Effective rehabilitation of children with cerebral palsy includes a set of activities. Attention is paid not only to the physical, but also to the mental development of the child, the acquisition of skills of independence and social adaptation. For children with disabilities, free observation, provision of vouchers for treatment in sanatoriums, provision of medicines and means of technical rehabilitation are also possible.
Causes of disease and risk factors
The causes of cerebral palsy are divided into intrauterine provoking factors and postpartum. The first type includes:
- difficult pregnancy;
- unhe althy lifestyle of mother;
- hereditary predisposition;
- difficult birth, during which fetal asphyxia occurred;
- acute or certain chronic maternal illnesses;
- preterm and low birth weight babies;
- infectious processes occurring in a latent form in the bodymother;
- toxic poisoning of the child's brain due to incompatibility between mother and fetus in terms of blood type and Rh factor or liver failure of the child.
Postpartum triggers include:
- Baby weight up to 1 kg at birth;
- birth of twins or triplets;
- head injury at an early age.
In every third case, however, it is not possible to identify the specific cause of the pathology. And as a rule, the rehabilitation of children with cerebral palsy does not depend on the causes of the development of the disease. The individual rehabilitation program may be revised only in the case of premature and small children - such patients often require more careful care and medical supervision.
Main phases of the course of the disease
Rehabilitation of children with cerebral palsy depends on the phase of the disease, the severity of the disease and the age of the patient. There are three phases of the course of the disease:
- Early (up to 5 months). Cerebral palsy is manifested by developmental delay, preservation of unconditioned reflexes.
- Primary (up to 3 years). The child often chokes on food, does not want to speak, asymmetry, hypertonicity or excessive muscle relaxation is noticeable.
- Late (over three years). Manifested by shortening of one limb compared to the other, swallowing, hearing, vision, speech disorders, convulsions, urination and defecation disorders, mental retardation.
Early signs of cerebral palsy
Early signs of cerebral palsy includethe following deviations:
- delayed physical development: head control, rolling over, sitting without support, crawling or walking;
- preservation of "childish" reflexes upon reaching 3-6 months of age;
- prevalence of one hand by 18 months;
- any symptoms that indicate hypertonicity or excessive relaxation (weakness) of the muscles.
Clinical manifestations of the disease can be both pronounced and almost imperceptible - it all depends on the degree of damage to the central nervous system and the brain. Seek medical attention if:
- child's movements are unnatural;
- baby has convulsions;
- muscles appear excessively relaxed or tense;
- baby does not blink in response to a loud sound at one month old;
- at 4 months the baby does not turn his head to a loud sound;
- not sitting without support at 7 months;
- does not speak single words at 12 months;
- baby does not walk or walks unnaturally;
- the child has strabismus.
Comprehensive rehabilitation of children with cerebral palsy gives the best results if it starts at an early age. With severe forms of the disease, untimely restoration of physical activity or late development of social skills, the child may remain completely unadapted to life.
Is it possible to cure the disease
CP refers to diseases that are almost impossible to cure completely. However, a comprehensive and timely started rehabilitation allowschildren with such a diagnosis should be trained on a par with he althy children and lead a full-fledged lifestyle. Significant progress can be considered the preservation of the child's single symptoms of the disease.
Modern methods of treatment of cerebral palsy
The main objective of individual rehabilitation programs for children with paralysis is the gradual development of skills and abilities, physical and social adaptation. Methods that are developed individually for each child gradually correct motor defects, improve motor activity, develop the patient emotionally, personally and socially, develop independence skills in everyday life. As a result of systematic rehabilitation, the child can integrate into society and adapt to later life independently.
The rehabilitation program for children with cerebral palsy includes the following approaches:
- water treatment: swimming, balneo or hydrotherapy;
- PET therapy, or animal treatment: hippotherapy (treatment with horses), psychophysical rehabilitation in the process of communicating with dolphins and swimming;
- use of orthopedic devices, exercise equipment, gymnastic balls, ladders;
- mud applications that increase the bioelectrical activity of muscles;
- therapeutic massage to reduce the degree of lethargy and muscle spasm;
- drug treatment: Botox, botulinum toxin, xeomin, dysport are used;
- Vojta therapy to restore natural patterns of behavior;
- physiotherapy treatment: myoton, ultrasound, magnetotherapy, darsonvalization;
- Montessori therapy, which allows you to form the ability to concentrate and develop independence;
- classes with a psychologist;
- speech therapy classes that correct speech disorders (program "Logorhythmics");
- special education;
- shiatsu therapy - massage of biologically active points;
- classes according to the Bobath method - special gymnastics using certain equipment;
- laser exposure to reflexogenic zones, tip of the nose, joints, reflex-segmental zones, area of paretic muscles;
- art therapy aimed at preparing the child for learning;
- Peto's technique - the division of movements into separate acts and their learning;
- orthopedic surgery;
- spa treatment;
- alternative treatments: osteopathy, manual therapy, catgut therapy, vacuum therapy, electroreflexotherapy.
