Cerebral Palsy( Cerebral Palsy) - Causes, Symptoms and Treatment. MF.
Child cerebral palsy( cerebral palsy) is a non-progressive lesion of the central nervous system, brain underdevelopment, which is manifested by motor disorders( paralysis, twitching, speech disturbance), imbalance, possibly intellectual disorders, epilepsy.
Causes of infantile cerebral palsy
Infantile cerebral palsy occurs in cases of intrauterine growth disorders( infection during pregnancy, cytomegalovirus, toxoplasmosis, herpes, late toxicosis of pregnant women, incompatibility of the mother and fetus by Rh factor, violation of autoimmune mechanisms of embryonic development).Premature birth, prolonged or rapid delivery, delivery in the wrong position of the fetus, birth trauma, jaundice increase the risk of the disease. All of the above leads to hypoxia( oxygen starvation) and asphyxiation( choking) of the fetus. As a result of a lack of oxygen, the laying and development of the child's brain is broken.
It is impossible to accurately determine the cause of the disease. Risk factors are physical and endocrine diseases of the mother( epilepsy, dementia, hypothyroidism), bad habits - use of alcohol, drugs, a long period of infertility, age to 18 and over 40 years, stress.
Symptoms of cerebral palsy
The disease can manifest from the first minutes of life, and maybe within the first months, depending on the severity of the nervous system. Symptoms of cerebral palsy depend on the degree of brain underdevelopment and the location of affected structures. The severity of symptoms can range from mild to very severe - leading to disability.
Delay in the appearance of motor skills in the child, lack of movement, excess movements, poor head restraint, cramps and a significant lag in speech development are serious symptoms and require immediate treatment to a pediatric neurologist.
The parts of the brain that are responsible for movement, muscle tone, balance are more often affected. The brain can not properly give commands and control muscles. There is such a violation in the form of paralysis, increased muscle tone, involuntary twitching and movements. The child lags behind in development - does not move or badly moves the limbs, late starts to hold his head, turn over, become interested in toys, sit down, crawl, walk. It can not be put on legs - the child rests on the socks and does not stand on the whole foot, does not hold the toy in his hand, can not consciously lift the limb, unclench the fist, move the foot. The increase in muscle tone limits the child's movements, up to a general inability to move.
Paralyzed may be one limb, one-sided arm-leg, two arms, two legs. Paralyzed limbs lag behind in development - remain shorter and thinner than healthy ones, deformations of the skeleton, contractures of the joints appear, which further disturbs the movement. As a result of brain damage, coordination of movements is impaired - gait suffers, the child can fall, do fanciful movements, nod his head, perform uncontrolled limb movements.
The baby may have epileptic seizures( loss of consciousness and convulsions).
Possible the development of strabismus, nystagmus( twitching of the eyeballs), impaired vision, hearing, psyche, respiration, gastrointestinal tract. Violated learning, behavior.
Symptoms of cerebral palsy of cerebral palsy
Brain structure and lesions in cerebral palsy
According to the International Classification of Diseases, seven groups of cerebral palsy are distinguished according to the localization of affected brain structures:
1 Spastic diplegia( Little's disease);
2 Spastic cerebral palsy( double hemiplegia, tetraplegia);
3 Pediatric hemiplegia;
4 Dyskinetic cerebral palsy;
5 Ataxic cerebral palsy;
6 Mixed forms of cerebral palsy;
7 Cerebral Palsy, unspecified.
Diagnosis of cerebral palsy
Diagnosis is based on neurological examination and instrumental examination methods:
- electrophysiological study of muscle potentials and evaluation of peripheral nerves;
- Electroencephalography - functional assessment of brain biocurrents.
- Consultations with the ophthalmologist, the otolaryngologist, the psychiatrist, the epileptologist, the orthopedist are also necessary.
Differentiate cerebral palsy with degenerative-dystrophic progressive diseases, brain tumors, chromosomal diseases, neuromuscular diseases( Verdig-Goffmann spinal amyotrophy, congenital myopathies), Oppenheim's myotonia, hereditary lipid metabolism disorders, hepatocerebral dystrophy( Wilson-Konovalov), spastic paraplegia of Strympel, the consequences of meningitis, suffered in the first year of life.
Given the variety of symptoms and severity of the listed diseases, self-diagnosis is unacceptable. It can be about the child's life, its duration and quality.
Treatment of infantile cerebral palsy
Treatment of cerebral palsy should be started as early as possible and administered continuously. The disease is incurable, but with treatment from an early age, the most favorable development of the child is possible.
In the first years of life, it is most possible to compensate for a defect, reduce the manifestations of spasticity, and consequently, deformations of the skeleton, contractures and improve adaptability to normal movements, balance retention, self-service.
