Classification of cerebral palsy

Cerebral palsy is a serious chronic disease. Cerebral palsy combines a complex of symptoms that are associated with impaired motor function of a person. Most often, the disease affects the fetus during its intrauterine development.

Cerebral palsy is non-progressive in nature, which means that the disease does not spread within the body, does not affect healthy areas of the nervous tissue, and only specifically damages certain areas of the brain.

The disease occurs due to pathological processes occurring in the central nervous system. As a result, it becomes difficult, if not impossible, for the child to coordinate his movements. The range is quite wide: from mild disorders to complete immobilization, depending on the degree of damage to the brain tissue.

Features of the classification of cerebral palsy

The nature and extent of the lesion is the basis for the classification of cerebral palsy.
In Russia, it is customary to rely on the classification of Semyonova K.A. According to this gradation, the following forms of cerebral palsy are distinguished:

• spastic diplegia;
• double hemiplegia;
• hemiplegia;
• hyperkinetic form;
• atonic astatic form.

Let's look at each type of lesion in more detail.

Clinical picture

The clinical picture of cerebral palsy (ICD 10 code G80) is determined by the form of the disease, each with its own group of neurological disorders.

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Spastic diplegia

Characteristic features:

• muscles of the lower and upper extremities are toned;
• the lower extremities are more affected;
• hands are more active and coordinated.

Diplegia is a very common type of cerebral palsy, its symptoms to a certain extent appear in newborns. Intelligence is not affected, the child can be successfully trained.

Despite this, exceptions are still possible; there are individual cases where intellectual development is below normal. Minor deviations in mental or speech development may be observed.

Spastic diplegia occurs most often in premature babies, but the main cause is hemorrhage in the ventricles of the brain and liquefaction of nervous tissue. The part of the brain responsible for motor activity is affected.

Symptoms of cerebral palsy

The main manifestation of cerebral palsy is impaired motor activity. Mental disorders in a child are diagnosed much later, when cognitive processes are actively developing. Unlike movement disorders, which can be diagnosed immediately after birth, mental disorders are diagnosed at the age of 2-3 years.

Diagnosing cerebral palsy after birth is quite difficult, since the child has virtually no motor skills during this period. Most often, the diagnosis is confirmed at the residual stage, starting at 6 months.

The pathology is accompanied by the following symptoms:

• Delays in the development of motor activity.
  In pediatrics, the average time for a child to develop certain motor skills has been determined. For example, a child early learns to roll over on his stomach, reach for objects of interest to him, hold his head up, and later sit or crawl. A delay in the development of such skills indicates the possibility of cerebral palsy. Other physical activity
• Lack of reflex activity. A child is born with a set of unconditioned reflexes, which fade away at a certain age, being replaced by acquired ones. If a reflex that is characteristic of infancy appears in an older child, this indicates the presence of cerebral pathology. A striking example is the grasping reflex, which normally disappears at 5 months.
• Muscle tone disorders. The disorder is diagnosed by a pediatric neurologist. It manifests itself in the form of sudden slow movements in the limbs, which are performed by the child without any purpose.
• Use of one limb. In the absence of any pathologies, the child’s motor activity manifests itself equally in all parts of the body. If the pathology develops, the regular use of one limb when performing certain actions is noted. For example, a child may constantly reach with one hand while the other remains idle. The presence of such a symptom is a serious reason to visit a doctor.

In general, there are various symptoms of cerebral palsy that occur at an early stage of the pathology.

Disability due to epilepsy: description of disability groups

Double hemiplegia

The characteristics of this form of cerebral palsy are as follows:

• severe hand disorder;
• severe damage to the lower extremities;
• speech disorders;
• inability to self-service;
• atrophy of the optic nerves (in half of the cases);
• hearing impairment;
• muscle rigidity.

The most severe of all types of cerebral palsy. The child is incapable of learning; moreover, he is completely unable to coordinate his movements. The reason is fetal hypoxia. The cerebral hemispheres or the entire brain are affected.

