Cerebral palsy (cerebral palsy): causes, symptoms, treatment, forms

If brain structures are damaged in the perinatal (intrauterine) period or at birth, the child may experience a disease that does not progress over time, manifesting itself in symptoms of spastic paralysis, muscle ataxia, dyskinetic disorders, and in half the cases - in disorders of intellectual and speech abilities. All these symptoms are combined under a single diagnosis - cerebral palsy. What is the essence of this pathology?

History of disease detection

Cerebral palsy was identified and studied in the early 19th century by the British physician Little, which is why cerebral palsy is also called “Little’s disease.” The British scientist and doctor believed that the main cause of cerebral palsy was pathological labor, during which the child experiences severe oxygen starvation (hypoxia). Sigmund Freud also studied cerebral palsy in his time. He suggested that the cause of the disease was damage to the child’s central nervous system during intrauterine development. This assumption was proven in 1980. But subsequent studies revealed that complicated labor is the most common cause of cerebral palsy.

Forecast

Cerebral palsy refers to diseases, the development of which leads to impaired functionality of the entire body.

How long a child with cerebral palsy can live depends on the characteristics of the disease:

form of the disease;
severity of pathology;
the presence of concomitant disorders.

The chosen treatment method also plays an important role.

Note! The life of a child suffering from cerebral palsy can be significantly extended if the baby is in a family, receives proper care, and is regularly treated and undergoes rehabilitation activities.

With a mild form of cerebral palsy, a person can live to old age without being any different from healthy people.

The prognosis for moderate cerebral palsy is relative. By the age of 30, patients’ entire body “wears out” significantly, so their life cycle decreases. Such patients do not always live to be 50 years old.

Severe cerebral palsy has a poor prognosis. In the most difficult cases, a child can live up to 5 years. According to statistics, heavy children do not live to see 14 years of age.

Parents with children with cerebral palsy should not rely on statistical data. There are many exceptions among patients, when parental care not only prolonged the child’s life, but also made it possible to achieve such progress that, according to doctors’ forecasts, was impossible.

General characteristics of the condition

Currently, doctors claim that cerebral palsy occurs immediately after birth or during pregnancy. There are many causes of the disease. But mainly it is damage to the central nervous system and associated neurological problems. During the disease, a wide variety of motor dysfunctions are observed. Muscular structures are most affected, which manifests itself in a lack of coordination. Motor activity is impaired due to damage to brain structures. The location and volume of these lesions determine the shape, nature and severity of muscle disorders, which can be single or in combination. Variants of major muscle disorders:

Muscle tension.
Movements of an involuntary chaotic nature.
Various gait disorders.
Limited mobility.
Muscle contractions.

In addition to impaired motor function, cerebral palsy may be accompanied by deterioration in hearing and speech activity. In addition, very often the disease is accompanied by epilepsy and deviations in psychological and mental development. Children have disturbances in the sphere of sensations and perception.

Cerebral palsy does not progress, since the damage to the brain is localized and does not spread or invade new areas.

Forms of cerebral palsy and their clinical manifestations

There are six main forms of cerebral palsy , which can occur separately and sometimes in combination with each other. Each of them has a different prognosis for maximum recovery of the child.

Little's disease

Spastic diplegia (paraplegia), or Little's disease, is the most common type of disease (up to 50%), which occurs due to hemorrhage or ischemia in the area of the periventricular white matter of the brain. Often against the background of these changes, hydrocephalus develops.

This form of cerebral palsy mainly develops in premature babies and combines the following symptoms:

spastic tetraparesis with an emphasis in the legs, that is, paralysis affects the legs more, and in the arms there may be varying degrees of its severity;
hypotonicity in the leg muscles of a child immediately after birth, which then transforms into hypertonicity and severe spasticity;
in a vertical position, the child’s legs are thrown over each other (crossed), due to the high tone in the adductor muscles of the thigh;
strabismus;
delay in the formation of speech skills and subsequent dysarthria;
relatively mild impairment of intellectual-mnestic functions.

The prognosis for Little's disease is quite favorable , provided that the child's rehabilitation began early and was carried out systematically. With this form of pathology, mental and speech disorders regress well, in contrast to motor deficits. These children with cerebral palsy can learn to care for themselves (fully or partially) and master writing skills. They can attend a school for children with cerebral palsy, and in some cases study in regular educational institutions. Their adaptation to work and learning is somewhat reduced due to some intellectual-mnestic disorders.

Hemiplegia

Hemiplegic cerebral palsy is most often caused by abnormalities in brain development or stroke. This is the most common form of the disease among children born at term. Manifested by the following group of symptoms:

hemiparesis on the side opposite to pathological changes in the brain, mainly the distal parts of the limbs are affected (the hand suffers the most);
partial epileptic seizures in the affected limbs, which develop already in the first months of life;
increased tone in paretic limbs with subsequent deformation and growth retardation;
Wernicke-Mann pose (the arm is bent at the elbow joint and pressed towards you, the leg is straightened and pulled up behind you when walking);
minor disturbances in mental development and speech are possible

The prognosis for this form of cerebral palsy is also quite good , since children master all skills, but simply over a longer period. More unfavorable for socialization and work activity are cases when the dominant hemisphere is affected.

Double hemiplegia

Double hemiplegia (tetraplegic form) is the most severe and unfavorable form of cerebral palsy in terms of recovery. Occurs as a result of massive damage to the brain substance (prolonged asphyxia, neuroinfections, toxic effects of drugs, alcohol, etc.).

Children are born with severe hypotonicity in the muscles of the trunk and limbs, which within a short time turns into hypertonicity . The arms and legs of such babies suffer equally. Pathological changes in muscle tone make normal motor development almost impossible. Such children have difficulty starting to sit down and are extremely rarely able to master the skills of standing and walking. Most patients suffer from mental retardation of varying degrees (idiocy, imbecility) and cannot speak . As a result of such gross violations, the prognosis for the socialization of such patients is extremely unfavorable.

Hyperkinetic form

The hyperkinetic form of cerebral palsy develops as a result of prolonged hypoxia or hemolytic disease of the newborn. It is characterized by damage to the subcortical structures of the brain, in particular the basal ganglia.

The main manifestations of the disease are:

hyperkinesis of various types and severity (hemiballismus, torsion dystonia, choreoathetosis, myoclonus, etc.);
speech disorder in the form of dysarthria.

This is a very favorable form. Such patients do not have intellectual impairments, so learning is not difficult for them. With the correction of speech disorders, an active social life is possible. But due to uncorrectable hyperkinesis, the work activity of such children is extremely limited.

Cerebellar form of cerebral palsy

The cerebellar (atactic) form is quite rare. Occurs due to damage to the structures of the cerebellum or its pathways. It is characterized by ataxia (shaky gait, impaired coordination of movements), decreased tone in the muscles on the side of the pathological changes, nystagmus (oscillatory movements of the eyeballs). There are no mental disorders in such patients. Therefore, this form is favorable for training and developing work skills in some patients.

Atonic-astatic form

The atonic-astatic form of cerebral palsy is expressed in reduced muscle tone, which makes it impossible to maintain an upright body position. Children suffering from this form of cerebral palsy cannot walk or sit. Sometimes symptoms of ataxia, dysarthria, and intellectual impairment are added. The prognosis for this disease is also favorable.

It must be remembered: the prognosis and outcome of the disease will be favorable only if systematic, comprehensive treatment of cerebral palsy is carried out.

