RU2342114C1 - Treatment method of movement disorder syndrome in children - Google Patents

Abstract

FIELD: medicine; neurology.

SUBSTANCE: physical exercises performed on the child are taken consistently in seven stages. Thus the initial impact stage is determined in compliance with the motoric age of the child which depends on his motor skills. At the first stage development of a protective reflex is stimulated, a labyrinthine righting reflex by performance of classical and acupressure massage of neck and back extensors muscles, carrying the child which is on a stomach on the forearm bracing him for femur, passive turnover by hands and legs from back to stomach and vice-versa, tractions by the top hand with a small abruption from a surface when the child is in lateral position, tractions by hands of the child laying at an angle of 45 degrees with an abruption of a head from a surface. At the second stage all the exercises are carried out on stomach putting a wedge or platen under chest, thus alternate serial massage of arms, passive carrying out of hands forward, drawing hands asides, abduction upwards with keeping head in the lifted position. At the third stage the child is taught how to turn from back to side and to crawl on his stomach. At the fourth stage the child is taught how to sit with legs spead forward, to stand up and to stand on all fours. At the fifth stage crawling on all fours is taught. At the sixth stage the child is taught how to rise on his feet by the support. At the seventh stage walking skills are taught. In case of spastic form of cerebral infantile paralysis, starting from the second stage intramuscular injections of type A botulotoxin preparation are made at the rate of 30 units per 1 kg of the child weight with a 8-12 week interval.

EFFECT: extension of the range of treatment methods of the movement disorder in children.

3 cl, 15 dwg, 2 ex, 1 tbl

Description

The invention relates to medicine, and more particularly to methods of treating cerebral palsy.

A known method of treating cerebral palsy (cerebral palsy) by exposure to pulsed current (1).

The disadvantage of this method is the low efficiency and long duration of treatment.

A known method and device for the treatment of cerebral palsy by exposure to pulsed current (2).

The disadvantage of this method and device is the low treatment efficiency, increased complexity and complexity of the equipment used.

A known method of treating cerebral palsy with physical effects on a child by using various simulators (3).

The disadvantages of this method are the insufficiently high effectiveness of the therapeutic effect, the high structural complexity and cost of the simulators used, the need for highly qualified personnel for the maintenance of simulators, and increased labor intensity. The foregoing limits the possibility of using this method.

There is a method of imperative corrective gymnastics and rehabilitation technologies of E.E. Blum, based on biomechanical methods of eliminating spasticity using author's simulators.

The method excludes drug and surgical intervention. Treatment takes place in 3 stages (preliminary, preparatory, basic) exclusively in the clinic. Efficiency criteria are the age of the child, the severity of motor disorders and the degree of preservation of the psyche (4).

The disadvantages of this method are the inability to use the exercises at home by parents, because this requires bulky author's simulators, the implementation of the method is possible only in a specialized center, the high cost of treatment. As a result, the low availability of this rehabilitation method.

A known method for the correction of motor disorders developed by K. and B. Bobatov. The basis of this method is the therapeutic and pedagogical approach, in which both the child and his parents become partners of specialists. The fundamental principles of this method are: 1) inhibition or inhibition of pathological movements, body positions and reflexes; 2) facilitation or strengthening of the correct movements and positions of the body; 3) stimulation using tactile and kinesthetic stimuli for the child to feel the correct movements and body position in space (5).

The disadvantages of this method are the use of special expensive aids (training equipment, strollers, stand-ups), the lack of staging, sequence of classes and insufficiently high treatment efficiency.

There is also a method of treating cerebral palsy with physical effects by massaging various parts of the child’s body (6).

The disadvantages of this method are the low effectiveness of treatment, the inability to prevent cerebral palsy in children with motor disorders of the first year of life.

The aim of the invention is to increase the effectiveness of treatment and the possibility of preventing cerebral palsy in children of the first year of life.

