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How does cerebral palsy develop? Treatment of cerebral palsy. Reasons and discussions

Cerebral palsy (G80)

Children's neurology, Pediatrics

general information

Short description

Union of Pediatricians of Russia

ICD 10: G80

Year of approval (revision frequency): 2016 (revision every 3 years)

Cerebral palsy (CP)- a group of stable disorders of motor development and postural maintenance, leading to motor defects caused by non-progressive damage and/or abnormalities of the developing brain in the fetus or newborn child.

Classification

Coding according to ICD-10

G80.0 - Spastic cerebral palsy

G80.1 - Spastic diplegia

G80.2 - Childhood hemiplegia

G80.3 - Dyskinetic cerebral palsy

G80.4 - Ataxic cerebral palsy

G80.8 - Other type of cerebral palsy

Examples of diagnoses

Cerebral palsy: spastic diplegia.

Cerebral palsy: spastic right-sided hemiparesis.

Cerebral palsy: dyskinetic form, choreo-athetosis.

Cerebral palsy: ataxic form.

Classification

In addition to the above-described international classification of cerebral palsy (ICD-10), there are a large number of original clinical and functional classifications. The most widespread classifications in Russia are those of K.A. Semyonova (1978):

Double hemiplegia;

Hyperkinetic form;

Atonic-astatic form;

Hemiplegic form;

and L.O. Badalyan et al. (1988):

Table 1 - Classification of cerebral palsy

Early age

Older age

Spastic forms:

Hemiplegia

Diplegia

Bilateral hemiplegia

Dystonic form

Hypotonic form

Spastic forms:

Hemiplegia

Diplegia

Bilateral hemiplegia

Hyperkinetic form

Ataxic form

Atonic-astatic form

Mixed forms:

Spastic-ataxic

Spastic-hyperkinetic

Atactico-hyperkinetic

In the domestic literature, the following stages of development of cerebral palsy are distinguished (K.A.

Semyonova 1976):

Early: up to 4-5 months;

Initial residual stage: from 6 months to 3 years;

Late residual: older than 3 years.

Bilateral (double) hemiplegia in international clinical practice is also called quadriplegia, or tetraparesis. Considering the persisting disagreements in expert assessments using topographic classifications of cerebral palsy, international differences in classifications, today terms such as “bilateral”, “unilateral”, “dystonic”, “choreoathetoid” and “ataxic” cerebral palsy are becoming increasingly common ( Appendix G2).

Greater unanimity was achieved with the introduction of the functional classification of cerebral palsy - GMFCS (Gross Motor Function Classification System), proposed by R. Palisano et al. (1997). This is a descriptive system that takes into account the degree of development of motor skills and limitations of movements in everyday life for 5 age groups of patients with cerebral palsy: up to 2 years, from 2 to 4 years, from 4 to 6 years, from 6 to 12 years, from 12 to 18 years. According to the GMFCS, there are 5 levels of development of gross motor functions:

Level I- walking without restrictions;

Level II- walking with restrictions;

Level III- walking using hand-held mobility aids;

Level IV- independent movement is limited, motorized vehicles may be used;

Level V- complete dependence of the child on others - transportation in a stroller/wheelchair.

In addition to the classification of general motor functions, specialized scales for assessing spasticity and individual functions, and, first of all, the functions of the upper limbs, are widely used in patients with cerebral palsy.

Etiology and pathogenesis

Cerebral palsy is a polyetiological disease. The leading cause of cerebral palsy is damage or abnormal development of the fetal and newborn brain. The pathophysiological basis for the formation of cerebral palsy is damage to the brain during a certain period of its development with the subsequent formation of pathological muscle tone (mainly spasticity) with the preservation of postural reflexes and a concomitant violation of the formation of chain righting reflexes. The main difference between cerebral palsy and other central paralysis is the time of exposure to the pathological factor.

The ratio of prenatal and perinatal factors of brain damage in cerebral palsy is different. Up to 80% of observations of brain lesions causing cerebral palsy occur during fetal development; Subsequently, intrauterine pathology is often aggravated by intrapartum pathology.

More than 400 biological and environmental factors have been described that influence the course of normal fetal development, but their role in the formation of cerebral palsy has not been fully studied. There is often a combination of several unfavorable factors both during pregnancy and childbirth. Intrauterine causes of cerebral palsy primarily include acute or chronic extragenital diseases of the mother (hypertension, heart defects, anemia, obesity, diabetes mellitus and thyroid diseases, etc.), taking medications during pregnancy, occupational hazards, parental alcoholism, stress, psychological discomfort, physical trauma during pregnancy. A significant role is played by the influence of various infectious agents, especially those of viral origin, on the fetus. Risk factors also include uterine bleeding, abnormalities of placental circulation, placenta previa or abruption, immunological incompatibility of the blood of mother and fetus (according to the ABO, Rh factor and others).

Most of these unfavorable factors of the prenatal period lead to intrauterine fetal hypoxia and disruption of the uteroplacental circulation. Oxygen deficiency inhibits the synthesis of nucleic acids and proteins, which leads to structural disorders of embryonic development.

Various complications during childbirth: weakness of uterine contractility, rapid or prolonged labor, cesarean section, long anhydrous period, breech and breech presentation of the fetus, a long period of standing of the head in the birth canal, instrumental obstetrics, as well as premature birth and multiple pregnancies are also considered factors high risk of developing cerebral palsy.

Until recently, birth asphyxia was considered the leading cause of brain damage in children. A study of the anamnesis of children who suffered birth asphyxia showed that 75% of them had an extremely unfavorable background of intrauterine development, aggravated by additional risk factors for chronic hypoxia. Therefore, even in the presence of severe birth asphyxia, the causal relationship with the subsequently developed psychomotor deficit is not absolute.

A significant place in the etiology of cerebral palsy is occupied by intracranial birth trauma due to mechanical effects on the fetus (compression of the brain, crushing and necrosis of the brain matter, tissue ruptures, hemorrhages in the membranes and matter of the brain, disturbances in the dynamic blood circulation of the brain). However, one cannot fail to take into account that birth trauma most often occurs against the background of a previous defect in fetal development, during pathological, and sometimes even during physiological childbirth.

The role of hereditary predisposition and genetic pathology in the structure of cerebral palsy remains a completely unresolved issue. Often, the diagnosis of cerebral palsy is based on undifferentiated genetic syndromes, which is especially typical for ataxic and dyskinetic forms of cerebral palsy. Thus, the presence of athetosis and hyperkinesis, which are usually strictly associated with kernicterus, in the absence of reliable anamnestic data, may have a genetic basis. Even “classical” spastic forms of cerebral palsy, with a clear progression (and, moreover, the appearance of new) clinical symptoms, should alert the doctor from the point of view of the possible presence of spastic paraplegia and other neurodegenerative diseases in the child.

Epidemiology

Cerebral palsy develops, according to various sources, in 2-3.6 cases per 1000 live births and is the main cause of childhood neurological disability in the world. Among premature babies, the incidence of cerebral palsy is 1%. In newborns weighing less than 1500 g, the prevalence of cerebral palsy increases to 5-15%, and with extremely low body weight - up to 25-30%. Multiple pregnancies increase the risk of developing cerebral palsy: the incidence of cerebral palsy in singleton pregnancies is 0.2%, in twins - 1.5%, in triplets - 8.0%, in quadruple pregnancies - 43%. However, over the past 20 years, in parallel with the increase in the number of children born from multiple pregnancies with low and extreme low body weight, there has been a trend towards a decrease in the incidence of cerebral palsy in this population. In the Russian Federation, the prevalence of registered cases of cerebral palsy is 2.2-3.3 cases per 1000 newborns.

Clinical picture

Symptoms, course

Clinical picture

Spastic bilateral cerebral palsy

Spastic diplegia G80.1

The most common type of cerebral palsy (3/4 of all spastic forms), also known as “Little’s disease”. Spastic diplegia is characterized by bilateral damage to the limbs, legs to a greater extent than the arms, and early formation of deformities and contractures. Common accompanying symptoms are delayed mental and speech development, the presence of pseudobulbar syndrome, pathology of the cranial nerves leading to atrophy of the optic discs, dysarthria, hearing impairment, as well as a moderate decrease in intelligence. The prognosis for motor abilities is less favorable than for hemiparesis. Spastic diplegia develops mainly in children born prematurely and is accompanied by characteristic changes in magnetic resonance imaging (MRI) of the brain.

Spastic tetraparesis (double hemiplegia) G80.0

One of the most severe forms of cerebral palsy, which is a consequence of abnormalities in brain development, intrauterine infections and perinatal hypoxia with diffuse damage to the brain substance, often accompanied by the formation of secondary microcephaly. Clinically manifested by bilateral spasticity, equally expressed in the upper and lower extremities, or predominant in the arms. With this form of cerebral palsy, a wide range of concomitant pathologies is observed: consequences of damage to the cranial nerves (strabismus, optic nerve atrophy, hearing impairment, pseudobulbar syndrome), severe cognitive and speech defects, epilepsy, early formation of severe secondary orthopedic complications (joint contractures and bone deformities). Severe motor defects of the hands and lack of motivation for treatment and training sharply limit self-care and simple work activities.

Spastic unilateral cerebral palsy G80.2

It is characterized by unilateral spastic hemiparesis, and in some patients - delayed mental and speech development. The arm usually suffers more than the leg. Spastic monoparesis is less common. Focal epileptic seizures are possible. The cause is hemorrhagic stroke (usually unilateral) and congenital abnormalities of brain development. Children with hemiparesis acquire age-related motor skills somewhat later than healthy children. Therefore, the level of social adaptation, as a rule, is determined not by the degree of motor defect, but by the intellectual capabilities of the child.

Dyskinetic cerebral palsy G80.3

It is characterized by involuntary movements, traditionally called hyperkinesis (athetosis, choreoathetosis, dystonia), changes in muscle tone (both increased and decreased tone may be noted), and speech disorders, often in the form of hyperkinetic dysarthria. There is no correct alignment of the torso and limbs. The majority of children experience preservation of intellectual functions, which has a favorable prognosis for social adaptation and learning; disorders in the emotional-volitional sphere often predominate. One of the most common causes of this form is hemolytic disease of newborns with the development of nuclear jaundice, as well as acute intrapartum asphyxia in full-term children with selective damage to the basal ganglia (status marmoratus). In this case, as a rule, the structures of the extrapyramidal system and the auditory analyzer are damaged. There are athetoid and dystonic variants.

Ataxic cerebral palsy G80.4

It is characterized by low muscle tone, ataxia and high tendon and periosteal reflexes. Speech disorders in the form of cerebellar or pseudobulbar dysarthria are common. Coordination disorders are represented by the presence of intention tremor and dysmetria when performing purposeful movements. It is observed with predominant damage to the cerebellum, fronto-pontine-cerebellar tract and, probably, the frontal lobes due to birth trauma, hypoxic-ischemic factor or congenital developmental anomalies. Intellectual deficits in this form vary from moderate to profound. In more than half of the cases, a thorough differential diagnosis with hereditary diseases is required.

