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Also called the “flaccid” form. It is characterized mainly by a decrease in muscle tone. The child cannot control the movements of the head, limbs, and torso. There are also disturbances in motor coordination and balance, but these symptoms are not dominant. Another feature of this form is that motor disorders are certainly combined with a sharp delay in the development of speech and psyche.

In the supine position, the child is lethargic and inactive. Muscle tone is reduced, and less so in the arms than in the legs. Hand movements are more active.

The child begins to hold his head only after 6 months. If he is taken under the armpits, he cannot maintain a vertical position; his head and torso are tilted forward. In the prone position - unable to hold your head up for a long time and lean on your arms.

The child begins to sit at one and a half to two years. In this position, the legs are spread wide and turned (rotated) outward. Kyphosis of the thoracic spine is pronounced. The position is unstable, the body sways from side to side. Resistance appears at 4-6 years.

A child begins to stand at the age of 4-8 years, spreading his legs wide apart and holding an adult’s hand or support. Without support, he falls under the influence of gravity, while the protective reaction of the arms and compensatory movements of the torso aimed at maintaining balance are absent. The patient's torso is supported by resting on the heels during recurvation (hyperextension) of the knee joints. The head and torso are tilted forward, the hip joints are in a state of flexion, the legs are tilted back, and the feet are planovalgus. The posture is largely due to severe quadriceps weakness.

Such children can move independently after 7-9 years of age, and only over short distances. The gait is characterized by instability and irregularity. Children often fall. The legs are wide apart when walking.

80-90% of children experience a pronounced decrease in intelligence and speech impairment. Such children are often aggressive, negatively disposed, and it is difficult to come to an agreement with them about anything.

The prognosis for the restoration of motor functions and social adaptation is unfavorable.

A.S. Levin, V.V. Nikolaeva, N.A. Usakova

Original nootropic drug for children from birth and adults with a unique combination of activating and sedative effects

Early diagnosis and comprehensive treatment of cerebral palsy

S.A. Nemkova, Russian National Research Medical University named after N.I. Pirogov" of the Ministry of Health of Russia, Moscow, Doctor of Medical Sciences.

Keywords: cerebral palsy, children, treatment, rehabilitation, Pantogam ®
Keywords: cerebral palsy, children, treatment, rehabilitation, Pantogam ®

Cerebral palsy (CP) is a disease that occurs as a result of brain damage in the perinatal period or as a result of an abnormality in its development and is characterized by disturbances in motor and statokinetic functions, as well as psycho-speech and sensory disorders.

CLASSIFICATIONS of cerebral palsy:
According to the International Statistical Classification ICD-10, the following are distinguished:
G 80.0– Spastic cerebral palsy.
G 80.1– Spastic diplegia.
G 80.2– Childhood hemiplegia.
G 80.3– Dyskinetic cerebral palsy.
G 80.4– Ataxic cerebral palsy.
G 80.8– Another type of cerebral palsy.
G 80.9– Cerebral palsy, unspecified.

Clinical classification K.A. Semenova includes the following forms of cerebral palsy: double hemiplegia, spastic diplegia, hemiparetic form, hyperkinetic form, atonic astatic form, mixed forms.

The frequency of forms of cerebral palsy is: spastic diplegia - 69.3%, hemiparetic form - 16.3%, atonic-astatic form - 9.2%, hyperkinetic form - 3.3%, double hemiplegia - 1.9%.

Early manifestations of cerebral palsy are:
delayed motor and psycho-speech development, absence or delayed reduction of congenital and tonic reflexes, as well as the formation of attitudinal reflexes, impaired muscle tone, increased tendon reflexes, the appearance of pathological attitudes and synkinesis.

