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Also called the “flaccid” form. It is characterized mainly by a decrease in muscle tone. The child cannot control the movements of the head, limbs, and torso. There are also disturbances in motor coordination and balance, but these symptoms are not dominant. Another feature of this form is that motor disorders are certainly combined with a sharp delay in the development of speech and psyche.

In the supine position, the child is lethargic and inactive. Muscle tone is reduced, and less so in the arms than in the legs. Hand movements are more active.

The child begins to hold his head only after 6 months. If he is taken under the armpits, he cannot maintain a vertical posture; his head and torso are tilted forward. In a prone position - unable to hold your head up for a long time and lean on your arms.

The child begins to sit at one and a half to two years. In this position, the legs are spread wide and turned (rotated) outward. Kyphosis of the thoracic spine is pronounced. The position is unstable, the body sways from side to side. Resistance appears at 4-6 years.

A child begins to stand at the age of 4-8 years, spreading his legs wide apart and holding an adult’s hand or support. Without support, he falls under the influence of gravity, while the protective reaction of the arms and compensatory movements of the torso aimed at maintaining balance are absent. The patient's torso is supported by resting on the heels during recurvation (hyperextension) of the knee joints. The head and torso are tilted forward, the hip joints are in a state of flexion, the legs are tilted back, and the feet are planovalgus. The posture is largely due to severe quadriceps weakness.

Such children can move independently after 7-9 years, and only for short distances. The gait is characterized by instability and irregularity. Children often fall. The legs are wide apart when walking.

80-90% of children experience a pronounced decrease in intelligence and speech impairment. Such children are often aggressive, negatively disposed, and it is difficult to come to an agreement with them about anything.

Prognosis for recovery of motor functions and social adaptation adverse.

A.S. Levin, V.V. Nikolaeva, N.A. Usakova

Diseases

In our country, the classification adopted by the world-famous neurologist Ksenia Aleksandrovna Semenova has been in effect for many years. A clear gradation of symptoms and manifestations of the disease helps speech therapists, psychologists and doctors select the optimal 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 illness is considered very severe and is extremely difficult to treat.

Symptoms

Even in the first year of the baby’s life, parents can see a decrease in the rate of psychosis. motor development. Self-diagnosis sites on the Internet today help you become convinced or disabuse yourself of your fears. Parents answer a series of questions by filling out fields on an electronic form and then receive a probable diagnosis. This is only an approximate result; a specialist in a medical institution must confirm or refute it.

The specialist makes a diagnosis based on such symptoms of atonic- astatic form Cerebral palsy:

Parents may notice deviations from the norm in the child’s behavior even in the first year of life. As a rule, the baby cannot maintain balance, his coordination of movements is impaired, tremors are clearly noticeable, and his movements are excessive. The following causes of the atonic-astatic form of cerebral palsy lead to such consequences:

• Only the cerebellum is affected. In this case, children do not show initiative and read and write poorly.
• Damage to the cerebellum and frontal lobes. Then the child may show aggressiveness and underdeveloped cognitive activity.

According to research by Ekaterina Semenova, children with this form of cerebral palsy also experience mental retardation, and in a severe stage. The doctor recommended sending patients to institutions of the Ministry social protection. This is due to the fact that in most cases, with this form of cerebral palsy, the child cannot care for himself or attend preschool and school institutions.

Parents usually turn 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 parents will have to answer the following questions:

1. How long has the child been experiencing behavioral changes?
2. Have parents previously noticed deviations in their child’s physical activity?
3. Was oxygen deprivation diagnosed during pregnancy?
4. The baby was born ahead of schedule or according to the traffic regulations?
5. Was the birth normal, or was the baby injured?
6. During pregnancy, did the baby's mother suffer from rubella, syphilis, influenza, or various chronic ailments, including pneumonia and tuberculosis?
7. Were stimulants used during labor?
8. What body weight was the baby born with?

