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, the provision of vouchers for treatment in sanatoriums, the provision of medical preparations and technical rehabilitation facilities.

Causes of the disease and risk factors

The reasons for the development of cerebral palsy are divided into intrauterine provoking factors and postpartum. The first type includes:

• severe pregnancy;
• unhealthy lifestyle of the mother;
• hereditary predisposition;
• complex births during which fetal asphyxiation arose;
• acute or certain chronic diseases of the mother;
• children born prematurely and with low weight;
• infectious processes occurring in a latent form in the mother's body;
• toxic poisoning of the brain of the child due to incompatibility of the mother and fetus in the blood group and Rh factor or liver failure of the child.

Postpartum triggering factors include:

• baby weight up to 1 kg at birth;
• the birth of twins or triplets;
• head injuries at an early age.

In every third case, however, it is not possible to identify a 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. An individual rehabilitation program can be revised unless in the case of premature and small babies - these patients often require more thorough care and medical supervision.

The main phases 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:

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). The child often chokes on food, does not seek to talk, asymmetry, hypertonicity or excessive muscle relaxation are noticeable.
3. Late (older than three years). It is manifested by the shortening of one limb compared with another, impaired swallowing, hearing, vision, speech, convulsions, impaired urination and defecation, and mental retardation.

Early signs of cerebral palsy

The early signs of cerebral palsy include the following deviations:

• delayed physical development: head control, turning over, sitting without support, crawling or walking;
• preservation of "children's" reflexes after reaching 3-6 months of age;
• prevalence of one arm by 18 months;
• any symptoms that indicate hypertonicity or excessive muscle relaxation (weakness).

The clinical manifestations of the disease can be either pronounced or almost imperceptible - it all depends on the degree of damage to the central nervous system and brain. Seek medical help if:

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

Comprehensive rehabilitation of children with cerebral palsy gives the best results if it starts at an early age. In severe forms of the disease, untimely restoration of physical activity or the late development of social skills, the child may be completely unsuitable for life.

Can the disease be cured?

Cerebral palsy refers to diseases that are almost impossible to cure completely. However, a comprehensive and timely rehabilitation started allows children with such a diagnosis to undergo training along with healthy children and lead a full-fledged lifestyle. Significant progress can be considered the preservation of a child's individual symptoms of the disease.

Modern methods of treating cerebral palsy

The main objective of individual rehabilitation programs for children with paralysis is the phased development of skills and 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 independence skills in everyday life. As a result of systematic rehabilitation, a child can infiltrate society and adapt to later life on his own.

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

• treatment with water procedures: swimming, balneotherapy or hydrotherapy;
• PET therapy, or treatment with animals: hippotherapy (horse treatment), psychophysical rehabilitation in the process of communication with dolphins and swimming;
• the use of orthopedic devices, simulators, gymnastic balls, ladders;
• mud applications that increase the bioelectric activity of muscles;
• therapeutic massage, which reduces the degree of lethargy and muscle spasm;
• drug treatment: botox, botulinum toxin, xeomin, dysport are used;
• Vojta-therapy, allowing to restore natural patterns of behavior;
• physiotherapeutic treatment: myoton, ultrasound, magnetotherapy, darsonvalization;
• Montessori therapy, which allows to form the ability to concentrate attention and develop independence;
• classes with a psychologist;
• speech therapy classes, correcting speech disorders (program "Logorhythm");
• special pedagogy;
• Shiatsu therapy - massage of biologically active points;
• classes according to the Bobat technique - special gymnastics with the use of certain equipment;
• laser exposure to reflexogenic zones, the tip of the nose, joints, reflex-segmental zones, the area of ​​paretic muscles;
• art therapy aimed at preparing the child for learning;
• Peto's technique - separation of movements into separate acts and their learning;
• surgical orthopedic interventions;
• 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 methods.

Physical rehabilitation of children with cerebral palsy

Physical recovery of a sick child should begin as early as possible. Leading experts in the world recognized that rehabilitation of a disabled child (CP) brings the best results up to three years, but in Russia many centers refuse to accept children up to a year or up to three years, and doctors are in no hurry to establish a diagnosis and formalize disability. Nevertheless, physical rehabilitation is the most important stage in the adaptation of a special child to further 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 in order to prevent muscle weakness and atrophy, to avoid the development of complications, and they also resort to it in order to promote the motor development of the child. Medical massage, physical education exercises 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, develop physical fitness and prevent getting used to pathological positions.

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 it, due to hypertonicity, seeks to accept. Classes should be conducted in a relaxed atmosphere, three times a day or a week, each movement is repeated from 3 to 5 times. The movements themselves are carried out slowly, because the main goal of treatment is muscle relaxation. Exercise complexes are developed individually. Treatment according to the method of Bobat therapy can be carried out at home - a parent or guardian is trained to perform techniques with the help of a specialist in a rehabilitation center.

