Movement disorder syndrome - treatment in Chelyabinsk

Movement disorder syndrome in newborns: signs | Movement disorder syndrome in infants: treatment

Motor disturbance syndrome is one of the consequences of perinatal damage to the central nervous system during the period from 26 (28) weeks of pregnancy to 7 days after birth.

The causes of perinatal damage to the central nervous system can consist of a state of hypoxia as a result of hemolytic disease of the newborn, for example, due to Rhesus conflict, intrauterine infection, disruption of the utero-placental - fetal blood flow.

Movement disorder syndrome in children may be the result of obstetric trauma.

Movement disorder syndrome is often accompanied by a child’s mental or physical developmental delay, for example, slowing or impaired articulation and facial expressions. Movement disorder syndrome in the newborn occurs in 5% of children.

The main risk groups are: borderline age of the mother (under 18 and over 35 years), pathology of the placenta (premature abruption, placenta previa), rapid or long labor, bad habits of the mother during pregnancy and breastfeeding. Diabetes mellitus in the mother during pregnancy, multiple births and polyhydramnios, taking medications that have a direct or indirect effect on the fetus.

Motor impairment syndrome can occur in children who are on mechanical ventilation for a long time or have damage to the respiratory center.

Motor dysfunctions in an infant: necessary knowledge when choosing a clinic

For many parents, such diagnoses cut the ground from under their feet. Choosing a clinic, choosing a doctor, choosing a country where to conduct treatment - these are questions that every family must answer as soon as possible.

Increasingly, parents are choosing to undergo treatment abroad. The modern market is now oversaturated with clinics that provide medical tourism services. But the choice must be taken with full responsibility.

Factors to consider when choosing a treatment location:

• Duration of existence of the company in the market of medical services and tourism;
• Availability of documentation for the relevant work;
• Customer reviews.

Experts from the Mednavi medical tourism agency will help you decide on the country, clinic, and doctors; will help you collect the necessary documents and permits; will provide legal support. Call us +7 (495) 023-10-24. Mednavi cooperates with the world's largest clinics and centers. Confidently take a step towards solving your problem, and soon you will see your baby take his first steps.

Development of motor skills in a newborn

In newborns, responses are built at the level of the globus pallidus and thalamus. Further, with the maturation of “older” structures, a process of inhibition of earlier formations occurs, followed by some changes in the body’s reactions in response to the environment. New formations of structures subjugate the old ones.

Psychomotor activity in children: periods

In newborn children, there are three stages of development of psychomotor activity:

1. The thalamopallidal period lasts from birth to four months;
2. The next period is striopallidal. Its duration is six months, i.e. up to 10 months. During this period, muscle tone decreases, the baby learns purposeful body movements
3. At 10 months, a period begins that is characterized by the maturation of higher cortical functions; speech and complex conditioned reactions are actively beginning to develop.

The described periods determine the phases of development of motor skills in children:

1. The first motor reflexes (spontaneous) begin on the fourth day of life and last up to two months;
2. From the second to the fifth months of life, a monokinetic phase occurs, the peculiarity of which is an attempt to independently coordinate the arms and legs;
3. From the fifth month to a year, movements acquire some direction - the dromokinetic phase;
4. The cratikinetic phase is characterized by a transition to the motor skills of an adult, during which coordination develops and muscle tone is normalized. This phase begins at twelve months.

Motor reflex in children and its development

The motor reflex in a newborn develops in an ascending manner - complex gestures replace simple ones. If any parts of the brain are affected, the baby may develop those motor reactions that are characteristic of earlier stages of development.

Symptoms of the disease

Typically, the syndrome of motor disorders in newborns is manifested by a whole set of symptoms.

These children experience changes in voluntary activity associated with muscle weakness. During examination, altered reflexes are noticeable.

Various types of movement disorders are observed in the muscular system.

A child with this disease develops more slowly than his peers. It is more difficult for him to acquire familiar everyday skills; he has difficulties with coordination, holding his head, crawling, and walking.

Sometimes there is a violation of the swallowing reflex and chewing, decreased vision and hearing. In the future, various speech difficulties arise.

The methods used by the Center for Osteopathy and Health to correct the child’s condition make it possible to achieve the following positive effects:

• accelerate intellectual and physical development;
• normalize muscle tone;
• restore range of motion in muscles;
• eliminate paresis;
• correct the formation of the baby’s skeleton;
• increase the overall effectiveness of the treatment used;
• stabilize the activity of the central nervous system;
• achieve a significant improvement in the course of cerebral palsy;
• form a full swallowing reflex, chewing and functions of the speech apparatus;
• revive regeneration processes in tissues;
• strengthen the body's defenses, etc.

Remember, the sooner you begin rehabilitation of movement disorders, the faster our specialists will be able to alleviate your child’s condition or completely eliminate symptoms!

Patient reviews

Answers to frequently asked questions

Why is it urgent to start therapy for motor activity syndrome in a newborn? In the absence of medical intervention, a significant slowdown in mental development occurs, which entails subsequent inferiority of intellectual development.

A violation of the swallowing reflex can cause diseases of the respiratory and digestive systems, speech.

Most skills and reflexes develop in children with these symptoms later than in their peers. The child’s psycho-emotional and speech spheres are delayed in structure, and various motor disorders intensify.

In what cases is it advisable to show a child to a doctor at the Osteopathy and Health Center? The disease is not always diagnosed in a timely manner. And sometimes it is simply necessary to make sure that it is absent in order to relieve unnecessary anxiety and eliminate concerns about the health of the newborn.

It is imperative to show it to a specialist if the baby has muscle hypertonicity, there is a suspicion of paresis, a noticeable decrease in muscle strength, or a delay in psycho-emotional skills.

It is useful to contact the Center for Osteopathy and Health if parents notice involuntary movements in the child, he has a dysfunction of the musculoskeletal system, it seems to them that the baby’s sucking or grasping reflex is altered, the baby is not able to hold his head, lift and bend his legs, or hands, does not show interest in toys or if there are difficulties in grasping toys with hands, rolling over and crawling, etc.