The child should be observed at the pediatrician, neurologist, orthopedist, speech therapist, psychologist, rehabilitologist. The efforts of all specialists and parents should be aimed at the maximum possible social adaptation of the child. The therapeutic effect should be directed to the daily life of the child, to satisfy his desire to move on his own - to take a toy, eat, dress, sit, stand, walk. For each child, an individual training program should be developed by physiotherapists, possibly using auxiliary devices and special equipment.
Treatment of cerebral palsy should be comprehensive and include medical therapy, permanent physiotherapy, orthopedics - surgical methods of treatment, psychological help, speech development, sanatorium treatment. The child practically needs to be taught how to perform all available movements and support them.
Medical treatment of cerebral palsy consists of neuroprotectors, antioxidants, vascular drugs, brain metabolites, muscle relaxants, vitamins. Cerebrolysin is widely used intravenously, cortexin intramuscularly, ceraxone intravenously - syrup - tablets, somazine - intravenous - syrup, actovegin intravenously - tablets, solcoseryl intravenously, piracetam intravenously - tablets. Injections of these drugs are prescribed by a neurologist. Glycine, neurovitamin in tablets are prescribed courses. To relieve the spastic tension of the muscles, depending on the severity, do either injections of mido-kalma, or prescribe tablets - midocalam, baclofen or other muscle relaxants. It is possible to administer drugs to the biologically active points of the limbs and face - ATP, proserin. In especially severe cases, it is possible to use injections of botulinum toxin - botox, dysport. In the affected muscle( tense muscle) with a special needle at several points, the drug is injected. The procedure is effective, but requires repetition after 6 months.
If a child has epileptic seizures, self-medication is not only unacceptable, but also dangerous for life. Selection of antiepileptic drugs is individual, depends on the type of seizure, frequency and severity, age, concomitant diseases. Used drugs valproic acid, toparamate, lamotrigine. Only a doctor does this. Self-administration and withdrawal of the drug are unacceptable.
The medical treatment of infantile cerebral palsy is symptomatic, it is possible to use both analgesics, antispasmodics, antidepressants and tranquilizers.
But the therapeutic exercise of a patient with cerebral palsy should be dealt with constantly, gradually recovering from the disease more and more new movements, adapting to your body and the surrounding world. Visiting the training of rehabilitation specialists, parents will have to learn both the technique of massage and therapeutic gymnastics, because this treatment has to be repeated and repeated on a daily basis. Physiotherapy exercises are also playful moments - from "take candy and bring the ball" to playing the piano and training in sports equipment, gymnastics balls, cushions, steps, walkers.
Physiotherapeutic methods of treatment - balneotherapy, mud and thermal treatment, ozocerite, electrophoresis of medicinal substances, electrostimulation of muscles and nerves.
Surgical treatment of cerebral palsy is recommended for pronounced contractures. Apply gypsum bandages and surgical treatment. Orthopedists - surgeons can lengthen tendons and muscles, bones( achilloplasty, arthroplasty), transplant tendons, prune tendons to relieve spasticity, perform operations on nerves. The intervention is aimed at the prevention and treatment of contractures, dislocations and subluxations of the joints, to increase limb stability
Balneotherapy - in warm water, muscle tone decreases, hyperkinesis( twitching) decreases, and the volume of active movements increases. Assign iodine-bromine, valerian, conifers, turpentine, oxygen, radon, sea, pearl baths, hydromassage, swimming. Modern baths "Aquadelis", "Aquamanus", "Aquapedis" provide an opportunity for underwater massage with jet aeration, chromo-light therapy and ozonation. Four-chamber galvanic baths "Verishofen" combine the possibility of exposure to warm water and galvanic or pulsed current and medicinal substance - bischofite, turpentine, nicotinic acid, sage, pine extract.
Climatic color-dynamic quantum - the camera is combined with a laser shower and a pool. In the pool, horizontal or vertical extension of the spine is performed, joint development, underwater shower - massager, cascade shower - waterfall.
Hardware programmed joint development , active mechanotherapy trainers with biologically feedback - these are modern methods of treating patients with paralysis.
Integrated use of such procedures is highly efficient.
Sanatorium treatment - Evpatoria, Saki, Truskavets, Odessa and others, where the most effective methods can be prescribed by treatment methods:
- stage gypsum;
- orthopedic - surgical correction;
- massages;
- physiotherapy procedures - electrophoresis, magnetotherapy, electrosleep, interdin, myoton, phototherapy, darsonvalization, ultrasound;Electrophoresis is performed with proserin, nicotinic acid, fasting gel;
- acupuncture;
- mud therapy;
- laser therapy;
- Shiatsu - therapy - massage of biologically active points;
- lessons with a speech therapist;
- in Evpatoria - dolphin therapy - communication and swimming with dolphins;
- Montessori therapy. Montessori's method shapes the children's broad horizons, the inner motivation for learning new things, the ability to concentrate on work, observation and independence;
- Bobat method - help the child in "self-organization" with the use of auxiliary tools and special equipment.