Diagnostics

Complaints and anamnesis

In cerebral palsy, clinical symptoms and the degree of functional impairment vary significantly from patient to patient and depend on the size and topography of brain damage, as well as on the intensity and duration of previously conducted treatment and rehabilitation measures (Appendix D3)

Physical examination

In general, the leading clinical symptom in cerebral palsy is spasticity, which occurs in more than 80% of cases. Spasticity is a “motor disorder, part of the upper motor neuron syndrome, characterized by a speed-dependent increase in muscle tone and accompanied by increased tendon reflexes as a result of hyperexcitability of stretch receptors.” In other cases, there may be both a decrease in muscle tone and impaired coordination (ataxic cerebral palsy), as well as an unstable nature of its changes (dyskinetic cerebral palsy). In all forms of cerebral palsy the following may occur:

Pathological tonic reflexes, especially pronounced when changing body position, especially when the patient is vertical;

Pathological synkinetic activity during voluntary movements;

Violation of coordination interactions between muscles of synergists and antagonists;

Increased general reflex excitability - pronounced startle reflex.

The presence of these disorders from the early stages of a child’s development leads to the formation of a pathological motor stereotype, and in spastic forms of cerebral palsy - to the consolidation of habitual settings of the limbs, the development of joint contractures, and a progressive limitation of the child’s functional capabilities. Brain damage in cerebral palsy may also initially be accompanied by cognitive and sensory impairments and seizures.

Complications develop mainly in the late residual stage and include, first of all, orthopedic pathology - the formation of joint-muscular contractures, deformities and shortening of the limbs, subluxations and dislocations of joints, scoliosis. As a result, motor disorders lead to additional restrictions on the child’s ability to self-care, difficulties in obtaining education and full socialization.

Instrumental diagnostics

Comments: magnetic resonance imaging (MRI) is a more sensitive method than CT of the brain, and allows you to diagnose brain damage in the early stages, identify post-hypoxic brain damage, liquorodynamic disorders, congenital anomalies of brain development).

Comments: Video-EEG monitoring allows you to determine the functional activity of the brain; the method is based on recording electrical impulses that come from individual areas and zones of the brain.

Comments: Radiography of skeletal bones is necessary to identify and evaluate deformations of the structures of the osteoarticular system that occur secondary to muscle spasticity.

Other diagnostics

Comments: is indicated for all patients with an established diagnosis of cerebral palsy withperiodicity determined by the severity of the motor defect and speedprogression of musculoskeletal pathology

Comments: indicated in the presence of stigmata of disembryogenesis, in clinicalpicture of “floppy child syndrome”.

Differential diagnosis

Differential diagnosis.

Cerebral palsy is, first of all, a descriptive term; therefore, to make a diagnosis of cerebral palsy, as a rule, the manifestations of specific non-progressive motor disorders, which usually become noticeable in the initial residual stage, and the presence of one or more risk factors and complications in the perinatal period are sufficient. However, a wide range of differential diagnoses of cerebral palsy and a high risk of missing hereditary diseases (including those with pathogenetic treatment), especially in young children, require a thorough diagnostic search for any differences in clinical symptoms and history from the “classic” picture of cerebral palsy. “Warning” factors include: the patient’s absence of perinatal risk factors, progression of the disease, loss of previously acquired skills, repeated cases of “cerebral palsy” or early deaths of children in the family without an established cause, multiple developmental anomalies in the child. In this case, a mandatory neuroimaging examination (MRI of the brain), consultation with a geneticist, followed by additional laboratory tests are required. In the presence of hemiparesis and signs of stroke, a study of blood coagulation factors, including polymorphism of coagulation genes, is indicated. All patients with cerebral palsy require examination for visual and hearing impairments, delayed mental and speech development, and assessment of nutritional status. The exclusion of hereditary metabolic diseases, in addition to specialized biochemical tests, involves visualization of internal organs (ultrasound, MRI of internal organs, as indicated). If the “flaccid child” symptom complex predominates in the clinical picture (“prostrate” posture, decreased resistance in the joints during passive movements, increased range of motion in the joints, delayed motor development), a thorough differential diagnosis of cerebral palsy with hereditary neuromuscular diseases should be carried out.

Treatment

Conservative treatment

According to the European consensus on the treatment of cerebral palsy using botulinum therapy, published in 2009, there are several main groups of therapeutic effects for spastic forms of cerebral palsy. (Appendix G1).

It is recommended to prescribe an oral drug with a muscle relaxant effect: Tolperisone (N-anticholinergic, centrally acting muscle relaxant) (ATX code: M03BX04) tablets of 50 and 150 mg. Prescribed dose: from 3 to 6 years - 5 mg/kg/day; 7-14 years - 2-4 mg/kg/day (in 3 doses per day).

It is recommended to prescribe an oral drug with a muscle relaxant effect: Tizanidine w, vk (ATX code: M03BX02) (drugs that affect neuromuscular transmission, a centrally acting muscle relaxant, in the Russian Federation is not recommended for use under 18 years of age). By stimulating presynaptic α2 receptors, it inhibits the release of excitatory amino acids that stimulate NMDA receptors. Suppresses polysynaptic impulse transmission at the level of interneurons of the spinal cord). Tablets 2 and 4 mg. Starting dose (<10 лет) - 1 мг 2 р/д, (>10 years) - 2 mg 1 time per day; maximum dose - 0.05 mg/kg/d, 2 mg 3 times a day.

For more severe spasticity, the use of baclofen w, vk (ATX code: M03BX01) (γ-aminobutyric acid derivative, stimulating GABAb receptors, centrally acting muscle relaxant) is recommended: tablets of 10 and 25 mg.

Comments: The initial dose is 5 mg (1/2 tablet of 10 mg each) 3 times a day. WhenIf necessary, the dose can be increased every 3 days. Generally Recommendeddoses for children: 1-2 years - 10-20 mg/day; 2-6 years - 20-30 mg/day; 6-10 years - 30-60mg/day For children over 10 years of age, the maximum dose is 1.5-2 mg/kg.

To reduce local spasticity, therapy with botulinum toxin type A (BTA) is recommended: Botulinum toxin type A-

hemagglutinin complex w,vk (ATC code: M03AX01).

Comments: Intramuscular administration of BTA allows local, reversible,dose-dependently reduce muscle tone for up to 3-6 months or more. In Russia instandards for the treatment of cerebral palsy, botulinum therapy has been introduced since 2004, for use intwo BTA preparations are registered for children: Dysport (Ipsen Biopharm Ltd.,UK) - according to indications, dynamic foot deformation caused byspasticity in cerebral palsy, in children over 2 years of age and Botox (ATC code: M03AX01)(Allergan Pharmaceutical Ireland, Ireland) - according to indication: focalspasticity associated with dynamic foot deformity of the type“cauda equina foot” due to spasticity in patients 2 years of age and older with childhoodwith cerebral palsy who are undergoing outpatient treatment.

The calculation of the BTA dose is based on determining 1) the total dose per administration; 2) generaldoses per kilogram of body weight; 3) the number of units of the drug permuscle; 4) the number of units of the drug per point of administration; 5) number of unitsdrug per kilogram of body weight per muscle.

According to Russian recommendations, the dose of Botox is 4-6 U/kg body weightchild's body; the total total dose of the drug for one procedure should notexceed 200 units. When using the drug Dysport, the total amountof the drug during the first injection should not exceed 30 units/kg per child’s body weight (no more than 1000 units in total). The maximum dose for a large muscle is 10-15 U/kg body weight, for a small muscle - 2-5 U/kgbody weight. BTA preparations are not equivalent, in terms of dosages,there is no coefficient for direct conversion of various commercial forms of BTAexists.

Reducing spasticity, by itself, has minimal impact onacquisition of new functional capabilities by a child with cerebral palsy, and forupper limbs “high level of evidence of effectivenessBTA injections were identified only as an adjunct to physical rehabilitation in childrenwith spastic forms of cerebral palsy. When compared with placebo or notreatment, BTA injections alone have not shown sufficient effectiveness.” Due toThis mandatory element of treatment for patients with cerebral palsy isfunctional therapy.

In addition to antispastic drugs, concomitant medications used for cerebral palsy may include antiepileptic drugs, M- and H-anticholinergics, dopaminomimetics used for dystonia and hyperkinesis. Nootropics, angioprotectors and microcirculation correctors, drugs with metabolic effects, vitamins and vitamin-like agents are widely used in the treatment of cerebral palsy in Russia. The use of these drugs is aimed at correcting concomitant pathology in cerebral palsy. The main problem with the use of these drugs is the lack of research on their effectiveness in cerebral palsy.

Surgery

Orthopedic and neurosurgical methods, playing no less a role in the restoration and preservation of the functional abilities of patients with cerebral palsy, require detailed consideration in separate recommendations due to their specificity and diversity.

If oral antispastic drugs and BTA injections are ineffective, the use of neurosurgical methods for the treatment of spasticity is recommended:

Selective dorsal rhizotomy

Chronic epidural spinal cord stimulation

Intrathecal baclofen pump installations
(Strength of recommendation - 1; Strength of evidence - B)

Medical rehabilitation

Methods of physical rehabilitation are traditionally represented by massage, therapeutic exercises, hardware kinesiotherapy, and in a number of centers - robotic mechanotherapy using specialized simulators, including those based on the principle of biofeedback (for example, Lokomat - a robotic orthopedic device for restoring walking skills, Armeo - a complex for functional therapy of the upper extremities, etc.). Therapeutic gymnastics for cerebral palsy, especially for children in the first years of life, is effectively complemented by techniques based on inhibition of pathological reflexes and activation of physiological movements (methods of Voight, Bobath, etc.). A domestic development that has found wide application in the complex rehabilitation of patients with cerebral palsy is the use of the method of dynamic proprioceptive correction, carried out using specialized suits (for example, Adelie, Gravistat, Atlant) - systems consisting of supporting elastic adjustable elements, with the help of which targeted correction is created postures and dosed load on the musculoskeletal system of patients in order to normalize proprioceptive afferentation.

Traditionally, in Russia, during the rehabilitation of patients with cerebral palsy, physiotherapeutic methods are widely used, including those based on natural factors: applications of mud, paraffin, ozokerite for antispastic purposes, electrophysiological methods - electrical stimulation, electrophoresis with medicinal substances, water treatments, etc.

Thus, reducing spasticity in cerebral palsy is only the first step towards increasing the functional activity of patients, requiring further targeted functional rehabilitation methods. Functional therapy is also a priority method of rehabilitation for forms of cerebral palsy that are not accompanied by changes in muscle tone of the spastic type.

Alternative methods of treatment and rehabilitation of patients with cerebral palsy include acupuncture and acupuncture, manual therapy and osteopathy, hippotherapy and dolphin therapy, yoga, methods of Chinese traditional medicine, however, according to the criteria of evidence-based medicine, the effectiveness and safety of these methods has not currently been assessed.