Of course, not all methods of rehabilitation of children with cerebral palsy are listed above. There are many ready-made programs developed and currently being developed by rehabilitation centers, alternative approaches and techniques.
Physical rehabilitation of children with cerebral palsy
The physical recovery of a sick child should begin as early as possible. Leading experts in the world have recognized that the rehabilitation of a disabled child (CP) brings the best results up to three years, however, in Russia, many centers refuse to accept children under one year orup to three years, and doctors are in no hurry to establish a diagnosis and formalize disability. But still, physical rehabilitation is the most important stage in the adaptation of a special child to later life, and you should start working with a small patient immediately after the diagnosis of cerebral palsy is established.
Rehabilitation of children with cerebral palsy is necessary to prevent weakening and atrophy of muscles, avoid the development of complications, and is also resorted to in order to promote the motor development of the child. Therapeutic massage, physical education and exercises on special simulators are used. In general, any motor activity is useful, and the supervision of a specialist will help to form motor stereotypes, properly develop physical fitness and prevent addiction to pathological positions.
Rehabilitation Bobath Therapy
The most common form of rehabilitation is Bobath therapy in combination with other equally effective methods. The essence of therapy is to give the limb a position opposite to that which, due to hypertonicity, it seeks to accept. Classes should be held in a calm environment, three times a day or a week, each movement is repeated 3 to 5 times. The movements themselves are carried out slowly, because the main goal of treatment is to relax the muscles. Complexes of exercises are developed individually. Treatment according to the Bobath therapy method can also be carried out at home - a parent or guardian is trained to perform techniques with the help of a specialistin a rehabilitation center.
Means of technical rehabilitation
In the physical restoration of the motor activity of a child with cerebral palsy, the means of technical rehabilitation of children are also used. Severe cerebral palsy requires devices for mobility (walkers, wheelchairs), development (exercise bikes, special tables and chairs) and hygiene (bath seats, toilet seats) of the child. Also, rehabilitation means for children with cerebral palsy involve the use of orthopedic devices and exercise equipment. For example, the Adele suit is used, which redistributes the load, the Gross simulator, which develops motor skills, the Veloton, which stimulates muscles, the Spiral suit, which allows you to form new movement stereotypes, and so on.
Social rehabilitation of disabled children with cerebral palsy
Closer to school age, more attention is paid to the social adaptation of the child. Efforts are directed to the formation of independence skills, mental development, preparing the child for collective learning and communication. In addition, the patient is taught to dress himself, serve himself, exercise hygiene, move around and so on. All this will reduce the burden on those caring for a disabled child, and the smallest patient will be able to adapt to life.
Psychologists, speech therapists and teachers work with special children. The role of parents or guardians who will deal with the child at home is extremely important. Social rehabilitation of children (ICP) pursuesgoals:
- expansion of vocabulary and horizons;
- development of memory, attention and thinking;
- education of personal hygiene;
- cultivating self-care skills;
- development of speech, formation of culture.
Children with this diagnosis can study in experimental classes, which are more often formed in private schools, but with significant restrictions, it is better to think about boarding school or homeschooling. In the boarding school, the child can communicate with peers, receive special skills and participate in career guidance activities. Homeschooling requires more parental involvement and daily medical supervision.
In many cases, further labor activity of a person diagnosed with cerebral palsy is possible. Such people can master the professions of mental labor (teachers, but not elementary grades, economists, architects, junior medical staff), work at home as programmers, freelancers, and even (with the preservation of hand movements) as seamstresses. Employment is impossible only in severe cases.
Disability with cerebral palsy
Infantile cerebral palsy has several forms and degrees of severity. Disability in cerebral palsy is issued if the disease is accompanied by restrictions in relation to normal life, learning, self-service, speech contact. Registration of disability is possible only after a medical examination. A mother with a child will have to undergo a neurologist, surgeon, psychiatrist, pediatrician, orthopedist, ophthalmologist and ENT specialist. This "adventure" does not end there. Followed by:
- issue a final conclusion from the head of the medical institution;
- go through the verification of documents already in an adult clinic;
- give a package of documents to the collection point for papers for medical and social examination.
Depending on the term for establishing disability, it is necessary to conduct a medical and social examination (and, consequently, to re-pass all doctors) again after a certain period of time. It is also necessary to obtain conclusions again if the completed individual rehabilitation program undergoes changes - for example, if a child, as prescribed by a specialist, needs a new means of rehabilitation.
