The first signs of cerebral palsy: what you need to pay attention to

Causes of the disease

Cerebral palsy is a common disease.
Its frequency is approximately 2 children per 1000 births, and data may vary depending on the region. The cause of the disorder, like any other cerebral palsy, is pathological changes in the cerebral cortex, subcortical structures, capsules or brain stem. The difference between cerebral palsy and other similar disorders is only in the time of its diagnosis (postnatal period) and the disturbance in the manifestation of reflexes. Cerebral palsy is the result of abnormal development of brain structures or damage to a healthy brain. The process can occur both during pregnancy and childbirth, and in the early neonatal period.

Among the causes of this disease are the following:

• premature birth or birth trauma;
• multiple pregnancy;
• infectious diseases suffered by the mother during pregnancy, as well as mercury poisoning;
• traumatic brain injuries in the early neonatal period or in the first few years of life.

Cerebral palsy is not considered a genetic disease, since most of its cases occur in pathologies of pregnancy and childbirth. However, in 2% of cases inheritance is traced to an autosomal recessive type. Up to half of children with a similar diagnosis were born prematurely. The remaining patients were twins in multiple pregnancies, had low birth weight, or were born by instrumental delivery or emergency cesarean section. It is believed that asphyxia (insufficient oxygen supply to the brain) is one of the factors that can trigger cerebral palsy.

Cerebral palsy can also develop in children born at term. Among the causes that cause such pathologies, birth trauma comes first. In the early neonatal period, they can be caused by brain injuries and other types of brain dysfunction. Heavy metal poisoning, jaundice, stroke - all these factors lead to impaired blood circulation in the cerebral cortex, which affects their normal development. In a healthy child, cerebral palsy can be a consequence of drowning or other cases in which temporary cessation of breathing occurs, as well as inflammatory diseases of the brain, including those of infectious origin.

Types of cerebral palsy disease

Depending on the location of the pathological focus in the brain, the disease manifests itself differently. There are the following forms of cerebral palsy, based on the type of motor impairment:

1. Spastic tetraplegia. This is the most severe form of cerebral palsy. It develops with severe damage to many brain structures. It manifests itself as paresis or paralysis of all extremities, speech, vision, hearing disorders, mental disorders, and epilepsy is often detected.
2. Spastic diplegia. It is also called Little's disease after the doctor who described it. With this most common type of disease, the main manifestation is weakness of the leg muscles. Speech, swallowing, and neuropsychic development disorders are also found in this form of the disease, but their severity is less. Therefore, such children can learn and socialize.
3. The hemiplegic or hemiparetic form of cerebral palsy is manifested by unilateral damage to the muscles of the limbs, that is, dysfunction of the muscles of only the left or only the right half of the body. Such patients have a characteristic gait. Motor disorders are combined with epilepsy, less often with delayed neuropsychic development.
4. The dyskinetic form is characterized by the development in a child of hyperkinesis, that is, involuntary movements in the limbs and other parts of the body due to damage to subcortical structures.
   Intellectual abilities are usually not affected in this form. A person has the opportunity to study, find a job, and have normal contact with society.
5. The atonic-astatic or atactic form of cerebral palsy is manifested by low muscle tone of the body, as well as impaired coordination and static movement due to damage to the cerebellar structures. The ability to move, speak, and swallow is impaired. The delay in neuropsychic development in the atonic-astatic form of cerebral palsy is quite pronounced.
6. Mixed forms of cerebral palsy: different types of cerebral palsy are combined due to multifocal brain damage. For example, a combination of spastic diplegia or tetraplegia with hyperkinesis or atonic-astatic form of cerebral palsy is often observed.

Forms of cerebral palsy and their clinical manifestations

In the first days and months of life, a child with cerebral palsy may not differ from his peers, and symptoms of the disease appear later. Their severity depends on the degree of brain damage, as well as the timeliness of diagnosis and treatment.

The clinical picture of cerebral palsy may include the following disorders:

• increase or decrease in the tone of certain muscles;
• skeletal deformity;
• long-term preservation of reflexes, which normally disappear between the ages of 6 and 8 months;
• impaired reflexes, including swallowing;
• mental retardation, hearing and vision problems;
• convulsive syndrome.

Doctors at the Clinical Brain Institute argue that any changes in a child’s behavior should be a reason for additional examination. Currently, to determine an accurate diagnosis, a generally accepted classification is used, which identifies 5 main forms of cerebral palsy.

Diagnosis of cerebral palsy

It becomes possible to suspect pathology immediately after the birth of a child when assessing his condition by a neonatologist who gives less than 5 points on the Apgar scale. This indicator can be considered a positive test for cerebral palsy.

Warning regarding this disease remains in relation to premature, low birth weight children, newborns with various malformations, with intrauterine growth retardation, and serious maternal illnesses.

Severe signs of cerebral palsy in a newborn appear immediately after birth with deep damage to the brain. In other cases, the disease begins to manifest itself over time.

Physical examination

During a neurological examination and assessment of the neurological status, the doctor reveals:

• muscle tone disorders;
• asymmetry in muscle development and normal reflexes in the limbs;
• the presence of pathological reflexes, limb clonus;
• lack of contact between the child and the mother;
• lack of adequate response to tactile, sound and visual stimuli.

