The Cerebral Palsy (CP) is the concept uniting group of the motive frustration arising owing to damage of various brain structures to the perinatal period. Cerebral palsy can include mono - gemi-, couple - tetra-paralyzes and paresis, pathological changes of a muscular tone, giperkineza, violation of the speech, unsteadiness of gait, disorder of coordination of movements, frequent falling, lag of the child in motor and mental development. At a cerebral palsy violations of intelligence, mental disorders, epilepsy, a hearing disorder and sight can be observed. Cerebral palsy mainly according to clinical and anamnestichesky data is diagnosed. The algorithm of inspection of the child with a cerebral palsy is directed to detection of the accompanying pathology and an exception of other congenital or postnatal pathology. The people having cerebral palsy have to undergo for life rehabilitation therapy, as required receive drug, surgical and physiotherapeutic treatment.
According to world statistics cerebral palsy meets frequency of 1,7-7 cases at 1000 children about one year. In Russia this indicator according to various data makes 2,5-6 cases on 1000 children. Among premature children incidence of a cerebral palsy is 10 times higher than average. According to the last researches about 40-50% of children with a cerebral palsy were born as a result of premature birth.
If to speak about chronic diseases of children's age, then in modern pediatrics cerebral palsy is one of the leading problems. Among the reasons of increase in number of patients of a cerebral palsy absolutely fairly call not only deterioration in ecology, but also the progressive development of a neonatology allowing to nurse now babies with various pathology including premature newborns with a weight from 500 g.
Causes of a cerebral palsy
According to modern representations cerebral palsy results from impact on TsNS of the child of various damaging factors causing the wrong development or death of certain sites of a brain. And action of these factors happens in the perinatal period, i.e. to, in time and directly after the child's birth (the first 4 weeks of life). The main pathogenetic link in formation of cerebral palsy is a hypoxia to which development lead various causal factors of a cerebral palsy. First of all at a hypoxia those sites of a brain which are responsible for maintenance of balance and providing motive reflex mechanisms suffer. Frustration of a muscular tone, typical for a cerebral palsy, paresis and paralyzes, pathological motive acts result.
The Etiologichesky factor of a cerebral palsy operating during pre-natal development is various pathology of pregnancy: fetoplatsentarny insufficiency, premature otsloyka of a placenta, toxicoses, nephropathy of pregnant women, infections (cytomegalovirus, rubella, toxoplasmosis, herpes, syphilis), Rhesus factor conflict, threat of termination of pregnancy. Somatic diseases of mother (diabetes, a hypothyroidism, the congenital and acquired heart diseases, arterial hypertension) and the injuries transferred the woman during pregnancy can also cause development of cerebral palsy.
Treat the risk factors of development of a cerebral palsy influencing the child during childbirth: pelvic prelying of a fruit, rapid childbirth, premature birth, a narrow basin, a large fruit, excessively strong patrimonial activity, long childbirth, the dicoordinated patrimonial activity, the long waterless period before childbirth. Only in certain cases the patrimonial trauma is the only cause of cerebral palsy. Often the difficult delivery leading to developing of a cerebral palsy turns out to be consequence of already available pre-natal pathology.
Major factors of risk of emergence of a cerebral palsy in the postnatal period are asphyxia and a hemolytic disease of the newborn. The asphyxia of the newborn leading to a cerebral palsy can be connected with aspiration of amniotic waters, various malformations of lungs, pregnancy pathology. More frequent postnatal cause of a cerebral palsy consists in toxic damage of a brain at the hemolytic disease developing as a result of incompatibility of blood or the immunological conflict of a fruit and mother.
Classification of a cerebral palsy
According to location of an affected area of a brain in neurology of a cerebral palsy classify on 5 types. The most common form of a cerebral palsy is the spastic diplegiya. According to various data cerebral palsy of this form makes from 40 to 80% of total number of cases of a cerebral palsy. The defeat of the motive centers leading to development of the paresis more expressed in legs is the cornerstone of this cerebral palsy form. At damage of the motive centers only of one hemisphere there is a gemiparetichesky cerebral palsy form which is shown paresis of a hand and leg on the party opposite to the struck hemisphere.
