games.

Tasks in the first year of life: 1) fostering the habit of contact and the need for it - addressing the child, drawing his attention to surrounding objects; 2) the development of visual perception and concentration with the use of light stimuli, as well as the display of objects with simple and clear forms (ball, rattle); 3) development of auditory perception and concentration with the use of voice, tambourine bell, etc. Use of sounds of different directions of tonality, sequence, Encouraging the child to extract sounds (“patties”, rattle, etc.); 4) development of lip movements - sucking, chewing (gradual transition to solid nutrition), prompting the child to blow, blow out air; 5) training of touch - contact with a variety of objects, at first by correcting the movement of the child's hand; 6) exercises for the hands - stimulation of grasping (“give me a pen”), “patties”, punches, rolling the ball, playing with cubes, with water, throwing, playing with fingers, etc .; 7) training of general motor skills - the transition from spontaneous movements to a given rhythm to singing, tambourine, etc., crawling, somersaulting, standing up, walking by the handle. Of particular importance is the performance of rhythmic gymnastic exercises; 8) teaching the simplest movements; 9) stimulation of participation in the reproduction of rhythm, sounds, melodies; 10) the motivation to name one's desires and objects with a certain word by repeated repetition; 11) development of emotional reactions - joy, trust, well-being, etc. By demonstrating emotions, stories, appropriate games and reinforcing the child's reaction; 12) in the process of education, intimidation and effeminacy should be avoided. Not all features of the child's behavior are associated with his mental retardation; 13) along with purposeful educational influences, it is necessary to provide the child with the opportunity for independent play and activities.

The process of social adaptation of such children should be facilitated by improving interpersonal relationships.

Involving parents in the process of raising children can become more effective if they are constantly informed about current pedagogical tasks and some of the learning tasks are transferred home.

LOGOPEDIC CORRECTION

The changing unstable nature of muscle tone disorders in the speech muscles, its great dependence on external influences, the emotional state of the child, the position of his body and head in space determine the peculiarities of sound pronunciation in these children. The lack of stability of articulatory disorders leads to the inconstancy of violations of the phonetic side of speech. If in a calm state dystonia of the speech muscles is observed, then when trying to speak, a sharp increase in muscle tone in the articulatory muscles is observed.

The appearance of hyperkinesis of the speech muscles sharply distorts speech, makes it obscure, and sometimes impossible. In addition, hyperkinesis of the diaphragm and intercostal muscles can also be noted, which, in turn, grossly disrupts breathing, fluency of speech, and in severe cases leads to the appearance of violent screams or groans.

The most common form of speech disorders is pseudobulbar dysarthria, which is characterized by impaired muscle tone. This speech disorder is characterized by limited mobility of the articulatory muscles; the most subtle isolated movements are especially affected, salivation is increased, breathing and voice formation are disturbed.

The main tasks of stimulation and correction of pre-speech development in the early stage of the disease are:

1. special breathing exercises aimed at developing voice reactions;

2. acupressure systemic massage, which stimulates the development of oral reflexes, eliminates oral synkinesis, corrects the position of the tongue and the tone of its muscles;

3. massage of the facial muscles (especially the muscles of the lips), the hyoid muscles, and the muscles of the neck, which provide the possibility of pronunciation;

4. development of a visual binocular fixation reflex, coordination of hand and eye movements, on the basis of which orienting, then orienting-cognitive reactions are formed, and, finally, inner speech, the first elements of its understanding.

Speech therapy work for all forms of speech disorders is based on taking into account data from a pathogenetic analysis of the structure of a speech defect. In this case, it is necessary to identify the leading defect, secondary disorders and compensatory-adaptive reactions. The work should be aimed at the development of all aspects of the child's speech activity. The system of speech therapy measures includes not only the development of articulatory motor skills and the sound-producing side of speech, but also the formation of its lexical and grammatical side, the creation of the conditions necessary for the child to master written speech.

