Hemiplegia - paralysis of half 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 cerebral hemispheres is affected crosswise, or rather, the opposite. Spastic hemiplegia is manifested in impaired movement on the affected side.
Classification of cerebral palsy
Since 1974, the classification of Semenova K.A. has been adopted in Russia. Her system has advantages in that it covers the entire clinic of brain damage and makes it possible to predict for the patient. Symptoms of brain damage include impaired speech, psyche, and movement.
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 syndrome) - with it there is muscle atony, movements are preserved, but coordination is impaired. Speech is disturbed in 60% of cases.
- Hyperkinetic form (there are hyperkinesis).
Spastic hemiplegia is also a form of cerebral palsy, with it affecting the arm and leg 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 (cerebral palsy), the affected side is always hypertonic, although hypotension also occurs in the first month.
The appearance of the patient:
- the tone of the arm is increased, and it is bent in all joints;
- the brush in young children is pressed to the body and compressed into a fist;
- in older children, it has the form of the so-called "obstetrician's hand";
- balance may be maintained or delayed;
- the head is turned in a healthy direction and at the same time is inclined to the affected shoulder;
- the pelvis is pulled up, and there is a lateral curvature of the trunk - the affected side seems to be shortened;
- the affected leg is prone to sharp extension and turned to the outside;
- muscle hypertonicity increases reflexes on the affected side.
The child has a delay in physical development:
- he will walk only after 2-3 years;
- the gait is unstable, and the child often falls on the sick side;
- the child cannot step on the affected foot, he can only lean on his fingers.
At the same time, the hand is sharply bent and turned inward. At the same time, the bent hand is laid towards the little finger, the thumb is pressed, the spine with lateral curvature (scoliosis), the valgus foot (like the letter "X"), the Achilles tendon is shortened.
Over time, these poses become persistent. The muscles on the affected side are atrophic and underdeveloped.
Important! With hemiplegia, the child has a characteristic gait and a vertical pose, which in medicine is known as the Wernicke-Mann pose. It is very precisely characterized by the phrase: "The hand asks, the foot mows." This is because the leg on the affected side is straightened in the thigh and knee, it is bent in the foot, and the child rests only on his fingers. Ahead goes ahead, and a hand on the affected side asks for alms. 40% of children with a similar pathology have a mental retardation.
There is no direct proportion to the degree of motor impairment. Social adaptation in such patients is determined by the degree of development of intelligence. A favorable prospect is that cerebral palsy does not progress, because brain damage in this disease is point-like and does not spread. ICD 10 spastic hemiplegia has the code G81.1, the inborn variant is G80.2.
Etiology of the phenomenon
The reasons include:
- impaired brain development;
- fetal hypoxia;
- fetal infections, especially viral;
- Rhesus conflict with hemolytic disease of the newborn;
- fetal brain injury during childbirth;
- brain infections in early childhood - up to 3 years;
- toxic damage to the fetal brain;
- pathological birth;
- bruises of the spinal cord and brain in a child;
- brain tumors;
Also causes of spastic hemiplegia:
- parasitic infestations;
- exo and endogenous intoxication;
- 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 a violation of the formation of central motor neurons in the fetal development.
Pathology classification
By 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 changes in the cells, muscle tone and reflexes remain normal. This form of hemiplegia can disappear spontaneously by itself. By the location of the lesion, these types are distinguished:
- Double spastic hemiplegia cerebral palsy - all limbs. This form is considered the most severe.
- Homolateral lesion - the focus in the brain is on the side of the affected limbs.
- The contralateral form is the focus and limbs in the crosshairs.
Options for the course of the disease:
- central hemiplegia - muscle hypertonicity and paralysis;
- cross hemiplegia - arm on one side, leg on the other;
- sluggish 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 hemiplegia of cerebral palsy is: right-, left- and bilateral.
Symptomatic manifestations
Common symptoms include:
- speech impairment, mental disability;
- muscle hypertonicity with seizures;
- decreased articular reflexes with a parallel increase in tendon and periosteal;
- myalgia;
- cyanotic skin on the limbs and their cooling;
- pathological reflexes;
- gait disturbance;
- involuntary movements in the affected limbs;
- facial expressions for the same reason.
Pathological reflexes are unconditional innate 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, ankylosing spondylitis;
- extensor stop signs - Babinsky, 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 - late residual.
According to the stages, signs and symptoms are also early and late. Early symptoms of spastic hemiplegia in infants:
- neuropsychic development lags behind - the child does not hold his head, cannot turn over, does not stretch and does not follow his eyes with objects;
- does not sit and creep;
- in games, the baby uses only one hand, the second - all the time bent and pressed to the body.
