Cerebral palsy what group of disability. Cerebral palsy groups

Effective rehabilitation of children with cerebral palsy includes a set of measures. Attention is paid not only to the physical, but also to the mental development of the child, the acquisition of skills of independence and social adaptation. For children with disabilities, free observation, provision of vouchers for treatment in sanatoriums, provision of medicines and means of technical rehabilitation are also possible.

Causes of the disease and risk factors

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

• severe pregnancy;
• unhealthy lifestyle of the mother;
• hereditary predisposition;
• difficult childbirth, during which fetal asphyxia occurred;
• acute or some chronic diseases of the mother;
• children born prematurely and with low birth weight;
• infectious processes occurring in a latent form in the mother's body;
• toxic poisoning of the child's brain due to incompatibility of the mother and fetus in terms of blood group and Rh factor or liver failure of the child.

Postpartum triggers include:

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

In every third case, however, it is not possible to identify the specific cause of the pathology. And as a rule, the rehabilitation of children with cerebral palsy does not depend on the causes of the development of the disease. may be revised except in the case of premature and low birth weight children - such patients often require more careful care and medical supervision.

The main phases of the course of the disease

Rehabilitation of children with cerebral palsy depends on the phase of the disease, the severity of the course of the disease and the age of the patient. There are three phases of the course of the disease:

1. Early (up to 5 months). Cerebral palsy is manifested by developmental delay, preservation of unconditioned reflexes.
2. Primary (up to 3 years). The child often chokes on food, does not seek to speak, asymmetry, hypertonicity or excessive muscle relaxation is noticeable.
3. Late (over three years). It is manifested by the shortening of one limb compared to the other, swallowing, hearing, vision, speech disorders, convulsions, urination and defecation disorders, mental retardation.

Early signs of cerebral palsy

Early signs of cerebral palsy include the following abnormalities:

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

Clinical manifestations of the disease can be both pronounced and almost imperceptible - it all depends on the degree of damage to the central nervous system and the brain. You should seek medical help if:

• the child's movements are unnatural;
• the child has convulsions;
• muscles appear excessively relaxed or tense;
• the baby does not blink in response to a loud sound at one month;
• at 4 months, the child does not turn his head to a loud sound;
• does not sit without support at 7 months;
• does not speak single words at 12 months;
• the baby does not walk or walks unnaturally;
• the child has strabismus.

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

Is it possible to cure the disease

Cerebral palsy refers to diseases that are almost impossible to cure completely. However, comprehensive and timely rehabilitation allows children with such a diagnosis to be trained on an equal footing with healthy children and lead a full-fledged lifestyle. Significant progress can be considered the preservation of individual symptoms of the disease in the child.

Modern methods of treatment of cerebral palsy

The main task for children with paralysis is the gradual development of skills and abilities, physical and social adaptation. Methods that are developed individually for each child gradually correct motor defects, improve motor activity, develop the patient emotionally, personally and socially, develop independence skills in everyday life. As a result of systematic rehabilitation, the child can integrate into society and adapt to later life independently.

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

• treatment with water procedures: swimming, balneo- or hydrotherapy;
• PET therapy, or animal treatment: hippotherapy psychophysical rehabilitation in the process of communicating with dolphins and swimming;
• the use of orthopedic devices, exercise equipment, gymnastic balls, ladders;
• increasing the bioelectric activity of muscles;
• therapeutic massage to reduce the degree of lethargy and muscle spasm;
• drug treatment: Botox, botulinum toxin, xeomin, dysport are used;
• Vojta therapy, which allows you to restore natural patterns of behavior;
• physiotherapy treatment: myoton, ultrasound, magnetotherapy, darsonvalization;
• Montessori therapy, which allows you to form the ability to concentrate and develop independence;
• classes with a psychologist;
• speech therapy classes that correct speech disorders (program "Logorhythmics");
• special pedagogy;
• shiatsu therapy - massage of biologically active points;
• classes according to the Bobath method - special gymnastics using certain equipment;
• laser impact on reflexogenic zones, nose tip, joints, reflex-segmental zones, area of ​​paretic muscles;
• art therapy aimed at preparing the child for learning;
• Peto's technique - division of movements into separate acts and their learning;
• surgical orthopedic interventions;
• Spa treatment;
• alternative methods of treatment: osteopathy, manual therapy, catgut therapy, vacuum therapy, electroreflexotherapy.

Of course, not all methods of rehabilitation of children with cerebral palsy are listed above. There are many ready-made programs developed and currently being developed by rehabilitation centers, alternative approaches and techniques.

Physical rehabilitation of children with cerebral palsy

The physical recovery of a sick child should begin as early as possible. Leading experts in the world have recognized that the rehabilitation of a disabled child (CP) brings the best results up to three years, but in Russia many centers refuse to accept children under one or three years old, and doctors are in no hurry to establish a diagnosis and formalize disability. But still, physical rehabilitation is the most important stage in the adaptation of a special child to later life, and you should start working with a small patient immediately after the diagnosis of "cerebral palsy" is established.