Early clinical and neurological diagnosis of cerebral palsy is largely based on the doctor’s knowledge sequence of stages formation nervously- mental development 1 year old child : 1 month – the child tries to hold his head, fix his gaze, innate reflexes are expressed; 2 months – briefly holds the head on the stomach and in an upright position, fixes the gaze, hums, physiological astasia-abasia; 3 months – holds his head, follows the object, weakens the grasping reflex and tries to voluntarily hold the inserted toy, rests on his forearms on his stomach; 4 months – turns his head in the direction of the sound, reaches out and takes a toy, turns on his side, sits down and sits with the support of his hands, pronounces vowel sounds; 5 and 6 months – sits with support from 1 arm or briefly independently, turns from back to side and stomach, distinguishes familiar faces, first syllables appear; 7 and 8 months – sits independently, gets on all fours, tries to stand briefly against a support; 9 and 10 months – kneels with support, stands and tries to move with support, stands independently for a short time, speaks the first words; 11 and 12 months – walks with support from 1 handle and tries to walk independently, performs simple instructions, says a few words, tries to eat on his own with a spoon.
Assessment of the degree of delay in motor and psycho-speech development:
up to 3 months – mild, 3–6 months – moderate, more than 6 months – severe.
Correction factors for prematurity:
up to 1 year – the period of prematurity in months is added, from 1 year to 2 years – half the period of prematurity in months is added.

For motor development healthy child a certain sequence is characteristic, which is manifested by the extinction of unconditioned reflexes, the formation of adjustment (straightening) reflexes, and the improvement of equilibrium reactions.

One of early signs Cerebral palsy is a violation of the timely reduction (at 2 months in full-term children, at 3–4 months in premature infants) of unconditioned reflexes - palmar-oral, proboscis, Moro, support and automatic gait, postural reactions (labyrinthine, as well as cervical tonic asymmetric and symmetric reflexes). As unconditioned reflexes fade, starting from 1 month of life, adjustment reflexes are formed (labyrinth adjustment, chain cervical adjustment, etc.), which provide turns and straightening of the body and are improved up to 10–15 months. In patients with cerebral palsy, tonic reflexes can persist for life, which inhibits the formation of adjustment reflexes, voluntary motor activity, balance reactions and leads to the development of a pathological postural stereotype.

Impaired muscle tone is one of the early signs of developing cerebral palsy. Muscle hypertonicity and asymmetrical posture that persist after 4 months are observed in the consequences of perinatal lesions of the central nervous system and the threat of cerebral palsy (its spastic forms). The “spread out frog” position is observed with diffuse muscle hypotonia in premature infants, with perinatal lesions of the central nervous system, and the threat of atonic-astatic form of cerebral palsy.

CLINICAL FORMS OF CEREBRAL PALSY

At spastic diplegia the history of prematurity is common (67%), the clinical picture shows tetraparesis (the lower extremities are affected to a greater extent than the upper ones), sharply increased muscle tone of the extremities, body, tongue, high tendon reflexes, increased tonic reflexes, pathological attitudes and deformations are observed limbs, a spastic gait with a cross is formed, while only half of the patients walk independently, 30% with support, the rest move in a wheelchair. Speech disturbances in the form of spastic dysarthria and vision pathology in 70% of patients (refractive errors, optic nerve atrophy, strabismus) are characteristic.

Hemiparetic form often caused by birth trauma, the clinic notes spastic hemiparesis, with the upper limb suffering more than the lower, shortening and hypotrophy of the affected limbs, hemiparetic gait, Wernicke-Mann position with flexion of the arm and extension of the leg (“the hand asks, the leg squints”). , foot deformities and contractures on one side, the incidence of symptomatic epilepsy is high (about 35% of cases).

Hyperkinetic form is often the outcome of bilirubin encephalopathy due to kernicterus, which develops in full-term newborns with a bilirubin level in the blood of 428–496 µmol/l, in premature infants – at 171–205 µmol/l. Characterized by violent involuntary movements (hyperkinesis) of the limbs and torso, which intensify with excitement and disappear during sleep. Hyperkinesis appears first in the tongue (at the age of 3–6 months), then spreads to the face, and then by 2–6 years to the trunk and limbs. Disturbances in muscle tone such as dystonia are noted, autonomic disorders, hyperkinetic dysarthria, and sensorineural hearing loss are common (in 30–50%).