Instrumental examination

To determine the nature, localization and severity of brain damage, the following methods are used:

• MRI or CT of the brain allows you to assess the extent of atrophy of the cerebral cortex, the size of the lesion, its location and type (hemorrhage, cyst, ischemic focus).
• An electroencephalogram reveals disturbances in the formation and distribution of brain biopotentials and determines the presence of epiactivity.
• Neurosonography (ultrasound) can detect displacement of the midline structures of the brain due to any damage.
• Electromyography is a method for studying neuromuscular conduction and identifying the location of its lesion.
• A fundus examination is performed by an ophthalmologist and can reveal optic nerve atrophy.

Electromyography

Differential diagnosis

Clinical manifestations of the disease may resemble symptoms of other diseases. In order to correctly diagnose cerebral palsy, after conducting all the necessary studies, pathologies such as:

1. Congenital diseases of amino acid metabolism, for example phenylketonuria, leucinosis.
2. Hereditary pathologies of lipid metabolism (leukodystrophy).
3. Mucopolysaccharidoses.
4. Hereditary collagenopathies (Marfan syndrome).
5. Neurofibromatosis.
6. Hereditary muscular dystrophies (Strumpel's disease, spinal amyotrophy).
7. Congenital myasthenia.
8. Neuroendocrine disorders, such as hypothyroidism.

Psycho-emotional and personal development of the child

The degree to which a child’s psycho-emotional development deviates from normal indicators depends on many factors. And first of all, this is the mental development of the child and the degree of damage to his brain. However, the attitude of the people around the child is no less important.

Psycho-emotional abnormalities in children with cerebral palsy can manifest themselves in different ways. Thus, some children are overly irritable, excitable, and are characterized by sudden changes in mood throughout the day.

Some guys, on the contrary, are shy, fearful, they have difficulty making contact with others, and do not show initiative in their actions.

Most children are characterized by delayed mental development of the infantilism type. This means that they exhibit underdevelopment of the emotional-volitional sphere of personality.

Intelligence in such cases may correspond to the norm. However, it is the emotional sphere that is revealed to be immature.

Parents of a sick child should know that all responsibility for his mental development, for the formation of his character, etc. lies with them. Excessive care and compassion will ultimately lead to the fact that he will withdraw into himself even more and will not develop as a person.

Medication methods

For cerebral palsy, it is recommended to take nootropics - medications to improve metabolism in the brain - “brain vitamins”. They include Encephabol, Oycamide, Enerbol, Tanakan, etc. These remedies can be taken at home, but only after approval by a doctor. You cannot prescribe medications for home use on your own!

Botulinum toxin

Botulinum toxin is a substance that blocks the transfer of nerve stimulation to the muscles. It provides partial, time-limited muscle relaxation. This effect is applied at the site where the transmission of nerve stimulation occurs - at the neuromuscular junction. The drug used in the treatment of cerebral palsy contains a biotechnologically prepared, purified botulinum toxin A-hemagglutinin, supplied in the form of a suspension that must be diluted before use. The effect of application does not appear immediately - depending on the presence of blockage of neuromuscular endings, it occurs approximately on the 4-7th day.

The duration of the effect is variable and depends on many factors.

Significant factors for the effectiveness of botulinum toxin include:

• dose level;
• therapeutic efficacy of a specific batch of the drug;
• the reactivity of the patient's body.

Not decisive, but important factors:

• duration of dystonic contraction;
• previous surgical treatment.

Ideally, a good therapeutic effect lasts about 3 months (usual duration is 8-12 weeks).

This treatment is considered safe; its biggest drawback is the high cost of the drug. The next disadvantage is the injection form of administration, which is especially problematic in young children, since it involves a larger number of injections required to influence the entire muscle chain, and a temporary effect in the absence of imposing intensive rehabilitation.

The nature of children's behavior

In cases of mental development disorders associated with cerebral palsy, the following features in the behavior of children are observed:

• the child is guided mainly by emotions associated with pleasure;
• Children with cerebral palsy are characterized by egocentricity;
• they cannot work purposefully in a team;
• they do not know how to correlate their own interests with the interests of the people around them;
• there are elements of infantility in behavior;
• even at high school age, such children have an increased interest in games;
• they are extremely suggestible, incapable of volitional efforts on themselves;
• behavior is also characterized by instability of emotions, disinhibition;
• children tend to get tired quickly;
• they have difficulty adapting to new conditions, they have various fears - most often fear of heights, darkness, etc.;
• children are very sensitive to the mood and behavior of others, which is reflected in increased impressionability: incidents that are neutral for other children can cause a violent reaction in them.
• Sleep disturbances, nightmares, and nighttime anxiety are common.

Features of physical development

Impaired motor activity in cerebral palsy leads to curvature of the spine, contractures and other pathologies of internal organs. To prevent complications, it is very important to form muscle tone.

All work and attention of parents should be directed to the correct formation of motor functions. The most appropriate interventions would be massage and therapeutic exercises.

The main thing in classes is their early start, as well as continuity. The success of treatment will depend on this.

A set of exercises is selected depending on the severity of the disease and individual developmental characteristics. Corrective work comes down to the formation of vital skills, such as the ability to walk and take care of oneself.

