Rehabilitation of children with cerebral palsy: a description of the methods

Effective rehabilitation of children with cerebral palsy includes a set of measures. 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 is also possible, provision of permits for treatment in sanatoria, provision of medical products and technical rehabilitation.

Causes of the disease and risk factors

The causes of cerebral palsy are divided into intrauterine provocative factors and postpartum factors. The first type is:

• Severe pregnancy;
• Unhealthy lifestyle of the mother;
• Hereditary predisposition;
• Complex births during which fetal asphyxia emerged;
• Acute or some chronic illness of the mother;
• Children born before the term and with low weight;
• Infectious processes that occur in a latent form in the mother's body;
• Toxic poisoning of the child's brain due to incompatibility of the mother and fetus by blood group and Rh factor or liver failure of the child.

Postpartum triggers include:

• The weight of the child up to 1 kg at birth;
• The birth of twins or triplets;
• Head trauma 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 disease. The individual rehabilitation program can be revised except in the case of premature and small children - such patients often require more thorough care and medical supervision.

The main phases of the disease course

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 disease:

1. Early (up to 5 months). Cerebral Palsy is manifested by a delay in development, the preservation of unconditioned reflexes.
2. Initial (up to 3 years). A child often chokes on food, does not seek to speak, asymmetry, hypertonus or excessive muscle relaxation is noticeable.
3. Late (over three years). It is manifested by the shortening of one limb in comparison with the other, disturbances of swallowing, hearing, sight, speech, convulsions, disturbances of urination and defecation, mental retardation.

Early signs of infantile cerebral palsy

The early signs of cerebral palsy include the following deviations:

• Delay in physical development: head control, overturning, sitting without support, crawling or walking;
• Preservation of "children's" reflexes after reaching 3-6 months of age;
• The predominance of one hand to 18 months;
• Any symptoms that indicate hypertonic or excessive relaxation (weakness) of the muscles.

Clinical manifestations of the disease can be both pronounced and almost invisible - it all depends on the degree of damage to the central nervous system and the brain. Seek medical attention if:

• The child's movements are unnatural;
• The child has cramps;
• The muscles look excessively relaxed or tense;
• The baby does not blink in response to a loud sound in one month;
• At 4 months the child does not turn his head to a loud sound;
• At 7 months does not sit without support;
• At 12 months does not speak individual words;
• The baby does not walk or walk unnaturally;
• The child has strabismus.

Complex rehabilitation of children with cerebral palsy gives the best results if it starts at an early age. In severe forms of the disease, untimely recovery of physical activity or the late development of social skills, a child may remain completely unadapted to life.

Is it possible to cure a disease

Cerebral Palsy refers to diseases that are almost impossible to cure completely. However, comprehensive and timely begun rehabilitation allows children with such a diagnosis to be trained on a par with healthy 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 goal of individual rehabilitation programs for children with paralysis is the phased development of skills and abilities, physical and social adaptation. Techniques that are developed individually for each child, gradually correct motor defects, improve motor activity, develop the patient emotionally, personally and socially, develop skills of independence in everyday life. As a result of systematic rehabilitation, a child can infiltrate into society and adapt to further life independently.

The program of rehabilitation of children with cerebral palsy includes the following approaches:

• Treatment with water procedures: swimming, balneotherapy or hydrotherapy;
• PET-therapy, or treatment by animals: hippotherapy (treatment by horses), psychophysical rehabilitation in the process of communicating with dolphins and swimming;
• Application of orthopedic devices, simulators, gymnastics balls, ladders;
• Mud applications, which increase the bioelectrical activity of muscles;
• Therapeutic massage, which allows to reduce the degree of lethargy and spasm of muscles;
• Medicamental treatment: Botox, botulinum toxin, xeomin, dysport;
• Vojta-therapy, allowing to restore natural models of behavior;
• Physiotherapeutic treatment: myotone, ultrasound, magnetotherapy, darsonvalization;
• Montessori therapy, which allows to form the ability to concentrate attention and develop independence;
• Classes with a psychologist;
• Logopedic exercises, corrective speech disorders ("Logorhythmics" program);
• Special pedagogy;
• Shiatsu-therapy - massage of biologically active points;
• Lessons on the Bobat technique - special gymnastics with the use of certain equipment;
• Laser exposure to reflexogenic zones, tip of the nose, joints, reflex-segmental zones, area of paretic muscles;
• Art therapy aimed at preparing a child for learning;
• Peto's method is the division of movements into separate acts and their learning;
• Surgical orthopedic interventions;
• Spa treatment;
• Alternative methods of treatment: osteopathy, manual therapy, catgut therapy, vacuum therapy, electro reflexotherapy.