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

Rehabilitation Bobath Therapy

The most common form of rehabilitation is Bobath therapy in combination with other equally effective methods. The essence of therapy is to give the limb a position opposite to that which, due to hypertonicity, it seeks to accept. Classes should be held in a calm environment, three times a day or a week, each movement is repeated 3 to 5 times. The movements themselves are carried out slowly, because the main goal of treatment is to relax the muscles. Complexes of exercises are developed individually. Treatment according to the Bobath therapy method can also be carried out at home - a parent or guardian learns how to perform techniques with the help of a specialist in a rehabilitation center.

Means of technical rehabilitation

In the physical restoration of the motor activity of a child with cerebral palsy, the means of technical rehabilitation of children are also used. Severe cerebral palsy requires devices for mobility (walkers, wheelchairs), development (exercise bikes, special tables and chairs) and hygiene (bath seats, toilet seats) of the child. Also, rehabilitation means for children with cerebral palsy involve the use of orthopedic devices and exercise equipment. For example, the Adele suit is used, which redistributes the load, develops motor skills, Veloton, which stimulates muscles, the Spiral suit, which allows you to form new movement stereotypes, and so on.

Social rehabilitation of disabled children with cerebral palsy

Closer to school age, more attention is paid to the social adaptation of the child. Efforts are directed to the formation of independence skills, mental development, preparing the child for collective learning and communication. In addition, the patient is taught to dress himself, serve himself, exercise hygiene, move around, and so on. All this will reduce the burden on those caring for a disabled child, and the smallest patient will be able to adapt to life.

Psychologists, speech therapists and teachers work with special children. The role of parents or guardians who will deal with the child at home is extremely important. Social rehabilitation of children (ICP) pursues the following goals:

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

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

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

Disability with cerebral palsy

It has several forms and degrees of severity. Disability in cerebral palsy is issued if the disease is accompanied by restrictions in relation to normal life, learning, self-service, speech contact. Registration of disability is possible only after a medical examination. A mother with a child will have to undergo a neurologist, surgeon, psychiatrist, pediatrician, orthopedist, ophthalmologist and ENT specialist. This "adventure" does not end there. Followed by:

• issue a final conclusion from the head of the medical institution;
• go through the procedure of reconciliation of documents already in an adult polyclinic;
• give a package of documents to the point of acceptance of papers for medical and social examination.

Depending on the term for establishing disability, it is necessary to conduct a medical and social examination (and, consequently, to re-pass all doctors) again after a certain period of time. It is also necessary to obtain conclusions again if the completed individual rehabilitation program undergoes changes - for example, if a child, as prescribed by a specialist, needs a new means of rehabilitation.

Benefits for disabled children with cerebral palsy

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

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

• free rehabilitation in federal and regional centers and sanatoriums;
• a discount of at least 50% on the payment of municipal or public housing, as well as housing and communal services;
• the right to receive priority land plots for individual construction, gardening and housekeeping;
• provision of medicines (as prescribed by a doctor), medical nutrition products;
• free travel to the place of sanatorium treatment and back, as well as in public transport (a benefit is provided for a disabled child and one accompanying person);
• compensation for the services of a psychologist, teacher and speech therapist, determined by an individual rehabilitation program (in the amount of no more than 11.2 thousand rubles per year);
• exemption from payment in kindergartens;
• compensation payments to unemployed persons caring for a disabled child (a parent, adoptive parent or guardian can receive 5.5 thousand rubles, another person - 1.2 thousand rubles);
• pension for a disabled child and additional payments (in total 14.6 thousand rubles as of 2017);
• the period of caring for a child with a disability is included in the mother's seniority;
• the mother of a disabled child with cerebral palsy has a number of benefits under labor law: she cannot be involved in overtime work, business trips, has the right to work part-time, retire earlier, and so on;
• a single mother raising a disabled child cannot be dismissed, except in cases of complete liquidation of the enterprise.

Rehabilitation centers in Russia

In special centers, the rehabilitation of children with cerebral palsy is carried out comprehensively and under the supervision of relevant specialists. As a rule, systematic classes, an individual program and professional medical support for both children and parents can achieve significant results in a relatively short period of time. Of course, to consolidate the result, you need to continue to engage in the proposed program at home.

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

There are several rehabilitation centers in Russia. The Grossko Center in Moscow works according to a comprehensive program: upon admission, diagnostics are carried out, then specialists-instructors in physical recovery deal with a special child. Physical rehabilitation of children with cerebral palsy at the Grossko Center includes physiotherapy exercises, swimming, exercises with special simulators that allow developing coordination of movements and fixing motor stereotypes, classes on a treadmill, roller skating. Based on the results of pedagogical testing, programs are adjusted so that recovery meets the needs and condition of a particular small patient.