Forecast

Outcomes and prognosis

The prognosis for the possibility of independent movement and self-care in patients with cerebral palsy largely depends on the type and extent of the motor defect, the level of development of intelligence and motivation, the quality of speech function and hand function. According to foreign studies, adult patients with cerebral palsy, an IQ >80, intelligible speech and the ability to move independently were employed in 90% of cases in jobs that were also available to persons without health limitations.

The mortality rate among patients with cerebral palsy is also directly dependent on the degree of motor deficit and concomitant diseases. Another predictor of premature death is decreased intelligence and inability to self-care. Thus, it was shown that in European countries, patients with cerebral palsy and an IQ of less than 20 in half of the cases did not reach the age of 18 years, while with an IQ of more than 35, 92% of patients with cerebral palsy lived more than 20 years.

In general, the life expectancy and prognosis of social adaptation of patients with cerebral palsy largely depend on the timely provision of medical, educational and social assistance to the child and his family. Social deprivation and lack of access to comprehensive care can have a negative impact on the development of a child with cerebral palsy, perhaps even more significant than the initial structural damage to the brain.

Prevention

Prevention and follow-up

Prevention of cerebral palsy includes both antenatal and postnatal measures. Antenatal measures include improving the somatic health of mothers, preventing obstetric and gynecological pathology, premature birth and complicated pregnancy, timely detection and treatment of infectious diseases of the mother, and promoting a healthy lifestyle for both parents. Timely detection and prevention of complicated labor and competent obstetric care can significantly reduce the risk of intrapartum damage to the newborn’s central nervous system. Increasing importance has recently been given to studying the role of hereditary coagulopathies in the formation of focal brain damage in children with unilateral forms of cerebral palsy and the prevention of these complications.

Postnatal measures for the prevention of cerebral palsy include the use of corporate controlled hypothermia when nursing premature infants, the controlled use of steroids in premature newborns (by reducing the risk of developing bronchopulmonary dysplasia, corticosteroids increase the risk of developing cerebral palsy), intensive measures to reduce hyperbilirubinemia and prevent dyskinetic forms of cerebral palsy.

Optimal care for a patient with cerebral palsy implies a multidisciplinary approach by a team of medical, pedagogical and social specialists, focusing on the needs of both the patient himself and his family members involved in the daily rehabilitation and social adaptation of a child with cerebral palsy (16). Cerebral palsy, being primarily a dysfunctional condition, requires continuous daily rehabilitation from the first days of the patient’s life, taking into account the following medical and social aspects:

Movement, maintaining posture and physical activity of the child;

Communication;

Accompanying illnesses;

Daily activities;

Baby care;

Quality of life of the patient and family members.

At the early stage of development of cerebral palsy (up to 4 months, according to the classification of K.A. Semyonova), the diagnosis is not always obvious, however, the presence of a burdened perinatal history and delayed psychomotor development of the child are indications for targeted monitoring of the child by a pediatrician and neurologist. Providing assistance to newborns at risk of developing cerebral palsy begins in the maternity hospital and continues at stage 2 - in specialized departments at children's hospitals, and at stage 3 - on an outpatient basis at children's clinics under the supervision of a pediatrician, neurologist and medical specialists (orthopedist, ophthalmologist, etc. ). The initial examination of a patient with cerebral palsy (Appendix B) and further treatment can be carried out in a hospital setting, a day hospital or on an outpatient basis in a children's clinic, which is determined by the severity of the patient's general condition. An additional stage of rehabilitation treatment for cerebral palsy is the referral of patients to sanatorium institutions. The length of continuous stay of a child with cerebral palsy in a medical institution depends on the severity of motor disorders and concomitant pathology. It is important not only to conduct courses of comprehensive rehabilitation treatment in a medical institution, but also to follow recommendations regarding the level and nature of physical activity, and the use of technical means of rehabilitation at home. The key principles of providing assistance for cerebral palsy are early initiation, continuity and continuity of all stages of rehabilitation, and a multidisciplinary approach. There is a constant increase in the number and improvement of existing traditional and alternative methods of treating patients with cerebral palsy, but the fundamental goal remains the same - timely compensation of functional disorders that have developed as a result of damage to the child’s brain, and minimization of secondary biomechanical deformations and social consequences of the disease. If it is impossible to have a pathogenetic effect on the cause of cerebral palsy, the task is to optimally adapt the child to the existing defect, based on the principles of plasticity of the nervous system.

Information

Sources and literature

Clinical recommendations of the Union of Pediatricians of Russia
1. 1. Badalyan L.O., Zhurba L.T., Timonina O.V. Cerebral palsy. Kiev: Zdorov Ya. 1988. 328 pp. 2. Baranov A.A., Namazova-Baranova L.S., Kurenkov A.L., Klochkova O.A., Karimova Kh.M., Mamedyarov A.M. , Zherdev K.V., Kuzenkova L.M., Bursagova B.I. Comprehensive assessment of motor functions in patients with cerebral palsy: educational and methodological manual / Baranov A.A. [et al.]; Federal State. budgetary scientific institution Scientific Center for Children's Health - M.: Pediatr, 2014. - 84 pp. 3. Klochkova O.A., Kurenkov A.L., Namazova-Baranova L.S., Mamedyarov A.M., Zherdev K.V. General motor development and formation of hand function in patients with spastic forms of cerebral palsy against the background of botulinum therapy and complex rehabilitation // Bulletin of the Russian Academy of Medical Sciences. 2013. - T. 11. - P. 38-48. 4. Kurenkov, A. L.L., Batysheva, T.T., Vinogradov, A.V., Zyuzyaeva, E.K. Spasticity in cerebral palsy: diagnosis and treatment strategies / A.L. Kurenkov // Journal of Neurology and Psychiatry. - 2012. - t. Mamedyarov A.M., Kuzenkova L.M., Tardova I.M., Falkovsky I.V., Dontsov O.G., Ryzhenkov M.A., Zmanovskaya V.A., Butorina M.N., Pavlova O L.L., Kharlamova N.N., Dankov D.M., Levitina E.V., Popkov D.A., Ryabykh S.O., Medvedeva S.N., Gubina E.B., Vladykina L.N. ., Kenis V.M., Kiseleva T.I., Krasavina D.A., Vasilyeva O.N., Nosko A.S., Zykov V.P., Mikhnovich V.I., Belogorova T.A., Rychkova L.V. Multilevel injections of botulinum toxin type A (Abobotulinumtoxin) in the treatment of spastic forms of cerebral palsy: a retrospective study of the experience of 8 Russian centers. Pediatric pharmacology. 2016;13(3): 259-269. 6. Kurenkov A.L., Klochkova O.A., Zmanovskaya V.A., Falkovsky I.V., Kenis V.M., Vladykina L.N., Krasavina D.A., Nosko A.S., Rychkova L.V., Karimova Kh.M., Bursagova B.I., Namazova-Baranova L.S., Mamedyarov A.M., Kuzenkova L.M., Dontsov O.G., Ryzhenkov M.A., Butorina M.N., Pavlova O.L., Kharlamova N.N., Dankov D.M., Levitina E.V., Popkov D.A., Ryabykh S.O., Medvedeva S.N., Gubina E. O.B., Agranovich O.V., Kiseleva T.I., Vasilyeva O.N., Zykov V.P., Mikhnovich V.I., Belogorova T.A. The first Russian consensus on the use of multi-level injections of Abobotulinumtoxin A in the treatment of spastic forms of cerebral palsy. Journal of Neurology and Psychiatry. S.S. Korsakov. 2016; 11 (116): pp. 98-107. 7. Semenova K.A., Mastyukova E.M., Smuglin M.Ya. Clinic and rehabilitation therapy for cerebral palsy. M.: Medicine. 1972. 328 p. 8. Boyd R.N., Graham H.K. Objective measurement of clinical findings in the use of Botulinum toxin type A for the management of children with cerebral palsy. Eur J Neurol. 1999; 6 (Suppl. 4): 23–35. 9. Bax M., Goldstein M., Rosenbaum P., Leviton A., Paneth N., Dan B., Jacobsson B., Damiano D. Proposed definition and classification of cerebral palsy. Dev Med Child Neurol. 2005; 47 (8): 571‒576. 10. Delgado M.R., Hirtz D., Aisen M., Ashwal S., Fehlings D.L., McLaughlin J., Morrison L.A., Shrader M.W., Tilton A., Vargus-Adams J. Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Practice parameter: pharmacologic treatment of spasticity in children and adolescents with cerebral palsy (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society // Neurology. 2010; 74(4): pp. 336-43. 11. Heinen F., Desloovere K., Schroeder A.S., Berweck S., Borggraefe I., van Campenhout A., Andersen G.L., Aydin R., Becher J.G., Bernert G. et al. The updated European Consensus 2009 on the use of Botulinum toxin for children with cerebral palsy. Eur J Paediatr Neurol. 2010; 14: 45-66. 12. Koman L.A., Mooney J.F. 3rd, Smith B.P., Goodman A., Mulvaney T. Management of spasticity in cerebral palsy with botulinum-A toxin: report of a preliminary, randomized, double-blind trial. J Pediatr Orthop. 1994; 14 (3): 299-303. 13. Lance J.W. The control of muscle tone, reflexes, and movement: Robert Wartenberg Lecture. Neurology. 1980; 30 (12): 1303-13. 14. Little W.J. Course of lectures on the deformities of the human frame. Lancet. 1843; 44: 350-354. 15. Miller F. Cerebral palsy. New York: Springer Science. 2005. 1055 p. 16. Palisano R., Rosenbaum P.L., Walter S., Russell D., Wood E., Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997; 39 (4): 214–223. 17. Surveillance of cerebral palsy in Europe (SCPE). Surveillance of cerebral palsy in Europe: a collaboration of cerebral palsy surveys and registers. Dev Med Child Neurol. 2000; 42: 816-824. 18. Tardieu G., Shentoub S., Delarue R. Research on a technique for measuring spasticity. Rev Neurol (Paris). 1954; 91 (2): 143-4.

Information

Keywords

Motor development disorder

Spasticity,

Delayed psycho-speech development,

Poor posture maintenance

Pathological reflexes,

Loss of coordination

Epilepsy.

List of abbreviations

Cerebral palsy - cerebral palsy

MRI - magnetic resonance imaging

Criteria for assessing the quality of medical care

№	Quality criteria	Force	Level reliability evidence
1	Treatment with antispastic drugs for local spasticity (botulinum toxin type “A”) was performed.	1	A
2	Treatment with antispastic drugs for generalized spasticity (oral muscle relaxants) was performed.	1	IN
3	Physical methods of rehabilitation were performed (physical therapy/massage/applied kinesiotherapy/robotic mechanotherapy/physiotherapy, etc.), focused on solving specific therapeutic problems (reducing tone, suppressing pathological reflexes, preventing secondary deformations, improving function, etc.)	1	WITH

Appendix A1. Composition of the working group:

Baranov A.A., academician RAS, professor, doctor of medical sciences, Chairman of the Executive Committee of the Union of Pediatricians of Russia.