How much does an osteopathy session for children cost? The cost of consultation and osteopathic treatment is shown in the table below. The consultation will be free if you stay for treatment on the same day.

Motor disorders in children

Motor dysfunctions in newborns and infants are strikingly different from motor impairments in older children and especially adults. At an early age, damage to any part of the brain most often causes changes that affect the entire functioning of the body. And this, in turn, makes it extremely difficult to narrowly diagnose the problem.

Motor dysfunction in children: pyramidal and extrapyramidal

In newborns and infants, the diagnosis of pyramidal and extrapyramidal motor disorders is difficult: doctors mainly draw their conclusions based on the infant’s reflex activity and muscle tone.

Muscle tone changes with growth. This is especially noticeable in the first and second age periods (up to three months), at which time physiological hypertension is the norm.

Muscle hypotonia, hypertension and dystonia in infants: causes, symptoms and clinical signs

Muscular hypotonia is a condition in which resistance to passive gestures decreases and their number significantly increases. At the same time, there is a decrease in spontaneous and voluntary activity; tendon reflexes can be normal, increased or decreased. It depends on how affected the nervous system is. The syndrome described above is the most common diagnosis in children under one year of age.

Muscular hypotonia can be observed from birth or from any age if clinical symptoms begin to appear.

Congenital muscle hypotonia can lead to normotension, dystonia, hypertension, or it will remain the dominant symptom throughout the first year of a person’s life. Clinical manifestations of muscle hypotonia can range from a slight decrease in resistance to passive movements to atony, as well as the absence of active reflex gestures in a newborn or infant.

In the case when muscle hypotonia is mild and there are no other neurological disorders, then most often this syndrome either does not affect the growth and development of a person at all, or leads to a delay in the development of motor skills of a small person.

The lag may be uneven. Such children later stand on their feet and begin to walk; they walk for a long time with the support of adults. There are cases when muscle hypotonia of only one limb occurs; this occurs with paresis of the legs or arms.

Muscular dystonia is a syndrome in which muscle hypotonia alternates with hypertension. In such children, who are at rest, with passive gestures, general muscle hypotonia is observed. Muscle tone increases sharply with sudden changes in emotions, with active attempts to perform any action. These conditions are called dystonic attack. A clearly defined dystonia syndrome practically does not allow the straightening reflex to develop due to changing muscle tone. In mild forms, muscular dystonia does not affect the process of motor function.

Muscular hypertension syndrome is a syndrome in which there is an increase in resistance to passive movements, spontaneous and voluntary activity is significantly reduced, and tendon reflexes are increased. It is considered normal if the above-described clinical indicators are weak, unstable and weaken over time, but with an increase in muscle tone, the symptoms intensify and do not fade away.

Muscular hypertension can be of varying degrees: from a slight increase in resistance to absolute stiffness, in which any movement becomes impossible. In this case, muscle relaxants cannot cause muscle relaxation.

If muscle hypertension is mild and there are no other neurological disorders, then the effect of this syndrome on the patient will be insignificant. It will be expressed in a slight inhibition of the growth process in the first twelve months. For example, there may be a delay in the progress of the grasping reflex, a delay in the process of learning the skills of manipulating objects, etc. Such children get to their feet late and prefer to crawl; they are characterized by walking on their toes.

Causes of movement disorder syndrome

Movement disorder syndrome in children under one year of age can be caused by abnormal development of the fetus during the intrauterine stage. This could be hypoxia, umbilical cord entanglement, malpresentation, etc. Only a neurologist can determine the true cause of the syndrome of impaired motor activity. You should not try to diagnose yourself at home, much less treat.

When conducting a differential diagnosis, the doctor first determines the type of disorder: hypotension or hypertonicity of myocytes is observed. Then the area of ​​damage to the nerve fiber and the presumed cause of this disorder are determined. And only after this can effective and safe treatment be started.

Muscle hypotonia is characterized by the absence of resistance during forced movement of the arms and legs. If you lay the baby on his back and try to bend his arms and legs, spread them apart and bring them back, you may feel resistance. This is the effect of the peripheral nervous system, which does not have time to process the signal coming from myocytes. With serious damage to the spinal cord and central nervous system, the child may become like a “rag doll.”

Movement disorder syndrome can develop in children for the following reasons:

• hypoxia suffered during the prenatal period of development;
• cerebral hypoxia that develops during labor, for example, when the umbilical cord is entangled;
• asphyxia of a child with amniotic fluid due to violation of the technique of providing obstetric obstetric care;
• damage to myocytes and their insufficient development against the background of inferiority of the capillary bloodstream;
• disruption of nerve connections due to pathology of the development of the structure of the central and peripheral nervous system;
• traumatic effects in the spine, head;
• incorrect position of the first cervical vertebra and its displacement;
• assimilation of the first cervical vertebra by the occipital bone;
• compression of individual large branches of the peripheral nervous system (femoral, sciatic, elbow, brachial, radial);
• hereditary genetic developmental disorders;
• improper metabolism and much more.

It is not uncommon for movement disorder syndrome to be present in children who are not treated with rickets prophylaxis. With vitamin D deficiency, pathological deformations begin in the structures of bone, tendon and muscle tissue. Which can subsequently lead to the appearance of decreased or increased muscle tone.

Impaired motor reflexes associated with cerebellar dysfunction

Underdevelopment of the cerebellum, birth trauma, asphyxia, hereditary degeneration - all this leads to cerebellar disorders of the motor reflex.

Impaired cerebellar motor reflexes: clinical manifestations:

• Muscle tone is reduced;
• The balance reaction when sitting, standing, walking is impaired;
• Poor hand coordination when moving.

You can recognize such disorders yourself: such a child makes a lot of unnecessary movements when grasping an object, this is especially typical in a sitting position. Children with cerebellar disorders sit up late, learn to walk after a year, but often fall.