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

Physical recovery of a sick child should begin as soon as possible. Leading specialists in the world have recognized that the rehabilitation of a disabled child (CP) brings the best results to three years, but in Russia many centers refuse to take children for a year or up to three years, and doctors are in no hurry with the diagnosis and disability registration. But still, physical rehabilitation is the most important stage in the adaptation of a special child to later life, and it is important to start studying with a small patient immediately after the diagnosis of "infantile cerebral palsy".

Rehabilitation of children with cerebral palsy is necessary to prevent muscle weakness and atrophy, to avoid the development of complications, and also to resort to it in order to promote motor development of the child. Apply therapeutic massage, physical education and exercises on special simulators. In general, any motor activity is useful, and the supervision of a specialist will help to form motor stereotypes, properly develop the physical form and prevent addiction to pathological conditions.

Rehabilitation Bobat-therapy

The most common form of rehabilitation is Bobat-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 take. Classes should be conducted in a relaxed environment, three times a day or a week, each movement is repeated 3 to 5 times. The movements themselves are slow, because the main goal of the treatment is muscle relaxation. Complexes of exercises are developed individually. Treatment according to the Bobat-therapy method can be carried out at home - the parent or guardian is trained to perform receptions with the help of a specialist in the rehabilitation center.

Technical rehabilitation means

When physical recovery of the motor activity of a child with cerebral palsy is also used means of technical rehabilitation of children. Cerebral palsy in severe form requires adaptations for mobility (walkers, wheelchairs), development (exercise bikes, special tables and chairs) and hygiene (bath seats, toilet seats) of the child. Also, rehabilitation tools for children with cerebral palsy suggest the use of orthopedic devices and simulators. It is used, for example, Adele suit, redistributing load, Gross simulator, developing motor skills, "Veloton", stimulating muscles, "Spiral" suit, allowing to form new stereotypes of movements, and so on.

Social rehabilitation of disabled children with cerebral palsy

Closer to school age, more attention is paid to social adaptation of the child. Efforts are focused on building self-reliance skills, mental development, preparing the child for collective learning and communication. In addition, the patient is taught to dress independently, serve himself, carry out hygiene, move around and so on. All this will reduce the burden on people caring for a disabled child, and the smallest patient - 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 and at home, is extremely important. Social rehabilitation of children (CP) pursues the following goals:

• Expansion of vocabulary and horizons;
• The development of memory, attention and thinking;
• The development of personal hygiene skills;
• Self-service training;
• Development of speech, formation of culture.

Children with this diagnosis can be educated in experimental classes, which are more often formed in private schools, but with significant restrictions it is better to think about boarding or training at home. In the boarding school the child can communicate with peers, receive special skills and participate in career counseling activities. When teaching at home requires more active parental involvement and daily medical supervision.

In many cases, further labor activity of a person with a diagnosis of cerebral palsy is possible. Such people can master the profession of intellectual work (teachers, but not junior classes, economists, architects, junior medical staff), work at home programmers, freelancers and even (with safety of hand movements) seamstresses. Employment is impossible only in severe cases.

Disability in cerebral palsy

Children's cerebral palsy has several forms and degrees of severity. Disability in cerebral palsy is made if the disease is accompanied by restrictions in relation to normal functioning, training, self-service, speech contact. Disability registration is possible only after a medical examination. Mother and child have to undergo a neurologist, surgeon, psychiatrist, pediatrician, orthopedist, ophthalmologist and ENT. On this "adventure" does not end. Followed by:

• Finalize the conclusion of the head of the medical institution;
• Pass the procedure for reconciling documents already in the adult polyclinic;
• To give a package of documents to the receipt point for medical and social expertise.

Depending on the term of disability, it is necessary to carry out medical and social expertise (and consequently, to re-pass all physicians) again after a certain period of time. Also, it is necessary to obtain anew the conclusions in the event that the designed individual rehabilitation program is undergoing changes - for example, if the child, on the prescription of a specialist, requires a new remedy.