The acquired skills must be adapted to everyday life, constantly practiced until they become automatic.

Features of motor development of children with cerebral palsy:

• it is necessary to stimulate his interest in outdoor games;
• you need to develop fine motor skills;
• it is also necessary to form a correct image of your body;
• It is also important to stimulate communication with others;
• At every opportunity, it is necessary to develop the child’s self-care skills.

Development of fine motor skills in children with cerebral palsy:

Exercise therapy

Physical therapy is necessary to consolidate the results of other types of treatment. It prevents muscle atrophy and contracture, improves reflexes, and reinforces correct postures in memory. Physical activity is very important for the health of the whole body. However, exercise therapy is not prescribed if the convulsive syndrome persists, as well as in the absence of normal indicators of intracranial pressure.

A set of exercise therapy exercises is selected by a rehabilitation doctor or neurologist and strictly individually. Cerebral palsy occurs in different forms in each child, with varying degrees of severity. This must be taken into account. Loads increase gradually.

Typically, a set of exercises for children with cerebral palsy includes warming up, fixing the limbs in certain positions, stretching muscles, training the joints of the arms and legs (swinging movements), walking, balance exercises, muscle relaxation, and endurance. Classes with young children can be carried out in the form of a game in order to involve them and redirect their attention as much as possible.

Different types of cerebral palsy require more attention to different types of exercises. So, with the atonic-astatic form of the disease, daily short exercises are preferable. In the atonic form, the emphasis is on balance training. If cerebral palsy is in the form of spastic diplegia, then exercises with continuous movement are necessary.

Regular exercise therapy will help you step by step to regain the full ability to move from the disease. But this requires patience and perseverance.

Factors influencing the child's will

Factors influencing the will of the child can be divided into:

• external, which include the conditions and nature of the disease, the attitude of others towards the sick child;
• and internal ones, such as the child’s attitude towards himself and his own illness.

Weakness of will in most children suffering from cerebral palsy is directly related to the characteristics of their upbringing. Very often in a family with a sick child, one can observe the following picture: the attention of loved ones is focused exclusively on his illness, parents show concern about every issue, limit the child’s independence, fearing that he may get hurt or fall, or be awkward. In such a situation, the child himself will inevitably be overly restless and anxious. Even infants subtly feel the mood of loved ones and the atmosphere of the space around them, which are fully transmitted to them. This axiom is true for all children - both sick and healthy. What can we say about children suffering from musculoskeletal disorders, who are distinguished by increased impressionability and acuteness of feelings?

Or another picture: an unhappy mother who, while caring for her child, forgets about her own life and becomes a hostage to illness. She looks tired and unhappy. But any child needs a happy mother, capable of giving love and warmth, and not her health and nerves. For a sick baby, this need is a thousand times greater.

All this leads to the fact that the child grows up lacking initiative, unsure of his strengths and capabilities, and timid. He resigns himself to his illness and does not strive for independence. He expects in advance that those around him will do everything for him. Over time, the child gets used to this state of affairs and finds it comfortable. And from here comes a pronounced egocentrism, the desire to manipulate people.

The importance of the educational position of parents in relation to children with cerebral palsy is confirmed by the fact that the children among them with a high level of volitional development come from families that are prosperous in terms of the psychological climate. In such families, parents are not fixated on the child’s illness. They stimulate and encourage his independence within acceptable limits. They try to form adequate self-esteem in the child. Their attitude can be expressed by the formula: “If you are not like others, this does not mean that you are worse.”

We must not lose sight of the child’s own attitude towards the illness. It is obvious that he is also significantly influenced by the situation in the family. Studies have shown that awareness of the defect in children with cerebral palsy manifests itself by the age of 7-8 years and is associated with their worries about the unkind attitude of others and lack of communication.

Children can react to the current situation in different ways:

1. the child withdraws into himself, becomes overly timid, vulnerable, and strives for solitude;
2. the child becomes aggressive and easily enters into conflict.

The difficult task of forming a child’s attitude towards his own physical defect again falls on the shoulders of the parents. Obviously, this difficult period of development requires special patience and understanding from them. The help of specialists should not be neglected. For example, it is quite possible to overcome a child’s worries about his appearance thanks to well-organized psychological work with him.

Thus, the characteristics of the development of the personality and emotional-volitional sphere of a child with cerebral palsy largely depend not only on the specifics of the disease, but primarily on the attitude of parents and relatives towards the child. Therefore, you should not assume that the reason for all the failures and difficulties of upbringing is the baby’s illness. Believe me, you have enough opportunities in your hands to make your baby a full-fledged personality and just a happy person.

Neurosurgeon Dmitry Zinenko: “We give children with cerebral palsy a chance for a full life”

The doctor spoke about new methods of treating this serious disease

Probably everyone has heard about cerebral palsy (CP), but only a few can imagine the full range of sensations experienced by patients with this disease. To understand what these children are faced with, strain at least the muscles of your arm or leg with all your strength. Don't relax for a minute, two, three... Did you like it? And patients with cerebral palsy experience this every second. Around the clock. For years.