Approximately in a quarter of cases cerebral palsy has the hyperkinetic form connected with damage of subcrustal structures. Clinically this form of a cerebral palsy is shown by the involuntary movements — the giperkineza amplifying at nervousness or fatigue of the child. At violations in a cerebellum the atonicheski-astatic form of cerebral palsy develops. This cerebral palsy form is shown by violations of a statics and coordination, a muscular atoniya. About 10% of cases of a cerebral palsy fall to its share.
The most severe form of a cerebral palsy carries the name a double hemiplegia. In this option cerebral palsy is a consequence of total defeat of both hemispheres of the brain leading to a muscular rigidnost because of which children are not able not only to stand and sit, and even independently to hold the head. Also mixed options of cerebral palsy including the clinical symptoms characteristic of the cerebral palsies different forms meet. For example, the combination of the hyperkinetic cerebral palsy form to a spastic diplegiya is often observed.
Cerebral palsy symptoms
Cerebral palsy can have various manifestations with various degree of expressiveness. The clinical picture cerebral palsy and its weight depend on localization and depth of defeat of brain structures. In some cases cerebral palsy is swept up already during the first hours the child's lives. But cerebral palsy symptoms obvious several months when the child begins to lag behind significantly in psychological development the norms accepted in pediatrics become more often later. The delay in formation of movement skills can be the first symptom of a cerebral palsy. The child with cerebral palsy long does not hold the head, does not turn over, is not interested in toys, cannot move consciously extremities, does not hold a toy. In attempt to put the child from a cerebral palsy on legs it does not put a leg on full foot, and rises on tiptoe.
Paresis at cerebral palsy can be only in one extremity, have unilateral character (a hand and a leg on the party opposite to an affected area of a brain), to cover all extremities. Insufficiency of an innervation of organs of articulation causes violation of the proiznositelny party of the speech (dizartriya) at the child with a cerebral palsy. If the cerebral palsy is followed by paresis of muscles of a throat and throat, then there are problems with swallowing (dysphagy). Often cerebral palsy is followed by substantial increase of a muscular tone. The expressed spastika at a cerebral palsy can lead to a full obezdvizhennost of an extremity. Further the children having cerebral palsy have a lag of paretichny extremities in physical development therefore they becomes thinner and shorter than healthy. In the investigation of it deformations of a skeleton, typical for a cerebral palsy are formed (scoliosis, deformations of a thorax). Besides, cerebral palsy proceeds with development of contractures of joints in paretichny extremities that aggravates motive violations. Disorders of motility and deformation of a skeleton at children with a cerebral palsy lead to emergence of a chronic pain syndrome with localization of pains in shoulders, a neck, a back and .
Cerebral palsy of a hyperkinetic form is shown by suddenly arising involuntary motive acts: turns or nods the head, twitchings, emergence of grimaces on a face, elaborate poses or the movements. The dicoordinated movements, instability when walking and in a standing position, frequent falling, muscular weakness and a tremor are characteristic of the atonicheski-astatic cerebral palsy form.
At cerebral palsy squint, functional violations of a GIT, disorder of respiratory function, an urine incontience can be observed. Approximately in 20-40% of cases cerebral palsy proceeds with epilepsy. To 60% of children from a cerebral palsy have problems with sight. Relative deafness or full deafness is possible. In half of cases cerebral palsy is combined with endocrine pathology (obesity, a hypothyroidism, a growth inhibition, etc.). Often cerebral palsy is followed by various degree mental retardation, a delay of mental development, disorder of perception, violations of ability to training, deviations in behavior, etc. However to 35% of children from a cerebral palsy have normal intelligence, and in 33% of cases of a cerebral palsy violations of intelligence are expressed in easy degree.
Cerebral palsy is the chronic, but not progressing disease. In process of growth of the child and development of its TsNS earlier hidden pathological manifestations which create feeling of a so-called "false progression" of a disease can come to light. Deterioration in a condition of the child with a cerebral palsy can be also caused by secondary complications: epilepsy, stroke, hemorrhage, application of an anesthesia or serious somatic illness.