Namazova-Baranova L.S., corresponding member. RAS, Professor, Doctor of Medical Sciences, Deputy Chairman of the Executive Committee of the Union of Pediatricians of Russia.

Kuzenkova L.M., professor, doctor of medical sciences, member of the Union of Pediatricians of Russia

Kurenkov A.L., professor, doctor of medical sciences, member of the Union of Pediatricians of Russia

Klochkova O.A., Ph.D., member of the Union of Pediatricians of Russia

Mamedyarov A.M., Ph.D., member of the Union of Pediatricians of Russia

Karimova Kh.M., Ph.D.

Bursagova B.I., Ph.D.

Vishneva E.A., Ph.D., member of the Union of Pediatricians of Russia

Appendix A2. Methodology for developing clinical guidelines

Target audience of these clinical recommendations:

1. Pediatricians;

2. Neurologists;

3. General practitioners (family doctors);

4. Rehabilitation doctors, physical therapy doctors, physiotherapists;

5. Students of medical universities;

6. Students in residency and internship.

Methods used to collect/select evidence: search in electronic databases.

Description of methods used to assess the quality and strength of evidence: the evidence base for recommendations is publications included in the Cochrane Library, EMBASE, MEDLINE and PubMed databases. Search depth - 5 years.

Methods used to assess the quality and strength of evidence:

Expert consensus;

Assessment of significance in accordance with the rating scheme.

Methods used to analyze evidence:

Systematic reviews with evidence tables.

Description of the methods used to analyze the evidence

When selecting publications as potential sources of evidence, the methodology used in each study is examined to ensure its validity. The outcome of the study influences the level of evidence assigned to the publication, which in turn influences the strength of the recommendations.

To minimize potential bias, each study was assessed independently. Any differences in ratings were discussed by the entire writing group. If it was impossible to reach consensus, an independent expert was involved.

Evidence tables: filled out by the authors of clinical guidelines.

Comments were received from primary care physicians regarding the clarity of these recommendations, as well as their assessment of the importance of the proposed recommendations as a tool for daily practice.

All comments received from experts were carefully systematized and discussed by members of the working group (authors of the recommendations). Each point was discussed separately.

Consultation and expert assessment

The draft guidelines were peer-reviewed by independent experts who were primarily asked to comment on the clarity and accuracy of interpretation of the evidence base underlying the guidelines.

Working group

For final revision and quality control, the recommendations were re-analyzed by members of the working group, who concluded that all comments and comments from experts were taken into account, and the risk of systematic errors in the development of recommendations was minimized.

The strength of recommendations (1-2) based on the corresponding levels of evidence (A-C) and indicators of good practice (Table 1) - good practice points (GPPs) are given when presenting the text of the recommendations.

Table A1 - Scheme for assessing the level of recommendations

WITH degree of reliability of recommendations	Risk-benefit ratio	Methodological quality of available evidence	Explanations for application of recommendations
1A		Reliable consistent evidence based on well-performed RCTs or compelling evidence presented in some other form.	A strong recommendation that can be used in most cases in the majority of patients without any modifications or exceptions
1B	The benefits clearly outweigh the risks and costs, or vice versa	Evidence based on the results of RCTs performed with some limitations (inconsistent results, methodological errors, indirect or random, etc.) or other compelling reasons. Further studies (if conducted) are likely to influence and may change our confidence in the benefit-risk estimate.	A strong recommendation that can be applied in most cases
1C	The benefits are likely to outweigh the potential risks and costs, or vice versa	Evidence based on observational studies, unsystematic clinical experience, results of RCTs performed with significant shortcomings. Any estimate of effect is considered uncertain.	Relatively strong recommendation, subject to change as higher quality evidence becomes available
2A	The benefits are comparable to the possible risks and costs	Reliable evidence based on well-performed RCTs or supported by other compelling data. Further research is unlikely to change our confidence in the benefit-risk assessment.	The choice of the best strategy will depend on the clinical situation(s), patient, or social preferences.
2B	The benefits are comparable to the risks and complications, but there is uncertainty in this assessment.	Evidence based on the results of RCTs performed with significant limitations (inconsistent results, methodological flaws, indirect or random), or strong evidence presented in some other form. Further studies (if conducted) are likely to influence and may change our confidence in the benefit-risk estimate.	An alternative strategy may be a better choice for some patients in certain situations.
2C	Ambiguity in assessing the balance of benefits, risks and complications; the benefits may be weighed against the possible risks and complications.	Evidence based on observational studies, anecdotal clinical experience, or RCTs with significant limitations. Any estimate of effect is considered uncertain.	Very weak recommendation; alternative approaches may be used equally.

*In the table, the numerical value corresponds to the strength of recommendations, the letter value corresponds to the level of evidence

These clinical recommendations will be updated at least once every three years. The decision to update will be made on the basis of proposals submitted by medical professional non-profit organizations, taking into account the results of a comprehensive assessment of drugs, medical devices, as well as the results of clinical testing.

Appendix A3. Related documents

Procedures for providing medical care: Order of the Ministry of Health and Social Development of the Russian Federation dated April 16, 2012 N 366n “On approval of the Procedure for the provision of pediatric care”

Standards of care: Order of the Ministry of Health of the Russian Federation dated June 16, 2015 N 349n “On approval of the standard of specialized medical care for cerebral palsy (phase of medical rehabilitation)” (Registered with the Ministry of Justice of Russia on July 6, 2015 N 37911)

Appendix B. Algorithm for managing a patient with myasthenia gravis

Appendix B: Patient Information

Cerebral palsy (CP), according to modern concepts, is a non-progressive disease of the central nervous system, the development of which is associated with perinatal brain damage at various stages of fetal and child development. The basis of the clinical picture of cerebral palsy are motor disorders, changes in muscle tone, impaired cognitive and speech development and other manifestations. The incidence of cerebral palsy, according to various authors, remains at the level of 2-3.6 cases per 1000 newborns, and with the use of modern technologies for intensive care of very premature infants, against the background of a decrease in mortality, the percentage of children with neurological deficit and cerebral palsy is increasing.

The prognosis of cerebral palsy depends on the severity of clinical manifestations.

Antispastic therapy and rehabilitation treatment are the most effective methods of treating cerebral palsy.

The life expectancy and prognosis of social adaptation of patients with cerebral palsy largely depend on the timely provision of medical, educational and social assistance to the child and his family.

Appendix G1. The main groups of therapeutic interventions for spastic forms of cerebral palsy

Appendix G2.

Appendix G3. Advanced patient management algorithm

Appendix G3. Explanation of notes.

... g - a medicinal product included in the List of vital and essential medicinal products for medical use for 2016 (Order of the Government of the Russian Federation dated December 26, 2015 N 2724-r)

... vk is a medicinal product included in the List of medicinal products for medical use, including medicinal products for medical use prescribed by decision of medical commissions of medical organizations (Order of the Government of the Russian Federation dated December 26, 2015 N 2724-r)

Attached files

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Sometimes a pregnancy does not end as expected, and the baby is born with a developmental pathology, for example, cerebral palsy (cerebral palsy). It should be noted that the disease is not inherited, but occurs during pregnancy or childbirth. Cerebral palsy is a disease that is a series of syndromes that arise due to damage to the brain; the signs of the disease are associated with a violation of the human motor sphere.

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.

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.

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.

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.

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:

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.

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.
Diagnosed with neonatal 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.

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.

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.

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 year to 3. 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.

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:

Complications

Cerebral palsy does not progress over time. But the danger of the disease is that additional pathologies develop against its background. Complications of cerebral palsy:

Prevention of cerebral palsy

During pregnancy, you need to strictly monitor your health. It is important to eliminate bad habits, regularly go to see your doctor, and strictly follow his recommendations. Diagnose conditions dangerous to the fetus, such as hypoxia, in a timely manner. The doctor should correctly assess the mother's condition and choose the correct route of delivery.

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 of age - 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.

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.

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.

The first signs of cerebral palsy can be detected in newborns in the first days of life and up to one year. Professionals and even parents can determine the presence of the disease in the early stages of development, which is necessary to prevent exacerbations. Cerebral palsy in children often manifests itself as a complex of symptoms that need to be recognized in a short time.

Doctors do not always properly examine the child in order to promptly identify the symptoms of cerebral palsy. Parents spend a lot of time with their baby, which gives them a chance to independently detect the disease. The most characteristic appearances of cerebral palsy at an early age:

Inability to detect folds between buttocks.
Lack of lumbar curve.
Asymmetry of two areas of the body.

In the first days of life with severe cerebral palsy, the following signs can be diagnosed:

Excessive muscle tone or being too relaxed.
In the first days of life, optimal muscle tone is visible, but disappears after some time.
If hypertonicity occurs, the child’s movements look unnatural and are often carried out too slowly.
Unconditioned reflexes do not disappear, and the child does not begin to sit or hold his head up on his own for too long.
Asymmetry of various parts of the body. On the one hand, symptoms of hypertonicity occur, on the other, muscle weakening may follow.
Muscle twitching, in some cases complete or partial paralysis is possible.
Unreasonably increased anxiety, frequent loss of appetite.

On a note! If a child actively uses only one side of the body, gradual muscle atrophy occurs on the other part, the limbs do not develop fully, and often do not grow to the required parameters. There is a curvature of the spine, disturbances in the function and structure of the hip joints.

Most often, cerebral palsy in children is detected quickly, since they make active movements with the limbs located on one side. Often patients hardly use the arm with weakened tone, which is rarely separated from the body. The child does not turn his head without great effort, even several months after birth. Often parents need to turn their baby over on their own from time to time.

Even if you do not notice dangerous signs or doubt their presence, it is necessary to conduct regular diagnostic examinations. Be attentive to the health of the child if he was born premature, develops too slowly, or you notice problems during childbirth.

On a note! If you discover serious deviations in the development or behavioral characteristics of the baby, you should consult a doctor for advice.

Methods for self-diagnosis of cerebral palsy:

Method	Peculiarities
Absence of characteristic reflexes	After birth, babies develop characteristic reflexes, which then gradually disappear. If the child is healthy, the blink reflex appears in response to loud noise. In cerebral palsy, this feature often does not appear.
Same type of movements	If you suspect your child has cerebral palsy, check for repetitive movements. The presence of cerebral palsy is often indicated by constant nodding or freezing in a specific position for a long period of time. If you notice such deviations, it is advisable to consult a pediatrician
Reaction to touch	To check if your child has a dangerous disease, you can place your palms on his stomach. If you do not notice a special reaction in the child, most likely the disease does not exist, or at least does not manifest itself in a pronounced form. If there is pathology, the legs will move in opposite directions. The severity of negative symptoms depends on the level of brain damage

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.

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.

How to recognize cerebral palsy in an infant?

If the brain damage is minimal, typical symptoms are difficult to identify not only for parents, but even for professional specialists. Clumsy movements and overstrain of muscle tissue are observed only with severe damage to brain cells.