Until recently, the rehabilitation of such patients actually consisted of their maximum adaptation to an acceptable existence in society, but now techniques have emerged that make it possible to influence the cause of the disease. We are talking about this with Doctor of Medical Sciences, Head of the Neurosurgical Department of the Scientific Research Clinical Institute of Pediatrics named after Academician Yu.E. Veltishchev" Federal State Autonomous Educational Institution of Russian National Research Medical University named after. N.I. Pirogov by Dmitry Zinenko.

— Dmitry Yuryevich, at the beginning of our conversation, let’s briefly tell the readers what cerebral palsy is.

— Cerebral palsy is a disease manifested by a complex of motor disorders. A visible manifestation of the disease is complicated coordination of movements and impaired motor activity caused by “tightness” of the muscles. Without going into details, the disease is characterized by a “hodgepodge” of symptoms; it may have different clinical manifestations. There are patients with both increased and decreased muscle tone. Or there may be an alternation of increased and decreased tone - so-called dystonia. The severity of the patient's condition depends on how widespread this process is - it could be one arm or leg, just the legs, or the muscles of the whole body are involved in the process.

— What are the causes of cerebral palsy?

— The occurrence of the disease is influenced by a large number of factors. Most often this is due to brain damage during pregnancy or in the first month of a baby’s life, or trauma during childbirth. As a rule, we are talking about circulatory disorders that lead to hypoxia and ischemia of the brain substance, that is, the communication pathways between the cerebral cortex and the rest of the body are damaged.

Currently, there are two children with cerebral palsy per thousand births; the vast majority of children with this diagnosis are children born prematurely.

— How often do intellectual functions suffer with cerebral palsy?

— Of course, in some cases, this disease also affects the cerebral cortex. Accordingly, cognitive functions may be impaired. However, contrary to the prevailing belief about the mental inferiority of children with cerebral palsy, seventy percent of them have intact intelligence. This is the difficulty: children realize their defect, look at their healthy peers and suffer not only physically, but also psychologically, because with age they begin to feel the limitations of their capabilities.

— To what extent can patients with cerebral palsy be adapted to society, and when should this process begin?

— As with any disease: the sooner treatment begins, the better for the patient and the more opportunities for successful social adaptation. Why? If, for example, a child has increased muscle tone (and such children account for about 80 percent of the total number of patients), this leads to the fact that the capillaries are compressed, as a result of which the nutrition of the muscle is disrupted. Because of this, over the years, muscle fiber turns into connective tissue and, accordingly, loses its function.

The question of the degree of possible adaptation is complex and multifaceted. Historically, patients with cerebral palsy are treated mainly by rehabilitation specialists, who have in their arsenal only conservative treatment methods, aimed mainly at mitigating the consequences of the disease. And the latest advances in functional neurosurgery make it possible to influence the cause of the disease, and this actually opens up completely new horizons in the treatment of children with cerebral palsy and the subsequent social integration of patients.

— What achievements are we talking about?

— First, a little theory. When any muscle in our body contracts, it sends an impulse to the brain—a signal about its action. The brain analyzes this information and gives a signal for further action. This impulse is transmitted by the dorsal (sensory) roots. However, with cerebral palsy, the information does not reach the brain, but is immediately transmitted to the motor roots, since the brain, due to damage, loses its control function and the impulse, figuratively speaking, runs in a circle, returning back to the muscle. This explains the spasm.

The situation can be corrected by selective dorsal rhizotomy - an operation during which the sensitive roots are partially intersected to break the vicious circle, as a result of which the muscles relax. Imagine, a child wakes up after anesthesia, and his legs are already relaxed!

Now we are trying to operate on children with spasticity in the lower extremities around the age of two or three years. I can say with confidence: even a well-performed operation at an older age (for example, at eight years old) will not give the effect that we could get with early intervention. This is due not only to the degeneration of muscles into connective tissue, but also to the fact that over the years the child develops a pathological stereotype of movement. That is, after the operation, in many cases he gets the opportunity to walk normally, but teaching him to do this is much more difficult.

— For which patients with cerebral palsy can this treatment method be most effective?

— There are five functional classes of cerebral palsy; In children with the first three, as a rule, we have intact intelligence, that is, they can be taught. After the operation, under the guidance of a rehabilitation therapist, they learn to use their muscles and move independently. In other words, the surgeon in this case creates completely new conditions for the child’s life.

Children with levels four to five practically do not communicate, and in the vast majority of cases it is impossible to teach them anything. But this does not mean that they do not suffer from pain, contractures, and bedsores. They lie pinched, with deformed limbs due to spasticity, in forced positions. We also perform operations on such children, thereby relieving them of suffering and making it easier to care for them.

Selective dorsal rhizotomy is most effective for leg spasticity. With the arms it is somewhat more difficult: in this case we have to go to the cervical spine, where our options are limited. But there are still children whose muscles of the limbs, torso, and oral muscles are spasmed - they cannot even speak.

In this case, we install a baclofen pump on the anterior abdominal wall - a special device that is, in fact, a reservoir for a drug that is supplied through a special catheter into the spinal canal and blocks those very pathological impulses of the dorsal roots that lead to muscle spasm. It is possible to individually adjust the dose of the drug; for each patient it is selected according to his condition. On average, the baclofen pump needs to be refilled once every six months - this is a painless procedure that is carried out in a hospital setting.