This goal is achieved by the fact that the physical effect on the child is carried out by sequentially carrying out seven stages of rehabilitation, and the initial stage of exposure is determined by the motor age of the child, depending on his motor skills, and:

- at the first stage they stimulate the development of a protective reflex, a labyrinth installation reflex;

- at the second stage, they ensure the dominance of the position on the abdomen;

- at the third stage, the child is taught coups from the back to the stomach and crawling in a plastusky way;

- at the fourth stage, they teach the child to sit with his legs forward, lift and stand on all fours;

- at the fifth stage, they teach the child to crawl on all fours;

- at the sixth stage, they teach the child how to lift to his feet at the support;

- at the seventh stage, the child masters walking skills, and

with spastic forms of cerebral palsy, starting from the second stage, an intramuscular injection of the drug type A botulinum toxin is performed at a rate of 30 units. per 1 kg of the child’s weight with an interval of 8-12 weeks, in the second and fifth stages, in the interval between exercises, a simulator is used to correct motor disorders.

Comparison of the proposed method with others known in the field of medicine, showed its compliance with the criteria of the invention.

The invention is illustrated by drawings. Figure 1 shows the position on the wedge, figure 2 - exercise "signalman", figure 3 - "arm-leg", figure 4 - "wheelbarrow", figure 5 - "low start", figure 6 - “Half frog”, FIG. 7 - “spider”, FIG. 8 - “half-lotus”, FIG. 9 - “heron”, FIG. 10 - “heron” (variant), FIG. 11 - “clip”, FIG. 12 - "half-scraping", Fig.13 - "tumbler - 1 phase", Fig.14 - "tumbler - 2 phase", Fig.15 - "Sagittarius".

The proposed method for the treatment of motor disorders in children is based on the following.

The main known methods of treating cerebral palsy do not have the proper therapeutic and therapeutic effect. This is due to the fact that when working with children with disabilities we are talking mainly about social rehabilitation, i.e. about adapting to life with existing defects. When working with children of the first year of life with severe manifestations of perinatal CNS pathology, the emphasis is still placed on drug therapy, passive rehabilitation methods (massage, electrophoresis, paraffin, etc.). Working with children with disabilities, specialists strive to develop motor functions corresponding to the calendar age of the child, i.e. if we are talking about a one-year-old baby, they stimulate walking, if they are about a six-month-old baby, they can sit, while these children can hold their heads badly, not manipulate their hands, not crawl, etc. The traditional approach to the treatment of spasticity also does not always give the expected results.

For the successful treatment of cerebral palsy, a certain rehabilitation structure is needed with specific goals and objectives; for this, strict compliance with the principles of rehabilitation must be observed.

The stages of human ontogenesis coincide with the stages of phylogenesis. First, the development of life occurs in the aquatic environment. In this case, the body does not need much effort to overcome the forces of gravity and the possibilities for this are also not yet developed. This is the intrauterine period.

The next step is the “belly-belly”: in phylogenesis creeping, lacking limbs, but living creatures living almost on land appear. In ontogenesis - the stage of development of the protective reflex, LUR, SDG, i.e. age from birth to six months. In this case, the development of anti-gravity mechanisms is necessary, as to perform these actions, it is necessary to overcome the increased forces of gravity.

Stage "four legs." In phylogenesis - the land stage of the development of animals, the appearance of anthropoid apes. In ontogenesis, this means getting up and crawling on all fours, which requires even more advanced mechanisms to overcome the forces of gravity. This is the age of 6-8 months.

Stage of “upright walking”. Only after having mastered the land on four legs for millions of years, did humanity appear, standing on two legs.

In parallel, mechanisms for coordinating movement improved and intelligence increased. This also happens in human ontogenesis.

The last stage starts from 8-10 months of age and then from year to year there is an improvement and complication of motor, coordination and intellectual abilities, against which speech develops. The chain links have never violated their order in either the phylogenesis or ontogenesis of a healthy child. This should not happen in ontogenesis in patients. You can not proceed to the next stage without mastering the previous one.

This is ensured by the sequence of development.

The age of the child, which corresponds to the stage of independent “upright posture” (12 months), is the peak of development in ontogenesis. Further, only perfection of skills, coordination, development of functions inherent only to man takes place. From the moment of birth to 12 months, the baby should gradually develop and quench reflexes at the right time, and on their basis motor skills should be formed, thereby ensuring the baby's progress to the top of development. The scheme of the child’s consistent development in the first year of life is genetically encoded. It is universal, very simple in essence, but very rigid.