Causes

Cerebral palsy is caused by damage to certain areas of the brain that are developing. This damage can occur during pregnancy, when the baby’s brain is just beginning to form, during childbirth, or in the first years of life. In most cases, the exact cause is very difficult to determine. In the scientific literature, the causes of cerebral palsy are divided into several groups:

Genetic causes (damage to the chromosomes of the mother or father, may occur due to aging of the body).
Oxygen starvation of the brain (placental insufficiency both during childbirth and during pregnancy). Factors in the development of oxygen deficiency: placental abruption, long or, conversely, rapid labor, umbilical cord entanglement, incorrect presentation of the fetus.
Infectious diseases, for example, encephalitis, meningitis, cause cerebral palsy. It is especially dangerous if the infection occurs with a high temperature.
Toxic effects on a child (work in hazardous industries, smoking, drugs, alcohol).
Physical impact (if the child was exposed to x-rays or radiation).
Mechanical causes, a consequence of birth injuries.

Also factors that give rise to cerebral palsy are:

Premature birth.
Low weight of the newborn.
Large baby weight or large fetus.
Chronic diseases of women.
Multiple pregnancy.

The risk of developing the disease increases if several factors affect the baby’s brain and nervous system.

Factors in the development of the disease in the first days of life may be:

Hemolytic disease (a congenital disease that develops due to incompatibility of the blood of mother and child).
Asphyxia of the child during labor.
Entry of amniotic fluid into the fetal respiratory tract.
Defects in the development of the respiratory organs.

Childhood cerebral palsy is a consequence of exposure to various factors that lead to disruption of the normal functioning of the child’s brain. The greatest impact has oxygen starvation, which develops due to premature placental abruption, breech position of the fetus, rapid or prolonged labor, and umbilical cord entanglement. Risk factors include Rh conflict between mother and baby and infections.

Sometimes the cause of the development of cerebral palsy is considered to be various pathologies of the vascular system. This is a misconception, since the child’s blood vessels are elastic and soft, they cannot rupture without reason. That is why vascular damage in a child can only occur as a result of severe trauma.

It is important to promptly establish the cause of the development of cerebral palsy, as this determines further tactics of working with the child and his treatment.

How common is cerebral palsy?

According to world statistics, almost a quarter of cases of pathology of the nervous system in children (24%) are due to cerebral palsy. Despite the development of medicine, pregnant women and newborn children continue to be the most vulnerable group of the population, subject to increased exposure to any stress factors.

Signs

Symptoms of cerebral palsy are divided into late and early. Early scientists include:

The child is lagging behind in physical development (does not hold his head up, does not crawl, does not sit, does not walk on time).
Reflexes that are characteristic of infants persist as the child grows up (the movements of the limbs are chaotic for a long time, the grasping reflex, the stepping reflex).
The child uses only one hand, this is clearly noticeable during play or in everyday life.
The child is not interested in toys.
If you put a child on his feet, he only stands on his toes.

Late signs of cerebral palsy are:

Skeletal deformity, the limb in the affected area is much shorter.
Loss of coordination, low mobility of the child.
Frequent limb cramps.
Gait is difficult, mostly on the toes.
Swallowing problems.
Salivation.
Speech problems.
Myopia, strabismus.
Disease of the gastrointestinal tract.
Involuntary defecation and urination.
Emotional and psychological problems.
Children have difficulty writing, reading, and counting.

The degree of disability depends on the level of development of the child and the efforts of relatives. The higher the level of intelligence, the less motor dysfunction the baby has.

Diagnosis of cerebral palsy after a year

By the age of one year, a child with cerebral palsy usually has all the signs of the disease: non-progressive motor impairment, uncoordinated movements, and developmental delays. Diagnostic methods are usually used to confirm the diagnosis, exclude diseases with a similar clinical picture, and clarify the form of the disease. However, making an accurate diagnosis of a baby can be difficult.

The child is examined by a neurologist who will prescribe an MRI - magnetic resonance imaging of the brain. The purpose of this procedure is to identify affected areas of the brain. In addition, MRI helps to determine the presence of changes in the substance of the cortex and subcortex of the brain, as well as to determine their type. This could be, for example, a decrease in white matter density.

Forms

There are two classifications of the disease - the first is based on the age of the baby, the second on the form of the disorder.

The disease is divided according to age:

Early – symptoms appear before the baby is 6 months old.
Residual initial – the disease is detected from 6 months to 2 years.
Residual later – after 2 years.

Regarding the forms of cerebral palsy, they are classified:

Spastic tetraplegia - affects the areas of the brain that are responsible for motor function. This usually happens during the prenatal period of a child’s development due to oxygen deficiency. This type of cerebral palsy is one of the most severe and serious forms of the disease. The disease manifests itself in the form of problems with swallowing, disturbances in the formation of sounds and their reproduction, paresis of the muscles of the limbs, problems with attention, visual impairment, strabismus, and mental retardation.
Spastic diplegia is the most common type of disease, accounting for about 75% of all cases. As a rule, it is detected in children who were born as a result of premature birth. The disease manifests itself in the form of damage to the lower extremities, mental and mental development delays, and speech problems. But, despite all the manifestations of the disease, patients with cerebral palsy of this type successfully study at school and are adapted to society. They perform certain types of work.
The hemiplegic form often shows disturbances in the movement of the upper limbs. The cause of this form of cerebral palsy is cerebral hemorrhage or infarction in the brain. Such children have good learning abilities, they can learn a whole range of actions, but their speed will not be great. Children who suffer from this form of the disease often experience mental retardation, delayed speech development, mental problems, and frequent epileptic seizures.
The dyskinetic form is caused by hemolytic disease (a congenital disease that develops when there is a Rh conflict between the blood of the mother and baby). Such children have involuntary body movements, paresis and paralysis appear in all parts of the body. Limb positions are not normal. Moreover, this type of cerebral palsy is considered the mildest form. Children can study at school, not be inferior in intellectual abilities to their peers, they can graduate from a higher educational institution, and live a normal life in society.
Ataxic form - the main causes of the disease are fetal hypoxia or injuries to the frontal lobes of the brain. A sign of this form is paresis of the vocal cords and muscles of the larynx, trembling of the limbs, involuntary movements. As a rule, children suffer from mental retardation. With proper work with a child, he can learn to stand and even walk.
Mixed form – when a patient has symptoms of several forms of the disease.

It should be noted that it is difficult to reliably diagnose the form of cerebral palsy in newborns; characteristic signs are revealed by 6 months of the baby’s life.

Symptoms

Children with cerebral palsy are characterized by delayed motor development.
Symptoms of cerebral palsy are mainly movement disorders. Moreover, the type of such disorders 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.

At an early stage, the diagnosis is rarely made, because there are very few motor skills at this age. But, nevertheless, there are certain signs that may be the first symptoms:

delayed motor development: there are average periods 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 that fade away by a certain age. The existence of these reflexes after reaching this age is a sign of pathology. For example, the grasping reflex (pressing a child’s palm with a finger causes the finger to be grasped and the palm to squeeze) does not normally occur after 4-5 months. If it is still detected, this is a reason for a more thorough examination;
violation of muscle tone: increased or decreased tone can be determined by a neurologist during examination. Changes in muscle tone may result in excessive, aimless, sudden or slow, worm-like movements in the limbs;
predominant use of one limb to perform actions. For example, a child normally reaches for a toy with both hands with equal 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 were found to have any even minor abnormalities during a routine examination by a doctor must be examined every 2-3 weeks. During repeated examinations, attention is paid to the dynamics of the identified changes (whether the disorders persist, increase or decrease), whether all motor skills are formed with a delay, or whether 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, that is, after six months of life. Such 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, and convulsions. Exactly what symptoms will come to the fore depends on the clinical form of the disease. Let's take a look at 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 impaired 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 damage to all four limbs, with the greatest severity of the process in the legs, mental, intellectual and speech disorders. Symptoms manifest themselves most clearly towards the end of the first year of life. Muscle tone is increased in all extremities, but more so in the legs (mainly in the arm flexors and leg extensors). 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 the entire foot on the surface, but stand on the 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 voluntary movements even more difficult. The heel tendon shortens and the feet become deformed.