Means of technical rehabilitation

In the physical restoration of motor activity of a child with cerebral palsy, 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) for a child. Also, rehabilitation tools for children with cerebral palsy involve the use of orthopedic devices and simulators. For example, Adele’s suit, which redistributes the load, the Gross simulator, which develops motor skills, “Veloton”, stimulates the muscles, the “Spiral” suit, which allows the formation of new stereotypes of movements, and so on, are used.

Social rehabilitation of children with disabilities with cerebral palsy

Closer to school age, more attention is paid to the social adaptation of the child. Efforts are directed towards the formation of self-reliance skills, mental development, and the preparation of a child for collective learning and communication. In addition, the patient is taught to dress independently, to care for himself, to carry out hygiene, to move around and so on. All this will reduce the burden on persons caring for a disabled child, and the smallest patient - to adapt to life.

Psychologists, speech therapists and educators 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 (cerebral palsy) pursues the following goals:

• expansion of vocabulary and horizons;
• development of memory, attention and thinking;
• the development of personal hygiene skills;
• self-service skills training;
• development of speech, the formation of culture.

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

In many cases, further work is possible with a diagnosis of cerebral palsy. Such people can master the profession of mental labor (teachers, but not the lower grades, economists, architects, nurses), work at home as programmers, freelancers and even (with the preservation of hand movements) seamstresses. Employment is impossible only in severe cases.

Disability in cerebral palsy

Cerebral palsy has several forms and degrees of severity. Disability during cerebral palsy is documented in the event that the disease is accompanied by restrictions in relation to normal life, training, self-care, and voice contact. Making a disability possible only after a medical examination. Mom with a child will have to go through a neurologist, surgeon, psychiatrist, pediatrician, orthopedist, optometrist and ENT specialist. On this "adventure" does not end there. Followed by:

• draw up a final conclusion from the head of the medical institution;
• go through the procedure of reconciling documents in an adult clinic;
• give a package of documents to the paper acceptance center for medical and social examination.

Depending on the term for establishing disability, a medical and social examination (and, therefore, all doctors must be re-entered) must be repeated after a certain period of time. It is also necessary to obtain conclusions again if an individual rehabilitation program is undergoing changes - for example, if a child, as prescribed by a specialist, needs a new means of rehabilitation.

Benefits for children with disabilities with cerebral palsy

Making a disability 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 have the following privileges:

• free rehabilitation in federal and regional centers and resorts;
• a discount of at least 50% for payment of municipal or state housing, as well as housing and communal services;
• the right to receive priority land plots for individual construction, gardening and housekeeping;
• provision of medicines (as prescribed by the doctor), medical nutrition products;
• free travel to and from the place of spa treatment, as well as in public transport (the privilege is granted to a disabled child and one accompanying person);
• compensation for the services of a psychologist, teacher and speech therapist defined 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 may receive 5.5 thousand rubles, another person - 1.2 thousand rubles);
• pension for a disabled child and additional payments (a total of 14.6 thousand rubles as of 2017);
• the period of caring for a child with a disability is counted by the mother in the length of service;
• the mother of a disabled child with cerebral palsy has a number of benefits under labor law: 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 dismissed, except in cases of complete liquidation of the enterprise.

Rehabilitation centers in Russia

In special centers, 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 engage in the proposed program at home.

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

There are several rehabilitation centers in Russia. The Grossko Center in Moscow operates according to a comprehensive program: diagnostics are carried out upon admission, then physical recovery instructors are engaged with a special child. The physical rehabilitation of children with cerebral palsy at the Grossko Center includes physical therapy, swimming, exercises with special simulators to develop coordination of movements and fix motor stereotypes, treadmill exercises, and rollerblading. According to the results of pedagogical testing, correction programs are carried out so that the restoration corresponds to the needs and condition of a particular small patient.

The cost of child rehabilitation (Cerebral Palsy) at 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 classes (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 classes do exist, and the Grossko Center itself is a prominent institution.

Russian Research Institute of Traumatology and Orthopedics R. R. Wreden

The Center for Rehabilitation of Children with Cerebral Palsy 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. At the disposal of highly qualified specialists of the center with many years of practical experience of more than twenty fully equipped departments.

Moscow Scientific and Practical Center for the Rehabilitation of Disabled Persons Due to Cerebral Palsy

The Moscow SPC for the rehabilitation of persons with disabilities 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. In addition to direct physical recovery, psychiatrists, speech therapists, professional massage therapists and conductologists - teachers who work with children and adults with central nervous system disorders, deal with young patients.

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

Rehabilitation of a disabled child (cerebral palsy) at the Institute. A. Peto in Budapest - the capital of Hungary - is the center where hundreds of families strive to get. The institution is famous for its excellent specialists, the use of the most modern developments in the treatment of small patients, as well as the visible results achieved by children with cerebral palsy who underwent a rehabilitation course.

There are many other rehabilitation centers and sanatoriums that accept children with cerebral palsy for rehabilitation. Only in Moscow, for example, do the Children's Rehabilitation Center with cerebral palsy "Movement", the Rehabilitation Center "Spark", the Rehabilitation Center "Overcoming" and others. In some institutions free rehabilitation of children with cerebral palsy is also possible. Families with children with disabilities are also supported in charities and social centers.