Since 2003, the international clinic of rehabilitation treatment by the method of Professor Kozyavkin V. has been operating in the balneological resort of Truskavets - one of the most effective methods of treating patients with cerebral palsy. This is a system of intensive neurophysiological rehabilitation, biomechanical correction of the spine and large joints, the use of space technologies for the treatment of children, the "Spiral" costume, physiotherapy methods, exercise therapy, simulators.
The suit "spiral" is used to form the correct stereotype of movements. By stimulating the compensatory possibilities of the organism and activating the plasticity of the brain, this system creates a new functional state in the patient's body for infantile cerebral paralysis, which opens up opportunities for rapid motor and mental development of the child. The spasticity of muscles decreases, new motor skills are acquired. The costume is shown in the photo.
Costume spiral for treatment of cerebral palsy according to the method of Kozyavkin
The child is fixed under the armpits, behind the pelvis and hips and hangs to the net. The physiotherapist shakes the child, turns it, holding hands and legs. The child himself holds on to the rings. In this position, the brain receives the right signal from the muscles and "in flight" the movements are mastered. The methodology is recognized by the European Parliament and Russia. Professor Kozyavkin V. - the first Ukrainian who received the prize "Calling", which is awarded to the best doctors in Russia. His method of rehabilitation of patients with cerebral palsy is recognized as one of the four most effective in the world. Statistical analysis of more than 12 thousand patients showed high efficiency of this system. Normalization of muscle tone was noted in 94%, formation of skills for proper head control - in 75% of patients, sitting skills acquired 62%, the appearance of independent walking was recorded in 19% of previously ill patients, 87% were able to unravel the spasmodically compressed fist.
New technologies are being developed, Russian scientists have developed orthopedic pneumatic overalls, which fix joints, stretch muscles, strain muscles from the outside, and the brain receives a corrected signal, and when it is practiced with limb physical exercises, it begins to move correctly, but its cost is tens of thousands of rubles.
Orthopedic pneumatic overall for treatment of cerebral palsy
New invention Debbie Ellatan for her son, a patient with cerebral palsy, is preparing for a wide sale in Europe, but it is not known when it will go on sale and how much it will cost. But the idea itself can be adopted. Development allows the child to be in an upright position and walk with his parent.
Unfortunately, cerebral palsy is incurable. The severity of persistent consequences, disability will depend on the amount of brain damage, timely and prolonged painstaking treatment. With the preserved intelligence and the possibility of independent movement, children with cerebral palsy can learn in ordinary schools and universities, work. For severe cases, there are special boarding schools, where training is combined with treatment, taking into account the individual capabilities of the child, a professional orientation is conducted in order to prepare for a profession appropriate to the psychophysical possibilities and interests of the patient.
Prophylaxis of cerebral palsy
Prevention of infantile cerebral palsy is to protect the health of a future mother, exclude bad habits, and monitor the course of pregnancy.
Doctor's consultation on cerebral palsy:
Question: can cerebral palsy occur in an adult?
Answer: Cerebral palsy can occur in adults as well - after severe craniocerebral trauma, stroke, multiple sclerosis, and neuroinfections. And although the cause of the disease is different - the manifestation of one - paralyzed limbs, high muscle tone, impaired movement, self-service.
Question: when should I start treatment?
Answer: treatment is most effective in the first month, year, three years after the disease. Then comes a period of persistent consequences and treatment is symptomatic.
Question: if time is lost, what should I do?
Answer: if time is lost, it does not matter for a child or an adult, treatment is still necessary, although much less efficiently. Conduct courses of drug therapy, appointed by a doctor, massage, physiotherapy, sanatorium treatment. The goal of treatment remains - the maximum adaptation to its motor defect, self-service, movement, reducing the speech defect, reducing the number of epileptic seizures.
Using all possible "folk" methods instead of traditional methods can lead to loss of time, worsen the manifestations of the disease - to start deformation of the skeleton, joints, miss the possibility of surgical correction.
Question: is cerebral palsy inherited?
Answer: it is not known exactly. It is believed that infantile cerebral palsy is a polyethological disease. There are hypotheses about the hereditary component in the causes of brain damage. Cerebral palsy occurs more often in boys and proceeds more severely, which is explained by the presence of a hereditary factor of cerebral palsy linked to the sex. But there is no clear evidence yet. At absolutely healthy people sick children are born and healthy people are born. Now in the most developed countries have learned to care for premature babies with very small weight, but, unfortunately, it contributes to the growth of patients with infantile cerebral paralysis.
Question: What is the life expectancy of patients with cerebral palsy?
Answer: infantile cerebral palsy is not a progressive disease. It leads to disability, but not death. The sick from the afflicted diseases die.
Doctor of neurologist of the highest category Svetlana Valentinovna Kobzeva