The cost of rehabilitation of a child (cerebral palsy) in the Grossko Center, of course, is not small. For example, you will have to pay 1,700 rubles for the initial appointment, and the cost of 10 physical therapy sessions (45-50 minutes each) is 30 thousand rubles. One lesson with a speech therapist (lasting 30 minutes), as well as a massage session (30-40 minutes according to the doctor's testimony) will cost 1000 rubles. However, the results of the classes really are, and the Grossko Center itself is a prominent institution.

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

The Rehabilitation Center for Children with Cerebral Palsy named after R. R. Vreden (RNIITO - Russian Research Institute of Traumatology and Orthopedics) in St. Petersburg provides its clients with a full range of services: from diagnosis to surgery, including, of course, treatment and recovery. More than twenty fully equipped departments are at the disposal of highly professional specialists of the center with many years of practical experience.

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

The Moscow Scientific and Practical Center for the Rehabilitation of Persons with Disabilities Due to Cerebral Palsy is considered one of the most accessible and well-known. The doctors of the center work on the basis of several dozen rehabilitation programs, use all modern domestic developments and find an individual approach to each patient. The center accepts children from three years of age. In addition to direct physical recovery, psychologists-defectologists, speech therapists, professional massage therapists and conductologists are involved with young patients - teachers who work with children and adults with CNS disorders.

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

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

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

The collective name "infantile cerebral palsy" (abbreviated as cerebral palsy) means not one pathology, but many disorders of the nervous system (NS), malformations that form during pregnancy, in the natal and postnatal periods, united by a single set of symptoms.

Movement disorders in cerebral palsy, often combined with mental, speech, cognitive impairments, epilepsy, visual and hearing disorders, etc., are secondary symptoms arising from developmental anomalies, injuries, and inflammatory pathologies of the brain. Although they are considered non-progressive, as a child with cerebral palsy grows and develops, the objective clinical picture may improve or worsen, depending on:

• forms of cerebral palsy, the degree of damage to the central nervous system;
• adequately selected therapy for concomitant disorders;
• success of the rehabilitation program for cerebral palsy;
• psycho-emotional state of a particular patient diagnosed with cerebral palsy;
• his social environment;
• joint efforts of parents, doctors, teachers and other caring people who, by the will of fate, are nearby, take part in the habilitation, the fate of children with cerebral palsy in the first year of life and older.

Manifesting at an early age, a childhood disease (ICP) will gradually develop over the years into an adult. Congenital or acquired in the natal and postnatal periods, pathologies of the central nervous system accompany a person throughout his life. If the brain damage is insignificant, it was possible to diagnose cerebral palsy in time, start symptomatic treatment and rehabilitation up to a year, continue them if necessary throughout life, there is a chance that motor, cognitive and other impairments will be minimal in adulthood. Modern habilitation and rehabilitation programs for cerebral palsy allow leveling pathological symptoms in mild degrees of damage.

Some adults who were once diagnosed with cerebral palsy receive education, various professions, move up the career ladder, run at the Paralympic Games. Among them are artists and lawyers, musicians and teachers, journalists and programmers. The whole world knows the names of prominent people who cannot be called "patients with cerebral palsy". Special people who, by the will of fate or nature, found themselves in a less advantageous position, in comparison with the rest, ordinary people, were able to rise above the disease, defeat it, and achieve much more than others in life.

Let's talk about some of them.

cerebral palsy in women

Known not only in her native continent, but throughout the world, the Australian prose writer, public figure, Anna Macdonald. She spent from 3 to 14 years in a closed institution, where they did not live in isolation from society, but there were people with disabilities with cerebral palsy and other serious illnesses. This dramatic segment of fate became the subject of the sensational book "Anna's Exit", and later the script of the feature film.

Similar, but not so dramatic, is the fate of the Russian screenwriter Maria Batalova. She has also been struggling with the symptoms of cerebral palsy for many years, but her relatives and people who love her have always been by her side. The bright lines of her works for adults, wonderful stories for children are permeated with philanthropy. In 2008, her screenplay for The House on the English Embankment was awarded the highest award at the Moscow Film Premiere Film Festival.

Six gold medals of the Russian championships in horse dressage among Paralympic athletes are on the account of a beautiful young mother and at the same time a successful model, Anastasia Abroskina. Her disease, which had long outgrown childhood (cerebral palsy, hyperkinetic form), could not break the will to win, destroy the thirst for life of an elegant, seemingly very fragile, but in fact, incredibly persistent, purposeful woman.

In the middle of the 15th century, the illegitimate son of the notary Piero da Vinci, Leonardo, was born in Italy. From birth, the boy's right arm and right leg did not obey, he had a hemiplegic form of cerebral palsy. Therefore, when he grew up, he limped slightly when walking, and he learned to write, draw, etc., with his left hand. Thanks to his divine gift, numerous talents, the world cultural heritage was enriched with great canvases (“Annunciation”, “Madonna with a Flower”, etc.), sculptural works (unfortunately lost), and he was also an architect, scientist, inventor.

Among our contemporaries who are diagnosed with cerebral palsy and world famous are actors Sylvester Stallone, RJ Mitt, Chris Foncheska.