Treatment of atonic form of cerebral palsy

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

Original nootropic drug for children from birth and adults with a unique combination of activating and sedative effects

Early diagnosis and comprehensive treatment of cerebral palsy

S.A. Nemkova, Russian National Research Medical University named after N.I. Pirogov" of the Ministry of Health of Russia, Moscow, Doctor of Medical Sciences.

Keywords: cerebral palsy, children, treatment, rehabilitation, Pantogam ®
Keywords: cerebral palsy, children, treatment, rehabilitation, Pantogam ®

CLASSIFICATIONS of cerebral palsy:
According to the International Statistical Classification ICD-10, the following are distinguished:
G 80.0– Spastic cerebral palsy.
G 80.1– Spastic diplegia.
G 80.2– Childhood hemiplegia.
G 80.3– Dyskinetic cerebral palsy.
G 80.4– Ataxic cerebral palsy.
G 80.8– Another type of cerebral palsy.
G 80.9– Cerebral palsy, unspecified.

Clinical classification K.A. Semenova includes the following forms of cerebral palsy: double hemiplegia, spastic diplegia, hemiparetic form, hyperkinetic form, atonic-astatic form, mixed forms.

The frequency of forms of cerebral palsy is: spastic diplegia - 69.3%, hemiparetic form - 16.3%, atonic-astatic form - 9.2%, hyperkinetic form - 3.3%, double hemiplegia - 1.9%.

Early manifestations of cerebral palsy are:
delayed motor and psycho-speech development, absence or delayed reduction of congenital and tonic reflexes, as well as the formation of attitudinal reflexes, impaired muscle tone, increased tendon reflexes, the appearance of pathological attitudes and synkinesis.

Early clinical and neurological diagnosis of cerebral palsy is largely based on the doctor’s knowledge sequence of formation of stages of neuro- mental development 1 year old child : 1 month – the child tries to hold his head, fix his gaze, innate reflexes are expressed; 2 months – briefly holds the head on the stomach and in an upright position, fixes the gaze, hums, physiological astasia-abasia; 3 months – holds his head, follows the object, weakens the grasping reflex and tries to voluntarily hold the inserted toy, rests on his forearms on his stomach; 4 months – turns his head in the direction of the sound, reaches out and takes a toy, turns on his side, sits down and sits with the support of his hands, pronounces vowel sounds; 5 and 6 months – sits with support from 1 arm or briefly independently, turns from back to side and stomach, distinguishes familiar faces, first syllables appear; 7 and 8 months – sits independently, gets on all fours, tries to stand briefly against a support; 9 and 10 months – kneels with support, stands and tries to move with support, stands independently for a short time, speaks the first words; 11 and 12 months – walks with support from 1 arm and tries to walk independently, follows simple instructions, speaks a few words, tries to feed himself with a spoon.
Assessment of the degree of delay in motor and psycho-speech development:
up to 3 months – mild, 3–6 months – moderate, more than 6 months – severe.
Correction factors for prematurity:
up to 1 year – the period of prematurity in months is added, from 1 year to 2 years – half the period of prematurity in months is added.

For motor development A healthy child is characterized by a certain sequence, which is manifested by the extinction of unconditioned reflexes, the formation of attitudinal (straightening) reflexes, and the improvement of balance reactions.

One of the early signs of cerebral palsy is a violation of the timely reduction (at 2 months in full-term children, at 3–4 months in premature infants) of unconditioned reflexes - palmar-oral, proboscis, Moro, support and automatic gait, postural reactions (labyrinthine, as well as cervical) tonic asymmetric and symmetric reflexes). As unconditioned reflexes fade, starting from 1 month of life, adjustment reflexes are formed (labyrinth adjustment, chain cervical adjustment, etc.), which provide turns and straightening of the body and are improved up to 10–15 months. In patients with cerebral palsy, tonic reflexes can persist for life, which inhibits the formation of adjustment reflexes, voluntary motor activity, balance reactions and leads to the development of a pathological postural stereotype.

Impaired muscle tone is one of the early signs of developing cerebral palsy. Muscle hypertonicity and asymmetrical posture that persist after 4 months are observed in the consequences of perinatal lesions of the central nervous system and the threat of cerebral palsy (its spastic forms). The “spread out frog” position is observed with diffuse muscle hypotonia in premature infants, with perinatal lesions of the central nervous system, and the threat of atonic-astatic form of cerebral palsy.