Tendon reflexes increase, pathological foot and hand signs are revealed (Babinsky, Gordon, Zhukovsky and others).

Involuntary movements (hyperkinesis) may appear in the limbs, and more often they develop in the muscles of the face and arms. Sometimes this causes a negative reaction from others, because, for example, hyperkinesis in the facial area can look like grimacing or teasing. Hyperkinesis increases with excitement and decreases during sleep.

Speech disorders are expressed in blurredness, unclearness, and speech therapy defects. Moreover, this does not go away with age without appropriate treatment.

Mental and psychological problems are manifested by impaired concentration, poor memory, and emotional instability. Typically, mental impairment is not pronounced. Therefore, with good functioning of the upper limbs, such people adapt well to society, acquire a profession and serve themselves.

Spastic tetraplegia or double hemiplegia is characterized by uniform damage to all four limbs or more severe impairment of movements in the arms. This is the most severe form of cerebral palsy, because, as a rule, it is accompanied by severe mental, mental, speech disorders, and convulsive syndrome. Mental impairment reaches the level of mental retardation; speech may generally have the appearance of inarticulate mooing. Along with this, visual impairment due to atrophy of the optic nerves (which cannot be corrected by wearing glasses or lenses), strabismus, and hearing impairment are observed. Symptoms of this form of the disease are noticeable already in the first months of life. Tendon reflexes are very high, many pathological signs are detected from the feet and hands. Such children do not know how to sit, much less walk. Severe motor disorders lead to the early formation of contractures of many joints and spinal deformities. Patients require constant, lifelong care.

Hemiplegia means that the patient has muscle weakness on one side - left or right. That is, paresis affects the arm and leg of the same name, and it is often more pronounced in the arm 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, there is a noticeable lag between the affected limbs and the healthy ones. When the child is already walking, a characteristic pose catches the eye - the affected arm is bent and pressed to the body (the hand of the person asking), and the leg is straightened and does not bend when moving. In addition to motor disturbances, hemiplegia is accompanied by convulsive seizures and moderate or minor mental impairment. If seizures occur frequently, they can cause significant decline in intelligence.

Dyskinetic (hyperkinetic) form

It is characterized by the presence of involuntary movements – hyperkinesis. Usually these symptoms appear after a year. The movements can be very diverse: worm-like movements in the fingers, swings and imitation of hand throws, twisting of the body around its axis, grimacing. Involuntary contraction of the muscles of the larynx can lead to uncontrollable sounds and screams. With emotional overstrain, hyperkinesis intensifies, and disappears in a state of rest and sleep.

Hyperkinesis is accompanied by a decrease in muscle tone. Periodically, episodes of sudden increases in tone occur; in children in 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 in peers. However, such children eventually master self-care skills and do not need outside help.

In the dyskinetic form, speech may be impaired. Usually words are pronounced slowly, not entirely clearly, with impaired articulation.

Intelligence is practically not affected.

Ataxic form

This form occurs when the connections of the cerebellum or frontal lobes are predominantly affected. From birth, muscle tone is reduced. All motor skills are formed with a significant delay. Coordination and accuracy of movements are impaired. The gait is unsteady, attempts to take something end in missing and being missed. Possible trembling in the limbs. Sometimes hyperkinesis occurs with this form. Mental abilities may not be impaired, but may reach varying degrees of mental retardation.

Mixed form

This form is diagnosed when symptoms characteristic of two or more clinical forms (described above) are present.

Diagnosis of the condition

The disease is diagnosed based on the identified characteristic signs. Conditioned reflexes and muscle tone are checked, and an MRI of the brain is also taken. If there is a suspicion of brain damage, an EEG and ultrasound are performed.

A timely diagnosis is very important for a young patient. It is important to recognize the disorder. Children should be examined in the maternity hospital; doctors pay special attention to children:

With light weight.
Those born prematurely.
Having defects and developmental anomalies.
With a diagnosis of newborn jaundice.
Born as a result of difficult and prolonged labor.
With infectious diseases.

Cerebral palsy is diagnosed by a neurologist, but he may additionally prescribe other tests to clarify the diagnosis.

Why does the disease occur?

The main factor determining the occurrence of cerebral palsy is damage or insufficient development of one of the areas of the brain. There are more than 100 reasons why children are born with cerebral palsy. They are usually classified into groups:

reasons related to pregnancy;
reasons related to the moment of birth;
reasons related to the period of adaptation of the newborn to environmental conditions in the first month of life.

As practice shows, almost half of babies with this diagnosis are born premature. Such children are very vulnerable due to underdevelopment of organs and vital systems.

The most common risk factors are:

large child size;
incorrect presentation of the fetus;
narrow pelvis of a woman;
premature placental abruption;
Rhesus conflict;
artificial stimulation of the birth process;
acceleration of labor using the method of puncturing the amniotic sac.

In the postnatal period, the causes of damage to the central nervous system can be:

severe infections - acute herpes, meningitis, encephalitis;
lead intoxication;
head injuries;
oxygen starvation of the brain due to blockage of the airways.

Features of children with cerebral palsy

The main cause of cerebral palsy is a change in the structure of the brain, and the main symptoms are impaired motor activity. Movement disorders occur due to disruptions in the transmission of signals from the brain to the muscles. Cerebral palsy is characterized by the presence of speech, motor, emotional, and mental disorders. They are associated with damage to different muscle groups and brain tissue.

The developmental difficulties of such children are due to enormous difficulties during the performance of complex or coordinated movements. Such children have limited independence, the ability to move freely, and only a partial ability for self-care.

Any movements of children are slow, which is why there is a disproportion between thinking and the idea of the surrounding reality. Logical thinking and abstract knowledge are formed well in such children, and the idea of the world around them is formed only in conditions of constant movement of the child, as a result of which muscle memory is developed.

Children with cerebral palsy are not able to study for a long time; they absorb less information compared to their peers. These children have difficulties with counting and it is very difficult for them to learn mathematical operations.

Emotionally, they are vulnerable, impressionable, and very attached to their parents and guardians.

They usually have a speech disorder, which is why their circle of communication with peers is always limited.

Reasons for the development of cerebral palsy

The cause of cerebral palsy is a violation of the transmission of brain impulses to the muscles. It develops when brain cells are damaged in the early stages of development. This can happen both in utero, during childbirth or after birth.

During pregnancy

A woman’s body during pregnancy requires a gentle regimen and more careful attention. Adverse factors can be detrimental to a child’s development:

exposure to radiation, toxic substances, drugs, alcohol, and certain medications;
severe illness of the expectant mother;
infections suffered during pregnancy;
oxygen starvation;
pregnancy with complications;
incompatibility of the Rh factor of the blood of mother and baby.

During childbirth

Childbirth does not always go smoothly - doctors sometimes have to quickly respond to unforeseen situations. The development of cerebral palsy can be affected by:

fetal asphyxia (umbilical cord entanglement, prolonged labor, etc.);
birth injury.