In complicated forms of dysarthria, the work of a speech therapist involves the enrichment of auditory experience, the development of auditory attention, the skills of sound localization in space, auditory memory, phonemic hearing, and the semantic side of the child's speech. The work is based mainly on visual perception. When conducting speech therapy classes, it is necessary to pay attention to the prevention and overcoming of various synkinesis in the skeletal muscles and, especially in the fingers, as well as in the mimic muscles.

Work on articulatory motor skills is carried out in conjunction with physiotherapy exercises against the background of strictly individualized drug therapy.

FORECAST AND PREVENTION

The prognosis for children with cerebral palsy depends on the time of brain pathology and the degree of its severity. With antenatal injuries, the prognosis is the more serious, the earlier the pathological process developed. Widespread destructive brain lesions are worse prognostically than focal ones. Combined disorders significantly aggravate the prognosis - decreased vision, hearing, mental disorders, convulsions, hydrocephalic syndrome, somatic, infectious diseases.

The prognosis of motor, mental and speech disorders depends on the time of diagnosis, the start of treatment and its succession in different age periods.

The prognosis of social adaptation is more favorable with spastic hemi- and diplegia, and unfavorable with bilateral hemiplegia and atonic-astatic forms of cerebral palsy.

For the prevention of pre- and perinatal brain lesions, a comprehensive solution is needed for a wide range of issues related to the prevention of both the direct effects of harmful factors on the fetus and mediated by the mother's body, the improvement of methods for diagnosing pathological conditions of the fetus and newborn, corrective and restorative therapy, health education.

BIBLIOGRAPHY

1. Badalyan L.O., Zhurba L.T., Timonina O.V. Cerebral palsy. - "Health", Kiev, 1988.- 327 p.

2. Perinatal pathology /Under the total. ed. M.Ya.Studenikin (USSR), J.Kulz, G.Eggers (GDR). USSR-GDR.-M.: Medicine, 1984.- 267 p.

3. Semenova K.A. Makhmudova N.M. Medical rehabilitation and social adaptation of patients with cerebral palsy. - Tashkent: Medicine, 1979. - 487 p.

4. Shanko G.G., Bondarenko E.S., Freidkov V.I. Neurology of childhood: diseases of the nervous system of newborns and young children, epilepsy, traumatic and vascular lesions: Proc. allowance for in-comrade. - Mn .: Vysh. school., 1990.- 495 p.

5. Shukhova E.V. Rehabilitation of children with diseases of the nervous system. - M.: Medicine, 1979.- 255 p.


APPS

INDUSTRY STANDARDS FOR EXAMINATION AND TREATMENT OF CHILDREN WITH ICP IN HOSPITAL CONDITIONS

Insofar as cerebral palsy is a collective term that combines the consequences of damage to the developing brain by various adverse factors, then the clinical manifestations of cerebral palsy are diverse. Nevertheless, as a result of the action of completely different damaging factors in a given period of brain development, largely similar disorders of brain functions are formed. There are several classifications of clinical forms of cerebral palsy. The classification adopted in our country distinguishes 5 clinical forms of the disease (according to A. Ford, 1952, modified by K.A. Semenova, 1972):

  • spastic diplegia;
  • double hemiplegia;
  • hyperkinetic form;
  • atonic-astatic form;
  • hemiparetic form.

Spastic diplegia (Little's disease)

The most common form of cerebral palsy (up to 60% of all cases). First described in 1860 by the English surgeon W.J. Little. It is characterized by spastic tetraparesis with a predominant lesion of the legs (diplegia), the hands are affected to a lesser extent. Muscle tone changed by type spasticity or spastic-rigidity. The increase in tone is especially pronounced in the flexor muscles of the arms and in the posterior group of muscles of the thighs and legs. Intelligence can be normal or reduced to some degree. Possible speech disorders dyslalia, dysarthria. The rehabilitation potential of children with spastic diplegia depends on the severity of motor and intellectual disorders. The prognosis for spastic diplegia worsens if there are epileptic seizures ( symptomatic epilepsy). Systematic targeted rehabilitation treatment for mild and moderate forms of spastic diplegia can be very effective.

