Hemiplegia - paralysis of half of the body with its complete immobility. There are many varieties of pathology, one of them is spastic hemiplegia in cerebral palsy. With hemiplegia, one of the hemispheres of the brain is affected crosswise, or rather oppositely. Spastic hemiplegia manifests itself in movement disorders on the affected side.
Classification of cerebral palsy
In Russia, the classification of Semenova K. A. has been adopted since 1974. Its system has the advantages that it covers the entire clinic of brain damage and makes it possible to predict for the patient. Symptoms of brain damage include speech, mental and movement disorders.
According to this classification, 5 forms of cerebral palsy are distinguished:
- Hemiparetic form.
- Spastic diplegia, or Little's disease (spastic tetraparesis, in which the legs suffer more) is the most common form.
- Double spastic hemiplegia (considered the most severe).
- Atonic-astatic (Ferster's syndrome) - with it there ismuscle atony, movements are preserved, but coordination is impaired. Speech is impaired in 60% of cases.
- Hyperkinetic form (with hyperkinesis).
Spastic hemiplegia is also a form of cerebral palsy, with it the arm and leg are affected on one side, but the upper limb suffers, as a rule, more. In severe forms, changes become noticeable already in the first weeks of life, with moderate severity, signs appear by the end of the year, when the child should already actively take objects visible to him.
In spastic hemiplegia (ICP), the affected side is always hypertonic, although hypotension occurs in the first month.
Appearance of the patient:
- the tone of the arm is increased, and it is bent in all joints;
- the hand in young children is pressed to the body and clenched into a fist;
- in older children, it has the shape of the so-called "obstetrician's hand";
- balance may be maintained or delayed;
- the head is turned to the he althy side and at the same time tilted towards the affected shoulder;
- the pelvis is pulled up, and there is a lateral curvature of the body - the affected side seems to be shortened;
- affected leg is prone to sharp extension and twisted to the outside;
- muscle hypertonicity gives an increase in reflexes on the affected side.
Child has developmental delay:
- he will walk only after 2-3 years;
- gait is unsteady and the child often falls on the affected side;
- the child cannot step on the affected foot, he can only lean on his fingers.
At the same time, the arm is sharply bent and turned inward. At the same time, the bent hand is retracted towards the little finger, the thumb is pressed, the spine has a lateral curvature (scoliosis), the foot is valgus (like the letter "X"), the Achilles tendon is shortened.
Over time, these postures become persistent. The muscles on the affected side are atrophic and underdeveloped.
Important! In hemiplegia, the child has a characteristic gait and upright posture, which is medically known as the Wernicke-Mann position. It is very accurately characterized by the phrase: "The hand asks, the leg mows." This is observed because the leg on the side of the lesion is straightened at the hip and knee, bent at the foot, the child leans only on the fingers. The leg goes in front, and the hand on the affected side, as it were, asks for alms. 40% of children with this pathology have mental retardation.
There is no direct proportion with the degree of movement disorders. Social adaptation in such patients is determined by the degree of intelligence development. The favorable outlook is that cerebral palsy does not progress, because brain lesions in this disease are point-like and do not spread. Spastic hemiplegia according to ICD 10 has the code G81.1, the congenital variant is G80.2.
Etiology of the phenomenon
Reasons include:
- impaired brain development;
- fetal hypoxia;
- fetal infections, especially viral ones;
- Rhesus conflict with hemolytic disease of the newborn;
- fetal brain injury during childbirth;
- infectionsbrain in early childhood - up to 3 years;
- fetal brain toxicity;
- pathological childbirth;
- contusions of the spinal cord and brain in a child;
- brain tumors;
Also causes spastic hemiplegia:
- parasitic infestations;
- exo- and endogenous intoxications;
- blood diseases;
- meningitis.
Each case of cerebral palsy is individual, and it is not always possible to determine the exact cause of the disease. The etiology of spastic hemiplegia in congenital lesions is the result of impaired formation of central motor neurons in fetal development in the fetus.