After the baby is born

After the birth of a child, the living conditions of mother and baby have a decisive influence on his body. The following situations are dangerous for brain damage:

the child’s brain does not receive enough oxygen;
carcinogens enter the baby’s body;
head injuries;
past infections.

Treatment and rehabilitation of cerebral palsy

The goal and main task of all therapeutic measures is to reduce the manifestations of signs and symptoms of the disease. It is impossible to completely cure the disease, but with the right method, it is possible to ensure that the child acquires the necessary skills and abilities for life.

To choose the nature of treatment, the doctor needs to know the form of cerebral palsy, concomitant diseases and the severity of the disease.

As a rule, anticonvulsants and relaxants are prescribed as medications.

Currently, there are no universal treatments for cerebral palsy. The following methods have proven themselves well:

Massage.
Physiotherapy.
Medical drugs that are aimed at normalizing muscle tone (Dysport, Mydocalm, Baclofen).

The following methods and techniques have a positive effect in treating the disease:

Bobath therapy.
Voight's method.
Load suit "Gravistat" or "Adele".
Pneumatic suit "Atlant".
Speech therapy classes.
Assistive devices (chair, walkers, stand-up machines, exercise equipment, bicycles).

Balneotherapy and hydrotherapy in the pool are successfully used. It is easier for a child to move in water; he first learns to walk in water, after which it is easier for him to perform the same actions on land. Water treatments are completed with hydromassage.

Mud therapy has a good effect, as it has a stimulating effect on nerve cells and relieves muscle tone. In addition, hypertonicity is well normalized with the help of electrophoresis, magnetic therapy, and paraffin therapy.

If changes in muscle structure cannot be corrected, then surgical treatment of cerebral palsy is resorted to. The operations are aimed at performing plastic surgery of muscles and tendons. If it is possible to correct disorders in the tissues of the nervous system, then neurosurgical interventions, stimulation of the spinal cord, and removal of damaged areas are performed.

According to reviews, cerebral palsy must be treated as early as possible, since the condition may worsen due to the gradual development of the orthopedic problem. This may be curvature of the spine, flat feet, club feet, hip dysplasia, and others. If you miss time, you will have to treat not only cerebral palsy, but also correct orthopedic disorders by wearing spacers, splints, and splints.

General information about therapy

How long children with cerebral palsy live largely depends on the therapy provided and care for the sick child. Medicine has not yet found a method that can completely cure the disease. However, with the right treatment regimen, significant results can be achieved.

Babies with mild to moderate cerebral palsy are able to live independently, without the help of other people.

In severe cases, it is only possible to slow down the pathological progress, reduce the intensity of symptoms and slightly affect muscle activity.

Even when using the most modern methods of therapy and rehabilitation, doctors do not undertake to predict the outcome of treatment of seriously ill (especially bedridden) patients.

The greatest success is achieved in treating patients in the first year of life. Early adoption of measures prevents a number of serious complications (joint diseases, mental retardation, autism, etc.).

Note! Therapy is prescribed only after a complete examination and on an individual basis.

Main methods of treatment:

complex drug therapy;
physiotherapy;
massage sessions;
physical therapy courses.

Positive dynamics can be achieved through the regular use of specialized simulators.

Periodic rehabilitation, recommended at least twice a year, helps speed up recovery (to the extent possible).

In special rehabilitation centers, the child attends:

speech therapist;
psychologist;
physiotherapist.

He is undergoing all procedures necessary to improve his condition.

In severe cases, surgery may be performed to correct the tendons and muscles. In adulthood, the patient may undergo neurosurgery to remove the diseased spinal cord tissue and stimulate it.

Principles of working with children

Both doctors and teachers need to deal with children who suffer from cerebral palsy. It is better to start working from an early age for children - from 1 to 3 years old. It is necessary to take them to classes where they will be taught to speak, perform everyday activities, and teach self-service skills. Such cerebral palsy training centers develop the ability to interact and communicate with peers.

When working with such children, much attention is paid to the development of speech and behavior in society. Each child receives an individual approach that takes into account age and form of pathology. Children are usually taught in groups in the form of a game, led by a competent specialist. The movements of each child are carefully observed, incorrect movements are corrected, and correct ones are encouraged.

To develop correct movement skills, special devices and devices are used to support the head, limbs, and torso in the desired position. The child trains and explores the surrounding space.

Forms of the disease and its features

Cerebral palsy is a disease that appears differently in each individual case. Even experts do not give clear predictions about how cerebral palsy will progress and how long they live with such a diagnosis.

Features of the course of the disease and prognosis depend on the form of the pathology. In medicine, there are five forms of cerebral palsy:

spastic tetraplegia;
dyskinetic;
ataxic;
hemiplegic;
spastic diplegia.

A child diagnosed with cerebral palsy receives the status of “disabled.” This is due to the fact that even a mild form of the disease cannot be completely cured.

There is also a secondary form of cerebral palsy that occurs during pregnancy if the woman’s body has been negatively affected by external factors (toxic poisoning, smoking, taking drugs, etc.).

Exercise therapy and massage

Massage for cerebral palsy begins at 1.5 months. The course is conducted only by a specialist who can assess muscle tone, frequency of sessions, and degree of impact. It is not recommended to massage yourself.

Physiotherapy exercises include a complex of therapy; exercises must be regular. The complexity of the exercises is set individually for each child, taking into account age, abilities, level of mental and emotional development. The load should increase gradually as the child's condition improves.

As a rule, the following exercises are performed for cerebral palsy:

Stretching.
Decreased muscle tone.
Strengthening individual muscle groups.
Endurance exercises.
For balance.
To increase muscle strength.

Treatment

Treatment for cerebral palsy is prescribed by a neurologist after identifying the causes of the disease and making a diagnosis. During diagnosis, electroencephalography and electroneuromyography are performed to study in more detail the functioning of the child’s brain and muscles. Based on the data received, the treatment process begins immediately in order to avoid more severe consequences, and, as a maximum, to get rid of the disease itself.

Drugs

To relieve convulsions and epileptic seizures, anticonvulsant medications are prescribed, to improve blood circulation - nootropic medications, and in the case of muscle hypertonicity - muscle relaxants. When pain symptoms occur, antispasmodics are prescribed.

In the most serious cases of brain damage, surgery is prescribed.

Massage

Massage for cerebral palsy is used when the child reaches the age of 1.5 months. Massage should be performed only by an experienced specialist who can assess muscle tone. All types of massage are used: classical, segmental, acupressure, according to Manakov.

Parents should not perform these procedures on their own, since only a specialist can correctly calculate the required load and frequency of sessions.

Exercises

Examples of training and exercises to develop muscle groups and joints:

Development of motor skills

The baby is squatting, the adult is also squatting in front of the child. Holding the baby by the belt and placing his hands on his shoulders, the adult pushes the child to make such a movement so that the baby kneels;
From the position of the child on his knees, holding him under the armpits, the adult tilts him to the right and left;
When holding the child, it is necessary to give him the opportunity to stand on one or the other leg.

Development of joint functions

From a position lying on your back, keeping one leg straight, the other should be bent towards the tummy and returned back, changing legs;
From a position lying on your back, raise and lower your legs alternately, bending them at the knees.

Abdominal muscle development

From a position sitting on a chair, the child should be helped to lean forward, and he should perform extension to the initial position independently;
From a position sitting on the floor, the child should reach his toes. An adult helps;
From a lying position, the child raises his legs and throws them behind his head, with the help of an adult.