CLINICAL FORMS OF CEREBRAL PALSY

At spastic diplegia the history of prematurity is common (67%), the clinical picture shows tetraparesis (the lower extremities are affected to a greater extent than the upper ones), sharply increased muscle tone of the extremities, body, tongue, high tendon reflexes, increased tonic reflexes, pathological attitudes and deformations are observed limbs, a spastic gait with a cross is formed, while only half of the patients walk independently, 30% with support, the rest move in a wheelchair. Speech disturbances in the form of spastic dysarthria and vision pathology in 70% of patients (refractive errors, optic nerve atrophy, strabismus) are characteristic.

Hemiparetic form often caused by birth trauma, the clinic notes spastic hemiparesis, with the upper limb suffering more than the lower, shortening and hypotrophy of the affected limbs, hemiparetic gait, Wernicke-Mann position with flexion of the arm and extension of the leg (“the hand asks, the leg squints”). , foot deformities and contractures on one side, the incidence of symptomatic epilepsy is high (about 35% of cases).

Hyperkinetic form is often the outcome of bilirubin encephalopathy due to kernicterus, which develops in full-term newborns with a bilirubin level in the blood of 428–496 µmol/l, in premature infants – at 171–205 µmol/l. Characterized by violent involuntary movements (hyperkinesis) of the limbs and torso, which intensify with excitement and disappear during sleep. Hyperkinesis appears first in the tongue (at the age of 3–6 months), then spreads to the face, and then by 2–6 years to the trunk and limbs. Disturbances in muscle tone such as dystonia are noted, autonomic disorders, hyperkinetic dysarthria, and sensorineural hearing loss are common (in 30–50%).

Atonic-astatic the form is characterized by low muscle tone, impaired coordination of movements and balance, as well as excessive range of motion in the joints of the limbs.

Double hemiplegia – the most severe form of cerebral palsy, manifested by gross motor impairment, increased muscle tone, tendon reflexes, severe speech impairment, and the mental development of children at the level of mental retardation.

The most significant complications of cerebral palsy:
orthopedic-surgical, cognitive and sensory disorders (in 80%), episyndrome (in 35%), behavioral disorders, neurotic disorders (in 2/3 of patients), autonomic dysfunction syndrome (in more than 70%).

The leading principles of cerebral palsy rehabilitation are:
early start, comprehensive multidisciplinary approach, differentiated nature, continuity, duration, phasing, succession. Rehabilitation treatment of a patient with cerebral palsy should be carried out in accordance with an individual rehabilitation program and include the following areas:
1. Medical rehabilitation: drug therapy, physical therapy and massage (classical, segmental, periosteal, connective tissue, circular trophic, point), Vojta therapy, neuro-developmental system B. and K. Bobath; use of therapeutic-load suits (“Adelie”, “Gravistat”, “Regent”, “Spiral”), pneumatic suits (“Atlant”, etc.), mechanotherapy (exercises using simulators and special devices, including robotic complexes (Lokomat, etc.), physiotherapy (electrotherapy - electrophoresis and electromyostimulation, magnetic therapy, paraffin-ozokerite applications, mud therapy, hydrokinesiotherapy, acupuncture), orthopedic-surgical and sanatorium-resort treatment.

2. Psychological, pedagogical and speech therapy correction(psychocorrection, sensory education, classes with a speech therapist-defectologist, conductive pedagogy by A. Peto, Montessori method, work with families, etc.).
3. Social and environmental adaptation.

Drug therapy for cerebral palsy includes:

• Drugs that have neurotrophic and nootropic effects (Pantogam ®, Cortexin, Cerebrolysin, nootropil, phenibut).
• Drugs that improve general cerebral hemodynamics and microcirculation (Cortexin, cinnarizine, Actovegin, Trental, Instenon, etc.).
• Drugs that improve metabolism in the nervous system, reparative and absorbable effects (ATP, lidase, vitreous, sodium derivative, etc.).
• Anticovulsants.
• Drugs that normalize muscle tone (for hypertonicity - mydocalm, baclofen, botulinum toxin preparations; for hypotension - prozerin, galantamine).
• Drugs that reduce hyperkinesis (Pantogam ®, phenibut, nacom, thiopridal).
• Vitamins (B1, B6, B12, C, neuromultivitis, aevit, etc.).