Classification of pathology
According to etiology, spastic hemiplegia is divided into organic and functional, congenital and acquired. Organic is manifested in the defeat of brain cells, which is why nerve conduction is disturbed. With functional hemiplegia, there are no cell changes, muscle tone and reflexes remain normal. This form of hemiplegia may disappear spontaneously. According to the location of the lesion, the following types are distinguished:
- Double spastic cerebral palsy hemiplegia - all limbs. This form is considered the most severe.
- Homolateral lesion - the focus in the brain is on the side of the affected limbs.
- Contralateral form - focus and limbs in the crosshairs.
Options for the course of the disease:
- central hemiplegia - muscle hypertonicity and paralysis;
- crossed hemiplegia - arm on one side,leg on the other;
- flaccid type - the affected side is reduced in tone;
- spastic hemiplegia - the arm suffers more than the leg.
According to the localization of the sides of the lesion, the spastic form of cerebral palsy hemiplegia can be: right-, left- and bilateral.
Symptomatic manifestations
Common symptoms include:
- speech disorders, mental deficiency;
- muscle hypertonicity with seizures;
- decrease in articular reflexes with a parallel increase in tendon and periosteal;
- myalgia;
- cyanosis of the skin on the limbs and their cooling;
- pathological reflexes;
- gait disturbance;
- involuntary movements in affected limbs;
- distorted facial expressions for the same reason.
Pathological reflexes are unconditioned congenital reactions of a small organism, which, with its development and improvement of the cortico-spinal tract, disappear normally.
With cerebral palsy and some other nervous pathologies, they remain unchanged. There are a lot of them, and they all bear the names of their authors:
- flexion foot - Rossalimo, Zhukovsky, Bekhterev;
- extensor foot signs - Babinski, Oppenheim, Gordon and Schaeffer.
Stages of cerebral palsy
There are 3 stages of cerebral palsy:
- up to 5 months - early stage;
- from 6 months to 3 years - initial residual;
- after 3 years - lateresidual.
According to the stages, signs and symptoms are also early and late. Early symptoms of spastic hemiplegia in infants:
- neurological development lags behind - the child does not hold his head, cannot roll over, does not stretch and does not follow objects with his eyes;
- does not sit or crawl;
- in games, the baby uses only one hand, the second is always bent and pressed to the body.
These symptoms of spastic hemiplegia in infants can vary in severity, depending on the amount of brain damage.
The affected side is constantly in hypertonicity, because of this, the movements become excessively sharp, jerky. They arise aimlessly and are completely out of control. Some movements, on the contrary, are slow and worm-like. Remaining symptoms are late:
- shortening of the affected limb, which leads to scoliosis and curvature of the pelvic bones;
- contracture of the joints - their immobility;
- muscle cramps;
- due to incongruous muscle interaction, swallowing disorders are observed;
- increased salivation - saliva constantly flows out of the mouth.
The child does not respond to external sounds - this leads to the fact that he cannot speak. Speech is also impaired due to uncoordinated movements of the lips, tongue, and throat.
Speech with cerebral palsy
Spastic hemiplegia in children does not always result in a lack of speech. Intelligence in cerebral palsy can be different: remain normal orlag behind to the point of debility. With sufficient intelligence, children can study in a regular general education school and later receive a speci alty.
It is difficult for sick children to pronounce arbitrary sounds, because the muscles involved in the pronunciation process are always in hypertonicity.
Often vision is impaired - myopia and strabismus. On the part of the teeth - frequent caries, improper placement of teeth, enamel pathology. Uncontrolled work of the pelvic floor muscles leads to involuntary urination and defecation.
Often cerebral palsy is combined with epilepsy. Such children are always very vulnerable and strongly attached to their parents and guardians. This must be taken into account when carrying out the adaptation of the child. It has already been mentioned that cerebral palsy does not tend to progress, although parents often think so. Why? Because the child grows older and the symptoms may become more pronounced, for example, he has problems with learning. Symptoms do not increase: the baby was small, so it was not so noticeable until he learned to walk, eat, etc.