Characteristic postures of patients with spastic diplegia during verticalization:

—triple bend pose, in which the head and torso are tilted forward, the legs are bent at the hip and knee joints, support is on the front sections of the feet;

—ballerina pose, in which the head and torso are tilted forward, the legs are bent at the hip and unbent at the knee joints, support is on the front sections of the feet.

With a high tone of the adductor muscles and internal rotators of the thighs, a decussation of the legs is often formed when standing and performing step movements, and pathological internal rotation of the lower extremities is noted.

The clinic of spastic diplegia manifests itself most clearly by the end of the first year of life. Delayed in children reduction(reverse development) of congenital posture reflexes and the formation of straightening reflexes. On this basis, the formation of pathological muscle interactions ( synergy, synkinesis), when an unreasonably large number of muscles are simultaneously included in an attempt to perform any active movement in a patient. If the child walks independently, his gait is changed ( pathological motor stereotype), is not stable: body swaying is noted when walking, bending forward, legs are bent at the knee joints, or, conversely, there is overextension of the legs in the knee joints during the support period ( recurvation). During the swing period, sagging of the forefoot is often noted. The support is carried out on the front sections of the feet ( equinus), anterior internal ( equinovalgus) or anterolateral parts of the feet ( equinovarus). Step movements are small, mincing, the amplitude of the forward movement of the thigh and lower leg is reduced. At each step, the child seems to “bounce” over the support in an attempt to move the center of mass of the body forward over the support. There is no so-called. rear push, i.e. the child is not able to effectively push off with the foot from the support to take the next step. There is a shock setting of the foot on the support, the depreciation function of walking is disturbed, i.e. there is no slight flexion of the legs in the knee joint in the phase of the median support. This increases the impact load on the joints of the lower extremities, which leads to the early development of arthrosis of the joints ( dysplastic arthrosis) in independently or with the support of moving patients.

double hemiplegia

The most severe form of cerebral palsy. It appears already in the first months of life. Characterized by pronounced mental (mental retardation) and speech disorders, severe impairment of motor functions, and both arms and legs suffer (spastic tetraplegia or severe tetraparesis), often with uneven damage to the sides. Due to high muscle tone ( spastic-rigidity or rigidity) the arms are bent at the elbow and wrist joints, brought to the body, the legs are bent at the hip joints, bent or, conversely, unbent at the knee joints, rotated inward, the hips are adducted. The functions of maintaining a vertical posture in children with double hemiplegia are not formed. Sick children do not master the skills of sitting, standing, walking independently. Many of them are not able to hold their head, it is lowered on the chest or thrown back. Severe movement disorders are combined with early joint contractures and bone deformities. High muscle tone makes it difficult to care for a sick child. The rehabilitation potential of such children is low. For these patients, even self-service elements are not available. Most patients with double hemiplegia suffer from epileptic seizures. However, there are cases when a severe form of spastic diplegia is mistakenly regarded as double hemiplegia. In such cases, with persistent treatment, it is possible not only to reduce the severity of movement disorders, but also to improve mental and speech development.