Mechanisms of action of Pantogam: directly affects GABA-B receptors, potentiates GABAergic inhibition in the central nervous system; regulates neurotransmitter systems, stimulates metabolic and bioenergetic processes in nervous tissue; reduces cholesterol and beta-lipoprotein levels in the blood.

The range of clinical applications of Pantogam for perinatal lesions of the central nervous system and cerebral palsy includes:
1) cognitive impairment, including delayed psycho-speech development and mental retardation, early postoperative cognitive dysfunction, speech disorders;
2) delayed motor development, movement disorders;
3) neurotic and neurosis-like disorders, emotional disorders;
4) cerebral palsy in combination with epilepsy (since Pantogam ®, unlike most nootropic drugs, does not cause a decrease in the threshold of convulsive readiness);
5) hyperkinesis (Pantogam ® is used as long-term monotherapy - up to 4-6 months, in case of insufficient effectiveness - as part of complex therapy with thiopridal), extrapyramidal side effects neuroleptic therapy;
6) asthenic syndrome, decreased mental and physical performance;
7) autonomic dysfunction syndrome;
8) pain syndrome (as part of complex therapy).

The use of Pantogam in children with a complicated perinatal history has been shown to be highly effective in the complex rehabilitation of motor and cognitive disorders (with an improvement in psychomotor activity and hand-eye coordination by 10–45%, short term memory– by 20–40%, attention – by 30%), sleep disorders. It has been shown that the use of Pantogam in children with developmental dysphasia (alalia), resulting from perinatal damage to the central nervous system, improves speech indicators by more than 3 times. It was found that the use of Pantogam in the postoperative period effectively neutralizes the manifestations of postoperative cognitive dysfunction with the restoration of the indicator of concentration of attention and its subsequent improvement in 30% of patients by 2.5 times.

In children with perinatal pathology and cerebral palsy, one of the leading tasks of pathogenetic pharmacotherapy is to increase the energy potential of the brain using metabolically active agents. The L-carnitine preparation - Elkar ® ("PIK-PHARMA") - is a stimulator of energy metabolism, has antioxidant, anabolic, detoxification properties, as well as neuroprotective and neuromodulatory effects.
Studies of the effectiveness of using Elkar in children with perinatal pathology indicated a decrease in their excitability, normalization of autonomic functions, improvement in height and weight indicators and motor-reflex sphere, mental development, EEG. In cases of pathological bilirubinemia in newborns, a more rapid regression of jaundice was noted when taking Elcar with a decrease in indirect bilirubin in the blood.
In patients with cerebral palsy, when using Elkar in the process of complex rehabilitation, tolerance to both mental and physical activity, coordination, neurosensory processes (visual and hearing acuity), speech, autonomic functions, ECG and EEG have improved (with normalization of cortical electrogenesis, reduction of epileptic manifestations). In patients with cerebral palsy who received Elkar ® in the pre- and postoperative period of orthopedic-surgical treatment, there was a noticeable improvement in skin trophism, a decrease in postoperative complications, and the need to use analgesics.

Thus, early diagnosis and comprehensive treatment help to increase the effectiveness of rehabilitation measures, reduce disability and increase social adaptation of children with cerebral palsy.

The list of references is in the editorial office.

Basics of intensive rehabilitation. Cerebral palsy Vladimir Aleksandrovich Kachesov

7.1. ATONIC-ASTATIC FORM of cerebral palsy

Example rehabilitation of a 5-year-old child with an atonic-astatic form of cerebral palsy (from the author’s video archive).

A 5-year-old boy, Yura, was admitted to rehabilitation for an atonic-astatic form of cerebral palsy.