Symptoms up to a year
The stages of development of a child with spastic hemiplegia look like this:
- in the first weeks and months - seizures, the child does not raise or hold his head;
- impaired sucking, increased salivation;
- at the age of 4-5 months, the baby does not react to external sounds, does not turn his head, does not blink, does not hum;
- is indifferent to toys and does not reach for them;
- more than 7 months - does not sit down,does not roll over;
- does not attempt to crawl;
- when a child is over a year old, he does not try to get up and take steps, does not say anything;
- up to 12 years of age uses predominantly one hand, strabismus often occurs;
- gait is difficult, cannot lean on the foot, becomes only on the toes.
Important! A sick child is not aware of his defect - anosognosia.
Diagnostic measures
Clinical manifestations are too specific to be difficult to diagnose. But the pathology must be differentiated. To do this, you should find out the etiology, collect a complete and detailed history, conduct a physical examination and neurological examination with tests.
Lab tests:
- UAC and OAM;
- blood biochemistry;
- study of CSF after lumbar puncture;
Instrumental research:
- electromyography;
- CT and MRI of the brain;
- doppler;
- EEG.
MRI can reveal atrophy of the cortex and subcortex of the brain, reduced density of white matter and its porosity.
Principles of treatment
The tactics of treating a child with spastic hemiplegia of cerebral palsy almost completely depends on the cause of the disease. Today, it is considered correct to conduct early rehabilitation, even in the acute period, in a hospital. All recommended methods continue at home.
Hemiplegia is only a syndrome, it is important to remove the cause of the pathology, therefore, first of all, drugs are prescribed to improve the nervoustrophism in tissues and conduction of impulses from neurons. These are Baclofen, Mydocalm, Dysport and others.
It becomes important to restore the nerve pathways, relax the muscles and relieve spasticity. These include:
- neuroprotectors, neurotrophics, vasoactive agents;
- analgesics;
- fortifying therapy: B vitamins, antioxidants, cholinesterase inhibitors;
- muscle relaxants.
With this pathology, muscle relaxants are used for a long time. They do not act on damaged cells, but favor rehabilitation. For direct impact on diseased limbs, massage, exercise therapy, and kinesitherapy are used.
Try to achieve the physiological position of the limbs, turns in bed, make passive movements in the joints to improve the outflow of lymph and blood circulation.
All this is designed to prevent muscle atrophy and contractures, bedsores. Constantly such patients use standers - they help the child to stand. In addition to them, they use walkers, standers, exercise machines, a bicycle.
Very effective and widely used physiotherapy:
- barotherapy;
- magnetotherapy;
- electromuscle stimulation;
- laser therapy.
Additional non-traditional methods of influence:
- reflexology;
- manual therapy;
- phytotherapy;
- water treatments.
Sick children need a separate adaptation, especially if they are right-handed with damage to the right side.
The child must learn to use everydayitems. The room where he lives, you need to adapt as much as possible for him. Prosthetic and orthopedic help is also needed.
Here a lot depends on the parents and the help of a neurologist. Be sure to take classes with a speech therapist. The severity of the etiology always determines the further prognosis. A good result of treatment is the transition from hemiplegia to hemiparesis.
Prevention and prognosis
There is no specific prevention. Only general recommendations can be given. A pregnant woman should:
- constantly see a doctor;
- quit smoking and alcohol;
- eat rationally;
- regular exercise therapy with a sick baby;
- protect yourself from brain and spinal cord injuries;
- treat neuroinfections in time;
- visit and work with your neurologist regularly.
A favorable outcome of hemiplegia is the transfer of the child to a state of hemiparesis. Complete recovery is rare. The worst prognosis is for those who suffer from double hemiplegia. Such patients often receive the first group of disability, because they are not able to serve themselves and move around.