Diagnosis of a cerebral palsy
There are no special diagnostic criteria of cerebral palsy yet. However some symptoms, typical for a cerebral palsy, attract attention the pediatrician at once. Treat them: the low ball exposed on a scale Apgar at once after the child's birth, abnormal physical activity, violations of a muscular tone, lag of the child in psychophysical development, lack of contact with mother. Similar signs always guard doctors concerning a cerebral palsy and are the indication to obligatory consultation of the child by the children's neurologist.
At suspicion of cerebral palsy careful neurologic survey of the child is necessary. In diagnosis of a cerebral palsy electrophysiological methods of inspection are also used: an electroencephalography, an electromyography and an elektroneyrografiya, a research of the caused potentials; transkranialny magnetic stimulation. They help to differentiate a cerebral palsy from the hereditary neurologic diseases which are shown on the 1st year of life (a congenital myopathy, Fredreykh's ataxy, Louis Bar syndrome and ). In diagnosis of a cerebral palsy of a neyrosonografiya and MRT of a brain the organic changes accompanying a cerebral palsy allow to reveal use (for example, an atrophy of optic nerves, the centers of hemorrhages or ischemia, a periventrikulyarny leykomalyation) and to diagnose brain malformations (a mikrotsefaliya, congenital hydrocephaly and so forth).
Full diagnosis of a cerebral palsy can demand participation of the children's ophthalmologist, the children's otolaryngologist, an epileptolog, the children's orthopedist, the logopedist and the psychiatrist. If necessary to differentiate a cerebral palsy from various hereditary and exchange diseases the corresponding genetic researches and biochemical analyses are applied.
Rehabilitation treatment of a cerebral palsy
Unfortunately, so far cerebral palsy belongs to incurable pathology. However in due time begun, in a complex and continuously held rehabilitation events can develop considerably available to the child with a cerebral palsy motor, intellectual and speech skills. Thanks to rehabilitation treatment it is possible to compensate as much as possible the neurologic deficiency which is available at a cerebral palsy, to reduce probability of emergence of contractures and skeletal deformations, to teach the child to skills of self-service and to improve its adaptation. Development of a brain is the most active, informative process, acquisition of skills and training happen aged up to 8 years. During this period at a cerebral palsy it is necessary to make the maximum efforts on rehabilitation.
The program of complex rehabilitation therapy is developed individually for each sick cerebral palsy. It considers localization and weight of damage of a brain; existence of the hearing disorder accompanying a cerebral palsy and sight, disorders of intelligence, epileptic seizures; individual opportunities and problems of a sick cerebral palsy of the child. Holding rehabilitation actions at a cerebral palsy combination to violations of cognitive activity is the most difficult (including in a consequence of a blindness or deafness) and intelligence. The special techniques allowing the instructor to come into contact with the child are developed for such cases of a cerebral palsy. Additional difficulties in treatment of a cerebral palsy arise at patients with epilepsy at which the active stimulating therapy of a cerebral palsy can cause development of complications. For this reason children with a cerebral palsy and epilepsy have to undergo rehabilitation with application of special "soft" methods.
The basis of rehabilitation treatment at cerebral palsy is made by LFK and massage. It is important that to children with a cerebral palsy they were carried out daily. For this reason for the child's parents with cerebral palsy it is necessary to seize skills of massage and carrying out LFK. In that case they will be able independently to be engaged with the child during the period between courses of professional rehabilitation of a cerebral palsy. For more effective occupations of LFK and mechanotherapy with the children having cerebral palsy in the relevant rehabilitation centers there are special devices and devices. From the last developments in this area in treatment of a cerebral palsy the pnevmokombinizona fixing joints and providing a muscle strain, and also the special suits allowing to develop the correct motive stereotype and to reduce a spastika of muscles at the cerebral palsies some forms found application. Similar means help to involve as much as possible compensatory mechanisms of nervous system that often leads to development by a sick cerebral palsy by the child new, earlier not available to it, movements.
Also so-called technical means of rehabilitation belong to rehabilitation actions at a cerebral palsy: an orthomisinformation, inserts in footwear, crutches, walkers, wheelchairs, etc. They allow to compensate the motive violations which are available at a cerebral palsy, shortenings of extremities and deformation of a skeleton. Individual selection of such means and training of the child having cerebral palsy, to skills of their use is important.