These symptoms of spastic hemiplegia in infants can have varying degrees of severity, which is determined by the volume of brain damage.
The affected side is constantly in hypertonicity, because of this movement become excessively sharp, jerky. They arise aimlessly and are completely uncontrolled. Some movements, on the contrary, are slow and worm-like. The remaining symptoms are late:
- shortening of the affected limb, which leads to scoliosis and curvature of the pelvic bones;
- joint contracture - their immobility;
- muscle cramps;
- due to incompatible 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 disturbed due to uncoordinated movements of the lips, tongue and throat.
Speech at cerebral palsy
Spastic hemiplegia in children does not always produce a lack of speech. Intelligence in cerebral palsy can be different: remain normal or lag behind debility. With sufficient intelligence, children can study in a regular comprehensive school and later receive a specialty.
It is difficult for sick children to make arbitrary sounds, because the muscles involved in the pronunciation process are always in hypertonicity.
Often impaired vision - myopia and strabismus. On the part of the teeth - frequent caries, improper placement of teeth, enamel pathology. Uncontrolled work of the muscles of the pelvic floor 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 considered when carrying out the adaptation of the child. It has already been mentioned that cerebral palsy does not have the ability to progress, although often it seems to parents. Why? Because the child is growing up, and the symptoms can become more pronounced, for example, he has problems with learning. Symptoms do not intensify: 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 - bouts of seizures, the child does not raise and does not hold his head;
- impaired sucking, increased salivation;
- at the age of 4-5 months, the child does not respond to external sounds, does not turn his head, does not blink, does not walk;
- indifferent to toys and does not reach for them;
- more than 7 months - does not sit down, does not turn over;
- makes no attempt to crawl;
- when a child is more than a year old, he does not try to get up and take steps, says nothing;
- up to 12 years old, uses mainly with one hand, strabismus often occurs;
- the gait is difficult, cannot rely on the foot, it becomes only on the fingers.
Important! A sick child is not aware of his defect - anosognosia.
Diagnostic measures
Clinical manifestations are too specific to be difficult to diagnose. But pathology needs to be differentiated. To do this, you need to find out the etiology, collect a complete and detailed history, conduct a physical examination and a neurological examination with tests.
Laboratory research:
- UAC and OAM;
- blood biochemistry;
- study of CSF after lumbar puncture;
Instrumental research:
- electromyography;
- CT and MRI of the brain;
- dopplerography;
- EEG.
With the help of MRI, it is possible to detect atrophy of the cortex and subcortex of the brain, a reduced density of white matter and its porosity.
Treatment principles
The tactics of treating a child with spastic hemiplegia of cerebral palsy almost entirely 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, drugs are primarily prescribed to improve nervous trophism in the tissues and conduct impulses from neurons. These are “Baclofen”, “Midokalm”, “Dysport”, etc.
The restoration of the nerve pathways, muscle relaxation and the removal of spasticity become important. Among such means:
- neuroprotectors, neurotrophics, vasoactive drugs;
- analgesics;
- restorative 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 effects on diseased limbs, massage, exercise therapy, kinesitherapy are used.
They 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 contracture, pressure sores. Constantly such patients use standers - they help the child stand. In addition to them, they use walkers, stand-ups, exercise machines, a bicycle.
Physiotherapy procedures are very effective and widely used:
- barotherapy;
- magnetotherapy;
- muscle electrical stimulation;
- laser therapy.
Additional unconventional methods of exposure:
- reflexology;
- manual therapy;
- phytotherapy;
- water treatments.
Sick children need a separate adaptation, especially if it is a right-handed person with a lesion on the right side.
The child must learn to use everyday objects. The room where he lives, you need to adapt as much as possible for him. Orthopedic and orthopedic help is also needed.
Much depends on the parents and the help of a neurologist. Be sure to conduct classes with a speech therapist. The severity of 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 prophylaxis. Only general recommendations can be given. A pregnant woman should:
- constantly monitored by a doctor;
- quit smoking and alcohol;
- eat rationally;
- Exercise regularly with a sick baby;
- protect yourself from injuries to the brain and spinal cord;
- treat neuroinfections in time;
- regularly visit your neurologist and work with him.
A favorable outcome of hemiplegia is the transfer of the child to a state of hemiparesis. Full recovery is rare. The worst prognosis is for those with double hemiplegia. Such patients often receive the first group of disabilities, because they are not able to service themselves and move.