Atonic-astatic the form is characterized by low muscle tone, impaired coordination of movements and balance, as well as excessive range of motion in the joints of the limbs.

Double hemiplegia – the most severe form of cerebral palsy, manifested by gross motor impairment, increased muscle tone, tendon reflexes, severe speech impairment, and the mental development of children at the level of mental retardation.

The most significant complications of cerebral palsy:
orthopedic-surgical, cognitive and sensory disorders (in 80%), episyndrome (in 35%), behavioral disorders, neurotic disorders (in 2/3 of patients), autonomic dysfunction syndrome (in more than 70%).

The leading principles of cerebral palsy rehabilitation are:
early start, comprehensive multidisciplinary approach, differentiated nature, continuity, duration, phasing, succession. Rehabilitation treatment of a patient with cerebral palsy should be carried out in accordance with an individual rehabilitation program and include the following areas:
1. Medical rehabilitation: drug therapy, physical therapy and massage (classical, segmental, periosteal, connective tissue, circular trophic, point), Vojta therapy, neuro-developmental system B. and K. Bobath; use of therapeutic-load suits (“Adelie”, “Gravistat”, “Regent”, “Spiral”), pneumatic suits (“Atlant”, etc.), mechanotherapy (exercises using simulators and special devices, including robotic complexes (Lokomat, etc.), physiotherapy (electrotherapy - electrophoresis and electromyostimulation, magnetic therapy, paraffin-ozokerite applications, mud therapy, hydrokinesiotherapy, acupuncture), orthopedic-surgical and sanatorium-resort treatment.

2. Psychological, pedagogical and speech therapy correction(psychocorrection, sensory education, classes with a speech therapist-defectologist, conductive pedagogy by A. Peto, Montessori method, work with families, etc.).
3. Social and environmental adaptation.

Drug therapy for cerebral palsy includes:

• Drugs that have neurotrophic and nootropic effects (Pantogam ®, Cortexin, Cerebrolysin, nootropil, phenibut).
• Drugs that improve general cerebral hemodynamics and microcirculation (Cortexin, cinnarizine, Actovegin, Trental, Instenon, etc.).
• Drugs that improve metabolism in the nervous system, reparative and absorbable effects (ATP, lidase, vitreous, sodium derivative, etc.).
• Anticovulsants.
• Drugs that normalize muscle tone (for hypertonicity - mydocalm, baclofen, botulinum toxin preparations; for hypotension - prozerin, galantamine).
• Drugs that reduce hyperkinesis (Pantogam ®, phenibut, nacom, thiopridal).
• Vitamins (B1, B6, B12, C, neuromultivitis, aevit, etc.).

Pantogam ® (“PIK-PHARMA”) is a nootropic drug with a wide spectrum of clinical action, combining neurometabolic, neuroprotective and neurotrophic effects. Pantogam ® is included in clinical guidelines for the treatment of cerebral palsy (2014). The advantage of using Pantogam is the presence of a pharmacological form of release, both in the form of tablets and 10% syrup, which allows it to be used from the first days of life in children with perinatal damage to the central nervous system for the purpose of preventing and treating cerebral palsy. Pantogam ® – a preparation of hopantenic acid (a natural metabolite of GABA) – successfully combines mild psychostimulating, moderate sedative, anticonvulsant and detoxification effects.

Mechanisms of action of Pantogam: directly affects GABA-B receptors, potentiates GABAergic inhibition in the central nervous system; regulates neurotransmitter systems, stimulates metabolic and bioenergetic processes in nervous tissue; reduces cholesterol and beta-lipoprotein levels in the blood.