Cerebral palsy

Motor imbalance is often accompanied by cerebral palsy. An increase in muscle tone is observed to varying degrees in any form and stage of cerebral palsy.

Movement disorders

A disorder of the infant's brain gives rise to inconsistency in the stages of its development. In order to more accurately understand the features of motor dysfunction, we will consider the influence of tonic reflexes on motor activity (voluntary), mental and speech functions.

Tonic labyrinthine reflex is a disease in which the baby is unable to sit, roll over, does not follow objects with his eyes, does not rise, does not walk or stand. A baby with a pronounced tonic reflex, being on his back, cannot tilt his head, stretch his arms forward, grab an object that is in front of him, or grasp and sit down.

The degree of severity of the tonic reflex directly depends on the patient’s muscle tone. The asymmetric cervical tonic reflex is the most common reflex in cerebral palsy. The degree of this symptom directly depends on the muscle tone in the arms. Severe degree is characterized by simultaneous rotation of the head and arms. ASRT in combination with the tonic reflex does not allow the baby to grasp the toy, and visual coordination is impaired. If you give a toy in his hands, he cannot bring it to his mouth, forehead, eyes, or stomach. Such children have a hard time turning over onto their stomach.

A symmetrical tonic reflex is a symptom in which a baby, placed on his knees, is unable to straighten his arms in order to lean on them and support his weight. In this case, the head is tilted, the shoulders are drawn in, the arms are bent at the elbows, and the hands are in fists. When trying to raise his head from a sitting position, a small patient cannot resist and falls backward. Lowering your head does the opposite.

A positive supportive response is a response that manifests itself as an increase in tone in the legs when the legs touch the support. Since a toddler with cerebral palsy stands and walks on the balls of his feet, the above reaction is constantly stimulated. The leg joints are fixed. The equilibrium reaction is difficult.

Friendly reactions are reactions of the body that increase the tone of various parts of the body when trying to break the resistance of muscles in a limb: when trying to take a toy, unclench your hands, take a step. Friendly reactions do not allow the development of purposeful movements and lead to contractures. The most common manifestation of a friendly reaction in cerebral palsy is in the oral muscles: the child takes a toy, while the mouth opens wide.

Voluntary motor activity leads to the fact that all tonic reflexes work simultaneously, connecting with each other. This makes it difficult to identify one of the symptoms; one can only note the presence and enhanced symptoms of one or another reflex. Muscle tone affects the severity of symptoms.

Hemolytic disease of the newborn. The appearance of sharp tonic reflexes is typical for those children who have suffered hemolytic disease. It can even lead to a tonic attack. Voluntary motor skills are difficult to develop with hemolytic disease of the newborn, the cause of which is hyperkinesis (involuntary violent movements). Often in the first year of a baby’s life, such movements are expressed to a weak degree.

The main types of neurological pathology in children of the first year of life, section 3

Movement disorder syndromes

Motor disorders in newborns and infants are fundamentally different from those in older children and adults. Brain damage in the early stages of ontogenesis causes in most cases generalized changes, which makes topical diagnosis extremely difficult; more often we can only talk about the predominant damage to certain parts of the brain.

During this age period, the differentiation of pyramidal and extrapyramidal disorders is very difficult. The main characteristics in the diagnosis of movement disorders in the first year of life are muscle tone and reflex activity. The symptomatology of changes in muscle tone may look different depending on the age of the child. This especially applies to the first and second age periods (up to 3 months), when the child has physiological hypertension.

Changes in muscle tone are manifested by muscle hypotonia, dystonia and hypertension. Muscle hypotonia syndrome is characterized by a decrease in resistance to passive movements and an increase in their volume. Spontaneous and voluntary motor activity is limited, tendon reflexes can be normal, increased, decreased or absent depending on the level of damage to the nervous system. Muscular hypotonia is one of the most commonly detected syndromes in newborns and infants. It can be expressed from birth, as is the case with congenital forms of neuromuscular diseases, asphyxia, intracranial and spinal birth trauma, damage to the peripheral nervous system, some hereditary metabolic disorders, chromosomal syndromes, and in children with congenital or early acquired dementia. At the same time, hypotension can appear or become more pronounced at any age, if the clinical symptoms of the disease begin several months after birth or are progressive in nature.

Hypotension, expressed from birth, can transform into normotension, dystonia, hypertension, or remain a leading symptom throughout the first year of life. The severity of clinical manifestations of muscle hypotonia varies from a slight decrease in resistance to passive movements to complete atony and absence of active movements.

If the syndrome of muscle hypotonia is not clearly expressed and is not combined with other neurological disorders, it either does not affect the child’s age-related development or causes a delay in motor development, more often in the second half of life. The lag is uneven; more complex motor functions are delayed, requiring coordinated activity of many muscle groups for their implementation. So, a seated child sits for 9 months, but cannot sit up on his own. Such children begin to walk later, and the period of walking with support is delayed for a long time.

Muscular hypotonia may be limited to one limb (obstetric paresis of the arm, traumatic paresis of the leg). In these cases the delay will be partial.

A pronounced syndrome of muscle hypotonia has a significant impact on delayed motor development. Thus, motor skills in the congenital form of spinal amyotrophy Werdnig-Hoffmann in a child of 9-10 months can correspond to the age of 2-3 months. Delayed motor development, in turn, causes peculiarities in the formation of mental functions. For example, the inability to voluntarily grasp an object leads to underdevelopment of visual-motor coordination and manipulative activity. Since muscle hypotonia is often combined with other neurological disorders (convulsions, hydrocephalus, cranial nerve paresis, etc.), the latter can modify the nature of the developmental delay determined by hypotonia as such. It should also be noted that the quality of the hypotonia syndrome itself and its impact on developmental delay will vary depending on the disease. In cases of convulsions, congenital or early acquired dementia, it is not so much hypotension as delayed mental development that is the cause of delayed motor development.