Diagnostics

 Signs of cerebral palsy are usually not noticeable at birth. Symptoms appear during the first 18 months of life. More severe cases of cerebral palsy tend to be diagnosed earlier than others. Immediately after birth, an Apgar score is assessed. Children who have low Apgar scores are at increased risk for cerebral palsy. The presence of abnormal muscle tone and movement may indicate cerebral palsy. In some children, infantile reflexes may persist for a long time. Imaging of the brain using ultrasound, x-rays, MRI and/or CT may reveal structural abnormalities. Some brain lesions associated with cerebral palsy include scarring, cysts, enlarged cerebral ventricles (hydrocephalus), periventricular leukomalacia, areas of necrosis, and intracerebral hemorrhage. Blood and urine tests and genetic tests may be used to rule out other possible causes, including muscle disease, peripheral nerve disease, mitochondrial and metabolic disease, and other inherited diseases.

Hemiplegia

Characteristic symptoms for this form of the disease:

• affects one side (right or left);
• delayed intellectual development;
• deviations in mental development;
• characteristic gait (straightened leg with bent arm);
• epilepsy attacks are possible.

To some extent, children with this type of cerebral palsy can be taught, but they will be noticeably behind their peers. Hemiplegia occurs after cerebral infarction or cerebral hemorrhage. The cortex and subcortical structures that are responsible for motor activity are affected.

Hyperkinetic type of disease

The hyperkinetic form (dyskinetic form) of cerebral palsy has the following symptoms:

• involuntary movements of the limbs;
• incorrect positioning of the legs;
• violations of the correct posture of the spine;
• slow movements;
• convulsions;
• speech disorder.

This type of cerebral palsy has a slight effect on the child’s intelligence, so the child can study quite successfully at school, have quite normal contact with others, and successfully adapt to society.

The cause is hemolytic disease complicated by kernicterus. Subcortical structures are affected.

Ataxic form

Atonic-astatic form (ataxic) of cerebral palsy:

• muscle tone is reduced;
• tendon reflexes are pronounced;
• frequent cases of speech impairment;
• coordination of movements is completely impaired;
• no sense of balance;
• possible concomitant disease – mental retardation;
• defects of intellectual development;
• speech impairment.

The cause of the disease is birth trauma, hypoxia, ischemia. The cerebellum is affected.

Classification according to ICD-10

According to the international classification ICD-10, there are some clarifications that complement Semyonova’s classification of cerebral palsy; they relate to the localization of the lesion. So:

• spastic type, is in turn subdivided into hemiplegia, diplegia, monoplegia, quadriplegia.
• hyperkinetic type.
• atactic type.
• combination type.

According to international grading, monoplegia is damage to one limb, quadraplegia is damage to both arms and legs; diplegia – damage mainly to the legs; damage to one side is hemiplegia.

Some signs of cerebral palsy are noticeable from birth. But the doctor makes the final diagnosis after conducting all the necessary studies during the first two years of the child’s life. In cases where the symptoms are mild, the diagnosis will be made when the child turns 5 years old.

To make an accurate diagnosis, the doctor needs to conduct some research to study:

• motor abilities of the child;
• muscle tone disorders;
• level of mental development;
• degree of mental development;
• carefully study the medical history;
• conduct additional diagnostic studies.

About the disease

Right-sided hemiparesis is a pathology that is a right-sided lesion of the muscles of the body.

It is characterized by a noticeable decrease in strength and general motor ability of muscles, and incomplete paralysis of the limbs is possible.

This condition manifests itself due to acquired or congenital pathological changes in the pyramidal tracts and the brain.

Doctors observe deviations from the norm when a lesion appears in the left hemisphere of the brain.

This disease leads to the following consequences for the patient:

1. Mobility and the patient’s ability to move independently, as well as to care for themselves independently, are reduced when hemiparesis occurs on the dominant side (right-sided hemiparesis in right-handed people);
2. The patient experiences inflammatory changes that are associated with prolonged skeletal muscle cramps . This consequence occurs after serious disorders - intracerebral hemorrhages and strokes;
3. A problem arises when trying to follow instructions for physical therapy when the patient is undergoing motor recovery due to limited mobility. This happens when there is spastic increased muscle tone.

In children

In children, this pathology occurs as a congenital disease . The reasons for its occurrence are abnormal functionality and structure of the brain , as well as birth injuries. In medical terminology, this disorder is called cerebral palsy - cerebral palsy.

Cerebral palsy appears due to a circulatory disorder in the brain. This pathology affects the fetus while still in the womb and leads to erroneous development and damage to brain structures.

Right spastic hemiparesis

Spastic hemiparesis, often called central, occurs when there is inflammation of the brain or cervical spinal cord.