With the help of this technology, spastic syndrome can be eliminated almost completely, which opens the way for the child to a full life. Under the guidance of a rehabilitation therapist, you can develop fine motor skills, which, in turn, contributes to the development of speech. And, as in the case of selective dorsal rhizotomy, the earlier treatment is started, the better the result. We can use this technique from any age, sometimes even up to a year.

The third method we use is the installation of special electrodes in the brain, which are connected to a “charger” implanted under the skin. The device has a chip with which you can regulate the operation of the electrodes. The installation site, that is, the specific lesion, is calculated using MRI.

Selective dorsal rhizotomy is indicated for spasticity; a baclofen pump and electrodes can also be used for dystonia. But neurosurgeons have not yet learned how to treat low muscle tone. However, it should be noted that approximately 70–80 percent of cases of cerebral palsy are associated precisely with increased muscle tone.

— Dmitry Yuryevich, it turns out that at the moment Russian medicine has technologies that can, if not cure, then significantly make life easier for 70–80 percent of patients with cerebral palsy. However, in reality everything happens differently. Why?

— One of the reasons, I think, is a wary attitude towards new methods. Although they can be called new very conditionally: they have been used abroad for more than 20 years. However, what's the point of guessing about the reasons? Let me state the facts: we are given about a thousand quotas per year, and there are more than a hundred thousand for children with cerebral palsy in Russia. But neurosurgeons in this case could not only help a huge number of people, but also save significant funds for the state budget. The calculations are simple: for example, the cost of selective dorsal rhizotomy is about 300 thousand rubles; it can be indicated for 20–30 percent of children with cerebral palsy. Then one and a half to two years of rehabilitation, and the patient has a chance for a full life: he can learn, socialize, and subsequently benefit society. The situation is similar with the use of other neurosurgical techniques. At the same time, the maintenance of one child with cerebral palsy costs the state on average about 3 million rubles per year; But conservative treatment in this case gives only a temporary effect, and it must be repeated over and over again. Add here the funds to pay sick leave to the parents of such children...

The situation is kind of strange: the state spends crazy amounts of money on the rehabilitation of children with cerebral palsy, instead of allocating funds for surgical treatment. It is clear that we will not cure all sick children, but it is quite possible to help 60–70 percent of them.

Practical recommendations

• If your child has sleep disturbances, try to adjust his daily routine. It is necessary to create a calm environment for him, to refuse overly active, noisy games before bedtime. As far as possible, reduce the effect of external stimuli on his senses. Stop listening to music, or let it be soft, unobtrusive instrumental compositions. (Songs with lyrics in a language familiar to the child will be an additional burden for perception, and, therefore, another irritant that prevents the child from relaxing and falling asleep.) Limit watching TV.
• In order for a child to develop an adequate assessment of himself and the world, parents and loved ones, it is necessary to abandon excessive guardianship towards him. The strength of the child’s volitional qualities will depend on how the family perceives the child – as a disabled person who is unable to achieve success in life, or as a person, albeit in some ways different from those around him, but taking an active life position.
• If in the process of working with a child you notice that he is tired - has become irritable, aggressive, or, on the contrary, is overly withdrawn - you should not try to continue working. In order for work with a child to be fruitful, he himself must first of all be interested in it. It's better to take a break, offer him something to play, or just leave him alone for a while. It is likely that after some time the baby will regain energy, and you will be able to continue your activities with renewed vigor.

The need for the development and education of children with cerebral palsy

Even 20 years ago, they did not always agree to educate such children; there were very few boarding schools for them. The problem of this disease and the adaptation of children in society fell entirely on the parents, who often did not have special knowledge and did not fully understand the essence of the diagnosis. Because of this, the child's life was deplorable. There is no opportunity to learn, communicate, develop - this only aggravated the condition. Society's attitude to the problem was negative: children were pitied while they were small, but teenagers and adults with cerebral palsy were simply not accepted into educational institutions or to work. They remained unclaimed.

Recently, the problem of social adaptation of children with disabilities has been treated differently. Of course, at any time, left without any opportunities for development, such a baby will sharply deteriorate. Even if he retains his intellectual function, he loses many opportunities and loses his personality. Children must be given opportunities for learning, communication, games, and normal children's activities. Of course, as much as possible.

Unfortunately, among the causes of childhood disability, cerebral palsy occupies one of the leading positions. From birth, children need constant adult help, supervision, and care. Many of them find it difficult to enter society and begin to communicate even at the simplest level. This is often due to the special behavior of such children: they are irritable, whiny, and sometimes aggressive.

Prevention

If we talk about cerebral palsy caused by genetic failures, then it is impossible to prevent it. Other risk factors can be reduced or eliminated entirely.

• To prevent infection with measles, rubella, and chickenpox during pregnancy, you should be vaccinated against these diseases.
• In the early stages, you can overcome Rh incompatibility.
• To avoid head injuries, you should take care of the baby’s safety, especially from birth to two or three years. Car seats are recommended for infants.
• If IVF is necessary, care must be taken to ensure that the pregnancy is not multiple. This is the task of doctors performing IVF.

Scientists from England and Norway believe that the genetic component is present only during the development of certain forms of the disease. More research is needed to prove this.