You can suspect the presence of brain disorders if you have the following symptoms:

Sleep pathologies.
Inability to roll over independently.
The child cannot hold his head up.
Conditioned reflexes apply to only one side of the body.
The baby often remains in one position without moving for a long time.
Periodically there are cramps in the limbs.
Facial asymmetry of varying degrees of severity.
The limbs vary in length.

Video: Early detection of cerebral palsy in children under 1 year of age based on motor development

Common signs of cerebral palsy

The clinical picture may vary depending on the form of the disease. Each of them is characterized by specific symptoms that affect the child’s life in different ways.

Diplegic form

Occurs when brain damage occurs during fetal development. These disorders can be noticed by muscle hypertonicity. Sick children are in a characteristic position, as their legs are extended and often crossed.

Until one year of age, you may notice that the child practically does not use the lower limbs when moving. Often children do not try to sit up or even roll over. As the course of the disease worsens, serious deviations in physical development may develop.

It is quite easy to detect the presence of this form of the disease. To do this, it is enough to try to put the child on his feet. In this case, a sharp increase in muscle tone appears. The child moves, while leaning only on tiptoes. The gait is unsteady; with each new step, the child touches one foot with the other, moving the limbs straight in front of him.

On a note! In the diplegic form of the disease, deviations in mental development often appear.

Hemiplegic form

The disease often occurs when one of the cerebral hemispheres is damaged. A high risk of developing hemiplegic cerebral palsy remains in children suffering from intrauterine infection. This disease can occur even with minor hemorrhage during childbirth.

The hemiplegic form of cerebral palsy is manifested by limited movements in the limbs, while persistently increased muscle tone remains. The child moves actively, but at the same time he is diagnosed with too frequent muscle contractions in the part of the body, the innervation of which is responsible for the affected area of the brain.

Video - How to recognize cerebral palsy

Hyperkinetic form

Occurs when there are structural disorders of the subcortical ganglia responsible for innervation. Often the disease manifests itself as a result of negative immune activity in the mother’s body in relation to the child. In this case, the symptoms of cerebral palsy are also pronounced. The child’s muscle tone often stabilizes, but after a while it increases. In some cases, muscle tone does not increase, but decreases. The child's movements become awkward, he takes uncomfortable and unnatural poses. In many cases, with this form of the disease, intelligence is preserved, which is why the prognosis with timely treatment is considered conditionally favorable.

When should you be wary?

There are several types of symptoms that can be used to determine the severity and form of the disease. Often negative signs appear very clearly, making them almost impossible not to notice even before the age of one year. In most cases, cerebral palsy manifests itself with severe symptoms; disorders often lead to impairment of motor and coordination functions.

Motor signs of cerebral palsy:

Hyperkinetic form of this disease.
Dystonia and related disorders.
Development of motor skills in only one limb.
Muscle spasticity.
Periodic appearance of paresis, paralysis.

Dystonia with cerebral palsy steadily progresses, after some time additional negative symptoms arise, which can lead to a number of complications. Often it is not cerebral palsy that progresses, but the disorders and diseases associated with it. During the active growth of the child, the intensity of negative symptoms can either increase or decrease.

Often, after some time, cerebral palsy is complicated by structural pathology of the joints and muscle disorders. These deviations are almost impossible to stop if you refuse to use surgical intervention.

On a note! Often, pathologies arise as a result of disruptions in the functioning of certain parts of the brain. As a result, patients suffer from improper muscle function, and deviations in the functioning of internal organs are also possible.

If disturbances in the functioning of the brain occur, the following disorders may form:

Non-standard, illogical behavior.
Inability to learn something new, speak simple words.
Intellectual failure.
Hearing impairment, speech pathology.
Regular occurrence of problems with swallowing.
Lack of appetite.

If muscle and neurological disorders occur with cerebral palsy, the quality of life of children is greatly reduced. In some cases, concomitant diseases affect the human body more strongly than the primary pathologies. Often cerebral palsy is accompanied by a decrease in intelligence and damage to various brain structures.

Cerebral palsy in children is often characterized by standard features, but can occur in a unique pattern. To determine the presence of cerebral palsy, especially in mild forms, special tests are used. Based on a group of symptoms, a disease is identified. Doctors take into account a combination of signs from muscle tissue and the nervous system.

To make an accurate diagnosis and determine the dynamics of the disease, doctors use various diagnostic measures. Negative signs often appear from the first days or weeks of a baby’s life. It is possible to make a diagnosis and characterize the course of the disease up to a year, but the information obtained is clarified at an older age.

Diagnosis of cerebral palsy is carried out by assessing the general condition of the brain. Modern instrumental technologies are used, including MRI, CT, ultrasound. Using these diagnostic studies, it is possible to identify pathological foci, disturbances in the structure of the brain, as well as areas of hemorrhage.

The worsening of the clinical picture can be traced using neurophysiological research methods. Electromyography and similar measures are performed. Laboratory and genetic diagnostic methods are used to determine symptoms characteristic of cerebral palsy.

Cerebral palsy in severe stages often manifests itself together with the following abnormalities:

Epileptic seizures.
Hearing loss.
Vision pathologies. They are caused by atrophic processes in the optic discs.

Cerebral palsy often manifests itself together with a complex of accompanying symptoms, which is why it is often diagnosed in the first year of life. If cerebral palsy occurs due to a genetic predisposition to brain disorders, the disease progresses steadily. In many cases, you can eliminate the negative symptoms of the disease if you seek medical help in a timely manner. , study at the link. read on our website.

Cerebral palsy is one of the most severe diagnoses that parents of infants can hear from doctors. If you want to understand what this disease is, what the symptoms and treatment are, read this article.

Cerebral palsy - what is it?

Cerebral palsy is not a specific disease with specific symptoms. This is a whole group of pathologies of the motor system, which became possible due to serious disorders in the central nervous system. Problems with the musculoskeletal system cannot be considered primary; they always follow lesions of the brain.

Anomalies in the cerebral cortex, subcortex, capsules and brain stem most often occur during the fetal development of the baby. The exact causes that ultimately lead to cerebral palsy in newborns are still being studied by scientists. However, doctors (despite a lot of hypotheses) seriously consider two periods when global changes in the brain can lead to severe pathology - the period of pregnancy and the period immediately before, during and immediately after childbirth.

Cerebral palsy does not progress, the stage of the lesion and the limitation of motor functions do not change. The child grows, and some disorders become more noticeable, so people mistakenly believe that cerebral palsy can develop and become more complicated.

The group of diseases is quite common - based on statistics, it can be noted that out of a thousand children, two are born with one form or another of cerebral palsy. Boys are almost one and a half times more likely to get sick than girls. In half of the cases, in addition to motor dysfunction, various mental and intellectual disorders are observed.

Pathology was noticed back in the 19th century. Then the British surgeon John Little began studying birth injuries. It took him exactly 30 years to formulate and present to the public the idea that the lack of oxygen experienced by the fetus at the moment of its birth can result in paresis of the limbs.

At the end of the 19th century, the Canadian doctor Osler came to the conclusion that cerebral disorders are still associated with the hemispheres of the brain, and not with the spinal cord, as the British Little argued before him. However, medicine was not very convinced by Osler’s arguments, and for a very long time Little’s theory was officially supported, and birth trauma and acute asphyxia were named as starting mechanisms for cerebral palsy.

The term “cerebral palsy” was introduced by the famous doctor Freud, who was a neurologist and studied the problem in his own practice. He formulated intrauterine damage to the child’s brain as the main cause of the pathology. He was the first to draw up a clear classification of the different forms of this disease.

Causes

Modern doctors believe that cerebral palsy cannot be considered a hereditary disease. Damages to the musculoskeletal system and problems with mental development become possible in the event of improper development of the baby’s brain during the mother’s pregnancy, as well as banal underdevelopment of the brain.

If a child is born much earlier than expected, the risk of cerebral palsy is several times higher. This is confirmed by practice - many children with musculoskeletal disorders and an established diagnosis of cerebral palsy were born very premature.

However, it is not prematurity itself that is scary; it only creates the preconditions for the development of disorders.

The likelihood of cerebral palsy is usually influenced by other factors, which, in combination with premature birth, lead to the disease:

“mistakes” during the appearance and development of brain structures (first trimester of pregnancy);
chronic oxygen starvation of the fetus, prolonged hypoxia;
intrauterine infections that the baby suffered while still in the womb, most often caused by herpes viruses;
severe form of Rh conflict between mother and fetus (occurs when the mother is Rh negative and the child is Rh positive), as well as severe hemolytic disease of the child immediately after birth;
brain injury during childbirth and immediately after it;
brain infection immediately after birth;
toxic effects on the child’s brain from heavy metal salts and poisons - both during pregnancy and immediately after birth.

However, it is not always possible to establish the true cause of a child’s illness. If only because there is no way to understand at what stage of development of the embryo and fetus that total “mistake” occurred, just as there is no way to prove that brain damage is the result of a conflict of Rh factors. Some children with cerebral palsy have not one, but several causes for the development of the disease.

Forms and their characteristics

Since cerebral palsy is a group of disorders, there is a fairly detailed classification of the forms of each type of lesion. Each form of cerebral palsy has certain signs and manifestations:

Hyperkinetic (dyskinetic)

This form is most often diagnosed in children who suffer an antibody attack in utero associated with Rh conflict. When they are born, the development of hemolytic disease of the newborn (HDN) plays a role, its nuclear icteric form is especially dangerous. In this case, the subcortex of the brain is affected, as well as the auditory analyzers.

The child suffers from hearing loss and has uncontrollable eye twitching. He makes involuntary movements. Increased muscle tone. Paralysis and paresis can develop, but are not considered obligatory. Children with this type of cerebral palsy are quite poorly oriented in the surrounding space, they have difficulties with intentional actions of their limbs - for example, it is difficult for the child to pick up this or that object.

With all this, intelligence suffers to a lesser extent than with some other types of cerebral palsy. Such children (with due effort on the part of parents and teachers) are well socialized, they are able to study at school, many later manage to enter a university, get a profession and find a job.

Ataxic (atonic-astatic)

This type of cerebral palsy is associated with damage to the cerebellum, the frontal lobes of the brain, and the pathway between the cerebellum and the frontal lobe. Such damage is most often a consequence of chronic severe fetal hypoxia, anomalies in the development of these brain structures. Birth trauma to the frontal lobes is often cited as a likely cause.

With this form, the child’s muscle tone is reduced. When moving, the muscles are not coordinated with each other, so the child is not able to make purposeful movements. It is practically impossible to maintain balance due to decreased muscle tone. Shaking (tremor) of the limbs may be observed.

Such children are most susceptible to epileptic seizures. At an early age there are problems with the development of vision and speech. With proper care, systematic training, and adequate therapy, children with the atanic-astatic form of cerebral palsy can demonstrate certain low intellectual abilities, which allow them to only slightly master the basics of speech and understand what is happening. In more than half of the cases, speech remains undeveloped, and the children themselves do not show any interest in this world.