With this disease, stiffness and muscle tension are observed in the limbs of the opposite side of the body. If individual nerves of the spinal cord are subject to inflammation, then hemiparesis is combined with weakness and decreased muscle tone.

This pathology does not immediately become noticeable; it manifests itself over several months. First, muscle tone increases, which creates tension in the arm and leg, a feeling of stiffness arises, and the ability of the limbs to move decreases. Then, if no treatment is followed, muscle tone continues to increase.

Important! An increase in muscle tone indicates damage to parts of the central nervous system - the brain and spinal cord.

Disturbances in movements that are accompanied by spasticity are seen by others from the outside based on distinctive signs - people have difficulties in gait, it acquires special features. Doctors call it Wernicke-Mann gait . This indicates diseases suffered by the brain - stroke and traumatic brain injury.

Symptoms of right-sided spastic hemiparesis are varied. These include speech disorders, fever, cognitive impairment and seizures similar to epileptic seizures.

Increased muscle tone indicates that the brain and spinal cord are damaged. To reduce tone, the doctor prescribes drugs that relax the muscles. The period of admission is usually long - up to six months, but sometimes longer.

Stages of progress

Cerebral palsy has three stages according to the nature of its symptoms:

1. The first symptoms begin to appear in a baby under the age of five months. This is an early stage . At this stage, obvious deviations in the physical development of the child are recorded, which can be expressed in the following - the baby does not hold his head, does not follow objects, does not reach for them with his hand, only one hand is predominantly active, or only his hands are effective with less mobility of the lower extremities. All these symptoms are usually not noticeable at an early level, although in some cases they can be clearly visible even during this period. At this stage, the baby is prescribed treatment, which mainly includes massage and physical therapy.
2. The second stage is the initial stage , the pathology has not yet been recorded, but is already more clearly expressed. Muscle tone is very weak or, on the contrary, increased. Age – up to three years.
3. The third stage is late. The pathology is recorded and clearly visible, the characteristics of mental and mental development have been formed. Age: over three years old.

Classification of the disease

In medicine, cerebral palsy is a broad concept that covers many diseases. It is a mistake to believe that cerebral palsy is exclusively a motor disorder in a child. The development of pathology is associated with disturbances in the functioning of brain structures that arise even in the prenatal period. A feature of cerebral palsy is its non-progressive chronic nature.

Cerebral paralysis

Types of cerebral palsy according to ICD 10:

• Spastic cerebral palsy (G80.0)
• Spastic diplegia (G80.1)
• Pediatric hemiplegia (G80.2)
• Dyskinetic cerebral palsy (G80.3)
• Ataxic CPU (G80.4)

In addition, the cerebral palsy group includes diagnoses that include rare types of cerebral palsy (G80.8) and pathologies of an unspecified nature (G80.9).

Any form of cerebral palsy is provoked by pathologies of nerve cells. The deviation occurs during the prenatal period of development. The brain is an extremely complex structure, and its formation is a long process, the course of which can be affected by negative factors.

Often, cerebral palsy provokes complications that cause the patient’s condition to worsen. In medicine, aggravating diagnoses are compared in false progression - a pathological process in which the symptoms of cerebral palsy are aggravated due to concomitant diseases.

Thus, the ICD 10 classification of cerebral palsy identifies several types of disease that occur during the prenatal period and cause severe mental and physical disorders.

Diagnostic approach

It is quite difficult to diagnose the disease at an early stage of a baby’s life. And yet, the initial symptoms begin to make themselves felt from the first months of life. The main thing is not to miss the moment and recognize them in time.

The spastic form of the disease can be diagnosed already in the first half of a child’s life. This form has characteristic manifestations that are well defined in the very first months: increased muscle tone combined with pathological reflexes.

Hemiplegia manifests itself at the age of 5–7 months.

The atonic-astatic form of cerebral palsy becomes more obvious after seven months. Differential diagnosis of this form is quite complicated due to the similarity of its symptoms with the symptoms of other diseases.

Until the age of six months, the baby may not notice any disorders, and only as he grows do symptoms gradually appear. Most often they are associated with mental development disorders and neurological disorders. The child experiences outbursts of unreasonable aggression and increased excitability. There are speech disorders, movement disorders, loss of balance.