In 2008, one of the sensations of the Paralympic Games in Beijing was the triumph of the Russian athlete Dmitry Kokarev. The young swimmer brought one silver and three gold medals to our team.

The pride of all Crimeans is their fellow countryman, a legendary man, Niyas Izmailov, a special child, a disabled person with cerebral palsy, who grew up and became the world champion among ordinary bodybuilders.

Children and cerebral palsy: from birth for many years

World medical statistics state that today children with cerebral palsy (up to a year and older) are found in the population with a frequency of 0.1 to 0.7%. Moreover, boys are victims of pathology almost one and a half times more often than girls. For every 1000 citizens in different countries, there are, on average, from 2 to 3 people with a lesion of the nervous system, which is called "children's" (CP), since it occurred during intrauterine development, in the natal or postnatal period. However, in some countries, children with cerebral palsy are much more common among the population.

So, in the US, the numbers are much higher, and they differ even for neighboring states. For example, in 2002, statistics showed that children with cerebral palsy (1 year of age and older) per 1000 people occur with a frequency of:

• 3.3 in Wisconsin;
• 3.7 - in the state of Alabama;
• 3.8 in the state of Georgia.

On average, American scientists said that children with cerebral palsy (1 year and older) occur at a frequency of 3.3 patients per 1000 population.

• In Russia, according to Rosstat in 2014, per 100,000 children, there were, on average, 32.1 small patients with cerebral palsy (from 1 year of age to 14 years of age).
• According to the estimates of the Ministry of Health in the Russian Federation in 2010, there were more than 71 thousand children with cerebral palsy (1 year - 14 years).

The forecast of experts of the World Health Organization is not very comforting. Children with cerebral palsy are being born more and more often. And in the coming years, the number of babies who have signs of cerebral palsy from birth will increase.

Despite the fact that the disease is childhood, cerebral palsy accompanies the patient from birth, relentlessly following him all his life. Therefore, the fight against the disease is always going on.

If the baby has perinatal brain damage, cerebral palsy, the year (first from birth) can determine the entire future fate. After all, the objective clinical picture in the future will depend on how:

• signs of cerebral palsy were quickly identified;
• the form and extent of damage to the nervous system are precisely determined;
• the chosen symptomatic therapy is adequate;
• correctly compiled rehabilitation and habilitation programs for cerebral palsy.

Parents of children with various forms of cerebral palsy often regret the time, energy and money spent in vain on psychics, traditional healers, etc., in the first years after the birth of a baby. It is important that fathers and mothers who are confused and sometimes morally crushed by the changes that have taken place in their lives, with the birth of a special child, be guided on the right path by specialists, doctors, and psychologists. The road of habilitation, socialization is always very difficult, thorny for every family that has children with special needs.

Therefore, it is better not to stray by the roundabout paths, making your way to the touch, testing alternative methods on your own son or daughter, expecting miraculous healing and losing precious time during which deformities, contractures have time to form, and other related complications appear. And rely on the existing world experience in habilitation and treatment of cerebral palsy, enlist the support of specialists.

And the sooner the parents stop looking into the past, looking for an answer to the question “why” cerebral palsy was sent, seeing the causes of the disease in the “evil eye” of ill-wishers or stirring up their own actions, they will understand that it is necessary to live in the present, the sooner they will understand how to live in future.

Helping the baby to fight for life, rejoicing in every, albeit tiny, completely invisible to others, but such a huge victory for the family, giving, without a trace, all his love and tenderness to the most defenseless, helpless of all people, mom and dad, grandparents, other relatives and strangers by blood, but the most humane people on this Earth, who become foster parents, guardians, educators for abandoned children with cerebral palsy, acquire the meaning of existence. They improve spiritually, gaining invaluable experience of compassion and mercy.

Special people or patients with cerebral palsy?

Parents, doctors, teachers and other people are products and part of society. The worldview and attitude of each individual towards the disabled are formed by virtue of public opinion, the position of the state.

The moral norms of the modern human population, which distinguish people from animals, differ significantly from those that existed at the dawn of human civilization. They have changed significantly in the process of evolution of society.

Weaker children have always come into the world, including those with cerebral palsy. However, in addition to natural selection, in the old days people tried on the role of gods, deciding who has the right to life and who is not worthy. Infanticide, the killing of infants with signs of inferiority, has existed for thousands of years. Only in 374, for the first time in world history, a law was issued prohibiting the physical destruction of newborns with various pathologies. But only in the 9th century did the Christian world begin to equate infanticide with the usual murder of one's own kind.

The spiritual life of Western European society and the entire world civilization has experienced great positive changes, thanks to the great figures of the Renaissance and the humanists-educators who fought for the rights of the disabled during the French Revolution. Thanks to them, society for the first time realized its responsibility for the disadvantaged, outcasts, patients with cerebral palsy, etc.

Humanity has gone through a huge evolution of spiritual growth over the past hundred years. And this process continues today, before the eyes of each of us.