Hyperkinetic form

Intelligence in this form of cerebral palsy, as a rule, does not suffer. Posture and movements are significantly affected by involuntary violent movements ( hyperkinesis). They can be different: fast sweeping, jerky are called choreic hyperkinesia, slow worm-like - athetosis. Often observed choreoathetosis. Hyperkinesis in the hands and mimic muscles of the face prevail over hyperkinesis in the legs. Athetoid hyperkinesis predominates in the fingers, hands, choreic - in the muscles of the neck, torso, proximal(located closer to the body) parts of the limbs. The intensity of hyperkinesis increases when trying to perform any active movement, with emotional excitement. At rest, involuntary movements become much less, in a dream they almost completely disappear. There are peculiar violations of muscle tone - dystonia characterized by variable muscle tone. Normal fixation muscle tone, which determines the position of the limbs and the whole body in space, is absent in patients. Congenital tonic reflexes, primarily cervical reflexes, do not fade for a long time. This may be related to the increase in the intensity of hyperkinesis during stimulation. proprioceptors neck ( trigger zone of hyperkinesis). Always with this form of cerebral palsy, speech disorders are observed ( hyperkinetic dysarthria) associated with involuntary movements and impaired muscle tone.

Since the energy expenditure during involuntary movements increases significantly, many children suffering from a hyperkinetic form of cerebral palsy are underweight. This is also facilitated by dysfunction of the autonomic nervous system.

With this form of cerebral palsy, muscle tone naturally changes during the first year of a child's life. In children of the 1st month of life, it is reduced (the so-called. floppy baby syndrome). From the 2nd month of life are noted dystonic attacks during which there is a sudden increase in muscle tone, followed by its rapid decline. Involuntary movements in severe cases first appear at the age of 4 months, usually in the muscles of the tongue, but in most children with moderate damage to the nervous system, hyperkinesis occurs at the end of the 1st - beginning of the 2nd year of life.

Epileptic seizures in the hyperkinetic form of cerebral palsy are rare. The rehabilitation potential of patients is mainly determined by the nature and severity of involuntary movements. The prognosis is much worse with the so-called. double athetosis. In general, the currently existing technologies for rehabilitation treatment with a moderately severe hyperkinetic form of cerebral palsy give the highest result.

Sometimes the clinic of spastic diplegia is combined with hyperkinesis, mainly of the athetoid and choreoathetoid type ( spastic-hyperkinetic form of cerebral palsy), or ataxia – spastic-atactic form.

Atonic-astatic form

With this form of the disease from birth, there is a generalized decrease in muscle tone ( muscular hypotension), oppression of congenital postural(postural) reflexes. The formation of rectifiers is delayed ( installation) reflexes. Cerebellar disorders are characteristic: ataxia(impaired coordination of movements in statics and when performing movements), dysmetria(disproportionate movement, discrepancy between the amplitude of voluntary movements of their goal, violation of control over distance), intention tremor(corrective movements with an excess of amplitude when trying to perform a purposeful integral motor action). Children with a significant delay in comparison with the physiological norm begin to hold their heads, roll over from back to stomach and from stomach to back, sit, stand, walk on their own. Many children with this form of cerebral palsy have mental retardation of varying degrees, speech disorders. Epileptic seizures are possible. The rehabilitation potential is usually low due to mental disorders.

Hemiparetic form

It is characterized by damage to the limbs of the same side (left- or right-sided hemiparesis), predominantly expressed in the hand. Often, from birth, an asymmetry of spontaneous movements in the limbs of the healthy and affected side is noticeable. Congenital motor reflexes, as a rule, are formed, installation reflexes are formed defectively and with some delay. As a result, the position of the child during verticalization also turns out to be incorrect, for example, in a standing position, the shoulder girdle of the affected side is lowered, the arm is bent at the elbow joint and brought to the body, the leg is bent at the knee joint.

The asymmetry of the posture leads to the formation of the so-called. paralytic scoliosis, while the arc of curvature of the spine with a bulge facing the healthy side. Paretic limbs lag behind in growth, anatomical shortening of the arm and leg of the affected side is formed.

When such children walk independently, the gait is characteristically changed: due to a discrepancy between the length of the legs of the healthy and the affected side and the skew of the pelvis, the healthy lower limb, as it were, "adjusts" to the patient, there is excessive flexion of the healthy leg in the knee joint and, as a rule, hyperextension of the paretic leg in knee joint during the period of support. In the paretic lower limb there is no dorsiflexion of the foot, the support is carried out on the forefoot. The arm of the affected side, as a rule, is bent at the elbow joint, brought to the body and does not participate in the act of walking, does not perform friendly ( reciprocal) movements during walking. The muscles of the extremities of the paretic side, as a rule, are hypotrophic.