A boy from the first pregnancy, which proceeded without complications in a 27-year-old mother. Urgent birth. Long anhydrous period. Stimulation of labor. The child was born in blue asphyxia. Apgar score - 5 points. Resuscitation measures within 5 minutes. Then, for a month, he was in the neonatal care unit. After discharge home, there was a decrease in the tone of all muscle groups. The child could not hold his head. When the body verticalized, the eyes rolled under the forehead. From the moment he was discharged home, he received nootropics, Cerebrolysin, vitamins, massage, and acupuncture. Repeatedly annually he was treated in various rehabilitation centers in Ukraine and Russia. No positive dynamics were noted. The child was found to have no prospects for rehabilitation. Parents were repeatedly offered to place their child in a nursing home.

Upon admission to us for rehabilitation in November 1994, there was a sharp lag in weight, height and other age-related parametric data. Teeth: 2 upper and 2 lower incisors. At the age of 5 years, the child looked like one and a half year old children in terms of height and weight. Active movements in the limbs are sluggish and low-amplitude. When the body was verticalized, there was a short-term fixation of the eyes in the middle position for 2-3 seconds, then the eyes rolled under the upper edge of the eye sockets. The child held the head in a vertical position for 1-2 minutes. In a horizontal position, lying on his stomach, the child tried to raise his head, but could not turn it. I tried to bend my legs at the hip joints and crawl, but I didn’t have enough strength. Pacifier feeding. The child, according to his mother, never cried in all 5 years of his life. All reflexes are sharply reduced. According to the parents, Last year The child began to periodically make faint sounds. During the inspection period he did not make a sound. A CT scan of the brain did not reveal any gross pathology.

Rehabilitation. From the first day, the child was taken off nootropics and Cerebrolysin. Eleutherococcus was prescribed, 10 drops once in the morning for a month. Vitamin “C” 0.25 g, “calcinova” 3 times a day. It is recommended to give the child more water and juices. At the same time, procedures using the author's technology were started (see description of procedures) 2 times a day, morning and evening. General intensive massage of the whole body and limbs. Interestingly, already on the second day, in the evening, after three procedures, the child was able to raise his head and roll over in bed on his own. On the third day, he was already crying and trying to actively resist the procedures, although he was still very weak. The mother noted a sharp increase in the child's appetite. By the end of the week, the child was able to sit up independently in bed without support, actively walked and made various sounds. He began to reach for bright toys. The tone in the legs and arms sharply increased, by the end of the second week the child was actively trying to crawl, rolling from back to stomach, from stomach to back, and trying to sit up in the crib. By the end of the second week, the mother noted the eruption of new teeth. Discharged after 2 weeks for admission to continue rehabilitation after 3 months.

Three months after the first course of intensive rehabilitation, the child’s parametric characteristics (height, weight) corresponded to the age of 3 years. The number of teeth increased to 15. Movements in the hands were full, and some hypertonicity of the flexors of the upper and lower extremities was detected. Eats independently. Can walk, holds the torso straight, but there is a predominance of flexor tone and inward rotation of the feet. He speaks tongue-tied, but has a large vocabulary. Reads poetry. The child has a good memory. It’s amazing what the child tries to tell with emotions and details about the first days of rehabilitation.

The 2nd course of rehabilitation lasted for 2 weeks with the use of a therapeutic suit DK (see description in the following chapters). The child began to speak more clearly and count to 20. He learned to ride a 3-wheeled bicycle, which he did all day long. During the rehabilitation period, the legs stretched and straightened, but a slight inward rotation of the feet remained.

For a year, the child’s parents used the DK medical suit. Observation a year later showed that the child was developing rapidly. At the time of examination, the child was one year behind his peers in terms of height and weight. The child's intelligence was even higher than that of his peers. Knows a lot of poetry, can read, writes in block letters, counts to a thousand. Walks and runs freely, but a slight inward rotation of the feet remains.