Spastic tetraplegia (spastic tetraparesis)

This is the most severe form of cerebral palsy. It occurs due to damage to the brain stem, both hemispheres or the cervical spine. The most likely causes are intrauterine fetal hypoxia, mechanical asphyxia when the umbilical cord entangles the neck, and cerebral hemorrhage (due to damage by toxins, for example, or due to a brain infection). Often the cause is considered to be a birth injury in which the cervical spine was damaged.

With this form of cerebral palsy, the motor activity of all four limbs (both arms and legs) is impaired - to approximately the same extent. Since the arms and legs cannot move, their inevitable and irreversible deformation begins.

The child experiences muscle and joint pain and may have difficulty breathing. More than half of children with such cerebral palsy have impaired activity of the cranial nerves, resulting in strabismus, blindness, and hearing impairment. In 30% of cases, microcephaly is observed - a significant decrease in the volume of the brain and cranium. More than half of patients with this form suffer from epilepsy.

Unfortunately, such children cannot take care of themselves. Big problems also arise with learning, since the intellect and psyche suffer to a significant extent, and the child not only does not have the opportunity to take something with his hands, he does not have the banal motivation to take something or do something.

Spastic diplegia (Little's disease)

This is the most common form of cerebral palsy; it is diagnosed in three out of four sick children. When the disease occurs, some parts of the white matter of the brain are usually affected.

Spastic lesions are bilateral, but the legs are more affected than the arms and face. The spine becomes deformed very quickly and joint mobility is limited. Muscles contract uncontrollably.

Intelligence, mental development and speech development suffer quite markedly. However, this form of the disease is subject to correction, and a child with Little’s disease can be socialized - however, the treatment will be long and almost permanent.

Hemiplegic

This is a unilateral spastic lesion that most often affects the arm rather than the leg. This condition becomes possible as a result of hemorrhage in one hemisphere of the brain.

Socialization of such children is possible if their intellectual capabilities are sufficiently great. Such children develop far behind their peers. They are characterized by delayed mental and psychological development, problems with speech. Sometimes epilepsy attacks occur.

Mixed

With this form of pathology, brain dysfunction can be observed in a variety of structures and areas, so the likelihood of a combination of disorders of the motor system is quite real. Most often, a combination of spastic and dyskinetic forms is detected.

Unspecified

This form of the disease is spoken of when the lesions are so extensive that it is not possible to identify the specific parts of the brain in which the anomaly occurred (developmental defect or traumatic impact).

Symptoms and signs

It is not always possible to see the first signs of cerebral palsy in an infant in the maternity hospital, although serious brain disorders are noticeable from the first hours of the child’s life. Less severe conditions are sometimes diagnosed a little later. This is due to the fact that as the nervous system grows and the connections in it become more complex, disorders of the motor and muscular systems become obvious.

There are alarming symptoms that should make parents wary and consult a doctor. These symptoms are not always signs of cerebral palsy; quite often they indicate neurological disorders that are in no way related to cerebral palsy.

However, they cannot be ignored.

Parents should be suspicious if:

the child does not fix his head well, cannot hold it even at 3 months;
the baby’s muscles are weak, which is why the limbs look like “noodles”;
the child does not roll over on his side, does not crawl, cannot fix his gaze on a toy and does not take toys in his hands, even if he is already 6-7 months old;
unconditioned reflexes with which every child is born (and which normally should disappear by six months) continue to persist even after 6 months;
the limbs are spastically tense and do not relax, sometimes spasms occur in “attacks”;
the child has seizures;
visual impairment, hearing impairment;
chaotic movements of the limbs, uncontrolled and random (this symptom cannot be assessed in newborns and children in the first month of life, since for them such movements are a variant of the norm).

It is most difficult to identify signs of cerebral palsy in children under 5 months of age. This task is difficult even for an experienced doctor. He may suspect a pathology, but he has no right to confirm it until the child is 1 year old. One or more of the symptoms from the list above cannot be used to suspect cerebral palsy, nor can one mistake the symptoms of some similar diseases for cerebral palsy.

Parents should be very careful, because if treatment for some forms of pathology begins early, before 3 years of age, the results will be excellent, and the child will be able to lead a completely full life.

Stages of the disease

In medicine, there are three stages of the disease. The first (early) begins at approximately the age of 3-5 months, the initial stage is called a disease identified at the age of six months to 3 years, the late stage is said to be if the child is already 3 years old.

The smaller the stage, the better the prognosis for cure. Even if it is not possible to cure the child completely, it is quite possible to reduce negative manifestations as much as possible. The child’s brain (even one that has suffered from trauma or developmental defects) has a high ability to compensate; this can and should be used when correcting disorders.

Diagnostics

Quite often, genetic diseases, which are completely independent diseases, are mistaken for cerebral palsy, as a result of which children are given a diagnosis that does not correspond to reality. Modern medicine is very developed, but the symptoms associated with brain pathology still remain poorly understood.

The disease can usually be identified closer to 1 year. If a child at this age does not sit, does not crawl, or shows other progressive signs of nervous system disorders, the doctor will prescribe an MRI.

Magnetic resonance imaging is the only more or less reliable study that allows us to judge the presence of cerebral palsy - and even establish its probable form.

For young children, the procedure is performed under general anesthesia, since you must lie still and for quite a long time in the capsule to obtain images. Children can't do that.

With genuine cerebral palsy, layer-by-layer MRI images show atrophy of the cortical and subcortical zones of the brain, and a decrease in the density of white matter. To distinguish cerebral palsy from a huge list of genetic syndromes and conditions that are similar in manifestation, the child may be prescribed an MRI of the spinal cord.

If a child experiences seizures, the doctor prescribes electroencephalography. Ultrasound of the brain is relevant only for newborns; this technique is sometimes used in maternity hospitals if there is a suspicion of cerebral palsy.

The reason for an ultrasound examination may be such factors as prematurity and low birth weight of the child, the established fact of intrauterine infection, the use of special forceps by obstetricians during childbirth, hemolytic disease, low Apgar score of the newborn (if the child “scored” no more than 5 points at birth) .

At a very early stage after birth, symptoms of very severe forms of cerebral palsy may be visually visible. At the same time, it is also important to distinguish them and separate them from other similar pathologies. Doctors include a sluggish sucking reflex, lack of spontaneous movements of the limbs, and hydrocephalus as alarming symptoms of a newborn.

Treatment

Medicine cannot always find an explanation for recovery for various diagnoses. Below we will talk about traditional treatment in medicine, but now we want to show you an unusual story with a happy ending.

There is an amazing man Arkady Zucker, who was diagnosed with a severe form of cerebral palsy at birth. The doctors confidently told the parents that their child would never walk or speak normally; the life of a healthy person was impossible for him. However, his dad did not agree with the doctors' opinion, saying that he simply could not have a sick child. Since Arkady is his son, he is definitely healthy. We ask that you take the time to watch the 14-minute video of what happened next.

Treatment does not aim to restore the functioning of the affected parts of the brain, since this is practically impossible. Therapy is aimed at enabling the child to acquire skills and abilities that will help him become a member of society, get an education, and serve himself independently.

Not every form of cerebral palsy is subject to such correction, since the severity of brain damage in them varies. But in most cases, doctors and parents, through joint efforts, still manage to help the child, especially if treatment began in a timely manner, before the baby is 3 years old. The following options can be distinguished:

Massage and Bobath therapy

Motor functions are restored sequentially, for this purpose therapeutic massage and Bobath therapy are used. This method was founded by a British couple, therapists Bertha and Karl Bobath. They proposed to influence not only the damaged limbs, but also the child’s psyche. In combination, the psychophysical effect gives excellent results.

This therapy allows the child over time to develop not just the ability to move, but also to do it completely consciously. Bobath therapy is contraindicated only for children with epilepsy and convulsive syndrome. This method is recommended for everyone else.

A physical therapy specialist selects an individual program for each child, since Bobath therapy, in principle, does not provide a unified approach and a specific scheme. Depending on how much and how the limbs are affected, at the first stage the doctor does everything to ensure that the body “forgets” the incorrect position. For this purpose, relaxing technologies, exercises, and massage are used.

At the second stage, the specialist makes the correct physiological movements with the child’s limbs so that the body “remembers” them. At the third stage, the child begins to be motivated (in a playful or other form) to independently perform those very “correct” movements.

Bobath therapy allows the child, albeit later, to go through all the natural stages of development - standing on all fours, crawling, sitting, grasping with his hands, leaning on his legs. With due diligence in their studies, parents and doctors achieve excellent results - the “correct” positions are perceived by the child’s body as habitual and become an unconditioned reflex.

Nutrition

Proper nutrition is very important for a child with cerebral palsy, since many children with this diagnosis have concomitant pathologies of internal organs and the oral cavity. The digestive system is most often affected.

There is no special diet for children with cerebral palsy. When prescribing nutrition, the doctor takes into account the development of sucking and swallowing reflexes, as well as the amount of food that the child “loses” during eating - spills, cannot swallow, regurgitates.

Coffee and carbonated drinks, smoked fish and sausage, canned food and pickled foods, as well as spicy and salty foods are completely eliminated from the diet of children with this diagnosis.

Taking nutritional formulas is encouraged (regardless of age), as they provide a more balanced diet. If a child refuses to eat or cannot do so due to the lack of a swallowing reflex, a special probe may be installed.

Vojta therapy

A method that bears the name of its creator – the Czech doctor Vojta. It is based on the formation in children of motor skills characteristic of their age. To do this, the exercises are based on two starting skills - crawling and turning. Both in a healthy child are formed at the level of reflexes.

In a child with damage to motor skills and the central nervous system, they have to be formed “manually” so that they later become a habit and give rise to new movements - sitting, standing and walking.

The technique can be taught to parents by a vojta therapist. All exercises are carried out independently, at home. The clinical effectiveness of this type of intervention (as well as Bobot therapy) has not been proven to date, but this does not prevent medical statistics from regularly being updated with positive figures of improved conditions of children with cerebral palsy.

Medicines

There is no particular emphasis on pills and injections, since there is no medicine that would help cure cerebral palsy completely. However, some medications significantly alleviate the child’s condition and help him rehabilitate more actively. Not every baby with such a pathology needs their use; the appropriateness of using medications is determined by the attending physician.

To reduce muscle tone, it is often prescribed "Baclofen", "Tolperizon". Botulinum toxin preparations also reduce muscle spasticity - "Botox", "Xeomin". After Botox is injected into a spasmed muscle, visible muscle relaxation appears within 5-6 days.

This action sometimes lasts from several months to a year, after which the tone usually returns. But the motor skills acquired during this time are preserved, which is why botulinum toxins are included in the Russian standard for the treatment of cerebral palsy - as a means of complex therapy.

For epileptic seizures, the child is prescribed anticonvulsants, and nootropic drugs are sometimes prescribed to improve cerebral circulation.

Some disorders in cerebral palsy can be quite successfully corrected surgically. They operate on strained ligaments and tendons, perform muscle-tendon plastic surgery, and surgeons are excellent at eliminating the stiffness and limited movement of joints that accompany some forms of the disease.