Removing hypertension

Develop the baby’s hand, moving it in different directions, and lightly shake the hand at short intervals, relaxing the muscles.

Leg muscle training

From a position lying on his back, the adult helps the baby perform flexion and extension movements in the hip joint.

Exercises in water will help relieve muscle tension and increase their tone. A baby swimming in the central pool or even in the bathtub becomes much more energetic and better fights stress and depression. Finding a sick child in a dolphinarium has an amazing effect and helps greatly advance the treatment process.

Child development

The symptoms of cerebral palsy can be overcome by additional development of the child using play manipulations. Fine motor skills involved in playing with pyramids and cubes, rolling a ball, holding and releasing objects, affects the development of both the baby’s mental abilities and his speech apparatus.

As a result of these activities, the child learns to quickly memorize various objects, which leads to more intensive development and smoothing, or complete disappearance of the symptoms of cerebral palsy.

Disability

Disability for cerebral palsy is assigned depending on the severity and form of the disease. Children can receive the status of “disabled child with cerebral palsy”, and after 18 years - the first, second or third group.

To obtain disability, it is necessary to undergo a medical and social examination, as a result of which it is established:

Degree and form of the disease.
Nature of damage to the musculoskeletal system.
The nature of speech disorders.
The degree and severity of mental damage.
Degree of mental retardation.
Presence of epilepsy.
Degree of vision and hearing loss.

Parents of a disabled child can receive the necessary rehabilitation means and vouchers to sanatoriums at the expense of the state budget.

Complications of cerebral palsy

Among the main and most common complications of cerebral palsy the following may be noted:

Orthopedic and surgical complications: developmental disorders of the hip joints, curvature of the knee joints, forearms and feet.
Epileptic syndrome, which manifests itself as seizures, is especially common in the hemiparetic form of cerebral palsy. Convulsions aggravate the course of the disease, cause some difficulties with rehabilitation and pose a great danger to life. In patients with cerebral palsy, various forms of epilepsy occur, both benign with a positive prognosis and extremely severe.
Cognitive disorders, which include disorders of memory, intelligence, attention and speech. The main speech disorders in cerebral palsy are stuttering, pronunciation disorders (dysarthria), lack of speech in cases of preserved hearing and intelligence (alalia), and inhibition of speech development. Speech and movement disorders are interconnected, therefore each form of pathological condition is characterized by specific changes in speech.

Special products that make your child's life easier

Such devices and special equipment can be obtained from the state budget. This is only possible if the doctor has included a list of them in a special rehabilitation card, and the ITU commission, when confirming the disability, has recorded all the means as necessary for the rehabilitation of the child.

Such devices are divided into 3 groups:

For hygienic purposes: toilet chairs, bathing chairs. These devices are equipped with special seats and comfortable belts to secure the child.
Devices intended for movement: wheelchairs for children with cerebral palsy, parapodium, walkers, verticalizers. All these devices allow the child to move in space and explore it. A child who is not able to walk independently will need a stroller (cerebral palsy is a diagnosis for which this item is often extremely necessary), and more than one. For moving around the house - a home version, and for walking on the street, respectively, a street version. A stroller (cerebral palsy), for example, the Stingray, the most lightweight, is equipped with a removable table. There are very convenient and comfortable strollers with electric drive, but their prices are quite high. If your child can walk but has trouble keeping his balance, he will need a walker. They train coordination of movements well.
Devices for child development, medical procedures, training: splints, tables, exercise equipment, bicycles, special toys, soft cushions, balls.

In addition, a child with cerebral palsy will need special furniture, shoes, clothing, and dishes.

Other corrective treatments

A child with cerebral palsy most often has speech impairment. To correct it, classes are held with a speech therapist. It is important to follow all the doctor's recommendations.

Animal-assisted therapy—treatment with the help of animals—has become widespread. For the treatment of children with cerebral palsy, horseback riding, swimming with dolphins, and positive communication with animals are used.

A difficult but important issue is the social adaptation of a child with cerebral palsy. Among other things, communication with both healthy and similar children is required. For parents and loved ones of the child, working with a psychologist is also useful: after all, a lifelong ill child in the family is extremely stressful. Parents must prepare themselves for the fact that when the child grows up, it will be important for him to learn to accept himself and the world around him.

Live fully

Many children with cerebral palsy successfully adapt to society, some show themselves in creativity. For example, a seven-year-old boy with cerebral palsy (severe form), who cannot walk at all, but loves to sing, has become a real star. The Internet literally exploded with a video where he covered the track “Minimal” by rapper Eljay. A diagnosis of cerebral palsy does not at all prevent creativity and self-realization. This talented child was visited by the rapper himself; their photo together is very popular among fans of both Eldzhey and the boy Sergei.

Severity of cerebral palsy

Symptoms of cerebral palsy can be expressed in different ways. The severity of the disease in this case depends on the initial brain damage and how quickly and fully the rehabilitation of the sick child began.

With mild severity of the disease, children with cerebral palsy are able, albeit slowly, to acquire all the skills necessary for self-care. They attend both specialized and regular educational institutions and lead quite active social lives.

With moderate severity of cerebral palsy, the child cannot fully care for himself; he periodically needs the help of adults, but training and socialization take place.

With severe cerebral palsy, children are deeply disabled and unable to care for themselves. Therefore, they are completely dependent on their family and need constant outside care.

Signs of cerebral palsy in children under 12 months

It is not always possible to identify cerebral palsy by 6 months, because in addition to brain damage resulting from a head injury, the risk group includes premature babies and babies born with low birth weight. Sometimes cerebral palsy occurs due to complications during childbirth or a genetic predisposition. The first signs may appear by 10-12 months. For the age category up to 10 months, the first signs of cerebral palsy in a child will be as follows:

The baby has problems while eating. It becomes difficult for him to swallow;
At 1-3 months, the reaction to light worsens;
Sometimes parents notice how their baby is lying in a clearly uncomfortable position;
In infants, cerebral palsy manifests itself in increased muscle tone. Parents find it difficult to unfurl the baby’s legs or turn the baby’s head;
At 4 months, the child’s perception of sound weakens. If you make noise next to him, he will not turn his head;
Cerebral palsy in children at an early age can manifest itself in the form of periodically repeated head nodding. Sometimes he freezes in one position and does not move for several minutes;
When you try to turn the baby onto his stomach, he begins to be capricious and cry.

Treatment can only be prescribed by a doctor. There is no need to self-medicate; you should consult with doctors to determine the extent of brain damage. The first step is to examine the baby. Over time, the symptoms will worsen, muscle weakness and delayed muscle development may appear. It happens that children with cerebral palsy are slightly behind their peers in mental and physical development, although developmental delay should not be confused with any pathology.

Even if it is confirmed that your child has cerebral palsy, remember - this is not a death sentence. Cerebral palsy is curable and that’s a fact. Our website contains many stories of people who have proven that cerebral palsy is not an obstacle to achieving goals and living a full life.

How long do children with cerebral palsy live?

Life expectancy with this diagnosis largely depends on the form of pathology and the effectiveness of treatment, as well as on individual capabilities. Until recently, in the mid-20th century, patients with cerebral palsy did not even live to adulthood. Today the situation has changed dramatically thanks to the emergence of new methods practiced in specialized medical centers.

With a well-designed rehabilitation plan, including systematic exercise therapy and massage sessions, the patient will live to at least 40 years. This is a kind of milestone, when approaching it, life potential decreases: the body wears out faster due to deformation of the skeleton and internal organs.