The child’s developmental sequence cannot be violated under any conditions: unconditioned reflexes (protective), head control, chain setting reflexes (SDGs), sitting, resting on all fours, crawling, sitting down, standing up, walking. Each of these stages corresponds to a specific age of the child up to 12 months. Each stage is ensured by the necessary state of tone in various muscle groups, physiological mobility of the joints, the presence or extinction of unconditioned reflexes, the formation of installation reflexes, and the development of coordinating capabilities.

Thus, no matter what age the rehabilitation is started, it is first of all necessary to establish at what level of the development scale (from 0 to 12) the child is, determine what he should be able to at this level (regardless of calendar age), what conditions are necessary for this , i.e. determine his motor age.

Motor age is the age corresponding to the level of development of motor skills of the child from 0 to 12 months (see table).

Table for determining motor age and the corresponding stage of rehabilitation 18) Walking independently: DW ^* , months Rehabilitation Stages c) walking with a change of direction; 12 b) walking in a straight line; VII stage a) "running" in a few steps; eleven 17) Standing without support: b) longer, conscious; a) accidental, unconscious, short-term; 10 16) Standing and walking with a step at a support VI stage 15) Lift at the support from a position on all fours 9 14) The ability to sit down independently 13) Crawling on all fours V stage 12) Rise on all fours 8 11) In the abdominal position, alternating body lifts to straight arms and pelvic lifts with the head lowered to the surface. 7 Stage IV 10) Independent sitting (legs forward, back straight) 6 9) Plast crawl 8) Radial U-turns on the stomach 5 Stage III 7) Coups from the back to the stomach four 6) For a long time lies on his stomach, resting on his forearms 5) During traction, bends the head or holds it in the midline 3 II stage 4) Lying on his stomach raises his head, holds it for several minutes, turns to the sides 2 3) Head control in an upright position: the head drops back and forth for a minute. 2) Raise the head for several seconds in a position on the stomach one Stage I 1) The protective reflex of newborns: in the abdominal position, turning the head to the side in combination with swinging movements when trying to lift it 0 * DV - motor age

Despite the diversity of etiopathogenetic factors of perinatal pathology, it is necessary to strive to comply with the correspondence of motor skills to calendar age. In particular, the development of premature babies is often evaluated based on the appropriate date of birth. As a result of a child born 2 months earlier than 6 months, neurologists evaluate it as 4 months old, which entails underestimating the severity of the condition. Such a clinic should be regarded as a delay in psychomotor development.

Meanwhile, each case of the so-called delayed motor development should be considered in the aspect of cerebral palsy and all measures should be taken to eliminate it.

For a successful treatment result, the principle of early rehabilitation is necessary.

Following this principle, it is possible to act prophylactically, without waiting for gross delays in psychomotor development. To do this, children with whom this pathology is possible, classes from birth are necessary.

By the time of birth, a healthy child has already formed a number of unconditioned reflexes. With severe perinatal pathology, a set of reflexes will be insufficient for the further proper development of the baby.

Usually, congenital motor automatisms fall first or become poorly expressed: protective, grasping reflexes, support reflexes, crawling.

Many methods based on non-drug rehabilitation offer to stimulate their development. In our opinion, the only motor reflex that needs rehabilitation is protective, because it is the basis for the formation of the labyrinth installation reflex (LUR). As for the development of other reflexes, then restoring those automatisms that are normal by the end of the 2nd month should fade away normally is inexpedient and inefficient.

Based on this, already in the acute period of the perinatal pathology of the central nervous system, in addition to adequate drug therapy for the leading pathological syndromes (hypertension, hydrocephalic, convulsive, vegeto-visceral, etc.), it is necessary to create conditions for the occurrence of active movements that contribute to the formation of LUR.

Since these exercises are simple and small in number, every mother can be trained. At the same time, periodic specialist training consultations adjust the complex of these measures depending on the condition of the child. In the case when the condition of the child is threatening for the development of cerebral palsy, when the effect of independent studies is low, rehabilitation with the participation of a specialist is necessary from 2-3 months of age.

For the development of motor skills, especially in heavy children, it is impossible to do without the active participation of the child himself.