Other methods

Treatment of children with cerebral palsy with the help of pets shows very good results. Animal-assisted therapy (this is the international name of the method, not always used in Russia) allows the child to socialize faster and stimulates intellectual and mental functions. Most often, parents of a child with this diagnosis are advised to get a dog or cat. At the same time, the child should communicate and be near his pet as often as possible.

Hippotherapy - treatment with the help of horses - has also become very widespread. In many Russian cities there are clubs and centers where children with cerebral disorders engage in horse riding under the supervision of experienced hippotherapists.

While riding in the saddle, a person uses all muscle groups, and attempts to maintain balance are reflexive, that is, a signal from the brain is not at all necessary to set the muscles in motion. During classes, children develop useful motor skills.

The beneficial impulses that a horse sends to its rider while walking are a natural massage. During the procedure, the child is placed in a saddle, pulled along the horse’s spine, and sat down, trying to load all the “problem” areas of the body and limbs.

Emotionally, children perceive a live horse much better; emotional contact is precisely the factor that allows a child with cerebral palsy to develop motivation.

If parents and children do not have the opportunity to communicate live with such an animal, then a hippo trainer will come to the rescue, on which all movements are monotonous and the same.

Methods with unproven effectiveness

Quite often, children are prescribed vascular drugs “Cerebrolysin”, “Actovegin” and others, classified as nootropic. Although their use is widespread, it raises serious doubts, since clinical trials have not shown a significant change in the condition of children with cerebral palsy after a course of treatment with nootropic drugs.

Quite often on the Internet, parents who are constantly looking for new methods and ways to overcome a terrible illness come across modern homeopathic remedies, which promise “improved brain function.” None of these products currently have official approval from the Ministry of Health, and their effectiveness has not been proven.

Treatment of cerebral palsy stem cells- another commercial and very profitable step by manufacturers of drugs with unproven effects. Clinical trials have shown that stem cells cannot restore motor disorders, since they do not have any effect on the connection between the psyche and motor skills.

Experts believe that there is little benefit for cerebral palsy and from manual therapy. No one belittles its importance; for a number of other pathologies during the recovery period after injuries, the technique gives positive results. However, it is in children with cerebral palsy that its use is inappropriate.

Forecasts

With the modern level of medicine, a diagnosis of cerebral palsy is not a death sentence. Certain forms of the disease are amenable to complex therapy, which includes the use of medications, massage, rehabilitation techniques, and work with a psychologist and special education teacher. Just some 50-60 years ago, children with cerebral palsy rarely lived to adulthood. Now life expectancy has changed significantly.

On average, with treatment and good care, a child with cerebral palsy today lives to be 40-50 years old, and some have managed to overcome the retirement age line. It is quite difficult to answer the question of how many people live with such a diagnosis, because much depends on the degree and severity of the disease, its form and the characteristics of the course in a particular child.

A person with cerebral palsy is susceptible to premature aging; his actual age is always lower than his biological age, because deformed joints and muscles wear out faster, creating the preconditions for early aging.

Disability

Disability for cerebral palsy is issued based on the form and severity of the disease. Children can count on the status of “disabled child”, and after they reach adulthood, they can receive the first, second or third disability group.

To receive disability, a child will have to undergo a medical and social examination, which should establish:

form and degree of cerebral palsy;
the nature of the damage to the motor function (on one or both sides, whether there are skills to hold objects, support on the legs);
severity and nature of speech disorders;
severity and degree of mental impairment and mental retardation;
presence of epileptic seizures;
the presence and degree of hearing and vision loss.

Children with severe disabilities are usually given the category “disabled child,” which needs to be re-confirmed before their 18th birthday. Parents of such a child will be able to count on receiving the necessary rehabilitation means for their child and visiting a sanatorium at the expense of the federal budget.

Features of development

In infants, cerebral palsy has almost no obvious manifestations (at least until 3-4 months). After this, the baby begins to rapidly lag behind his healthy peers in development.

Children with cerebral palsy have difficulty in coordinated movements. As the child gets older, he will try to avoid them. If at the same time intellectual abilities are preserved, then the kids grow up “slow”; they do everything very slowly, unhurriedly.

Children with a slight People with cerebral palsy are rarely aggressive or angry. On the contrary, they are characterized by incredible affection for their parents or guardians. She can reach the point of panic if the baby is afraid to be left alone.

Some forms of cerebral palsy “deform” the personality so much that the child can become withdrawn, embittered, and aggressive (for no apparent reason). However, it would be wrong to attribute everything solely to the form of the disease. Parents play a very important role in shaping a child’s character. If they are positive, good-natured, and encourage the child’s achievements, then the likelihood of getting an aggressive child is minimized.

At the physical level, in children with cerebral palsy, the first place is the lack of understanding of what the correct position of the body in space should be. Since an erroneous signal comes from the affected brain, the muscles receive it incorrectly, hence the inability to do something consciously and spontaneous movements.

Reflexes (Moro, grasping and others), which are characteristic of all newborns, disappear in order to give way to new skills. In children with cerebral palsy, these innate reflexes are often preserved, and this makes it difficult to learn new movements.

Many children with cerebral palsy are characterized by insufficient body weight, minimal subcutaneous fat, and weak (often blackened and crooked) teeth. Individual developmental characteristics are determined by a single factor - the preservation of intellectual potential. If it exists, then a lot can be adjusted and corrected.

Rehabilitation means

Special means that make the life of a child with cerebral palsy easier can be obtained from the federal budget. True, this is only possible if the doctor has included an exact list of them in the rehabilitation card, and the ITU commission, when confirming the disability, has recorded a list of necessary means for rehabilitation.

All devices are divided into three large groups:

hygienic devices;
devices that make movement possible;
devices for child development, training and therapeutic procedures.

In addition, the child may need special furniture adapted for children with cerebral palsy, as well as shoes and dishes.

Hygiene

Such facilities include toilet chairs and bathing chairs in the bathroom. In order not to carry the child to the toilet (especially if he is already large and heavy), a toilet chair is used, which consists of a chair equipped with a removable sanitary tank. The chair also has wide, comfortable straps to securely hold the child in place.

The bathing chair has an aluminum frame and a seat made of waterproof material. On it, parents will be able to place the child comfortably and calmly give him a bath. The tilt adjustment allows you to change the angle to change your body position, and the seat belts keep your baby securely in place during the bath.

Mobility

A child who cannot move independently definitely needs a wheelchair, and more than one. Indoor strollers are used to move around the house, and strollers are used for walking. Walking option (for example, "Stingray") more lightweight, sometimes equipped with a removable table. Manufacturers of electric wheelchairs offer very good options, but their prices are quite high.

If a child has learned to walk, but cannot (or cannot always) maintain balance, he needs a walker. A well-fitting walker can also help with learning to walk. In addition, they train coordination of movements. Typically, a walker looks like a frame with four wheels and a safety device. The wheels cannot roll back, this completely eliminates tipping.

A more complex version of walkers is the parapodium. This is a dynamic verticalizer that will allow the child not only to stand, but also to exercise on the simulator at the same time. In such an orthosis, the child will be able to move independently. However, the parapodium is only suitable for children who have retained intellectual functions; for everyone else, it is better to use a regular static verticalizer.

The verticalizers secure the child in the popliteal space, as well as the feet, hips and waist. It allows for slight forward bends. If the model is equipped with a table, then the child can even play there.

Devices for child development

Such devices include special furniture, tables and chairs, some verticalizers, splints, a bicycle, exercise equipment and complex orthopedic shoes. All furniture is equipped with body position regulators and seat belts. It can be one item (chair or table) or a whole set, where each element is combined and matched with another.

A special bicycle for children with cerebral palsy is not only a toy, but also a means of active rehabilitation. It has a special (unusual for most people) design. It is always three-wheeled, and its steering wheel is not connected to the pedals. Therefore, turning the steering wheel in the wrong direction does not lead to the wheels turning in the desired direction.

This bicycle is equipped with attachments for the hands, legs and feet, as well as a cane, which allows parents to push the device with the child forward if the child cannot pedal independently.

Using a bicycle allows you to prepare your child well for learning to walk; it trains the leg muscles and alternating movements.

Exercise equipment

The modern medical industry has stepped far forward, and children with cerebral palsy today have access to not only the most familiar exercise bikes, but also real exoskeletons that will take on all the “work” of the muscles. In this case, the child will make movements together with the exoskeleton, due to which reflexive correct movement will begin to form.

The most popular in Russia is the so-called Adele costume. This is a whole system of supporting and load flexible elements. Exercising in such a suit allows the child to correct his posture and the position of his limbs, which ultimately has a good effect on other functions of the body. The baby begins to speak better, draw better, and it is easier for him to coordinate his own movements.

Adele's costume is very reminiscent of the outfit of a volunteer cosmonaut from a science-fiction film, but this should not be scary. The average course of treatment in such an outfit is about a month. In this case, a child (from 3 years old) will have to walk, bend and unbend, and squat (if possible) in this suit for 3-4 hours a day.

After such courses, which can be completed at a rehabilitation center, children feel more confident, they have easier control of their own arms and legs, their arches are strengthened, their stride appears wider, and they learn new skills. Doctors say that the risk of developing “fossilized” joints is reduced several times.

For home use, the most common treadmill, ellipsoid, as well as the expensive (but very useful and effective) Motomed and Lokomat exoskeletons are well suited.

And at home, in a rehabilitation center, you can use the Gross simulator. It is very easy to attach it in the country house, in the apartment, on the street, and even in the pool so that the child can exercise in the water. The simulator is a movable block with a tensioned cable, elastic rods, rings for hands that the child will hold on to. Insurance and a special lever-carbine mechanism are provided.

Classes on such a simple simulator (according to the Ministry of Health) give amazing results - every fifth child with cerebral palsy develops the skills to move their legs independently, about a third of children with this diagnosis, after systematic training, were able to attend specialized schools and study.

In half of the cases, speech development improves. More than half of the children had significantly improved coordination of movements, 70% of the children had the prerequisites for acquiring new skills - they were able to learn to sit, stand up, and take their first steps.

Orthoses, splints and splints are often used to fix joints in the correct position. The most popular manufacturing companies are Swash And Gait Corrector.

Children from 1 year old can play with special toys for “special” babies; they include sets for fine motor skills with small movable and securely fastened parts. The production of special toys for medical rehabilitation of such children is carried out in St. Petersburg; they are produced under the brand "Tana-SPb". Unfortunately, the cost of the sets is quite high. A complete set costs about 40 thousand rubles, but it is possible to buy one or two toys from the set (1500-2000 rubles each).

These motor toys are also great for children with severe mental retardation; they stimulate not only motor skills, but also many other functions of the child’s body.

Charitable foundations

Parents should not be left alone with a child’s serious illness. Many rehabilitation equipment cannot be purchased from the budget, and income does not allow you to buy them yourself. In this case, charitable foundations created to help children with cerebral palsy will help. No one will ask parents for any “entry fees”; it is enough to send letters to the funds describing the problem, confirming the diagnosis - and wait for the necessary support.