Determination of mental readiness for learning

Children with cerebral palsy undergo regular examinations by a doctor. Based on the physical condition and mental development of the child, the doctor determines whether he can study at school. Next comes choosing the type of school. If the intellect is well preserved and the degree of damage to the nervous system is minimal, then such children can study in a regular school. They may not be the best students, but it is quite possible to finish school. Then they are offered the opportunity to undergo specialized training and find a job.

If your mental state or the severity of your physical condition does not allow you to attend a regular school, then doctors recommend special educational institutions. In extreme cases, the child is considered unteachable. Such situations are rare, with severe damage to the nervous system.

The main parameters for determining the possibility of learning are the personal, intellectual and volitional characteristics of the development of children. Every component is important.

Assistive technology

Nowadays, medical technology has come a long way. Its latest achievements are used in the treatment of cerebral palsy.

For example, a climatic color-dynamic quantum chamber with a laser shower and a swimming pool has been developed. It combines several physical procedures at once. The patient is given a massage using an underwater shower; joints and spine are developed in the water.

There are also computerized treatment options. These are, for example, active mechanotherapy simulators with a feedback function, joint development using a special programmable device.

In addition to technical methods, nature treatment is used. Children with cerebral palsy benefit from communication with animals: horses, dolphins, etc. Some claim that even indoor cats help. The method is called animal-assisted therapy.

Home schooling

This type of training is preferable. There is a familiar atmosphere here, there are opportunities for relaxation, breaks for sleep and food. The school definitely cannot offer this. On the other hand, there must be someone who is constantly with the child and supervises the activities. Teachers will come to the student. Here he is deprived of the function of communicating with other children, which is not very good: he will not have full social experience, like other children. Such children develop worse speech, and their behavior becomes even more unstable. Parents and teachers make concessions to him and often indulge his desires - this has a negative impact on personal development.

Education is not all that children with cerebral palsy need. You will need the supervision of a doctor, and sometimes the presence of a nurse. Massages and a swimming pool are very helpful in relieving stress and pain from muscle tension. They will also have to be visited regularly. This is also an opportunity to develop your child according to an individual program.

Of course, a child or teenager feels comfortable at home, they are surrounded by the care of their parents. If upbringing is done correctly, children can be quite gentle and understanding. The better the intellect is preserved, the easier it is to cultivate normal moral qualities. The main thing for adults to remember is that their child will not always remain small. We need to prepare him for adult life as much as possible.

Evidence-based rehabilitation

Photo from the site /ilizarov.ru
- Vera Anatolyevna, tell us what exactly are you changing in the model of helping children with cerebral palsy in Tyumen?

— Over the past 4 years, we have been trying to promote the European model of helping children with cerebral palsy. There are many models - there is an American one, there is an Australian one. But we took the European model as a basis, translated it and are trying to follow the principles of monitoring children with cerebral palsy.

According to this model, any rehabilitation of a child with cerebral palsy should be based on clearly evidence-based principles. These must be proven and effective methods of treatment - Europe will not spend money any other way.

We found this model very interesting. In all children, before taking them for rehabilitation, we must definitely assess their rehabilitation potential. The potential of a child today is greatly appreciated. According to the classification system that exists everywhere in the world, and which we are trying very hard, with difficulty, to understand in Russia.

— What kind of classification is this?

— Cerebral palsy has different degrees of severity. Since 1997, all European doctors have followed the classification system for global motor functions. Unfortunately, in Russia it was officially adopted only in 2014. This is a very serious scale.

In this classification, the potential of children with cerebral palsy is divided into V levels of motor functions, and each level is further divided into age periods: 1.5-2 years; 2-4 years; 4-6 years; 6-12 years old and 12-18 years old.

The European classification system – the potential of children with cerebral palsy is divided into V levels. Photo: cerebralpalsy.org.au

Using this scale, we can determine the level of motor impairment as early as one and a half years. And when we set the level of motor functions, the classification system prescribes all stages of child development up to 18 years of age.

The movement develops according to its own laws. If a child has level I movement, established at one and a half years old, he has a 100% chance of mastering independent walking by the age of 2 years. If a child is assigned level II, it means he has a chance to go independently before the age of 4.

If a child has a level III-V impairment of motor functions, then such a child will not walk independently, but children of level III can go with additional means of rehabilitation, children of level IV will be able to sit with support. Level V includes only bedridden children who can only hold their head up.

Children of level IV-V everywhere in the world today are transferred to the status of palliative patients. And, seeing a child at 1.5-2 years old, we can already predict his rehabilitation potential and understand what rehabilitation methods can be applied. If we are talking about children of levels IV-V, then rehabilitation is also carried out, but according to different principles.

Using a large group of patients, our Canadian colleagues showed that children of different levels of movement reach the maximum of their motor development at a certain time. For example, level I are well-walking children who reach the ceiling of their level of movement at approximately 4.5-5 years, like healthy children. Maybe they place their feet incorrectly or have some problems with coordination, but these are children who will run, jump, and play sports.

Children of III-IV levels of movement reach the maximum of their development already at 3.5-4 years, and we are not even talking about any activation of movement or some kind of stimulation of the musculoskeletal system, because the laws limit us to this period. Children of movement level V reach the motor ceiling by 2.5-3 years.