Drug and surgical treatment of a cerebral palsy
Treatment of a cerebral palsy by means of medicines is generally symptomatic and is directed to knocking over of a concrete symptom of a cerebral palsy or the arisen complications. So, at a cerebral palsy combination to epileptic seizures antikonvulsant are appointed, at increase in a muscular tone — anti-spastic medicines, at a cerebral palsy with a chronic pain syndrome — anesthetics and spazmolitichesky means. Nootropa, metabolic medicines (ATP, amino acids, glycine), , antidepressants, tranquilizers, neuroleptics, vascular medicines can enter medicamentous therapy of a cerebral palsy.
The indication to surgical treatment of cerebral palsy are the contractures formed as a result of a long spastichnost of muscles and limiting physical activity of the patient. Most often at a cerebral palsy the tenotomiya directed to creation of basic position of the paralyzed extremity are applied. Lengthening of bones, change of sinews, etc. operations can be applied to stabilization of a skeleton at cerebral palsy. If cerebral palsy is shown by the rough symmetric muscular spastichnost leading to development of contractures and a pain syndrome, then for interruption proceeding from a spinal cord of a pathological impulsation to the patient with a cerebral palsy the spinal rizotomiya can be carried out.
Physiotherapeutic treatment and animaloterapiya of a cerebral palsy
The methods of physiotherapeutic influence applied in treatment of cerebral palsy perfectly are combined with LFK and massage. Well proved at a cerebral palsy an oksigenobaroterapiya, electrostimulation of nerves and muscles, a medicinal electrophoresis, mud cure, thermal procedures and balneotherapy. Application at cerebral palsy of the general bathtubs with warm water reduces expressiveness of giperkinez and reduces a muscular tone at a spastika. From water procedures at a cerebral palsy coniferous, oxygen, radonic, turpentine and iodine-bromine bathtubs, phytobathtubs with a valerian are appointed.
Rather new way of therapy of cerebral palsy is the animaloterapiya — treatment by means of communication of the patient with an animal. To the most widespread techniques of an animaloterapiya of a cerebral palsy today treat hippotherapy of a cerebral palsy (treatment with use of horses) and dolphin therapy of a cerebral palsy. During similar medical sessions the instructor and the psychotherapist at the same time work with the child having cerebral palsy. Are the cornerstone of therapeutic influence of the specified techniques: the favorable emotional atmosphere, establishment of special contact between a sick cerebral palsy and an animal, stimulation of brain structures through saturated tactile feelings, gradual expansion of speech and movement skills.
Social adaptation at a cerebral palsy
Despite the considerable motive violations having cerebral palsy many children can be successfully adapted in society. The huge role in it is played by parents and the child's family with a cerebral palsy. But the help of experts is necessary for them for the effective solution of this task: reabilitolog, the psychologists and correctional teachers who are directly taking care of children with a cerebral palsy. They work on that the child with a cerebral palsy as much as possible mastered skills of self-service, available to it, acquired knowledge corresponding to its opportunities and abilities, constantly got psychological support.
Cerebral palsy to a large extent promotes social adaptation at the diagnosis occupations in specialized kindergartens and schools, and further in specially created societies. Their visit is expanded by informative opportunities, give to the child and the adult with a cerebral palsy an opportunity to communicate and conduct active life. In the absence of the violations considerably limiting physical activity and intellectual opportunities, adults can conduct independent life with a cerebral palsy. Such patients with a cerebral palsy successfully work and can establish the family.
Forecast and prevention of a cerebral palsy
The forecast concerning cerebral palsy directly depends on the cerebral palsy form, timeliness and continuousness of the carried-out rehabilitation treatment. In certain cases the cerebral palsy results in deep disability. But is more often efforts of physicians and child's parents with a cerebral palsy it is possible to compensate to a certain degree the available violations as the growing and developing brain of children including the child with a cerebral palsy, has the considerable potential and flexibility thanks to which healthy sites of brain fabric can undertake functions of the damaged structures.
Prevention of a cerebral palsy in the prenatal period consists in the correct conducting pregnancy allowing to diagnose in time the states menacing to a fruit and to prevent development of a hypoxia of a fruit. In the subsequent the choice of an optimum way of a rodorazresheniye and the correct conducting childbirth is important for prevention of a cerebral palsy.