If you don’t know where to turn, here are just a few organizations operating throughout Russia and well-established in helping children with cerebral palsy:

Charitable Foundation “Children of Cerebral Palsy” (Tatarstan, Naberezhnye Chelny, Syuyumbike St., 28). The fund has been operating since 2004.
"Rusfond" (Moscow, PO Box 110 "Rusfond"). The foundation has been operating throughout the country since 1998.
Charitable Foundation "Creation" (Moscow, Magnitogorskaya str., 9, office 620). Since 2001, the Foundation has been working with children who are undergoing treatment and rehabilitation with cerebral palsy in clinics across the country.
Charitable Foundation “Spread Your Wings” (Moscow, Bolshoi Kharitonyevsky Lane, building 24, building 11, office 22). The foundation has been operating since 2000 and provides support to disabled children.
Foundation "Kindness" (Moscow, Skatertny Lane, 8/1, building 1, office 3). Works only with children with cerebral palsy since 2008.
Charitable Foundation “Children of Russia” (Ekaterinburg, 8 Marta St., 37, office 406). Helping children with cerebral and other disorders of the central nervous system since 1999.
Foundation for helping children with cerebral palsy “Ark” (Novosibirsk, Karl Marx St., 35). Helping families with children with cerebral palsy since 2013.

When planning to write to the funds, you should definitely open a bank account with the target indication “for treatment”. You can send applications to all funds, the age of the children does not matter. Applications are accepted from mothers of infants and from parents of children under 18 years of age.

What special devices exist for children diagnosed with cerebral palsy to make it easier for them to move independently, you will learn from the video below.

Doctors call cerebral palsy one of the most terrible diagnoses that can be given to a newborn - the causes of this disease in various forms continue to be discussed by doctors, as well as treatment methods. The only thing that experts say with confidence is that cerebral palsy is not a hereditary disease. Who is at risk and is it possible to reduce the likelihood of this disorder occurring in the fetus?

What is cerebral palsy

Experts assigned the abbreviation cerebral palsy to a group of symptom complexes that arise from movement disorders that do not tend to progress. However, this does not detract from the need for treatment of cerebral palsy, since a child who has been diagnosed with this condition will show delays or other symptoms of mental and physical development disorders as they grow older. This disease has nothing to do with the term “infantile paralysis” associated with polio. It will manifest itself in the following moments:

intelligence develops behind the norm;
problems with muscle tone that cause childhood disability;
disturbances of the emotional-volitional sphere;
epilepsy attacks.

According to ICD-10, cerebral palsy is coded G-80 (neurological disease) and is divided into several forms. Based on them, it is convenient for specialists to group all the causes of cerebral palsy and select treatment methods for cerebral palsy. According to the international classification, the following forms are distinguished:

80.0 – tetraplegia (clinical manifestations include increased muscle tone in the arms).
80.1 – diplegia (among the main symptoms is hypertonicity of the leg muscles).
80.2 – hemiplegic (spastic syndrome).
80.3 – dyskinetic (hyperkinetic).
80.4 – ataxic (atonic-astatic).
80.8 – mixed.
80.9 – unspecified.

Why does cerebral palsy occur in children?

With cerebral palsy, brain disorders are observed affecting the cortex, subcortical zones, capsules and trunk separately or together (determined by the form of the disease). Due to brain damage, there are also lesions of the nervous system, in which neuronal pathology appears (up to diffuse necrosis). What complications will follow depends on the form of cerebral palsy.

Causes of cerebral palsy in newborns

At the end of the 19th century, the main prerequisite for cerebral palsy was considered to be fetal asphyxia during childbirth, and doctors adhered to this theory for almost a century. The only one who spoke about risk factors during the prenatal period was Sigmund Freud. However, even in modern medicine there are difficulties in understanding cerebral palsy - the causes of this disease continue to be discussed by doctors. Doctors divide them into 3 categories:

Pathologies of fetal development during pregnancy (the influence of intrauterine infections, chronic diseases of the mother, etc.)
Damage to the cerebral hemispheres during difficult childbirth (birth injuries, asphyxia, early birth).
External factors in the postpartum period (toxic damage or physical trauma to the brain).

Is it possible to detect cerebral palsy during pregnancy?

Most parents want to know before the child is born that he will be completely healthy, but with cerebral palsy this is difficult. The main cause of this disease is prenatal in nature, so special concern should be exercised during childbirth and in preparation for it. When carrying a fetus, a woman can only try to prevent pathologies as much as possible with timely treatment, however, even in the absence of therapy, these are not the key reasons for the birth of children with cerebral palsy.

Diagnosis of cerebral palsy in newborns

Children with paralysis at the age of 3-4 years can be recognized even from a photo, but at the moment of birth only through a series of checks. The first is whether the baby has enough oxygen: if there is a deficiency, this can be considered a consequence of brain abnormalities and a symptom of cerebral palsy. The key symptom of cerebral palsy is considered to be a disorder of muscle coordination, which manifests itself in the first days after birth. However, to diagnose the disease you will need to pay attention to a few more points:

problem with muscle tone;
thrown back head, flaccid or strongly bent limbs;
impaired reflexes of the newborn.

Causes of cerebral palsy during pregnancy

According to statistics, 60% of children born with cerebral palsy received it during the formation of the body in the womb. However, this is not enough for a child to develop cerebral palsy - the causes of the prenatal occurrence of the disease must be combined with factors that arise during childbirth, or with postnatal ones. If we consider situations of cerebral palsy associated with pathologies of intrauterine development, they may arise due to:

chronic maternal diseases;
infections suffered during pregnancy;
genetic factors;
complications during pregnancy.

The mother has chronic diseases

Doctors advise women planning a pregnancy to treat everything that can be treated in advance, for good reason: chronic diseases of the mother can negatively affect the formation and development of the fetus. Not only diabetes mellitus and diseases of the endocrine system pose a danger - doctors also include chronic hypertension, heart disease (especially congenital defects), anemia, and excess weight as risk factors for the occurrence of this type of cerebral palsy. However, this reason alone does not provoke the birth of a child with cerebral palsy.

Disorders of pregnancy

Toxicosis, gestosis and other problems that a woman may encounter are not only problems with well-being - each of them is accompanied by a disturbance in the oxygen exchange of tissues, as a result of which fetal hypoxia develops, or may be a prerequisite for placental insufficiency or placental abruption. These factors increase the risk of cerebral palsy - the causes will lie in encephalopathy: a hypoxic-ischemic disorder occurring in the fetal brain.

Lifestyle of an expectant mother

Taking medications, alcoholism, frequent stress, nicotine abuse, difficult working conditions and even physical injuries are things that a pregnant woman should be protected from. These factors are included among the causes of cerebral palsy, although they increase the risk of this pathology by only 10%. They are directly related to the above-mentioned complication of pregnancy, which results in disruption of the placental blood flow to the fetus and the risk of perinatal hypoxia.

Hereditary predisposition

You cannot get cerebral palsy from close relatives - the causes of its occurrence are not hereditary, but doctors do not rule out genetic factors. According to medical theory, the presence of defects in the parents' chromosomes can affect the activation of pathological proteins, resulting in morphological changes in the body. However, doctors consider this cause of cerebral palsy to be the most controversial.

Breech presentation of the fetus

Normally, the baby should come out of the uterus head first, but this is not the only option for its position in the mother’s womb. According to statistics, every 20th woman experiences a breech presentation of the fetus: this can be diagnosed after the 36th week. The increased risk of having a child with cerebral palsy with this diagnosis is caused by 2 factors:

During childbirth, moving the buttocks forward does not expand the woman’s bone ring, therefore, with a narrow pelvis, this creates the precondition for birth trauma due to deformation of the skull and cervical spine.
If the cause of breech presentation is hydrocephalus and other developmental abnormalities, they increase the risk of brain disorders.

Prenatal factors for the occurrence of cerebral palsy

According to medical assumptions, the majority of patients with cerebral palsy - the causes of which are unclear due to the absence of problems with intrauterine development - owe the disease to birth injuries: they occupy a leading position among the prerequisites for acquired cerebral palsy. Brain damage in this situation occurs due to:

labor disturbances (including early labor);
asphyxia of the child;
spinal/skull deformities.

Premature birth

According to statistics, in premature babies, the frequency of the diagnosis of “cerebral palsy” is significantly higher than in those born at term, which is explained by the imperfection of the vessels located in the fetal brain. Their increased fragility leads to an increased likelihood of damage, and if birth trauma is added to this, brain pathology is almost inevitable. However, not every premature baby will have even a mild form of cerebral palsy - the causes of its occurrence in the prenatal period are more serious and are mainly associated with injuries.

Asphyxia of the newborn

Mostly, suffocation in a child during childbirth is preceded by an early diagnosis of chronic oxygen deficiency in the fetus, but this can also include problems with the placenta, cardiovascular and endocrine diseases of the mother. Often, fetal asphyxia has its causes in the prenatal period and is one of the main answers to the question of what causes cerebral palsy in newborns. However, its occurrence cannot be ruled out even after the normal course of pregnancy during childbirth, which is facilitated by:

entanglement of the umbilical cord around the fetal neck;
breech presentation;
labor dysfunction;
Pregnant age – women over 30 years of age are at risk.

Birth injuries

If the doctor excludes congenital cerebral palsy, noting the normal course of pregnancy and fetal development, the problem may lie in birth injuries, which lead to either a mild form of the disease or a more severe condition. In a situation where the child comes out with his legs forward, the doctor, even with careful actions, can provoke a stretch of the cervical spine and deformation of the skull, which will lead to brain damage and acquired diseases of the nervous system. A similar scheme is possible with:

disruption of labor;
rapid/protracted labor;
waterless birth.

Causes of cerebral palsy in children in the postpartum period

If the question of why children are born with cerebral palsy can be sorted out relatively quickly - intrauterine development disorders and the negative impact of birth injuries on the brain speak for themselves, then acquired cerebral palsy is absolutely unclear as a phenomenon for most parents. Here doctors highlight several of the most obvious reasons:

inflammation of the subarachnoid zone of the brain;
physical/mechanical impact (injury);
intoxication.

Toxic brain damage during hemolytic pregnancy

Rh conflict can make itself felt already in the first days of a baby’s life. Against this background, newborn jaundice develops and bilirubin accumulates, the danger of which is toxic damage to the nuclei of the brain. If the disease is recognized at an early stage, it is reversible, but later the affected areas die, which becomes the cause of cerebral palsy.

Mechanical head injuries

The acquired causes of cerebral palsy necessarily include any trauma to newborns (even a light blow) affecting the head in the first days of life. Against their background, due to deterioration of blood circulation (in severe situations - hemorrhages), oxygen deficiency occurs, the functioning of the affected area of the brain decreases, and motor and mental disorders appear.

Poisoning with drugs and toxic substances

In the first 4 weeks, the newborn is especially vulnerable, so taking medications (especially tranquilizers) by a breastfeeding mother is prohibited due to the risk of brain damage, especially if the pregnancy was difficult. No less dangerous for the baby are sepsis, alcohol and nicotine addictions of the mother, and lead poisoning.