Thus, in 2008, an event occurred that in the future should change the lives of people with disabilities with cerebral palsy and other pathologies in Russia. Our country has signed the Convention on the Rights of Persons with Disabilities. The new international law was ratified by deputies in 2012. It is designed to help socialize people with disabilities, reduce manifestations of discrimination against them by the state, officials, and society.

The state turned its gaze towards special people. The media talked about an accessible environment for people with disabilities, inclusion, equal opportunities. Many positive changes are happening before our eyes. The mere fact that large and small people in wheelchairs, with various orthopedic devices appeared on the streets of Russian cities, already indicates that the process has begun.

However, much remains to be changed. First of all, in the mind of each individual person. So that adults and children are not afraid of people with disabilities, including those with cerebral palsy, do not shy away from them in public places, do not humiliate and offend, voluntarily or involuntarily, do not ignore their difficulties. Society must understand that patients with cerebral palsy are ordinary people, only they have their own characteristics, like every person.

Special people have the same desires and dreams as ordinary people. Only in order to fulfill even the smallest of them, it is sometimes necessary to make incredible efforts. For example, to take a walk in the park on a fine day, learn to draw or find a true friend.

Therefore, they need help, not only material, but physical, psychological. Not alms, but the sincere participation of others. And yet - partnerships, on an equal footing.

They are the same people, just caught in a quandary.

Several diseases at once, which are based on an anomaly of development or damage to the brain during the intrauterine development of a child, at the time of childbirth or in the postnatal period, are called cerebral palsy.

In 1861, William Little, an orthopedic surgeon from England, first described the clinical picture of one of the varieties of cerebral palsy, he saw the causes of spastic diplegia in oxygen starvation at the time of childbirth. But he believed that it was not the brain that was affected, but the spinal cord. In honor of him, this form of cerebral palsy is sometimes called "Little's disease" today.

The term "cerebral palsy" was introduced into medical practice in 1893 by Sigmund Freud, at that time already a well-known psychoanalyst. In 1897, he first compiled a classification of children, listing the signs of cerebral palsy. Freud first described the development of cerebral palsy. Unlike Little, he saw differently the etiology and pathogenesis of cerebral palsy, the causes of pathology. According to Freud, not only the spinal cord suffered, but first of all, the brain with cerebral palsy, he looked for the causes of violations not only in birth injuries and asphyxia. Freud believed that the development of cerebral palsy begins much earlier. He was the first to call the cause of cerebral palsy an abnormal intrauterine development of the child.

Signs and manifestations of cerebral palsy

Since 1980, according to the definition of experts from the World Health Organization, signs of cerebral palsy, as a group of pathological syndromes of the nervous system, are considered non-progressive motor and psychoverbal disorders. They are a consequence of brain damage in cerebral palsy, the causes of which lie in the postnatal, intranatal and intrauterine periods of a child's development.

Throughout history, since the identification of signs of cerebral palsy by William Little, there have been many attempts to classify and streamline the symptom complexes of a group of syndromes. However, according to some scientists, it was not possible to draw up a single, clear concept of a multifaceted pathology, forms of cerebral palsy.

In general, the severity of the condition of patients with cerebral palsy is assessed according to three degrees of damage:

• mild - complete socialization is possible with a given degree of impairment in cerebral palsy, training, mastering not only self-service skills, but also professions, engaging in socially useful work, a full life;
• medium - partial socialization, self-service with the help of other people are possible;
• severe - a person remains completely dependent on others, cannot serve himself without outside help.

To date, several classifications are used in medical practice, including various forms of cerebral palsy.

In Russia, they often use the classification compiled in 1972 by Professor Xenia Alexandrovna Semenova, who in our country was affectionately nicknamed "grandmother of cerebral palsy." This classification combines the following forms:

• atonic-astatic;
• hyperkinetic;
• hemiparetic;
• spastic diplegia;
• double hemipletic;
• mixed.

In Europe, the following clinical classification scheme for signs of cerebral palsy is usually used:

• ataxic paralysis;
• dyskinetic paralysis;
• spastic paralysis.

At the same time, the dyskinetic form has two types of cerebral palsy, the symptoms of which differ from each other:

• choreoathetous;
• dystonic.

The spastic form also has two options for the development of cerebral palsy:

• bilateral paralysis;
• unilateral paralysis.

Bilateral damage is divided into:

• quadriplegia;
• diplegia.

In international medical practice, the ICD-10 statistical classification has been adopted. According to her, all cerebral palsy (ICP) is divided into:

• spastic - G80.0;
• spastic diplegia - G80.1;
• children's hemiplegia - G80.2;
• dyskinetic - G80.3;
• ataxic - G80.4;
• other types of cerebral palsy - G80.8;
• unspecified cerebral palsy - G80.9.

The development of a child with cerebral palsy goes through several stages.

The first of them is called "initial", it lasts from birth to six months.

If during it, as early as possible, the correct diagnosis of cerebral palsy is established, adequate therapy is prescribed, rehabilitation begins, there are much more chances to avoid unwanted complications and an extreme degree of disability.

The next stage, the initial residual, lasts from six months to 3 years.