Benefits for disabled children with cerebral palsy

Disability registration for some families is a vital issue, because it makes it possible to receive cash payments for rehabilitation and benefits.

So, families with children with disabilities with cerebral palsy are entitled to the following benefits:

• Free rehabilitation in federal and regional centers and sanatoria;
• A discount of at least 50% on payment of municipal or public housing, as well as housing and communal services;
• The right to priority acquisition of land for individual construction, gardening and housekeeping;
• Provision of medicinal products (prescribed by a doctor), products of therapeutic nutrition;
• Free travel to the place of sanatorium treatment and back, as well as in public transport (privilege is placed for disabled children and one accompanying person);
• Compensation for the services of a psychologist, teacher and speech therapist, determined by an individual rehabilitation program (not exceeding 11,200 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);
• A pension for a disabled child and additional payments (in total 14,600 rubles as of 2017);
• The period of care for a child with a disability is counted in the mother's work record;
• The mother of the disabled child with cerebral palsy has a number of benefits under labor law: can not be involved in overtime work, business trips, has the right to work part-time, to retire early, and so on;
• A single mother raising a disabled child can not be dismissed, except in cases of complete liquidation of an enterprise.

Rehabilitation centers in Russia

In special centers, the rehabilitation of children with cerebral palsy is carried out in a comprehensive manner and under the supervision of appropriate specialists. As a rule, systematic studies, an individual program and professional medical support for both children and parents make it possible to achieve significant results in a relatively short period of time. Of course, to consolidate the result you need to continue to deal with the proposed program and at home.

Russian Scientific and Practical Center for Physical Rehabilitation and Sports (Center Grossko)

In Russia there are several rehabilitation centers. Grossko Center in Moscow is working on a comprehensive program: upon admission, diagnostics are carried out, and then specialist instructors on physical recovery are engaged with a special child. Physical rehabilitation of children with cerebral palsy in the Grosssko Center includes physical exercises, swimming, exercises with special simulators that allow developing coordination of movements and fix motor stereotypes, training on the treadmill, roller skating. Based on the results of pedagogical testing, the programs are adjusted to ensure that the recovery corresponds to the needs and condition of a particular small patient.

The cost of child rehabilitation (cerebral palsy) in the Grosssko Center, of course, is not small. For example, for an initial reception you will have to pay 1,700 rubles, and the cost of 10 sessions of physiotherapy exercises (for 45-50 minutes) is 30,000 rubles. One lesson with a speech therapist (lasting 30 minutes), like a massage session (30-40 minutes according to the doctor's testimony) will cost 1000 rubles. However, the results of the exercises do exist, and the Grosssko Center itself is a prominent institution.

Russian Research Institute of Traumatology and Orthopedics. RR Vredena

The rehabilitation center for children with cerebral palsy named after RR Vreden (RIITO - 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 rehabilitation. At the disposal of highly professional specialists of the center with many years of practical experience of more than twenty fully equipped offices.

Moscow Scientific and Practical Center for the Rehabilitation of Persons with Disabilities due to Cerebral Palsy

Moscow NPC rehabilitation of people with disabilities due to cerebral palsy is considered one of the most accessible and well-known. Doctors of the center work on the basis of several dozens of rehabilitation programs, use all modern domestic developments and find an individual approach to each patient. The center accepts children from three years old. In addition to the physical rehabilitation itself, psychologists-defectologists, speech therapists, professional masseurs and conductor-teachers, who work with children and adults with disabilities of the CNS, are engaged with small patients.

Institute for Conductive Pedagogy and Restorative Movement Therapy in Budapest, Hungary

Rehabilitation of a disabled child (cerebral palsy) in the Institute. A. Petö in Budapest, the capital of Hungary, is the center where hundreds of families want to go. The institution is famous for its excellent specialists, the use of the latest developments in the treatment of small patients, as well as the visible results achieved by children with cerebral palsy who have undergone a rehabilitation course.

There are many other rehabilitation centers and sanatoriums that accept children with cerebral palsy for rehabilitation. Only in Moscow, for example, the Center for the rehabilitation of children with cerebral palsy "Movement", the Rehabilitation Center "Ogonyok", the Rehabilitation Center "Preodolenie" and others operate. In some institutions, free rehabilitation of children with cerebral palsy is also possible. Families with disabled children are also supported in charitable organizations and social centers.