The hyperkinetic form of the disease is determined somewhat later - by the beginning of the second year of life.

Additional diagnostics are carried out using the following instrumental methods:

• computed tomography of the brain;
• encephalography;
• ultrasound examination of the brain;
• electromyography;
• Craniography, etc.

The results of the study make it possible to obtain information about the depth of changes in the nervous system, determine the degree and severity of damage to a particular area of ​​the brain, and identify other disorders.

To make a diagnosis of cerebral palsy, the presence of specific movement disorders in a child at the initial stage of development of the disease is sufficient. As additional research measures, an MRI of the brain is performed, which allows one to assess the type of damage and determine the specific location of the brain lesion.

Such a study is necessary in order to exclude the presence of other diseases with similar symptoms. For the same purposes, differential diagnosis is carried out.

Cerebral palsy is not a progressive disease, its symptoms do not increase over time, and the patient’s condition does not worsen over time. If the opposite happens, then most likely the disease has a different nature.

The following diseases have the same symptoms as cerebral palsy:

• traumatic and non-traumatic brain damage;
• early autism;
• phenylketonuria;
• spinal cord lesions;
• schizophrenia, etc.

Cerebral palsy

Cerebral palsy can have a variety of manifestations with varying degrees of severity. The clinical picture of cerebral palsy and its severity depend on the location and depth of damage to brain structures. In some cases, cerebral palsy is noticeable already in the first hours of a child’s life. But more often, the symptoms of cerebral palsy become obvious after a few months, when the child begins to lag significantly behind the norms accepted in pediatrics in neuropsychic development. The first symptom of cerebral palsy may be a delay in the formation of motor skills. A child with cerebral palsy cannot hold his head up for a long time, does not roll over, is not interested in toys, cannot consciously move his limbs, and cannot hold toys. When trying to put a child with cerebral palsy on his feet, he does not put his foot on his full foot, but stands on his tiptoes.

Paresis in cerebral palsy can be in only one limb, be unilateral (arm and leg on the side opposite to the affected area of ​​the brain), and affect all limbs. Insufficient innervation of the speech apparatus causes a violation of the pronunciation aspect of speech (dysarthria) in a child with cerebral palsy. If cerebral palsy is accompanied by paresis of the muscles of the pharynx and larynx, then problems with swallowing (dysphagia) arise. Cerebral palsy is often accompanied by a significant increase in muscle tone. Severe spasticity in cerebral palsy can lead to complete immobility of the limb.

Subsequently, in children with cerebral palsy, the paretic limbs lag in physical development, as a result of which they become thinner and shorter than healthy ones. As a result, skeletal deformations typical of cerebral palsy (scoliosis, chest deformities) are formed. In addition, cerebral palsy occurs with the development of joint contractures in paretic limbs, which aggravates motor disorders. Motor skills disorders and skeletal deformities in children with cerebral palsy lead to the appearance of chronic pain syndrome with pain localized in the shoulders, neck, back and feet.

Infantile cerebral palsy of the hyperkinetic form is manifested by suddenly occurring involuntary motor acts: turning or nodding the head, twitching, grimacing on the face, pretentious poses or movements. The atonic-astatic form of cerebral palsy is characterized by discoordinated movements, instability when walking and standing, frequent falls, muscle weakness and tremor.

With cerebral palsy, strabismus, functional disorders of the gastrointestinal tract, respiratory disorders, and urinary incontinence may be observed. In approximately 20-40% of cases, cerebral palsy occurs with epilepsy. Up to 60% of children with cerebral palsy have vision problems. Possible hearing loss or complete deafness. In half of the cases, cerebral palsy is combined with endocrine pathology (obesity, hypothyroidism, growth retardation, etc.).

Often, cerebral palsy is accompanied by varying degrees of mental retardation, mental retardation, perception disorder, learning disabilities, behavioral abnormalities, etc. However, up to 35% of children with cerebral palsy have normal intelligence, and in 33% of cases of cerebral palsy, intellectual impairment is expressed in mild degree.

Cerebral palsy is a chronic but non-progressive disease. As the child grows and his central nervous system develops, previously hidden pathological manifestations may be revealed, which create a feeling of so-called “false progression” of the disease. Deterioration of the condition of a child with cerebral palsy can also be caused by secondary complications: epilepsy, stroke, hemorrhage, use of anesthesia or severe somatic illness.