Many patients who regularly undergo rehabilitation courses live to a ripe old age. The prognosis may worsen in severe forms of cerebral palsy, accompanied by frequent epileptic seizures or complete inability to self-care.

Is it possible to cure the disease?

The answer to the question about the lifelong nature of cerebral palsy (whether this disease is curable or not) comes from the fact that we are talking about a condition caused by irreversible damage to certain parts of the brain that are important for proper movement and positioning of the body. From this definition it follows that its main cause - irreversible damage - cannot be cured. But this does not mean that there are no effective means to help patients with this disease.

Despite the fact that even modern medicine cannot positively solve the problem of curing cerebral palsy in a child, it can improve its course and, consequently, the quality of life. There is no standard procedure; each patient needs a specific approach, i.e. The disease should be treated individually. The goal of therapy is to reduce the patient's movement disorder and develop his overall personality and skills so that he is able to lead as full a life as possible and be as independent as possible.

Why are children born with cerebral palsy?

Cerebral palsy is caused by abnormal development or damage to the brain during its active growth. This can happen during pregnancy, childbirth, or immediately after the baby is born. In some cases, the disease manifests itself a little later.

It is not always possible to determine the exact cause of cerebral palsy, but the main pathogenetic link is almost always hypoxia - oxygen starvation of the brain. Particularly susceptible to oxygen deficiency are the areas of the brain responsible for maintaining balance, reflexive and conscious movements. The result of their damage is a violation of muscle tone, paresis, paralysis and hyperkinesis - involuntary movements due to erroneous commands of the brain.

Cerebral palsy in newborns is usually associated with several damaging factors. More than 75% of them are problems of the perinatal period, which lasts from the 22nd week of pregnancy to the 7th day of the child’s life.

The causes of cerebral palsy that affect the fetus during intrauterine development include the following:

infectious viral pathologies – rubella, syphilis, herpes, toxoplasmosis, cytomegalovirus;
Rhesus conflict;
risk of miscarriage;
systemic diseases of the mother - diabetes mellitus, insufficient function of the thyroid gland (hypothyroidism), persistent increase in blood pressure, heart disease;
injuries received during pregnancy;
premature detachment or pathological changes in the placenta;
late toxicosis, nephropathy.

Risk factors that can lead to the development of cerebral palsy are premature, prolonged or rapid labor, breech presentation of the fetus, a narrow pelvis in a woman, weak or, on the contrary, excessively strong labor, and a long anhydrous period. Damage to brain structures can also occur due to mechanical trauma caused to the baby during childbirth.

The immediate cause of cerebral palsy is most often oxygen starvation of the brain.

Information: in the vast majority of cases, the cause of cerebral palsy is a pathology of intrauterine development.

In the postpartum period, cerebral palsy can occur due to asphyxia or hemolytic disease of the newborn, with the second option being the most likely. Hemolytic disease, caused by incompatibility between the blood of mother and fetus, sometimes leads to toxic damage to the brain.

Impaired respiratory function (asphyxia) is a consequence of existing diseases of the mother or child, or an unfavorable course of pregnancy.

Cerebral palsy - symptoms

Signs of cerebral palsy and symptoms of this disease may vary in nature and severity. This makes it difficult to diagnose the disease in newborns, when the clinical picture appears months after birth. In most cases, parents and doctors begin to suspect the disease when a child at 5-6 months does not crawl, sits poorly, or does not roll over. In most cases, babies with pathology retain infant reflexes longer.

The muscular system in such children has insufficient or increased tone. As a result of such changes, the baby’s limbs take on pathological positions. In 30% of cases, cerebral palsy is accompanied by the development of seizures. However, in some cases, these symptoms may be absent.

You can assume the presence of cerebral palsy if:

the baby does not blink at sharp, loud sounds;
at 4 months the baby does not turn his head to the source of sound, does not reach for a toy;
at 7 months the child is unable to sit without support;
At 1 year of age, he does not speak words, performs actions with only one hand, does not attempt to walk, and has squint.

Degrees of cerebral palsy

After a diagnosis of cerebral palsy has been made, the causes of the disease have been established, and doctors determine the degree of pathology. When characterizing cerebral palsy in children, neurologists often distinguish different levels of the disease. Neurologists use the International Patient Motor Function Classification Scale GMFCS. It can be used to describe the nature of disorders in a child over 2 years old. At the same time, the general functional activity of the child in his usual environment is assessed.

Depending on the results obtained, the following levels or degrees of cerebral palsy are distinguished:

Level 1
– the child moves independently without restrictions, there are difficulties in performing complex motor skills;
Level 2
– the patient is able to move, but there are restrictions;
Level 3
– movement is possible only with the use of additional devices (cane, walker) on flat surfaces;
Level 4
– children are able to sit independently, but cannot walk;
Level 5 impairment
is the most severe: the child is completely unable to move without additional assistance.

Is it possible to prevent cerebral palsy?

There is no clear answer to this question yet. You can say “no,” because it is not always possible to prevent, say, acute fetal hypoxia during childbirth. But you can also say yes. To prevent cerebral palsy in children, we need those basic, mandatory measures for everyone, the importance of which we sometimes don’t even think about. This includes pregnancy planning, cure for chronic infections, timely vaccination against rubella, regular visits to the obstetrician-gynecologist, extreme care for yourself and the child, exclusion of contacts with patients with viral diseases, control of blood pressure and the level of anti-Rhesus antibodies during pregnancy, prevention of premature birth. .

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Signs of cerebral palsy in children under 6 months

At 3-6 months, the manifestations of the disease become more noticeable than at birth and the presence of a pathological process can already be determined. Of course, you need to know the peculiarities of children’s development during this period, so as not to confuse possible pathology with the natural development of the child.

Basic unconditioned reflexes usually disappear before 6 months. For example, a child stops tilting his head and opening his mouth when pressing on his palm. If he continues to do this, then it is better to be wary.

You can check for the presence of the disease by focusing on the automatic walking reflex. It is an imitation of the movement of the legs when lifted by the armpits. At three to six months, the following nuances are considered pathological:

Convulsions manifested in the form of strange voluntary movements;
Developmental delay, which manifests itself in the fact that the baby begins to walk much later than expected;
Using predominantly one hand. This happens due to increased tone or paresis of the muscle tissue of the other limb. Because of this, movements seem extremely awkward;
Increased muscle tone or weakness;
Strabismus;
Inability to sit independently at 6-7 months;
Reflexive turning of the head when trying to put something in the mouth.

Closer to one year, a child with cerebral palsy may walk poorly (or not walk at all), speak little or not utter anything at all except incoherent sounds. This is already a reason to contact doctors to start treatment as soon as possible.

What can parents do?

Recognizing cerebral palsy in the first year of life is not easy because its symptoms often become apparent later. However, making a diagnosis in a timely manner means starting treatment on time and significantly making the future life of a sick baby much easier.

If your pregnancy was not going well, if you know that your child suffered complications during childbirth or in the first days of life, it is very important to regularly show him to a pediatrician and neurologist. If something worries you and the doctors, examinations can be carried out monthly to create a complete picture of its development. It often happens that it is the parents, in whose eyes the baby’s life passes, who encourage the local pediatrician to conduct more careful monitoring.