This classification system helps us, doctors, when we argue to parents that the rehabilitation potential has been exhausted. After all, to say: “Your child will never walk” and put nothing into it other than emotions is wrong, parents will simply be offended and leave.

Studying at a regular school

Some schools accept children with similar problems. But there are many “buts” that need to be taken into account before the baby sits down at the desk with everyone else.

It all depends on several factors:

• physical and intellectual learning ability;
• permission from a doctor to attend an educational institution;
• minimal student aggression;
• the school's ability to accommodate a disabled child;
• availability of qualified teachers in the field of defectology.

Unfortunately, it does not often happen that all these factors are met and a student with cerebral palsy can attend a regular school. Most often, he is sent to home-based training, external studies. It is also very important to choose a special program and approach to the baby. The usual situation: a class of 20-30 people, one teacher - it is impossible to pay attention to everyone. And a child with such a disease needs the constant participation and help of a teacher.

In addition, he cannot always move around on his own, climb stairs, or go to the toilet. His mother or nurse should be with him. This also makes attending a regular school very difficult. Here, non-acceptance by the team comes into the background, but it is no less important. Your baby, like anyone else, wants to have friends and normal relationships. Due to the problems and physical manifestations of the disease, he may be the object of ridicule and even bullying. Parents should take this into account, even if they have the opportunity to attend school and have a normal level of intelligence.

Surgical treatment of cerebral palsy

Surgery is resorted to in cases where conservative treatment methods do not have an effect. This treatment is carried out by surgeons together with orthopedic doctors.

Patients with cerebral palsy undergo operations to remove muscle contractures, tendon plastic surgery (Achilloplasty), and various adjustments in the lumbar region. If necessary, neurosurgical intervention is used: altered areas of the brain are removed, the spinal cord is stimulated to improve the transmission of nerve impulses to the muscles.

Why a regular school is not always suitable

Traditional public school is most often not suitable for children with disabilities, and here are the main reasons:

• the infrastructure of the school grounds and classrooms may not be suitable, for example, there are often no ramps and elevators;
• the pace of study brings discomfort and takes a lot of energy, for example, in high school the daily schedule consists of 7-8 lessons;
• The format of a public school does not allow a child to be productive - the requirements of the program do not correlate with the student’s capabilities, and children with disabilities may find it more difficult to write by hand, keep up with the teacher’s speaking speed, or focus on one task for a long time.

Distance learning for children with disabilities can solve these problems, as it makes the educational process more individualized. An online school can adapt to the needs of a child with a disability and provide the most comfortable conditions for classes.

Specialized boarding schools

Such boarding schools usually accept pupils for 5-6 days a week, and their parents pick them up only on weekends and holidays. Most often, their recipients are patients with severe cerebral palsy. This sounds very harsh and is equivalent to abandoning a sick child. But not every person has the time, means and energy to care for their child, and therefore it is better to place him in a boarding school, where he will communicate with the same “special” children and under the constant supervision of teachers and doctors.

As a rule, everyone is divided into groups depending on their capabilities and skills. And after completing the training, each graduate receives a certificate, lessons are held as in a regular school. In addition to general education subjects, physical education and classes are conducted that promote the development of many skills. There is a nanny and a doctor; if necessary, you can sign up for a massage.

Forms of cerebral palsy

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

Spastic form

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

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

Hyperkinetic form

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

Ataxic form

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

Combined form

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

Extra education

In addition to the fact that a child needs to learn to read, write, and count, it is also necessary to develop his other skills, such as motor skills. For patients diagnosed with cerebral palsy, it is necessary to undergo regular massages, which eliminates pain from muscle tension. It is also necessary to learn to swim, which will have a positive effect on the development of the nervous system.

A diagnosis of cerebral palsy does not mean that your child will never learn to speak, wash himself, brush his teeth and understand others. It all depends on how it is dealt with, what programs and methods are used for development. But educational technologies do not stand still; a lot of programs have been invented for children with this diagnosis that are easy to use at home.

General characteristics of the disease cerebral palsy

The full development of the fetal nervous system in the perinatal period is influenced by many factors.

As a result of the occurrence of any diseases or pathological conditions in a pregnant woman or fetus, the neurons of the child’s developing brain die, which inevitably manifests itself after birth in motor, coordination, sensory, mental and other disorders.

These manifestations are part of the symptom complex of the disease and are usually detected in the child immediately after birth.

The severity of symptoms depends on the depth of brain damage. They do not progress over time. With good care, adequate treatment and rehabilitation of children with cerebral palsy allows one to achieve good results in the form of restoration of impaired functions, improved quality of life, and socialization.

Parental help

If a child has cerebral palsy, the main task of education lies with the parents. No educational institution, no certified teacher, no even the noblest state education system can replace parental care and control. But you shouldn’t think that caring for a child, even one with disabilities, is some kind of difficult task - all the necessary skills and desire to care are inherent in parents by nature. But not only do parents have natural potential, the child also has abilities that are given to him from birth; the task of parents is to reveal the abilities of their daughter or son and help him adapt to life.