This example convincingly demonstrates that atonic-astatic forms of cerebral palsy can be corrected even faster than spastic forms. During the first course of rehabilitation measures, children with the atonic-astatic form of cerebral palsy must be prescribed a hard general massage of the whole body and limbs. At a certain stage of recovery, such a child will have a clinical picture resembling a spastic form of cerebral palsy with predominant lower paraparesis. But this clinic will differ from the true form of spastic paraplegia in the absence of spastic, uncontrolled movements, the absence of hyperreflexia and hyperesthesia. This clinic can be explained by “short muscle syndrome”, which develops as a result of rapid bone growth and delayed growth and development of the abductor and extensor muscles. Physiotherapy, massage, exercise therapy lead to accelerated muscle development, normalize muscle balance, align posture, and eliminate growth deformities of long tubular bones. Accelerated growth and teething in the first month of rehabilitation are an objective criterion for the positive dynamics of the rehabilitation process and the development of the body.

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The atonic-astatic form of cerebral palsy manifests itself in congenital pathologies of the development of the frontal lobes and cerebellum, and is one of the most severe and difficult to treat types of cerebral palsy.

Accompanied by failures in coordination, low muscle tone and other motor abnormalities. About 9-10% of diagnosed cases of cerebral palsy are of this form.

Most often, cerebral palsy develops for several reasons related to both the course of pregnancy and the process of childbirth.

Most of the disorders that provoke cerebral palsy occur during the embryonic formation of the fetus and can be aggravated by disturbances during childbirth.

But the reasons for the development of some cases are still unknown.

Most often, cerebral palsy develops under the influence of these factors:

• Insufficient oxygen supply to the brain (hypoxia). Most cases of cerebral palsy development are associated with this unfavorable factor. Causes of fetal hypoxia: bad habits mothers (smoking, drug addiction, alcohol consumption), diabetes, low hemoglobin content, diseases of the respiratory system (bronchial asthma, bronchitis and others), pathological position of the fetus during childbirth, umbilical cord prolapse, premature placental abruption, intrauterine infectious processes, hormonal imbalances. Hypoxia can also develop due to abnormalities in fetal development. As a result of hypoxia, the fetal brain does not form properly, especially the parts responsible for motor activity.
• Hemolytic disease of the fetus. If the blood of the child and mother are incompatible, this disease develops. The fetus's red blood cells are destroyed by the mother's immune system, and the fetus cannot develop fully. Severe brain intoxication occurs and, if the fetus survives, it remains with multiple disorders of brain activity.
• Injuries during childbirth. They may be due to the narrow pelvis of the woman in labor, large size fetus, hydrocephalus, pathological position of the fetus during childbirth, advanced age of the woman in labor, bone growths, post-term pregnancy, premature onset of labor, traumatic injuries to the pelvic area, prolonged labor, weak attempts, suffocation due to the umbilical cord. Manifestations birth injuries may be different, but usually trauma during childbirth is not the only cause of the development of cerebral palsy and only aggravates the existing pathology.
• Diseases viral, bacterial or non-infectious origin in the mother. The following infections contribute to the occurrence of various intrauterine disorders of brain development: measles rubella, toxoplasmosis, cytomegalovirus infection, herpes, influenza, syphilis, hepatitis and others. Non-communicable diseases and disorders, such as diabetes mellitus, heart disease (defects, tachycardia, arrhythmia and others), arterial hypertension, obesity, stress, thyroid disease, nervous strain, anemia also have a significant impact on the development of the fetus.
• Taking certain medications. There are a large number of medications that are prohibited or undesirable to take during pregnancy due to their negative effects on fetal development. These include most antibiotics, antidepressants, non-steroidal anti-inflammatory drugs, aspirin, opium alkaloids, vaccines, second-generation anxiolytics, lithium drugs, and some antiepileptic drugs.
• Hereditary factor. If a family has already had a child with cerebral palsy, during a second pregnancy the risk of having another child with this disease is extremely high. The same applies to cases where a child with cerebral palsy was born to close relatives. If one parent has cerebral palsy, the likelihood of having a child with this disease increases six times.
• Prematurity and low weight. Premature babies and those weighing less than 2,000 grams at birth are much more likely to develop cerebral palsy than babies born in the ninth month or normal weight. Children with multiple pregnancies are also at risk.