The range of clinical applications of Pantogam for perinatal lesions of the central nervous system and cerebral palsy includes:
1) cognitive impairment, including delayed psycho-speech development and mental retardation, early postoperative cognitive dysfunction, speech disorders;
2) delayed motor development, movement disorders;
3) neurotic and neurosis-like disorders, emotional disturbances;
4) cerebral palsy in combination with epilepsy (since Pantogam ®, unlike most nootropic drugs, does not cause a decrease in the threshold of convulsive readiness);
5) hyperkinesis (Pantogam ® is used as long-term monotherapy - up to 4-6 months, in case of insufficient effectiveness - as part of complex therapy with thiopridal), extrapyramidal side effects neuroleptic therapy;
6) asthenic syndrome, decreased mental and physical performance;
7) autonomic dysfunction syndrome;
8) pain syndrome (as part of complex therapy).

The use of Pantogam has been shown to be highly effective in children with a complicated perinatal history in the complex rehabilitation of motor and cognitive disorders (with improvement in psychomotor activity and hand-eye coordination by 10–45%, short-term memory by 20–40%, attention by 30 %), sleep disorders. It has been shown that the use of Pantogam in children with developmental dysphasia (alalia), resulting from perinatal damage to the central nervous system, improves speech indicators by more than 3 times. It was found that the use of Pantogam in the postoperative period effectively neutralizes the manifestations of postoperative cognitive dysfunction with the restoration of the indicator of concentration of attention and its subsequent improvement in 30% of patients by 2.5 times.

In children with perinatal pathology and cerebral palsy, one of the leading tasks of pathogenetic pharmacotherapy is to increase the energy potential of the brain using metabolically active agents. L-carnitine preparation - Elkar ® ("PIK-PHARMA") - is a stimulant energy metabolism, has antioxidant, anabolic, detoxification properties, as well as neuroprotective and neuromodulatory effects.
Studies of the effectiveness of using Elkar in children with perinatal pathology indicated a decrease in their excitability, normalization of autonomic functions, improvement in height and weight indicators and motor-reflex sphere, mental development, EEG. In cases of pathological bilirubinemia in newborns, a more rapid regression of jaundice was noted when taking Elcar with a decrease in indirect bilirubin in the blood.
In patients with cerebral palsy, when using Elkar in the process of complex rehabilitation, tolerance to both mental and physical activity, coordination, neurosensory processes (visual and hearing acuity), speech, autonomic functions, ECG and EEG have improved (with normalization of cortical electrogenesis, reduction of epileptic manifestations). In patients with cerebral palsy who received Elkar ® in the pre- and postoperative period of orthopedic-surgical treatment, there was a noticeable improvement in skin trophism, a decrease in postoperative complications, and the need to use analgesics.

Thus, early diagnosis and comprehensive treatment help to increase the effectiveness of rehabilitation measures, reduce disability and increase social adaptation of children with cerebral palsy.

The list of references is in the editorial office.