Mother's love overcomes barriers

Parents and teachers need to pay attention to psychological and pedagogical points:

1. It is necessary to pay less attention to the illness, and more to the development of the child himself, to the assertion of his independence and responsibility. Show that his presence in your life gives you happiness, and the child will respond with redoubled efforts, being active in the right direction, just to bring satisfaction and praise from his parents. Also develop courage, perseverance and other character traits needed to achieve success in life.
2. Teach your child that all people are different, and just because he is special does not mean that he is worse. You can emphasize that if a person doesn’t do something better than others, then something else can work out better. The human body tends to compensate for deficiencies; if difficulties arise, a person can achieve results in other ways. For example, if a person cannot earn money through physical labor, he can be diligent and earn much more through mental labor.
3. It takes daily focused work. If you want to achieve a certain result in your studies or physical development, you need to take small steps - every day you need to put a brick in the building that you want to build. Don’t put it off “for later” because “later” never comes.
4. Physical deficiencies can be compensated for by more significant qualities - intelligence, moral values. But physically, there is no need to be upset - if an ordinary person can become an Olympic champion, then a person, even with significant physical limitations, can lead a completely ordinary life through training and fully take care of himself.
5. There is no need to have pity for the child, not only in terms of physical assistance, but there is no need to even look at him with pity. Be demanding without regard to illness, and the child will feel healthy. Even if it is difficult, he will be grateful that at least in the family he is treated as a full-fledged member of society, and he will transfer these feelings into real adult life.
6. Being demanding does not mean demanding the impossible. The child is sick, there is no need to deny this, one must constantly strive for recovery, but if one does not accept the disease for what it is, then one does not strive to eliminate it. If the disease progresses or does not recede at an insufficient rate, you need to treat treatment as an integral work that needs to be done daily.

Positive emotions

Social educators and psychologists are very good. You need to listen to their advice and draw conclusions. But the child also needs to be given the opportunity to go to church, where he will improve both in the short and long term. Christianity cannot be considered only as a moral teaching; it is also healing, both spiritual and very real, physical.

It is also very important for a child to expand his horizons. It’s good, of course, if you have a computer at home, and it can be used both for games and for learning and work. But we must not forget that children love to play with their peers. It would be good if he had friends, and real ones, and not through social networks. An ordinary club will not work, but perhaps in the city there is an opportunity to spend time with other children with cerebral palsy, and even better - with healthy children. Even if he cannot draw, sing, dance, sometimes it is enough just to look at other children from the outside, and not only new impressions and emotions will arise, but a desire to improve his own life will arise.

Going to exhibitions, theaters, performances, dance competitions, various crowded events, city holidays - this should be present in life on a regular basis. But man does not live by only one culture. No matter how difficult it may be, you need to get out into nature - fishing, a beach holiday by the river or local lake. If possible, organize a resort vacation. Of course, all this is problematic, but we must take into account that these efforts have a good effect not only on the child, but also on the parents - there is an opportunity to communicate more closely with the child, and his positive emotions, his joy will pass on to the father and mother, who, caring about the child, they automatically take care of themselves.

Can cerebral palsy be cured?

Cerebral palsy is an umbrella term for a group of non-progressive conditions that are associated with damage to the brain early in its development (in utero, during childbirth, or in the first two years of life).

It follows from this that it is impossible to “cure” cerebral palsy, since we cannot eliminate the cause of the motor deficit - structural disorders in the central nervous system.

But the consequences of this damage can be compensated to varying (sometimes significant!) degrees.

In order to properly organize the movement of a child with cerebral palsy, it is necessary, first of all, to normalize muscle tone, make maximum use of sensory information, and carry out competent correction of motor disorders.

This requires long-term rehabilitation.

There are many methods, but the basis for successful recovery is exercise therapy, exercise therapy, massages, classes with a speech therapist, speech pathologist, and psychologist.

Work with children diagnosed with cerebral palsy must be comprehensive. And, of course, medication support is needed, which is prescribed by a doctor.

Basic rules for working with children with cerebral palsy

Working with children with cerebral palsy involves close interaction between the child and not only the doctor (neurologist, physiotherapist, physical therapist, surgeon), but also with the teacher, speech therapist, and psychologist. It needs to start from an early age. Classes with children 1-3 years old involve teaching them self-care skills, speech development, motor skills, and learning how to interact with other children.

It is very important to teach a sick child to communicate with peers, to form stereotypes in them, designed to facilitate socialization. At the same time, an individual approach must be present on an ongoing basis. The priority form of conducting classes is a game, but it must be led by an adult, competently correcting the child’s actions. The teacher should encourage correct movements and correct pathological postures.

When working with children with cerebral palsy, instruments and devices should be used aimed at maintaining and fixing correct postures, the position of arms and legs, head and torso. This is the only way to achieve the development and consolidation of articulatory skills and to correct visual movements in response to changes in the environment.

Small conclusion

Thus, inclusive education, at its core, is an excellent opportunity for children with special needs to enter an atmosphere of social communication. We can only hope that it will be fully implemented in the post-Soviet space.

The opportunity for different children, with different abilities, to be together, make friends, play, learn to help each other, take care of each other and understand that all people are different, but everyone lives together on the same Planet and under the same sky. It’s just that among them there are those who are the same as the others, only they have fewer opportunities, but they have the opportunity to say - I’m learning!