Passive methods aimed at relaxing the muscles do not provide potential opportunities for the further development of the child. Only with the active work of the musculo-articular complex is it possible to learn and form a stable motor stereotype characteristic of the physiological development of the child. At the same time, the centers of the brain involved in the formation of motor skills, differentiation and development of nerve cells are activated - reserve compensatory capabilities of the brain are stimulated, which is possible only with active movement. Therefore, the task of the rehabilitation doctor is to actively include in the work those muscle groups that are necessary for the formation of motor skill corresponding to the motor age of the child. As soon as the patient, having mastered the next motor skill, proceeds to the next stage, rehabilitation consists in actively consolidating the already existing motor skill, actively forming the skills of the next stage of development and passive work with muscle groups that will be involved later.

Thus, sequentially acquiring certain motor skills, the child, as it were, moves on a scale whose starting point is the motor skills of the newborn child, and the peak is a 1-year-old child (see table). In parallel with the development of new movements, coordination and intelligence develop, the role of positive motivations begins to prevail, which in turn provide an additional impetus to motor and mental development.

It should also be said about the time intervals for rehabilitation: they cannot be less than the intervals for the development of motor functions in a healthy child, regardless of the age at which rehabilitation measures begin. For example, a child of 1 year 6 months controls head movements (developed LUR), but does not know how to roll over, let alone sit and walk, i.e. its development corresponds to 3 months of life of a healthy child (motor age - 3 months). If we imagine 1 year as the final formation of basic motor skills, then 9 months (from 3 months to 1 year) are the minimum period that is necessary to restore motor functions in this child. Thus, at 2 years 3 months (1 year 6 months + 9 months), the child can begin to walk. In this case, there is a correspondence in the rates of development of a sick and healthy child, i.e. the ratio of these values is 1.

In case of violation of this correspondence, when the rehabilitation time increases compared to the reference, the coefficient also increases. We called this value the “compliance coefficient Ks”. If the compliance coefficient ranges from 1 to 2, this result can be considered excellent and the only one that you need to strive for.

For the integrity and completeness of rehabilitation measures, in addition to those already indicated, it is necessary to fulfill the principles of continuity, continuity and complexity.

Throughout the course of rehabilitation, the phase consists of alternating phases: treatment course - active rest with the implementation of methodological recommendations at home, and the inter-course period varies from one week to one month and depends on the form of cerebral palsy, the condition and well-being of the child.

After the doctor performs the main tasks in the course of correction of pathological postures, the formation of a new skill, trained relatives of the child daily many times this skill is acquired.

The combination of active rehabilitation methods with passive medication (correction of neurological syndromes and normalization of somatic status), the use of botulinum toxin type A drugs, classes with a psychologist, teacher, defectologist, speech therapy massage, music and rhythmic classes can increase the effect of rehabilitation.

The proposed method is implemented as follows.

A neurological examination of the child is carried out, the existing motor skills are distinguished, the motor age is determined on a scale No. 1, the neurological, mental and social development of the child is assessed, on the basis of which the initial stage of rehabilitation measures, clear tasks for the next classes are determined.

They determine the complex of exercises and activities that will be performed by parents at home, which parents will learn throughout the course of treatment.

After each course of treatment lasting 1-3 weeks, a break of 1-3 weeks should also be taken, during which parents deal with the child according to the plan developed by the doctor. The transition to the next stage is made only after the child has mastered the tasks of the previous stage. The duration of each exercise is 3-5 minutes. If the exposure is carried out alternately from two sides, then the exposure time is 3-5 minutes on each side.

Rehabilitation Stages

Stage I

At the first stage, they stimulate the development of a protective reflex, a labyrinth installation reflex with the help of successive exercises and manipulations.

Produce:

1) superficial and deep stimulation of muscles - extensors of the neck, back (classical and acupressure);

2) carrying the child on the forearm in a position on the abdomen with fixation for the thigh in such a way that the child's head faces the elbow bend with alternating hands;

3) passive coups for arms and legs from back to stomach and back;

4) from the starting position lying on its side, traction for the upper arm with a small gap between the body and the surface.

5) traction by the handles of a child lying at an angle of 45 degrees, while achieving separation of his head from the surface.

II stage

At the second stage, the position on the abdomen is dominated. To do this, add the following to the exercises of the first stage.