Demonstration. An example of rehabilitation of a 5-year-old child with an atonic-astatic form of cerebral palsy (from the author’s video archive).
A 5-year-old boy, Yura, was admitted to rehabilitation for an atonic-astatic form of cerebral palsy.
A boy from the first pregnancy, which proceeded without complications in a 27-year-old mother. Urgent birth. Long waterless period. Stimulation of labor. The child was born in blue asphyxia. Apgar score -5 points. Resuscitation measures within 5 minutes. Then, for a month, he was in the neonatal care unit. After discharge home, there was a decrease in the tone of all muscle groups. The child could not hold his head. When the body verticalized, the eyes rolled under the forehead. From the moment he was discharged home, he received nootropics, Cerebrolysin vitamins, massage, and acupuncture. Repeatedly annually treated in various rehabilitation centers Ukraine and Russia. No positive dynamics were noted. The child was found to have no prospects for rehabilitation. Parents were repeatedly offered to place their child in a nursing home.
Upon admission to us for rehabilitation in November 1994, there was a sharp lag in weight, height and other age-related parametric data. Teeth: 2 upper and 2 lower incisors. At the age of 5 years, the child looked like one and a half year old children in terms of height and weight. Active movements in the limbs are sluggish and low-amplitude. When the body was verticalized, there was a short-term fixation of the eyes in the middle position for 2-3 seconds, then the eyes rolled under the upper edge of the eye sockets. The child held the head in a vertical position for 1-2 minutes. In a horizontal position, lying on his stomach, the child tried to raise his head, but could not turn it. I tried to bend my legs at the hip joints and crawl, but I didn’t have enough strength. Nipple feeding. The child, according to his mother, never cried in all 5 years of his life. All reflexes are sharply reduced. According to the parents, over the last year the child began to periodically make faint sounds. During the inspection period he did not make a sound. A CT scan of the brain did not reveal any gross pathology.
Rehabilitation. From the first day, the child was taken off nootropics and Cerebrolysin. Eleutherococcus was prescribed, 10 drops once in the morning for a month. Vitamin "C" 0.25g, "calcinova" x 3 times a day. It is recommended to give the child more water and juices. At the same time, procedures using the author's technology were started (see description of procedures) 2 times a day, morning and evening. General intensive massage of the whole body and limbs. Interestingly, already on the second day, in the evening, after three procedures, the child was able to raise his head and roll over in bed on his own. On the third day, he was already crying and trying to actively resist the procedures, although he was still very weak. The mother noted a sharp increase in the child's appetite. By the end of the week, the child was able to sit up independently in bed without support, actively walked and made various sounds. Began to reach out to bright toys. The tone in the legs and arms sharply increased, by the end of the second week the child was actively trying to crawl, rolling from back to stomach, from stomach to back, and trying to sit up in the crib. By the end of the second week, the mother noted the eruption of new teeth. Discharged after 2 weeks for admission to continue rehabilitation after 3 months.
Three months after the first course of intensive rehabilitation, the child’s parametric characteristics (height, weight) corresponded to the age of 3 years. The number of teeth increased to 15. Movements in the hands were full, some hypertonicity of the flexors of the upper and lower limbs. Eats independently. Can walk, holds the torso straight, but there is a predominance of flexor tone and inward rotation of the feet. He speaks tongue-tied, but lexicon big. Reads poetry. The child has a good memory. It’s amazing what the child tries to tell with emotion and detail about the first days of rehabilitation.
The 2nd course of rehabilitation lasted for 2 weeks with the use of a therapeutic suit DK (see description in the following chapters). The child began to speak more clearly and count to 20. He learned to ride a 3-wheeled bicycle, which he did all day long. During the rehabilitation period, the legs stretched and straightened, but a slight inward rotation of the feet remained.
For a year, the child’s parents used a therapeutic recreation suit. Observation a year later showed that the child was developing rapidly. At the time of examination, the child was one year behind his peers in terms of height and weight. The child's intelligence was even higher than that of his peers. Knows a lot of poetry, can read, writes in block letters, counts to a thousand. Walks and runs freely, but a slight inward rotation of the feet remains.
This example convincingly demonstrates that atonic-astatic forms of cerebral palsy can be corrected even faster than spastic forms. When conducting the first course of rehabilitation measures, children with the atonic-astatic form of cerebral palsy must be prescribed a hard general massage of the whole body and limbs. At a certain stage of recovery, such a child will have a clinical picture resembling a spastic form of cerebral palsy with predominant lower paraparesis. But this clinic will differ from the true form of spastic paraplegia in the absence of spastic, uncontrolled movements, the absence of hyperreflexia and hyperesthesia. This clinical picture can be explained by “short muscle syndrome”, which develops as a result of rapid growth bones and retarded growth and development of abductor and extensor muscles. Physiotherapy, massage, exercise therapy lead to accelerated muscle development, normalize muscle balance, align posture, and eliminate growth deformities of long tubular bones. Accelerated growth and teething in the first month of rehabilitation are an objective criterion for the positive dynamics of the rehabilitation process and development of the body.