The syndrome of movement disorders in children of the first year of life may be accompanied by muscular dystonia (a condition when muscle hypotension alternates with hypertension). At rest, these children show general muscle hypotonia during passive movements. When trying to actively perform any movement, with positive or negative emotional reactions, muscle tone increases sharply, and pathological tonic reflexes become pronounced. Such conditions are called “dystonic attacks.” Most often, muscular dystonia is observed in children who have suffered hemolytic disease as a result of Rh or ABO incompatibility. Severe muscular dystonia syndrome makes it almost impossible for a child to develop straightening trunk reflexes and balance reactions due to constantly changing muscle tone. Mild transient muscular dystonia syndrome does not have a significant effect on the age-related motor development of the child.

Muscular hypertension syndrome is characterized by an increase in resistance to passive movements, limitation of spontaneous and voluntary motor activity, increased tendon reflexes, expansion of their zone, and foot clonus. An increase in muscle tone may prevail in the flexor or extensor muscle groups, in the adductor muscles of the thighs, which is expressed in a certain specificity of the clinical picture, but is only a relative criterion for topical diagnosis in young children. Due to the incompleteness of the myelination processes, the symptoms of Babinsky, Oppenheim, Gordon, etc. cannot always be considered pathological. Normally, they are not sharply expressed, are not constant and weaken as the child develops, but with an increase in muscle tone they become bright and have no tendency to fade.

The severity of muscle hypertension syndrome can vary from a slight increase in resistance to passive movements to complete stiffness (decerebrate rigidity posture), when any movements are practically impossible. In these cases, even muscle relaxants are not able to cause muscle relaxation, much less passive movements. If the syndrome of muscular hypertension is mildly expressed and is not combined with pathological tonic reflexes and other neurological disorders, its influence on the development of static and locomotor functions may manifest itself in their slight delay at various stages of the first year of life. Depending on which muscle groups have more increased tone, differentiation and final consolidation of certain motor skills will be delayed. Thus, with an increase in muscle tone in the hands, a delay in the development of directing the hands to an object, grasping a toy, manipulating objects, etc. is noted. The development of the grasping ability of the hands is especially impaired. Along with the fact that the child begins to pick up the toy later, he retains an ulnar grip, or grip with the entire hand, for a long time. The finger grip (pincer grip) develops slowly and sometimes requires additional stimulation. The development of the protective function of the hands may be delayed, and then the balance reactions in the prone position, sitting, standing and when walking are delayed.

With an increase in muscle tone in the legs, the formation of the support reaction of the legs and independent standing is delayed. Children are reluctant to stand on their feet, prefer to crawl, and stand on their toes when supported.

Cerebellar disorders in children of the first year of life can be a consequence of underdevelopment of the cerebellum, damage to it as a result of asphyxia and birth trauma, and in rare cases - as a result of hereditary degeneration. They are characterized by a decrease in muscle tone, impaired coordination during arm movements, and a disorder of balance reactions when trying to master the skills of sitting, standing, standing and walking. The actual cerebellar symptoms—intention tremor, loss of coordination, and ataxia—can be identified only after the development of the child’s voluntary motor activity. You can suspect coordination disorders by observing how a child reaches for a toy, grabs it, brings it to his mouth, sits, stands, walks.

Infants with poor coordination make a lot of unnecessary movements when trying to grab a toy; this becomes especially pronounced in a sitting position. Independent sitting skills develop late, by 10-11 months. Sometimes even at this age it is difficult for children to maintain balance; they lose it when they try to turn to the side or pick up an object. Because of the fear of falling, the child does not manipulate objects with both hands for a long time; He begins to walk after a year and often falls. Some children with impaired balance reactions prefer to crawl when they should already be walking on their own. Less commonly, with cerebellar syndrome in children of the first year of life, horizontal nystagmus and speech disturbances can be observed as an early sign of cerebellar dysarthria. The presence of nystagmus and the frequent combination of cerebellar syndrome with other disorders of cranial innervation may impart certain specificity to developmental delay in the form of a more pronounced delay in the function of gaze fixation and tracking, visual-motor coordination, and disturbances in spatial orientation. Dysarthric disorders particularly affect the development of expressive language skills.

The most common form of motor disorders in children of the first year of life is cerebral palsy syndrome (CP). The clinical manifestations of this syndrome depend on the severity of muscle tone, an increase in which to varying degrees is observed in any form of cerebral palsy. In some cases, high muscle tone prevails in a child from birth. However, more often muscle hypertension develops after the stages of hypotension and dystonia. In such children, after birth, muscle tone is low, spontaneous movements are poor, and unconditioned reflexes are suppressed. By the end of the second month of life, when the child is in a prone position and tries to hold his head upright, the dystonic stage appears. The child periodically becomes restless, his muscle tone increases, his arms are extended with internal rotation of the shoulders, his forearms and hands are pronated, his fingers are clenched into fists; the legs are extended, adducted and often crossed. Dystonic attacks last a few seconds, are repeated throughout the day and can be triggered by external stimuli (loud knocking, another child crying).

Movement disorders in cerebral palsy are caused by the fact that damage to the immature brain disrupts the sequence of stages of its maturation. Higher integrative centers do not have an inhibitory effect on primitive brainstem reflex mechanisms. The reduction of unconditioned reflexes is delayed, and pathological tonic cervical and labyrinthine reflexes are released. Combined with an increase in muscle tone, they prevent the consistent development of straightening and balance reactions, which are the basis for the development of static and locomotor functions in children of the first year of life (holding the head, grasping a toy, sitting, standing, walking).

To understand the features of psychomotor development disorders in children with cerebral palsy, it is necessary to consider the influence of tonic reflexes on the formation of voluntary motor activity, as well as speech and mental functions.