Produce:

1) lying on a wedge or roller located under the chest (all exercises of the second stage are performed in this position);

2) alternating hand massage in the same position;

3) passive removal of arms forward, dilution to the sides, abduction up - “signalman”, while the child keeps his head raised;

4) games that stimulate bringing one hand forward, while the child rests on the other hand.

Stage III

At the third stage, the child is taught flips from the back to the stomach and crawl in a plastusky manner.

Produce:

1) active upheavals from the back to the stomach by the arm and leg:

a) by the hand - having put the thumb of the right hand in the left hand of the child, we pull the hand in the direction of the coup to the right, bringing the child’s body to the side position, stop the forward movement of our hand, continuing to fix the child’s hand, while pointing the child’s right hand upwards; the child independently completes the coup;

b) by the leg - fixing the leg by the ankle joint, pull it in the direction of the coup, after flipping the body to the side, as in the first case, we stop the translational movements of our arm, continuing traction down the axis of the leg; the child independently completes the coup;

2) stimulate independent crawling in a plastussky way by creating alternate support for the feet in a position on the stomach.

Stage IV

At the fourth stage, the child is taught sitting with legs forward, lifting and standing on all fours.

Produce:

1) the whole complex of exercises of the second stage, but carried out on a high wedge with support on the arms straight in the elbow joints;

2) in the initial position on all fours the training of standing at three and two points - alternately raising the arm, leg, then the opposite arm and leg, swing the child back and forth in these positions - “arm-leg”;

3) walking the child with his hands on the table (in horizontal position) and on the floor (head down) with fixation for the hips, and then for the lower legs - a “wheelbarrow”;

4) an independent stand in position - one leg is set back with support on the knee, the other is in front with support on the full foot, bent at an angle of 90 degrees in the knee joint, the body rests on straight arms - “low start”;

5) the starting position is “low start”, but the hind leg is straightened;

6) the initial position is “low start”, but the front leg lies on the outer surface of the lower leg between the arms;

7) sitting with one leg forward, the other back, both legs are bent at the knee joints, with the support of the hands on their own knees - “half-frog”;

8) squatting, relying on full feet and hands, straightened in the elbow joints of the hands - “spider”;

9) independent sitting with legs forward, feet touching each other, knees apart;

10) independent sitting with the legs forward, knees apart, the shin of one leg lying on the shin of the other - “half-nose”;

11) the doctor holds the child in his arms in an upright position with his back to himself, fixing one leg in an upright position, the other in a horizontal position, stretched forward; the child holds its body on its own - “heron”; exercise is carried out with a change of legs;

12) sitting with legs forward, the instructor raises both legs, the child holds the body vertically - “clip”;

13) sitting with legs forward, the instructor raises one leg, the child holds the body vertically - “half-clip”;

14) the instructor holds the child with his back to his grip on the hips, the child seeks to maintain the vertical position of the body when the instructor is tilted back and forth - “tumbler”.

V stage

At the fifth stage, the child is taught to crawl on all fours.

Produce:

1) stimulation of an independent transition from the "half-frog" position to the four-foot position;

2) the initial position of the child on all fours on the floor; stimulation of crawl with independent movement of the hands and passive movement of the legs with the help of an instructor.

VI stage

At the sixth stage, the child is taught how to lift to his feet at a support.

Produce:

1) the initial position is “low start” at the support (chair, chair, sofa), but the child’s hands are located on the support; we ask the child to stand up independently, supporting him by the handles;

2) the initial position is “low start”, but without resting on the hands, the instructor holds the child behind (“Sagittarius”);

3) the child stands at the support, holding on to it; we spread the legs wider than the shoulders - the child independently becomes in the starting position, bringing the legs together;

4) heron exercise, but the vertical leg rests with the foot on the surface; exercise is carried out with a change of legs.

VII stage

At the seventh stage, the child learns walking skills.

Produce:

1) stimulation of walking at the support with the help of toys;

2) walking for one handle;

3) stimulation of walking, holding his hands behind the wall.