Hyperkinetic forms of cerebral palsy are very diverse, so it is difficult to give precise recommendations for the treatment of each specific form.
In the context of the pathogenesis of cerebral palsy described in this book, hyperkinesis can be considered not only as a consequence of local damage to the nuclei of the brain, but also as a dynamic generalized form of specific responses to nonspecific stimuli in the form of intermittent spastic contractions of striated muscles.
Increased chaotic movements are caused by damage to the nuclei of the brain and additional compression or overstretching of the membranes of the roots as they exit the intervertebral foramina. Irritation of the nerve fibers in the roots leads to additional distortion of the signals coming from the gamma receptors of the tendon-ligamentous apparatus of the joints of the limbs, which forms inadequate motor reactions of the child.

Features of rehabilitation of children with generalized forms of hyperkinesis

Based on the concept of a specific response to a nonspecific stimulus, we can recommend techniques that facilitate the rehabilitation of such children.
1. Tractional rotational manipulation technology is performed on all children with hyperkinesis, although its implementation in the first days causes certain difficulties.
Hyperkinesis of the head and individual limbs can be easily corrected, and sometimes stop even after a week-long course of procedures. In generalized forms of hyperkinesis, only 10% of children manage to eliminate chaotic movements immediately after the first course of traction rotational manipulation technology. After the procedures, the remaining children experienced improved sleep, easier movements, and the appearance of high-amplitude modeled movements. After the first course of intensive rehabilitation, all children with hyperkinesis experience accelerated growth and development. But, some time after the first course of procedures, the growth of the vertebrae in length leads to an increase in compression of the roots or overstretching of the dura mater around the nerve roots, which can manifest itself in the form of resumption of hyperkinesis. Unlike a relapse, renewed hyperkinesis will never achieve the same phenomena that were observed before the first course of procedures. The purposeful movements that the child learned after the first course of rehabilitation are preserved. The fact of increased hyperkinesis indicates the need to repeat a short course of traction rotational manipulation technology. After repeated 5-7 procedures, the phenomena of hyperkinesis decrease even more than after the first course of procedures. During the treatment period, it is very important not to miss the moment of facilitating movements in order to develop the skills of coordinated movements until the growth and development of the vertebrae leads to a new manifestation of the hyperkinesis clinic.

Cerebral palsy is a serious chronic disease. combines those that are associated with impaired human motor function. 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.

Appears 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 occur. The child experiences outbursts of unreasonable aggression and increased excitability. There are 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:

• ultrasound examination of the brain;
• Craniography, etc.

The results of the study provide information about the depth of changes 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 measures, studies are done, which allows you to assess the type of damage and determine the specific location of the brain damage.

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.

Prevalence of various forms of impairment

It is a common disease. According to rough estimates, for every one thousand healthy children there are up to 3 patients with cerebral palsy. If we consider the data on the prevalence of forms of cerebral palsy, we can note that

• Spastic diplegia is the leading among all forms,
• second place – hemiparetic form,
• third - double hemiplegia,
• fourth – atonic-astatic form,
• and finally, the fifth most common form of cerebral palsy is the hyperkinetic form of the disease.

Hyperkinetic form of cerebral palsy is for girls

Boys are much more likely to suffer from spastic diplegia and double hemiplegia, while girls are more likely to suffer from the hyperkinetic form of cerebral palsy.

If we compare the overall ratio of boys and girls diagnosed with cerebral palsy, it turns out that boys make up 58.1%, girls – 41.9%.

Cerebral palsy is an incurable disease, but this does not mean that its treatment does not need to be treated at all.

Patients need help from both doctors and teachers so that they can achieve the maximum possible positive results for this disease and can, to the extent possible, adapt to environment. For these purposes, it is necessary to identify the disease as early as possible and begin its treatment.