Tonic labyrinthine reflex. Children with a pronounced tonic labyrinthine reflex in the supine position cannot tilt their head, stretch their arms forward to bring them to their mouth, grasp an object, and later grasp, pull themselves up and sit up. They do not have the prerequisites for the development of fixation and free tracking of an object in all directions, the optical righting reflex to the head does not develop, and head movements cannot freely follow eye movements. The development of hand-eye coordination is impaired. Such children have difficulty turning from their back to the side and then onto their stomach. In severe cases, even by the end of the first year of life, turning from the back to the stomach is carried out only with a “block”, i.e. there is no torsion between the pelvis and the upper part of the body. If a child cannot tilt his head in a supine position or turn onto his stomach with torsion, he does not have the prerequisites for the development of sitting function. The severity of the tonic labyrinthine reflex is directly dependent on the degree of increase in muscle tone.

When the tonic labyrinthine reflex is expressed in the prone position as a result of increased flexor tone, the head and neck are bent, the shoulders are pushed forward and down, the arms bent in all joints are under the chest, the hands are clenched into fists, the pelvis is raised. In this position, the child cannot raise his head, turn it to the sides, release his arms from under the chest and lean on them to support the upper body, bend his legs and kneel. It is difficult to turn from the stomach to the back to sit down. A gradually bent back leads to the development of kyphosis in the thoracic spine. This position prevents the development of chain righting reflexes in the prone position and the child’s acquisition of a vertical position, and also excludes the possibility of sensory-motor development and vocal reactions.

The influence of the tonic labyrinthine reflex depends to a certain extent on the initial type of spasticity. In some cases, extensor spasticity is so strong that it can be expressed in the prone position. Therefore, children lying on their stomachs, instead of bending, straighten their heads, throw them back, and raise their upper torsos. Despite the extension position of the head, muscle tone in the arm flexors remains elevated, the arms do not provide support for the body, and the child falls on his back.

The asymmetric cervical tonic reflex (ASTR) is one of the most pronounced reflexes in cerebral palsy. The severity of ASTR depends on the degree of increase in muscle tone in the arms. With severe damage to the hands, the reflex appears almost simultaneously with turning the head to the side. If the arms are only slightly affected, as is the case with mild spastic diplegia, ASTD occurs intermittently and requires a longer latency period for its onset. ASTR is more pronounced in the supine position, although it can also be observed in the sitting position.

ASTR, combined with the tonic labyrinthine reflex, prevents the grasping of a toy and the development of hand-eye coordination. The child cannot move his arms forward to bring his hands closer to the midline and, accordingly, hold the object he is looking at with both hands. A child cannot bring a toy placed in his hand to his mouth or eyes, because when he tries to bend his hand, his head turns in the opposite direction. Due to arm extension, many children are unable to suck their fingers as most healthy children do. ASTR is in most cases more pronounced on the right side, which is why many children with cerebral palsy prefer to use their left hand. With pronounced ASTD, the child’s head and eyes are often fixed in one direction, so it is difficult for him to follow an object on the opposite side; as a result, the syndrome of unilateral spatial agnosia develops, and spastic torticollis is formed. scoliosis of the spine.

Combined with the tonic labyrinthine reflex, ASTR makes it difficult to turn on the side and on the stomach. When a child turns his head to the side, the resulting ASTR prevents the body from moving along with the head, and the child cannot free his arm from under the body. The difficulty of turning on one side prevents the child from developing the ability to transfer the center of gravity from one hand to the other when moving the body forward, which is necessary for the development of reciprocal crawling.

ASTR disrupts balance in a sitting position, since the spread of muscle tone on one side (increased predominantly in the extensors) is opposite to its spread on the other (predominantly increased in the flexors). The child loses his balance and falls to the side and backwards. To avoid falling forward, the child must tilt his head and torso. The effect of ASTP on the “occipital” leg can, over time, lead to hip subluxation due to a combination of flexion, internal rotation, and adduction of the hip.

Symmetrical cervical tonic reflex. If the symmetrical cervical tonic reflex is severe, a child with increased flexor tone in the arms and body, placed on his knees, will not be able to straighten his arms and lean on them to support the weight of his body. In this position, the head tilts, the shoulders retract, the arms are abducted, bent at the elbow joints, and the hands are clenched into fists. As a result of the influence of the symmetrical cervical tonic reflex in the prone position, the child’s muscle tone in the leg extensors sharply increases, so that it is difficult to bend them at the hip and knee joints and bring him to his knees. This position can be eliminated by passively raising the child's head by grasping his chin.

If the symmetrical cervical tonic reflex is severe, it is difficult for the child to maintain head control and, accordingly, to remain in a sitting position. Raising the head in a sitting position increases the extensor tone in the arms, and the child falls back; lowering the head increases the flexion tone in the arms and the child falls forward. The isolated influence of symmetrical cervical tonic reflexes on muscle tone can rarely be identified, since in most cases they are combined with ASTR.

Along with tonic cervical and labyrinthine reflexes, a positive supportive reaction and friendly movements (syncinesia) play an important role in the pathogenesis of motor disorders in children with cerebral palsy.

Positive supportive reaction. The influence of a positive supportive reaction on movements is manifested in an increase in extensor tone in the legs when the legs come into contact with the support. Because children with cerebral palsy always touch the balls of their feet first when standing and walking, this response is constantly supported and stimulated. All leg joints are fixed. Rigid limbs can support the child’s body weight, but they significantly complicate the development of balance reactions, which require joint mobility and fine regulation of the constantly reciprocally changing static state of the muscles.