In the case of spastic forms at the 3rd, 4th and 5th stages in the interval between exercises, it is possible to use a simulator (device) for the correction of motor disorders in children with perinatal damage to the central nervous system and cerebral palsy (see, for example, application for utility model No. 2006145819 dated 12.26.06), and, starting from the 2nd stage to the 7th stage, it is possible to inject type A botulinum toxin intramuscularly in a total dosage of 30 units. per 1 kg of the weight of the child with an interval of 8-12 weeks, guided by the following principles:

1) early use of the drug (the feasibility of starting the administration of the drug from the 1st year);

2) the choice for injection of only those target muscles that are involved in the formation of the motor skills of the child corresponding to this stage of development;

3) the introduction of the drug on a top-down basis, starting with the elimination of the flexion-adductor-pronator settings of the muscles of the upper limb belt until the child acquires the skills of crawling in the Plastunas and on all fours and only then the lower ones, which contributes to the formation of the correct motor stereotype.

CLINICAL EXAMPLE No. 1

Borisov Nikita, born on 01.25.04.

Diagnosis: Perinatal damage to the central nervous system, hypoxic genesis, recovery period. Cerebral palsy, atonic-astatic form.

He was admitted for treatment at the age of 1.5 years. The motor development of the child at the start of treatment corresponded to 3-4 months of life (motor age). Motor skills at the time of the beginning of rehabilitation: he holds his head confidently, preferred position - lying on his back, does not like to lie on his stomach, turns from his back to his stomach slowly, reluctantly, only after stimulation, does not crawl on his own, does not sit down, does not get up, sits with support , back “round”, independent sitting is impossible - the child immediately falls, leg support is weak, muscle tone is diffusely reduced.

Rehabilitation began from the second stage with two-week courses with two-week breaks between them. Within two months (at the age of 1 year, 7 months), it was possible to strengthen the muscles of the back and arms. Standing on the stomach, resting on the forearms and raising his head, became a favorite. The child began to make radial movements on his stomach, crawl back, actively roll over from his back to his stomach and back. Another 3 months (age 1 year 10 months) was needed to learn how to climb to all fours, to sit independently with a straight back and crawl on all fours. However, the child preferred to crawl like a "squirrel jumping", the correct crawl was only possible under control and at a slow pace. Over the next two months (the child’s age is 2 years), the child learned to climb to his feet at the support: first near the “Swedish stairs”, then near the chair and against the wall. Independent walking around the support appeared a month later, at the age of 2 years 1 month. For the next three months, previously mastered skills improved: a change of position while lying, sitting, on all fours, while standing, became completely independent, quick. At 2 years 4 months, the child took the first steps. Another 6 months improved walking skills: walking with a change of direction, back forward, whirling in place. At the moment, the motor phase of rehabilitation is completed, the child is engaged in the development of speech and intellectual abilities.

CLINICAL EXAMPLE No. 2

Pankratova Nastya, 05.10.04 year of birth.

Diagnosis: Perinatal damage to the central nervous system, mixed genesis, recovery period. Cerebral palsy, diarrheal form.

Received for treatment at the age of 1 year 3 months. From the anamnesis: a child from 1 pregnancy, 1 spontaneous preterm birth at 33 weeks. 2nd of twins, birth weight 1100 g. At the time of admission to rehabilitation, motor development corresponded to 2 months of life.

Neurological status and motor skills at the time of starting treatment: holds the head, does not turn over from the back to the stomach, does not sit, does not stand. Muscle tone is elevated in the lower extremities by spastic type. Babinsky's symptom is positive on both sides. Reliance on tiptoe, walking with the cross. Breeding in the hip joints is difficult on both sides.

Rehabilitation began from the second stage with two-week courses with two-week breaks between them. From the first lessons, the device includes a device for the correction of motor disorders in children with perinatal damage to the central nervous system and cerebral palsy (notification of receipt and registration of application No. 2006145819 of 12/26/06).

After 1 month from the start of correction, the child began to spend most of his free time on his stomach, playing with toys, while his legs were straightened and tense as much as possible. Over the next two months, the girl mastered the coups from the back to the stomach, the tone in the quadriceps muscles of the thighs decreased, due to which alternate bending of the legs in the knee and hip joints appeared in the position on the abdomen, and the child took control of the radial twists on the abdomen. Lumbar lordosis began to form. 6 months after the start of rehabilitation, the child possesses the following skills: correct crawling in the Plastun way (with the participation of the legs), independent lifting to the “on all fours” position, independent sitting with the legs forward, in the “half frog” position, held in the “soldier” position, those. an upper symptom of Landau appeared. Most of the time the child devotes to games on his stomach and crawling.