Benefits for disabled children with cerebral palsy
Disability registration is a vital issue for some families, because it provides an opportunity to receive cash payments for rehabilitation and benefits.
Thus, families with disabled children with cerebral palsy are en titled to the following benefits:
- free rehabilitation in federal and regional centers and sanatoriums;
- minimum 50% discount on municipal or public housing and utility bills;
- the right to priority land for individual construction, gardening and housekeeping;
- provision of medicines (as prescribed by a doctor), medical food products;
- free travel to the place of spa treatment andback, as well as in public transport (the benefit is for a disabled child and one accompanying person);
- compensation for the services of a psychologist, teacher and speech therapist, determined by an individual rehabilitation program (in the amount of not more than 11.2 thousand rubles per year);
- exemption from payment in kindergartens;
- compensation payments to unemployed persons caring for a disabled child (a parent, adoptive parent or guardian can receive 5.5 thousand rubles, another person - 1.2 thousand rubles);
- pension for a disabled child and additional payments (total 14.6 thousand rubles as of 2017);
- the period of caring for a child with a disability is counted towards the mother's seniority;
- the mother of a disabled child with cerebral palsy has a number of benefits under labor law: she cannot be involved in overtime work, business trips, has the right to work part-time, retire earlier, and so on;
- A single mother raising a disabled child cannot be fired, except in cases of complete liquidation of the enterprise.
Rehabilitation centers in Russia
In special centers, the rehabilitation of children with cerebral palsy is carried out comprehensively and under the supervision of relevant specialists. As a rule, systematic classes, an individual program and professional medical support for both children and parents can achieve significant results in a relatively short period of time. Of course, to consolidate the result, you need to continue to study according to the proposed program at home.
Russian Scientific and Practical CenterPhysical Rehabilitation and Sports (Grossko Center)
There are several rehabilitation centers in Russia. The Grossko Center in Moscow works according to a comprehensive program: upon admission, diagnostics are carried out, then specialists-instructors in physical recovery deal with a special child. Physical rehabilitation of children with cerebral palsy at the Grossko Center includes physiotherapy exercises, swimming, exercises with special simulators that allow developing coordination of movements and fixing motor stereotypes, classes on a treadmill, roller skating. Based on the results of pedagogical testing, programs are being adjusted so that recovery meets the needs and condition of a particular little patient.
The cost of rehabilitation of a child (cerebral palsy) in the Grossko Center, of course, is not small. For example, you will have to pay 1,700 rubles for the initial appointment, and the cost of 10 physical therapy sessions (45-50 minutes each) is 30 thousand rubles. One lesson with a speech therapist (lasting 30 minutes), as well as a massage session (30-40 minutes according to the doctor's testimony) will cost 1000 rubles. However, the results of the classes are really there, and the Grossko Center itself is a prominent institution.
Russian Research Institute of Traumatology and Orthopedics. R. R. Vredena
The Rehabilitation Center for Children with ICP named after R. R. Vreden (RNIITO - Russian Research Institute of Traumatology and Orthopedics) in St. Petersburg provides its clients with a full range of services: from diagnosis to surgery, including,of course, treatment and recovery. More than twenty fully equipped departments are at the disposal of highly professional specialists of the center with many years of practical experience.
Moscow Scientific and Practical Center for the Rehabilitation of the Disabled Due to Cerebral Palsy
Moscow Scientific and Practical Center for Rehabilitation of the Disabled Due to Cerebral Palsy is considered one of the most accessible and well-known. The doctors of the center work on the basis of several dozen rehabilitation programs, use all modern domestic developments and find an individual approach to each patient. The center accepts children from three years of age. In addition to direct physical recovery, psychologists-defectologists, speech therapists, professional massage therapists and conductologists work with young patients - teachers who work with children and adults with CNS disorders.
Institute for Conductive Pedagogy and Restorative Movement Therapy in Budapest, Hungary
Rehabilitation of a disabled child (ICP) at the Institute. A. Petyo in Budapest - the capital of Hungary - is the center where hundreds of families aspire to go. The institution is famous for its excellent specialists, the use of the most modern developments in the treatment of young patients, as well as the visible results achieved by children with cerebral palsy who have completed a rehabilitation course.
There are many other rehabilitation centers and sanatoriums that accept children with cerebral palsy for rehabilitation. Only in Moscow, for example, there is a Rehabilitation Centerchildren with cerebral palsy "Movement", Rehabilitation Center "Spark", Rehabilitation Center "Overcoming" and others. In some institutions, free rehabilitation of children with cerebral palsy is also possible. Families with disabled children are also supported by charitable organizations and social centers.