Inna D.:
Many mothers of children with cerebral palsy, having found themselves in such trouble, withdraw into their shell and begin to develop complexes.
But on the contrary, you need to go to people. I didn't understand this at first. Until my son was 2 years old, I didn’t go out with any of the other moms, I was alone all the time. And then something burned out in me, my attitude towards myself and my own life changed. Now I go out into the yard, healthy children are playing around my child, who at first somewhat avoided him. And now he is welcome, they treat him completely normally, although he is different from them. But he sees other children and wants to do everything the same way as they do, he reaches out for them. If you begin to be ashamed of yourself and your child, those around you will treat you accordingly. You need to learn to live with it and be happy. Natasha E.:
I treat my child as if he is healthy.
It may seem strange from the outside, but I try not to focus on my son’s health. I try to spend as much time with him as possible, on the one hand, to give him everything I can, and on the other hand, so as not to feel cut off from life. We devote a lot of time to classes in various centers for the rehabilitation of children, in which different methods complement each other. At the same time, even though my son is a home child and not a kindergarten child, I found the opportunity to go to work twice a week. This is exactly what I need, because I am a restless person by nature. I can't imagine myself sitting at home all the time. And now I’m happy in my own way. I can’t imagine any other life for myself. If everything had turned out differently, well, my life with my son would have been different, but as it turned out, so it turned out. We often joke that when the store gave out children, I got the best one... Of course, parents won’t be able to make a diagnosis on their own. Nevertheless, let us recall some symptoms that may indicate problems in the child’s central nervous system:

There is a certain sequence in which motor skills appear in infants. So, for example, by a month and a half, in a position lying on his stomach, the child should steadily hold his head up. A delay in the development of motor skills in a child and a significant delay in speech development are a serious cause for concern. It is recommended that all parents keep a diary of their child’s development, in which the baby’s main achievements will be noted (first smile, holding his head, turning over, walking, first tooth, etc.).
There is a group of unconditioned reflexes that appear in a child after birth and then gradually fade away. That’s what they’re called – newborn reflexes. For example, the palmar-oral reflex (when pressing on the palms of a newborn, he opens his mouth) or the automatic walking reflex (the baby, leaning on his legs, is slightly tilted forward, and he makes stepping movements). As a rule, these reflexes disappear in 1-2 months. If they remain for up to 4-6 months, then you should think about disruption of the central nervous system.
Lack of interest in toys (usually the child begins to reach for them at about 4 months).
Oculomotor disorders, such as severe strabismus.
The child freezes for a while in some position or makes involuntary movements, nodding his head.
The child does not show interest in contact with the mother, as a result of which there is an early refusal to breastfeed.

If you notice these symptoms, be sure to report them to your doctor.

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Assistive technology

Children with cerebral palsy find it difficult not only to stand, but also to sit. To alleviate the condition and make life more comfortable, there are various devices widely used by this category of patients:

Special seats, walkers, and wheelchairs have been developed for mobile movement.
For the physical development of a child, there are bicycles, verticalizers, and special shoes.
For the convenience of hygiene procedures, you can purchase toilet chairs or special seats for the bath.

The abundance of modern technology can make a child’s life or care much easier. For example, walking seat options are specially designed, equipped with a hood, a table, and special belts. There are electric wheelchairs.

Important! Patients require constant care to make their lives easier and prevent skeletal muscle dystrophy.

Complications of cerebral palsy can include multiple joint deformities, convulsions, and difficulty swallowing. Problems with muscles and joints cause the patient constant pain. Constant care requires a lot of time, moral and financial investment for the person caring for a special child. Prevention of cerebral palsy consists of timely examination and elimination of the causes that can cause such a symptom complex.

Video - cerebral palsy

Compensation methods

If a child suffers from an advanced form of cerebral palsy, it is necessary to use assistive and prosthetic devices in accordance with the individual needs of the patient. These include:

orthoses;
adjustable devices for sitting, strollers, etc.

Their goal is to compensate for musculoskeletal disorders, minimizing their impact on the patient’s daily life.

Care for a patient with cerebral palsy should be comprehensive, including treatment of complications and associated problems, their solutions with the participation of many specialists:

neurologist;
orthopedist;
ophthalmologist;
ENT specialist;
psychiatrist;
neurosurgeon;
gastroenterologist;
psychologist;
speech therapist;
endotherapist;
teacher;
prosthetic care specialist;
social worker, etc.

Treatment results depend on early diagnosis and are proportional to the quality and complexity of rehabilitation.

How to identify cerebral palsy in a three-month-old child?

In the period from 3 months to six months, the child exhibits congenital reflexes, including hand-to-mouth and heel reflexes. The presence of the first can be checked by pressing your fingers on the inside of the hand, while the child opens his mouth. To check for the presence of a heel reflex, you need to lift the child by placing him on his feet. Usually babies try to move around. In a healthy state, the child stands on his full foot. If cerebral palsy manifests itself, he rests only on his fingertips or cannot use his legs for support at all.

At 3 months, cerebral palsy can be quickly diagnosed if the child actively uses only one side of the body. In many cases, this symptom can be detected within a few days after the baby is born. Insufficient muscle tone on the one hand and hypertonicity on the other are caused by pathologies of the relationship between the two hemispheres of the brain.

The first signs of cerebral palsy

If the innervation is carried out incorrectly, the child's movements become clumsy, he uses opposite parts of the body in different ways, and an inhibited reaction appears. Manifestations of cerebral palsy can be seen even on the face. There may be a complete absence of chewing muscles, which causes asymmetry of the facial muscles. Strabismus often develops.

On a note! Sick children often cannot sit independently, and this deviation can persist for up to six months or longer.

What is cerebral palsy

According to statistics, out of a thousand newborns, 2 children are born with cerebral palsy, and the majority of those affected are boys. In Russia, this figure is slightly higher, and the disease is diagnosed in 3–6 children. Almost half of them are born as a result of premature birth.

Cerebral palsy is one of the most significant problems of modern pediatrics when it comes to chronic pathologies. Every year the number of children with this diagnosis is growing. Experts cite environmental deterioration and the rapid development of neonatology as the main reasons. Neonatologists' patients include infants with respiratory distress syndrome (RDS), low weight and various developmental defects.

There are several types of cerebral palsy, which differ in the degree of damage to the central nervous system and the characteristics of symptoms. The dominant symptom is a disorder of muscle tone, which entails impaired coordination of movements, frequent falls, and delayed intellectual and physical development.

Lifelong rehabilitation is indicated for children and adults diagnosed with cerebral palsy. If necessary, physiotherapeutic and drug treatment, as well as surgical intervention, are prescribed.

Forms of cerebral palsy

Today, individual types of the disease are classified depending on the nature of the movement disorder into 4 broad categories.

Spastic form

Affects approximately 70-80% of patients. Characterized by hardening and spasticity of the muscles in the affected parts. It, in turn, is divided into the following types:

diplegia – limbs are affected bilaterally;
hemiparesis - affects the limbs on one side of the body;
triparesis – affects both lower and one upper limb;
quadroparesis – all four limbs are affected.

Hyperkinetic form

Characterized by involuntary slow, circular movements, usually involving the arms, legs, or all extremities. Sometimes the muscles of the face and tongue are affected, which leads to grimaces, etc. Abnormal movements stop during sleep. This form of the disease affects about 10-20% of patients.

Ataxic form

This form is rare and mainly affects the perception of balance and deep sensitivity (proprioception). Patients usually walk unsteadily, have poor coordination, and have legs unusually far apart. Tremors may occur with free movement. The disease affects approximately 5-10% of patients.

Combined form

This type is represented by a combination of various forms of the disease. The most common combination is spastic + hyperkinetic type.