Friendly reactions (syncinesis). The effect of synkinesis on a child’s motor activity is to increase muscle tone in various parts of the body with an active attempt to overcome the resistance of spastic muscles in any limb (i.e., perform movements such as grasping a toy, extending an arm, taking a step, etc. ). Thus, if a child with hemiparesis squeezes a ball tightly with his healthy hand, muscle tone may increase on the paretic side. Trying to straighten a spastic arm can cause increased extensor tone in the homolateral leg. Strong flexion of the affected leg in a child with hemplegia causes friendly reactions in the affected arm, which are expressed in increased flexion in the elbow and wrist joints and fingers. Strenuous movement of one leg in a patient with double hemiplegia can increase spasticity throughout the body. The occurrence of friendly reactions prevents the development of purposeful movements and is one of the reasons for the formation of contractures. In cerebral palsy, synkinesis most often manifests itself in the oral muscles (when trying to grab a toy, the child opens his mouth wide). During voluntary motor activity, all tonic reflex reactions act simultaneously, combining with each other, so it is difficult to identify them in isolation, although in each individual case the predominance of one or another tonic reflex can be noted. The degree of their severity depends on the state of muscle tone. If muscle tone is sharply increased and extensor spasticity predominates, tonic reflexes are pronounced. With double hemiplegia, when the arms and legs are equally affected, or the arms are more affected than the legs, tonic reflexes are pronounced, observed simultaneously and have no tendency to inhibit. They are less pronounced and constant in spastic diplegia and hemiparetic form of cerebral palsy. In spastic diplegia, when the arms are relatively intact, the development of movements is hampered mainly by a positive supportive reaction.

In children who have had hemolytic disease of the newborn, tonic reflexes appear suddenly, leading to an increase in muscle tone - a dystonic attack. In the hyperkinetic form of cerebral palsy, the development of voluntary motor skills, along with the indicated mechanisms, is difficult due to the presence of involuntary, violent movements - hyperkinesis. It should be noted, however, that in children of the first year of life, hyperkinesis is slightly expressed. They become more noticeable in the second year of life. In the atonic-astatic form of cerebral palsy, balance reactions, coordination and static functions suffer more. Tonic reflexes can be observed only occasionally.

Tendon and periosteal reflexes in cerebral palsy are high, but due to muscle hypertension they are often difficult to evoke.

Motor pathology in combination with sensory deficiency also leads to disturbances in speech and mental development [Mastyukova E. M., 1973, 1975]. Tonic reflexes influence the muscle tone of the articulatory apparatus. The labyrinthine tonic reflex helps to increase muscle tone at the root of the tongue, which makes it difficult to form voluntary vocal reactions. With pronounced ASTR, the tone in the articulatory muscles increases asymmetrically, more on the side of the “occipital limbs”. The position of the tongue in the oral cavity is also often asymmetrical, which interferes with the pronunciation of sounds. The severity of the symmetrical cervical tonic reflex creates unfavorable conditions for breathing, voluntary opening of the mouth, and forward movement of the tongue. This reflex causes an increase in tone in the back of the tongue; the tip of the tongue is fixed, poorly defined and often boat-shaped.

Disorders of the articulatory apparatus complicate the formation of vocal activity and the sound-pronunciation aspect of speech. The cry in such children is quiet, slightly modulated, often with a nasal tint or in the form of separate sobs that the child produces at the moment of inspiration. A disorder in the reflex activity of the articulatory muscles is the cause of the late appearance of humming, babbling, and the first words. Humming and babbling are characterized by fragmentation, low vocal activity, and poor sound complexes. In severe cases, true prolonged humming and babbling may be absent.

In the second half of the year, when combined hand-mouth reactions actively develop, oral synkinesis may appear - involuntary opening of the mouth when moving the hands. At the same time, the child opens his mouth very wide and a forced smile appears. Oral synkinesis and excessive expression of the unconditioned sucking reflex also prevent the development of voluntary activity of facial and articulatory muscles.

Thus, speech disorders in young children suffering from cerebral palsy are manifested by a delay in the formation of motor speech in combination with various forms of dysarthria (pseudobulbar, cerebellar, extrapyramidal). The severity of speech disorders depends on the time of brain damage during ontogenesis and the predominant localization of the pathological process. Mental disorders in cerebral palsy are caused by both primary brain damage and secondary delay in its development as a result of underdevelopment of motor speech and sensory functions. Paresis of the oculomotor nerves, delay in the formation of static and locomotor functions contribute to the limitation of visual fields, which impoverishes the process of perception of the surrounding world and leads to a lack of voluntary attention, spatial perception and cognitive processes. The normal mental development of a child is facilitated by activities that result in the accumulation of knowledge about the environment and the formation of a generalizing function of the brain. Paresis and paralysis limit the manipulation of objects and make it difficult to perceive them by touch. In combination with underdevelopment of visual-motor coordination, the lack of objective actions impedes the formation of objective perception and cognitive activity. Speech disorders also play an important role in the disruption of cognitive activity, which complicates the development of contact with others.

Lack of practical experience may be one of the reasons for disorders of higher cortical functions at an older age, especially the immaturity of spatial concepts. Violation of communication connections with others, the impossibility of full-fledged play activities, and pedagogical neglect also contribute to delayed mental development. Muscle hypertension, tonic reflexes, speech and mental disorders in cerebral palsy can be expressed to varying degrees. In severe cases, muscle hypertension develops in the first months of life and, combined with tonic reflexes, contributes to the formation of various pathological postures. As the child develops, the delay in age-related psychomotor development becomes more pronounced.

In moderate and mild cases, neurological symptoms and delayed development of age-related psychomotor skills are not so pronounced. The child gradually develops valuable symmetrical reflexes. Motor skills, despite their late development and inferiority, still enable the child to adapt to his defect, especially if the hands are easily affected. These children develop head control, the function of grasping an object, hand-eye coordination, and torso rotation. It is somewhat more difficult and takes longer for children to master the skills of sitting, standing and walking independently while maintaining balance. The range of motor, speech and mental disorders in children of the first year of life with cerebral palsy can vary widely. It can concern both all functional systems that make up the core of cerebral palsy, as well as its individual elements. Cerebral palsy syndrome is usually combined with other neurological syndromes: damage to the cranial nerves, hypertensive-hydrocephalic, cerebrasthenic, convulsive, autonomic-visceral dysfunctions.