At this time, the diagnosis of cerebral palsy has already been made, the degree of brain damage is clear and predictions have been made. But no modern classifications and predictions are able to accurately predict the compensatory capabilities of the brain of a particular child. Especially if they are multiplied by the persistence of the patient himself, the efforts of his relatives, doctors, everyone who participates in the rehabilitation program for cerebral palsy. It is during this period that the rehabilitation of cerebral palsy gives its first fruits. In addition, the correct strategy for dealing with the disease at the initial residual stage lays the foundation for the development of a child with cerebral palsy in the future.

The residual stage starts at 3 years of age.

Although organic brain lesions are irreversible, and the symptom complex in this period is finally formed and is considered non-progressive, classes with children with cerebral palsy cannot be stopped. Persistent and consistent habilitation, rehabilitation, education in cerebral palsy are of great importance at any age, for children and adults. If you conduct regular training and classes, cerebral palsy can be corrected. A clear proof of this is the many adults and grown-up children who, thanks to training, habilitation and rehabilitation, were able to defeat cerebral palsy and live a full life.

At the end of the last millennium, Ukrainian scientists, Vladimir Ilyich Kozyavkin and Vladimir Oleksandrovich Padko, proposed a new rehabilitation classification of cerebral palsy, the symptoms of motor and psychoverbal disorders were systematized for a unified assessment of the condition of patients at different stages of rehabilitation with cerebral palsy. It is based on an assessment of three main syndromes, which, in combination with an additional one, make it possible to diagnose cerebral palsy. These are the syndromes:

• speech disorders;
• intellectual disorders;
• movement disorders.

Syndrome of speech disorders can be characterized by:

• delayed speech development;
• sensory, motor or mixed alalia;
• dyslalia;
• ataxic, spastic, hyperkinetic or mixed dysarthria.

The syndrome of intellectual disorders is defined as mental retardation of two degrees:

• light;
• expressed.

The syndrome of movement disorders, at various stages of development of cerebral palsy, is assessed based on:

• severity - plegia (complete absence) or paresis (limitation, weakness);
• prevalence - by the number of limbs involved;
• the nature of the violations - according to the type of changes in muscle tone.

Based on the assessment of the syndrome of motor disorders, the following stages are distinguished, which the development of cerebral palsy goes through:

• stages of locomotion;
• vertical phase.

The stage of locomotion is divided into several segments, each of which is characterized by a certain way of movement in space:

• impossibility of movement in space;
• movement with the help of body turns;
• simple crawling (plastunsky);
• spasmodic, non-alternating crawl;
• alternating, reciprocal or alternating crawling;
• kneeling;
• walking in an upright position, with the help of special devices and devices;
• independent walking (pathological).

The verticalization phase also has several stages:

• lack of head control in the prone position;
• the presence of head control in the prone position;
• ability to sit independently;
• getting up with support;
• ability to stand up without support.

Assessment of the state at different stages of rehabilitation, taking into account the development of a child with cerebral palsy, allows us to trace the dynamics of neurological syndromes, outline immediate goals and perspectives.

Each form of cerebral palsy has symptoms that distinguish it from others. The differences are due to the specific causes of cerebral palsy, the nature and extent of lesions of the nervous system. Therefore, even within the framework of the general form, children of the same age may have significant differences in development, even against the background of a single rehabilitation program.

Let us stop optionally on the main forms and their features.

The hyperkinetic, athetotic form (3.3% of patients) goes through two phases of the formation of neurological syndromes - the hyperkinetic one replaces the dystonic one. Muscle tone differs significantly - from severe spasticity to hypotension-dystonia. As a rule, dyskinesias, ataxia, psychoverbal retardation are diagnosed. Despite rehabilitation, training and classes with children with cerebral palsy of this form, deformities of the extremities, scoliosis are formed over time.

The atactic form (9.2% of patients) manifests with the "sluggish baby" syndrome in the first weeks after birth. With this form of cerebral palsy, the causes of pathological syndromes are hidden in lesions of the frontal lobes of the brain. The delay in motor development is combined with a decrease in muscle tone. With brisk tendon reflexes, the following are noted:

• intentional tremor of the upper extremities;
• torso ataxia;
• dysmetria;
• discoordination.

Despite the efforts of rehabilitation, regular classes, with cerebral palsy of this form:

• there are great difficulties, often the impossibility of verticalization of the body, since the mechanism of postural control is disturbed;
• astasia-abasia syndrome often develops (inability to sit and stand);
• gross mental retardation is recorded.

Spastic forms (up to 75% of patients) are characterized by:

• increased muscle tone;
• an increase in tendon reflexes;
• clonuses;
• pathological reflexes of Rossolimo, Babinsky;
• inhibition of surface reflexes;
• lack of muscle control
• oppression of normal synkinesis;
• formation of pathological friendly movements.

The clinical picture is different for different spastic forms of cerebral palsy.