Tests that help the doctor make a diagnosis

Echoencephalography is an ultrasound diagnostic method based on the principle of echolocation. This test can be carried out from birth. In a number of diseases of the central nervous system, it helps to identify the expansion of the ventricles of the brain and the asymmetry of its hemispheres.
Neurosonography can be performed as long as the size of the large fontanelle allows. This ultrasound diagnostic method allows you to clarify the structure of the brain and determine the size of its ventricles.
Electroencephalography (EEG) is a method for studying brain activity, based on recording the bioelectrical activity of individual zones, regions, and lobes of the brain. In some specialized clinics, this study is carried out from 6-7 months of life, and, if necessary, earlier. With cerebral palsy, pronounced age-related immaturity of the brain and some other conditions are revealed.
Computed tomography (CT) and nuclear magnetic resonance (NMR) are the most informative methods available today. CT is a radiation diagnostic method that allows you to obtain a series of cross-sectional images of almost any part of the human body. NMR is a method based on resonant absorption of radio waves. It allows you to obtain two-dimensional images of the organ under study in any section and convert them into three-dimensional images. CT and NMR show defects in brain development, clarifying the picture of existing disorders.
Electromyography is a fairly common method that studies the electrical activity of muscles. It should be recognized that it is not very informative from the point of view of diagnosing cerebral palsy and is carried out in later periods of the child’s life.

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Diagnostics

Symptoms of cerebral palsy may not be present or detected at birth. Therefore, the attending physician observing the newborn must carefully monitor the child so as not to miss symptoms. However, you should not over-diagnose cerebral palsy, since many motor disorders in children of this age are transient. Often, the diagnosis can only be made several years after the birth of the child, when movement disorders can be noticed. Diagnosis of cerebral palsy is based on monitoring the physical development of the child, the presence of various deviations in physical and intellectual development, test data and instrumental research methods such as MRI. Diagnosis of cerebral palsy includes:

Gathering information about the baby's medical history, including details about the pregnancy. Quite often, the presence of developmental delay is reported by parents themselves or it is revealed during professional examinations in children's institutions.
A physical examination is necessary to identify signs of cerebral palsy. During a physical examination, the doctor evaluates how long the baby's newborn reflexes last compared to normal periods. In addition, muscle function, posture, hearing function, and vision are assessed.
Tests to detect a latent form of the disease. Developmental questionnaires and other tests help determine the extent of developmental delays.
Magnetic resonance imaging (MRI) of the head, which may be done to identify abnormalities in the brain.

The complex of these diagnostic approaches makes it possible to make a diagnosis.

If the diagnosis is unclear, additional tests may be ordered to evaluate the condition of the brain and to rule out possible other diseases. Tests may include:

Additional questionnaires.
Computed tomography (CT) of the head.
Ultrasound examination of the brain.

Assessment and management of cerebral palsy

After cerebral palsy is diagnosed, the child must be further examined and other diseases that may be present simultaneously with cerebral palsy be identified.

Other developmental delays in addition to those already identified. Developing abilities need to be assessed periodically to see if new symptoms such as speech delay appear as the child's nervous system is continually developing.
Intellectual delay can be detected using certain tests.
Convulsive episodes. Electroencephalography (EEG) is used to look for abnormal activity in the brain if a child has a history of seizures.
Problems with feeding and swallowing.
Vision or hearing problems.
Behavior problems.

Most often, a doctor can predict many of the long-term physical aspects of cerebral palsy when the child is between 1 and 3 years old. But sometimes such predictions are not possible until the child reaches school age, when deviations can be detected during learning and the development of communication abilities.

Some children need repeat testing, which may include:

X-rays to detect hip dislocations (subluxations). Children with cerebral palsy usually undergo several x-rays between the ages of 2 and 5 years. In addition, x-rays may be ordered if there is pain in the hips or if there are signs of hip dislocation. It is also possible to order a spinal x-ray to identify deformities in the spine.
Gait analysis, which helps identify disorders and adjust treatment tactics.

Additional examination methods are prescribed if necessary and indicated.

Spastic cerebral palsy (CP) - causes

The cause of cerebral palsy is considered to be congenital, perinatal, intranatal and postnatal factors.

Congenital factors include:

malformations of the brain,
abnormalities of skull formation,
hereditary diseases,
chronic maternal illnesses,
pregnancy pathology,
toxoplasmosis.

Perinatal causes include:

prematurity,
hypoxia of the brain during childbirth,
brain injuries (forceps application, vacuum extraction, obstetric manual techniques, fetal asphyxia).

In the postnatal period, cerebral palsy factors include:

injuries,
concussions,
infectious diseases (meningitis, encephalomeningitis).

So, the main reasons for the development of cerebral palsy are dysfunction of the brain (pyramidal, extrapyramidal and cerebellar systems), and clinical manifestations depend on the severity of brain damage and consist of mono-, para-, hemi- and tetraparesis.

The following clinical forms of childhood spastic paralysis are distinguished: 1) spastic hemiplegia (hemiparesis); 2) spastic diplegia; 3) bilateral hemiplegia; 4) atonic-asthenic form; 5) hyperkinetic form; 6) atactic form.

Forms of childhood spastic paralysis

Spastic hemiplegia is characterized by damage to the limbs on one side: the right upper and right lower (right-sided hemiplegia), left upper and left lower (left-sided hemiplegia). The flesh tone in the affected limbs is increased, although in some children in the first weeks of life it may even be decreased (hypotonia).

Basically, symptoms of cerebral palsy can already be detected in a newborn. Firstly, there is an asymmetry of muscle tone and spontaneous movements. Muscle tone is increased on the affected side. Secondly, the paretic arm is brought closer to the body, the hand is clenched into a fist and the child makes fewer spontaneous movements with it. Thirdly, turning the head to the healthy side, tilting the shoulder girdle to the affected side with pulling up the pelvis creates the impression of shortening the affected side of the body; the affected lower limb is more extended than the healthy one and rotated outward. Tendon reflexes are strengthened on the affected side, and a clear Babinski reflex can be observed. A child with hemiparesis does not want to lie on his stomach; it is difficult for him to pull his hand out from under the chest, lean on it and grab objects with it. In a standing position, the child transfers his body weight to the healthy lower limb, and the affected one is slightly elevated and is located behind the healthy one due to the pelvis tilting backwards. The foot of the affected limb is turned inward, the toes are bent and tense, and in mild forms the heel touches the floor.

Clinical picture of cerebral palsy Position of the child when crawling

The child later begins to crawl, sit, and stand. When crawling, the head is turned to the healthy side, the child relies on healthy limbs, and pulls the paretic ones. In a sitting position, the affected leg is bent and adducted, while the healthy leg is extended at the knee joint. The spine is tilted to the affected side, the shoulder is lowered, and the child does not lean on the affected arm.

Sitting position with cerebral palsy

Children begin to walk much later and maintain balance much worse. The affected lower limb is rigid when walking, the child does not straighten it at the hip and knee joints, and transfers the load to the forefoot. At the age of 6-8 years, a pathological alignment of the limbs and torso is formed, namely: the shoulder is adducted with the forearm bent and pronated, the hand is bent in ulnar abduction, the fingers are bent, the first finger is adducted. With the development of scoliosis (C or S), the pelvis becomes permanently tilted, equinovarus or valgus deformity of the feet and muscle wasting develop. The distal parts of the affected limb are cyanotic and cold to the touch. Spastic diplegia (Little's disease) and tetraparesis (tetraplegia) develop. The lower extremities are more often affected. The current is severe. Upper extremity involvement is variable. In mild forms, clinical manifestations become informative at 4-6 months from birth; in severe forms immediately after childbirth, diagnosis is not difficult.