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Motor imbalance in the baby’s body: impaired speech and mental development

Various motor pathologies in the presence of sensory insufficiency lead to mental disorders. The articulatory apparatus directly depends on tonic reflexes: the labyrinthine tonic reflex increases the tone of the muscles of the root of the tongue, which leads to problems in the formation of vocal reactions, both voluntary and involuntary. An asymmetrical tonic neck reflex leads to an asymmetrical position of the tongue in the mouth, which makes it difficult to pronounce sounds. The symmetrical tonic cervical reflex makes breathing difficult, leads to voluntary opening of the mouth, the tongue is in front. All these symptoms lead to impaired development of speech activity. Children with such deviations are characterized by quiet screaming and sobs when inhaling. Severe forms of motor disorders can lead to the fact that babbling and humming are completely absent.

Impaired speech function in newborns and infants with cerebral palsy is expressed in delayed development of motor speech and various forms of dysarthria. The localization of the pathological process and the degree of brain damage determine the severity of speech dysfunction. Mental disorders in a young patient can be caused by both primary brain lesions and delayed development of motor and sensory function. Anomalies in the development of oculomotor nerves and inhibition of the development of locomotor functions limit the visual field, and this already leads to more serious problems: lack of attention, inhibition of spatial perception and cognitive reflexes. Normally, an infant should accumulate knowledge about the world around him and form brain functions such as generalization. Paralysis and paresis do not allow one to fully become familiar with an object by touch, which, combined with insufficient development of visual and motor functions, prevents the formation of object perception and interferes with cognitive activity. Speech impairment also leads to difficult contact with the environment and the world. At an older age, disruption of communication connections also leads to mental disorders.

Motor imbalance of the body: diagnosis and treatment

Moderate or severe impairment of muscle tone, impairment of the child’s posture and motor skills are all a consequence of movement disorders.

Medical diagnosis at an early age poses some difficulties:

• Frequent cases of strokes that do not manifest themselves in the neonatal period;
• Delay in the onset of symptoms of the disease;
• A high percentage of the formation of motor disorders occurs in the prenatal period (up to 70%).

Motor imbalance in newborns and infants: what you should pay attention to during a medical examination

When clinically assessing movement disorders in a patient, special attention should be paid to the following symptoms:

1. Muscle tone (increased or decreased);
2. Range of movement of the limbs (are there any restrictions in movement);
3. Close attention must be paid to the reflex area;
4. Saccadic eye movements (are there any disturbances in gaze fixation);
5. Psychomotor development;
6. Reduction of the labyrinthine-tonic reflex in children under one month of age.

Impaired motor function in a child is directly related to the period of action of the harmful factor on the development of the cerebral cortex. Damage is especially dangerous at 30-32 weeks; this can have catastrophic consequences for the newborn.

Motor dysfunction: risk factors

Risk factors:

• Particular attention should be paid to those children with an Apgar score of less than 5 points;
• The child is in postpartum shock or comatose state;
• Mechanical ventilation was performed for more than 48 hours;
• The newborn is a boy;
• Pay attention to the cord blood indicators, they should be normal;
• Close attention should be paid to those children whose mothers have been diagnosed with antiphospholipid syndrome;
• The newborn is premature;
• Low weight;
• There was brain damage during the birth period;
• Early rupture of the mother's membranes;
• Neonatal seizures;
• Excessive hyperoxygenation and hypocapnia.

If motor dysfunction progresses, then diagnosis of neurometabolic diseases is necessary.

Motor disorder in a newborn or infant can be associated with the following syndromes:

• Multi-infarction brain damage can lead to hypotension;
• Decreased number of movements, decreased leg muscle strength, increased muscle tone (spastic diplegia);
• Decreased limb length;
• Various violations of coordination of movement in the limbs;
• Dystonic syndrome;
• Hyperkinetic syndrome;
• Waxy rigidity;
• Opisthotonus;
• Violation of flexomotor reaction.

In neurology, benign motor phenomena are also distinguished:

• Moderate hypotension in a premature baby,
• Flexor hypotonicity,
• In an excited state - tremor of the chin, head and upper limbs.

Diagnosis: psychomotor disorder in a child

Psychomotor impairment leads to inhibition in the development of unconditioned and conditioned reflexes. This is manifested in a lack of interest in toys and people around him, emotions are scarce, there is no activity with objects, there is no intonation of speech, play activity is absent or weak. Mental skills are directly related to inhibition of motor development. Assessment of psychomotor development in children is most often carried out using the calendar method, the essence of which is to consider whether the child’s age meets medical standards for psychomotor skills.

A mild degree of motor dysfunction is recorded when the child’s chronological age deviates from the calendar age for up to three months. There may be a delay in certain psychomotor functions; this is typical for those children who have rickets or other somatic diseases. This degree of damage to motor functions is often completely restored, but provided there is complete absence of brain damage.

The presence in a full-term baby of psychomotor status, which is characteristic of four-week development, is an alarming signal. A developmental delay of up to six months is considered a mild disorder, a severe disorder is a deviation of more than six months.

Diagnosis of movement disorders: experience from Western Europe

The Prechtl method is the most commonly used diagnosis of a patient’s spontaneous motor activity in Western Europe. The diagnostics take about an hour, a video is recorded, after which a table of different types of movement is filled out, which are assessed in points. A “fussy” type of activity in a baby is considered the norm: a 3-5 month old baby makes many movements with his neck, shoulders, body, arms, legs, shoulders, and feet. It is important to note during this period the combinations “hand-face”, “hand-foot”, leg-foot.” Synchronized convulsive movements of the limbs during this period indicate early tetraparesis. Untimely diagnosis of impoverished reflex movements of the limbs can lead to spastic hemiparesis. Failure to raise the legs from a supine position, lack of fussy movements of the limbs are markers for diagnosing cerebral palsy of various forms and degrees.