The so-called. simulation and coordination synkinesis (imitation- involuntary movement of a limb, completely imitating the voluntary movement of another limb; coordination- movements that the patient cannot perform in isolation, but performs as part of a holistic motor synergy, and these movements cannot be arbitrarily delayed). In the hemiparetic form, more often are noted partial(focal) convulsive paroxysms, mental and speech disorders are possible.

The prognosis for this form of paralysis is usually determined by the severity of mental disorders and the presence of symptomatic epilepsy. The pathological motor stereotype of sick children is resistant to therapeutic effects.

In our country, the classification of cerebral palsy has been in effect for many years, adopted by the world-famous neurologist Ksenia Alexandrovna Semenova. A clear gradation of symptoms and manifestations of the disease helps speech therapists, psychologists and doctors to select the best treatment options. For example, the atonic-astatic form of cerebral palsy is distinguished by certain motor, speech and mental abnormalities. It occurs with pathologies of the cerebellum and frontal lobes of the brain. This form of malaise is considered very severe, it is extremely difficult to treat.

Symptoms

Even in the first year of a baby's life, parents can see a decrease in the pace of psychomotor development. Today, self-diagnosis sites on the Internet help to convince or disbelieve your fears. Parents answer a series of questions by completing the fields electronically and then receive a probable diagnosis. This is only an approximate result, a specialist in a medical institution should confirm or refute it.

The specialist makes a diagnosis based on the following symptoms of the atonic-astatic form of cerebral palsy:

Lit .: Big Medical Encyclopedia, 1956

Parents may notice deviations from the norm in the behavior of the child in the first year of life. As a rule, the baby cannot keep balance, his coordination of movements is disturbed, tremor is clearly visible, movements are excessive. The following causes of the atonic-astatic form of cerebral palsy lead to such consequences:

  • Damage to the cerebellum only. In this case, children do not show initiative, they read and write poorly.
  • Damage to the cerebellum and frontal lobes. Then the child may show aggressiveness, underdevelopment of cognitive activity.

According to the studies of Ekaterina Semenova, children with this form of cerebral palsy also have mental retardation, and in a severe stage. The doctor recommended sending patients to institutions of the Ministry of Social Protection. This is due to the fact that in most cases, with this form of cerebral palsy, the child cannot take care of himself, as well as attend preschool and school institutions.

Parents usually go to a therapist when they want to figure out how to help their child. To the question of which doctor treats cerebral palsy in the atonic-astatic form, one can give the following answer:

During the first visit to a specialist, the child will be examined, and the parents will have to answer the following questions:

  1. How long has the child been experiencing behavioral changes?
  2. Did the parents notice deviations in the physical activity of the baby before?
  3. Was oxygen starvation diagnosed during childbearing?
  4. Was the baby born prematurely or according to the DA?
  5. Was the birth normal or was the baby traumatized?
  6. Did the baby's mother during pregnancy suffer from rubella, syphilis, influenza, various chronic ailments, including pneumonia and tuberculosis?
  7. Were stimulants used during childbirth?
  8. With what body weight was the baby born?

Treatment of atonic form of cerebral palsy

More than 80% of children with this type of cerebral palsy have reduced intelligence. Usually they are aggressive, reacting negatively even to standard situations. In addition, in many patients, the treatment of the atonic form of cerebral palsy is also difficult because the child is not proactive, depressed, and refuses any manipulations. Also, 50% of children have convulsions, optic nerves atrophy. In general, the atonic-astatic form of cerebral palsy has an extremely unfavorable prognosis. However, to improve the patient's condition, however, are prescribed.