Quadriplegia (tetraplegia) is characterized by a violation of the muscle tone of the whole body, more often the hands are affected to a greater extent. If significant differences are recorded in the lesion, with a predominance in the upper limbs, we are talking about bilateral hemiplegia.

Signs of this spastic form are:

• lack of head control;
• impossibility of visual-spatial coordination;
• due to violations of the mechanisms of formation of postural reflexes, there are big problems with the verticalization of the body;
• have difficulty swallowing;
• articulation is difficult;
• speech problems;
• despite classes with children with cerebral palsy of this spastic form, as a rule, deformations of the limbs and spine, contractures develop;
• delays in psychoverbal development of various degrees.

Paraplegia is a predominant lesion of the lower extremities, combined with preserved motor function of the hands, minor or moderate impairment of the functionality of the upper extremities. With safe speech and perfect head control, despite training and classes, with cerebral palsy of this spastic form, a “ballerina pose” is formed and there are:

• flexion contractures in the knee joints;
• equino-varus or equino-valgus foot deformities;
• dislocations of the hip joints:
• hyperlordosis of the lumbar spine;
• kyphosis of the thoracic spine, etc.

Patients with paraplegia have difficulty learning skills:

• seats;
• standing;
• walk.

Hemiplegia is a spastic lesion of one side of the body, in which the arm is more affected. Are noted:

• violation of the function of grasping;
• extension with external rotation of the leg on the side of the lesion;
• in addition to increased tone, there is an increase in tendon reflexes;
• even under the condition of systematic training, cerebral palsy of this form is complicated by the shortening of the affected limbs as the child grows;
• contractures of the shoulder, elbow joints, hand, thumb can form;
• contractures develop in the lower limb, horse foot;
• high risk of scoliosis.

The prognosis for consistent habilitation, regular classes with children with cerebral palsy of this spastic form is more favorable in comparison with others. The success of social adaptation correlates with the syndromes of psychoverbal disorders and intellectual disorders.

Diagnosis of cerebral palsy: the importance of timely diagnosis

Rehabilitation of cerebral palsy is more successful, the earlier the correct diagnosis is made. An experienced pediatrician or neurologist may notice even minor neurological disorders in a newborn based on:

• careful examination;
• assessment of reflexes;
• measurements of visual acuity, hearing;
• determination of muscle functionality.

High-tech modern methods of examination help to confirm or refute the fears of doctors:

• Magnetic resonance imaging;
• CT scan;
• electromyography;
• electroneurography;
• electroencephalography, etc.

Since the neurological symptom complex in cerebral palsy is accompanied by a variety of disorders and pathologies, in addition to observation by a neuropathologist, patients need consultations:

• psychotherapists;
• epileptologists;
• speech therapists;
• otolaryngologists;
• optometrists, etc.

As well as forms of cerebral palsy, the causes of chronic symptom complexes of motor disorders are very diverse. Among the most frequent are:

• premature birth of a small person, prematurity (according to world statistics, about half of all episodes of cerebral palsy are associated with it);
• malformations of the central nervous system;
• brain damage as a result of hypoxia and ischemia;
• transferred intrauterine viral infections, including herpes;
• postnatal infectious diseases;
• toxic lesions;
• Rh-conflict of the blood of the mother and fetus;
• CNS injuries during childbirth and in the postnatal period, etc.

Curious statistics are collected on the popular forum "Children-Angels". Parents of children with cerebral palsy among the common causes of damage to the nervous system are called today:

• improper delivery - 27.1%;
• premature pregnancy - 20.2%;
• errors in resuscitation, treatment - 11%;
• vaccination - 8%;
• mother's illness during pregnancy and taking medications - 6.6%;
• psycho-emotional stress of future mothers - 5.7%, etc.

Complex treatment of cerebral palsy

When talking about the treatment of cerebral palsy, it means a complex of therapeutic and rehabilitation measures that can improve the clinical picture, reduce the severity of pathological symptoms.

Complex treatment of cerebral palsy may include:

• drug therapy;
• physiotherapy methods;
• rehabilitation measures;
• in some cases, surgical treatment is indicated.

Cerebral palsy, as a rule, is complicated by many other pathologies:

• epilepsy;
• scoliosis, arthritis and other diseases of the musculoskeletal system;
• hydrocephalus;
• atrophy of the optic nerve and other visual disorders;
• disorders of coordination of movements;
• hearing impairments;
• psychoemotional disorders;
• behavioral disorders;
• speech disorders, etc.

The goal of symptomatic therapy is not the causes, but the complications of cerebral palsy

Drug treatment of cerebral palsy and non-drug therapy, as a rule, are designed to deal with common complications. An integrated approach allows avoiding undesirable scenarios for the development of pathology, reducing the pathological symptoms of concomitant diseases.

So drug treatment allows:

• stop epileptic seizures;
• minimize, as far as possible, metabolic disturbances;
• relieve muscle tone;
• reduce pain symptoms;
• stop panic attacks, etc.

Habilitation and rehabilitation of cerebral palsy are based on three main principles:

• early start;
• A complex approach;
• duration.