The stage of mastering the crawl on all fours lasted another 2 months. The positions "low start", "Sagittarius", exercises "wheelbarrow", "heron" were mastered. With the beginning of the crawl, spontaneously appeared a desire and the ability to stand at the support.

Crawling to the object and leaning on it with his hands, the child symmetrically strained his legs and unbent them, lifting the body. At the same time, the feet rested “on tiptoe”, touched each other, as a whole were extremely tense (“legs-columns”).

Due to the presence of a cross when walking by the handles, the presence of equinovarus deformity of the feet and the possibility of independent verticalization, type A botulinum toxin was introduced into the adductors of the thighs and triceps of the lower leg and in parallel the 6th stage of rehabilitation was started. Within 2.5 months, the child mastered independent walking with a step in support with support on a full foot, the correct rise to his feet from the “on all fours” position, walks, holding on to one hand. The first independent steps appeared after another 2 months, at the same time the opportunity appeared to stand without support with hands. Independent walking is being improved.

Using the proposed method is possible and appropriate both at home, with prior training of parents, and in stationary medical, outpatient rehabilitation institutions and in medical centers of rural areas.

The advantages of the proposed method are:

1) lack of expensive material base;

2) the simplicity of understanding the goals and objectives, the availability of training allow the method to be used by paramedical staff and parents;

3) focus on certain skills (stages) allows you to achieve success in a shorter period of time (the presence of a clear algorithm of actions);

4) the ability to ensure continuity of treatment, because classes during the inter-course period can be carried out by parents at home;

5) the child’s consistent, phased development of motor skills, each of which is later used in everyday life.

As a result of the foregoing, it can be argued that the use of the proposed method allows to increase the efficiency and quality of rehabilitation of children with cerebral palsy, to carry out early, active prevention of severe manifestations of perinatal pathology, including cerebral palsy, in children of the first year of life with a burdened history, thereby reducing the level childhood neurological disability. As a result of this, the material resources allocated annually for the rehabilitation of a disabled child can be used to develop other social projects.

INFORMATION SOURCES

1. Semenova K.A. Cerebral Palsy M., "Medicine", 1968, S. 136-139.

2. Auth. testimonial. USSR No. 8395 54, cl. A61N 1/31, 1981.

3. Polish E.V. "Cerebral Palsy", M., 2004, 173 S.

4. www.cerebral-palsy.ru

5. Renate Holtz. Helping children with cerebral palsy. M., "Terevinth", 2006, 334 pp.

6. RF patent №2113204, class. A61H 7/00, 1998.

Claims (3)

1. A method of treating motor disorders syndrome in children, including performing physical exercises, characterized in that the exercises with the child are carried out sequentially in seven stages, while the initial stage of exposure is determined by the motor age of the child, depending on his motor skills, in the first stage they stimulate development protective reflex, labyrinth installation reflex by performing classical and acupressure of the muscles of the extensors of the neck and back, carrying the child on the forearm in a position on the stomach with fixation for the thigh, passive coups for hands and feet from the back to the stomach and back, traction for the upper arm with a slight margin in the position of the child lying on its side, traction for the hands of a child lying at an angle of 45 °, with the head torn off surface; at the second stage, all exercises are performed in a position on the abdomen with a wedge or roller under the chest, while doing alternate hand massage, passive hand removal forward, spreading to the sides, leading up with holding the head up; at the third stage, they teach the child to flip from the back to the stomach and crawl in a plastusky way; at the fourth stage, they teach sitting with legs forward, lifting and standing on all fours; at the fifth stage they teach crawling on all fours; at the sixth stage, they teach the child how to lift to his feet at the support; at the seventh stage, they teach walking skills. 2. The method according to claim 1, characterized in that in spastic forms of cerebral palsy, starting from the second stage, intramuscular injections of the drug type A botulinum toxin are performed at a rate of 30 units. per 1 kg of the weight of the child with an interval of 8-12 weeks. 3. The method according to claim 1, characterized in that in the case of spastic forms of cerebral palsy at the second to fifth stages, in the interval between exercises, a simulator is used to correct motor disorders.

Images