The medical term cerebral palsy combines diseases associated with various motor disorders caused by abnormalities in the development of the brain before birth.

The atonic-astatic form of cerebral palsy occurs when the cerebellum and frontal lobes of the brain are damaged. This is the most severe form of cerebral palsy, until recently it was considered practically incurable.

Symptoms of the atonic-astatic form of cerebral palsy

Symptoms of the disease can be noticed in a child already in the first year of life.

· The baby's muscles are relaxed, the tone is very weak.

· The child does not hold his head for a long time, control over its movements is reduced or absent altogether.

· The grasping reflex in the palms is practically absent.

· Movements are fussy, their coordination is impaired. Before performing any action, the child makes many unnecessary movements.

· Tremor of the limbs is pronounced.

A child with this diagnosis develops vestibular skills very late or does not develop at all. The child cannot sit and stand independently. Impaired balance may prevent you from starting to walk at all.

The earliest time a child begins to sit independently is not earlier than one and a half years. The groove, at the same time, is very unnatural and unstable, the knees are strongly separated, there is pronounced kyphosis of the thoracic spine. A more stable position of the body is observed only at the age of 4 years.

The baby constantly thinks that he will lose his balance and fall, because of this, manipulative skills of the hands do not develop for a long time (grabbing an object, holding a spoon in his hand and the ability to bring it to his mouth without spilling the contents).

The first attempts to stand independently or take a few steps appear at 4 years of age. In this case, the child can stand for a short time, holding onto a support. Deprived of support, he immediately falls, and the balance reflex is absent. Such children begin to walk no earlier than 7 years of age. Their gait is very unsteady, their steps are not rhythmic, they spread their legs wide apart, and all their muscles are very tense. The head and torso of such children make many unnecessary movements, and they can only move within the apartment.

More than 80% of children with this form of the disease have reduced intelligence. They are often very aggressive and tend to perceive any situation from the negative side. If the lesion affects only the cerebellum, children lack initiative and are unable to learn to write and read. When the frontal lobes are also affected, the child cannot assess his condition and is very aggressive.

Almost half of patients suffer from seizures, optic atrophy or strabismus.

Methods of treatment and rehabilitation

Treatment of such children comes down to taking very expensive and ineffective drugs. There is practically no cure for this form of cerebral palsy. Rehabilitation measures, massage and physiotherapy courses are carried out, which give a very low effect.

In numerous rehabilitation centers, children are given massages and do therapeutic exercises, but this also does not give real results.

With the formation of specialized hippotherapy centers for the treatment of children with such problems, there is a real possibility of recovery from this form of the disease.

Hippotherapy treatment

The horse is the most wonderful animal created in this world. The influence of a horse on sick children works wonders. Every day, the possibility of treating the most severe diseases with the help of hippotherapy is being studied more and more carefully.

Children with the atonic-astatic form of cerebral palsy, who began training in the first year of life, master motor skills much faster.

Experienced instructors and doctors teach children how to sit correctly in the saddle; these classes restore muscle tone, prevent scoliosis from developing, and straighten the head position.

After several months of training, one year old baby already sits confidently and can stand without support. Tremors are significantly reduced, the child no longer makes so many unnecessary movements.

The need to hold the reins correctly and control the horse stimulates the development of motor skills, and consequently mental development. The child learns the basics of literacy more easily, remembers simple poems, and learns to write.

The psychological impact of these noble animals significantly reduces children’s aggression, relieves feelings of fear, and helps them gain confidence in themselves and their capabilities. Children become more sociable and begin to communicate with their peers. In the most favorable cases, the child can even attend kindergarten.

The most important thing for parents is to choose the right center for classes. A specialist should prescribe a course of hippotherapy, and experienced instructors should conduct training and monitor the child. Before admission to the center, the child is examined in order to exclude the presence of an allergy to animal hair, or other symptoms that may become an obstacle to classes.