Neurophysiological diagnosis of psychomotor disorders:

• Electroencephalography is a diagnostic that monitors the formation of electroencephalographic rhythms (after two months, delta activity should normally disappear);
• Diagnostics of visual potentials - this system evaluates visual analyzers from the cortex to the optic nerve;
• Diagnostics of auditory potentials - determining the patient’s hearing by conducting an audio signal from the periphery of the brain to the temporal lobe cortex;
• Electromyography and electroneuropyography are diagnostics that detect a decrease in the speed of conduction along the nerves of the hands.

Diagnosis of movement disorders: neurosonography

Neuroimaging, neurosonography - diagnostics that determine spina bifida, subcortical necrosis and periventricular leukomalacia.

Diagnosis of abnormal zones of development of the frontal and temporal lobes is carried out using computed tomography and magnetic resonance imaging.

Laboratory diagnostics are acceptable for patients with impaired psychomotor functions, if the lag behind the calendar is more than three months:

1. Amino acid test;
2. Diagnosis of intrauterine infections;
3. Cytogenetic examinations.

Types of movement disorder syndromes

The division into types of movement disorder syndrome is carried out according to whether muscle tone is decreased or increased. There is hypotonicity, hypertonicity and a mixed type, in which some muscles may be in a tense state, while others at this time may not be able to perform movements at all. The latter is the most severe form of the disease.

Pathology is also divided according to stages of development:

1. The initial symptom complex is characterized by a slight increase or decrease in muscle tone. Only a doctor can recognize the characteristic signs (children often have seizures, they do not show interest in the bright things around them);
2. the second stage is a developed symptom complex, which becomes obvious even to parents who do not have special medical education (a child at the age of 1 year cannot hold his head up independently; when trying to sit, stand or crawl, he falls in unnatural positions);
3. the late period occurs at the age of 2.5 - 3 years (the child cannot sit or walk independently, a secondary delay in psychomotor development occurs).

At the first stage, it is possible to completely cure the child without retaining residual signs of disorders. At the second stage, treatment can provide a noticeable improvement in the condition, but isolated flaccid paresis and paralysis may persist. The third (late) stage of the disease is distinguished by the fact that skeletal deformation and delayed psycho-emotional development are irreversible phenomena. Such a child can only be partially adapted to the social environment. In this case, it is no longer possible to completely eliminate the consequences of movement disorders.

Additional methods for diagnosing movement disorders

Diagnosis of movement disorders should also include examination of the venous system. A pattern of veins that looks like the head of a jellyfish indicates stagnation in the venous system; a venous network on the scalp indicates rickets or hydrocephalus; a pattern of veins in the upper back indicates the growth of bronchopulmonary nodes; spider veins indicate chronic liver disease. One of the signs of birth injuries are bright purple spots of irregular shape that last up to several years.

For a complete picture of the disorders, it is necessary to diagnose hair growth: is there sufficient growth, is there any loss, dryness, fragility. All these factors indicate iron deficiency in the body, which can lead to anemia and movement disorders. Faded, gray nails also indicate iron deficiency or fungal diseases.

Impaired motor and psychomotor functions: therapy

Therapy for disorders of motor and psychomotor functions is divided into two types: physiotherapy and drug treatment.

If preventive diagnostics have shown a propensity for drug treatment, then use:

• Central paresis: hopantenic acid (125 milligrams per day, divided into two doses);
• Static paresis from the age of 12 months: – baclofen (from 0.5 to 1 milligram per kilogram of weight per day), mydocalm (5 milligrams per kilogram per day);
• Static paresis from two years of age: botulinum therapy;
• Inhibition of psychomotor development: hopatenic acid (125 milligrams per day, divided into two doses), pyritinol (10 milligrams per kilogram every day).

If the diagnosis reveals rigidity or spasticity, then thermal procedures must be performed.

Recovery period: what parents need to know and be able to do

Rehabilitation measures need to be studied by parents and practiced daily with the child. The main types of classes are exercises on a large gymnastic ball, various health-improving styling, and preparation for massage. In the future, with positive dynamics, exercises on the ball and laying should be combined with massages, physiotherapy, stimulation of visual and auditory analyzers.

During this period, speech therapy diagnostics of the glossopharyngeal muscles is necessary. During the rehabilitation period, it is also necessary to include classes on speech development. Currently, the most popular physiotherapeutic methods are the Voight technique, Bobath therapy, kinesitherapy, and induced limb movement therapy.

Let's look at the latter in more detail. Therapy for evoked movements of the upper and lower extremities is based on daily, six-hour reproduction of movements in the limbs of patients. This course lasts 21 days. To this is added professional massage, physical therapy, and laser therapy.

During the recovery period, one should not miss the formation of knowledge and self-care skills, cultural and hygienic skills in older children. It is necessary to create conditions under which children with cerebral palsy master these abilities. Parents should get away from overprotection; this will help the patient become more independent and develop more actively. It is necessary to pay attention to the fact that the level of requirements of the teacher corresponded to the level of requirements of the patient’s parents; this will not allow the patient to feel double standards of upbringing.

Developing self-care skills is one of the most important tasks of recovery. You need to solve many problems on a variety of topics: count the number of buttons, look at their color, shape, touch them, describe similar objects, etc.

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Cerebral palsy and motor impairment

Cerebral palsy is a diagnosis that parents of thousands of newborns and children hear every year. This disease is not contagious, contact with the patient is not dangerous. The word “cerebral” itself means “connections with the brain.” The word “paralysis” speaks of improper coordination of movement and orientation in space.

In addition to cerebral palsy, modern medicine distinguishes many more diseases associated with impaired motor functions. But, unfortunately, all the medical advances, the most accurate diagnostics, and new pharmaceutical products cannot completely solve this problem. Statistics show 2-3 patients per thousand population.

Movement disorders do not discriminate by gender, ethnic group, geography or nationality. But there is a treatment! Careful monitoring of the newborn, timely diagnosis, experienced doctors, and daily activities will put your child on his feet. Find out more, call us.