Male children are more likely to develop cerebral palsy, and on average, their disease is more severe.

Early manifestations

Early signs and symptoms of the astatic form of cerebral palsy can be seen early in life, and usually they do not appear in the first days after the birth of the child, but during its development in the first year.

• If you pull a child by the arms, his muscles do not tense, he remains passive. The head is thrown back, the legs are either bent at the hip area and raised, or are in an extended state.
• When a child lies on his back, he does not want to move and looks lethargic. The tone of his muscular system is extremely reduced. The arm muscles work better than the leg muscles, and the child is more active in the upper body.
• Does not reach out to the toy; stereotypical motor activity is observed in the hand area: repeatedly repeated movements that have no purpose.
• Tendon reflexes are intense.
• The child cannot hold his head up when suspended vertically. Begins to hold his head only in the second half of life.
• Does not roll over and cannot perform other actions (unable to hold a toy in his hand, poor control of movements).
• When lying on his stomach, he cannot hold his head up or support himself with his arms, so he does not learn to crawl for a long time. Some children begin to move, leaning on their arms and pulling their legs towards them, while still others do not experience reciprocal movements of their arms and legs when crawling.
• There is no interest in toys for a long time (a consequence of mental impairment).
• Unable to sit without support in the second half of life. Children begin to sit independently only in the second year, but it is difficult for them to maintain balance, the posture looks unstable.
• The ability to stand and walk is formed only at 7-9 years of age. The legs are wide apart, the gait is unsteady, and the arms are not used to maintain balance. Most children cannot walk for a long time, and when the environment changes, problems with movement arise.
• Most children suffer from mental disabilities, show aggression, and emotional reactions are weakly expressed. Half of the children have seizures. Strabismus, glaucoma, and nystagmus may also be observed.
• Intense trembling of the limbs appears.

The prognosis for the atonic-astatic form of cerebral palsy is unfavorable.

Complications

• Cramps. Epilepsy develops in half of children and may not appear immediately. Epileptic seizures negatively affect the development of the child: other symptoms become more intense, the child learns more slowly, and rehabilitation methods are difficult to apply.
• Mental retardation, which manifests itself with varying intensity in 90% of children with this form of cerebral palsy, complicates rehabilitation treatment and worsens the prognosis: most children, as they grow older, will not be able to provide for themselves and interact at a sufficient level with other people.
• Orthopedic disorders. Due to muscle weakness, patients with cerebral palsy develop various curvatures of the spine: lordosis, scoliosis, kyphosis. The muscles work inconsistently, and disruptions in the blood supply to the legs often occur. As the child grows, orthopedic disorders progress.
• Digestive disorders. Due to low physical activity, various malfunctions in the intestines progress, most often chronic constipation is observed. There is also a high risk of developing obesity.
• Other complications. There may be significant delays in physical development, drooling, enuresis. Problems with vision and hearing progress.

Exercises, regular work with specialists, massage and other rehabilitation methods can reduce the severity of some complications.

Methods of treatment and rehabilitation

Treatment of this form of cerebral palsy is usually ineffective; only rehabilitation measures are carried out, including acupuncture, physiotherapy, massage courses, physical exercises and speech therapy classes are also indicated.

All these methods have a small positive effect: the child becomes more active, moves better and speaks more clearly.

Taking medications also does not significantly improve the condition. Medicines are prescribed to eliminate some symptoms: diuretics and vasodilators to reduce intracranial pressure, nootropics to improve metabolic processes in the brain, and drugs with a sedative effect to reduce aggressiveness.

In rare cases, surgical intervention is indicated, but in this form of cerebral palsy, even surgical treatment is not able to improve brain function.

One of the specific methods of rehabilitation is hippotherapy. Interaction with a horse improves a child's emotional, mental and physical well-being, increasing his chances of social adaptation in the future.

Despite the fact that this form of cerebral palsy is practically incurable, regular rehabilitation measures contribute to the partial restoration of motor functions and reduce the severity of complications.

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