The initial residual stage is the most promising for compensating for neurological deficits. It is at the age of 6 months to 3 years that the most active response to rehabilitation programs is observed.

Individual rehabilitation programs for cerebral palsy

Comprehensive rehabilitation programs for young and mature patients with CNS lesions are made taking into account:

• forms of the disease;
• the extent of perinatal lesions;
• individual characteristics;
• concomitant diseases, etc.

Comprehensive rehabilitation for cerebral palsy may include:

• medical methods;
• methods of social and environmental adaptation;
• speech therapy classes;
• psychotherapy sessions;
• educational programs for patients with cerebral palsy, training, occupational therapy, etc.

Most patients with cerebral palsy need special devices, devices, orthopedic products that make life easier, make it possible for special people to move in space. If disability is established, for a person with cerebral palsy, during the examination by specialists of medical and social expertise, an individual rehabilitation program is drawn up, which may include various technical means or assistive devices.

They are conditionally divided into three groups:

• providing the possibility of movement in space (wheelchairs, walkers, standers, seats);
• designed for the development of motor abilities (verticalizers, bicycles, chairs, orthoses, tables, orthopedic shoes, etc.);
• facilitating patient hygiene (toilet chairs, bath seats, etc.).

Exercise therapy for cerebral palsy

Physical therapy or kinesitherapy for various forms of cerebral palsy can mitigate the negative effects of physical inactivity, forced lack of movement, and correct motor disorders.

Classes should be regular, systematic, throughout the life of a person with cerebral palsy. Types of fitness, alternation of exercises, loads are selected by kinesiotherapists, exercise therapy instructors, together with neuropathologists, pediatricians, psychotherapists and other specialists.

Special fitness workouts for different forms and degrees may include:

• medical gymnastics;
• gymnastic exercises;
• sports-applied training;
• training on simulators, etc.

Massage for cerebral palsy helps:

• optimize blood circulation;
• improve lymph flow;
• normalize metabolic processes in muscle tissue;
• improve the functionality of various systems and organs.

In clinical practice, the following massage techniques are widely used in rehabilitation programs for children and adults with cerebral palsy:

• classical;
• segmental;
• point;
• sedative;
• tonic;
• Monakov's system.

Speech development

Many patients with cerebral palsy have speech disorders of varying degrees. Regular and consistent sessions with speech therapists help:

• normalize the tone of the muscles that provide articulation;
• improve the motor skills of the speech apparatus;
• form the correct speech breathing and synchronize it with articulation and voice;
• develop optimal sound, voice power;
• smooth out phonetic defects, improve pronunciation;
• to achieve intelligibility of speech;
• facilitate verbal communication, etc.

In order for a patient with cerebral palsy to adequately perceive the world around him, objects, people, to form an idea of ​​their shapes, sizes, position in space, smells, tastes, etc., it is necessary to form a complete perception of information by his senses. The importance of sensory education (correction) is that it allows:

• develop tactile-motor, auditory, visual and other types of sensory perception;
• form sensory samples of shapes, colors, sizes, etc.;
• improve cognitive abilities;
• correct speech disorders, enrich vocabulary.

Animal Therapy

For the rehabilitation of children with cerebral palsy, classes with animals are successfully used:

• dolphin therapy;
• canistherapy;
• hippotherapy, etc.

In the process of communicating with younger brothers, the child receives not only positive emotions, vivid impressions, which in themselves are an excellent medicine. During training with horses, dogs, dolphins in children with various forms of cerebral palsy:

• expanding motor capabilities;
• new skills and abilities appear;
• muscle tone is normalized;
• the volume of movements increases;
• hyperkinesis is reduced;
• improves coordination;
• improve speech skills;
• fears and the effects of stress go away;
• psychological and behavioral disorders are reduced, etc.

Art classes with cerebral palsy, teaching drawing, modeling, applied arts:

• enrich the spiritual world of kids and adults;
• are an excellent training of sensory perception;
• develop fine motor skills;
• contribute to the correction of psycho-emotional disorders;
• form imaginative thinking;
• improve the ability to concentrate;
• help to get rid of behavioral disorders.

Little artists, sculptors, masters see the fruits of their labor, get satisfaction from creativity, joy from communicating with beauty, gain confidence in their own abilities. Many children find their favorite hobby, and for some, the passion for needlework and drawing develops into the main business of their lives.

Habilitation for cerebral palsy and socialization of disabled people

Today, in relation to children with cerebral palsy, the term "habilitation" is more often used. It is more accurate, as it reflects the fact that, unlike, the complex of therapeutic and pedagogical measures is aimed not at restoring lost skills and abilities (motor, speech, cognitive), but at their acquisition, for the first time. Habilitation serves the socialization of children with various forms of cerebral palsy. In the process of training and education, the child masters:

• movement;
• self-care skills;
• labor activity;
• speech;
• sensory perception, etc.

The ultimate goal of habilitation, which, unfortunately, is not always achievable due to the degree and extent of damage to the nervous system, is the integration of patients with cerebral palsy into society.

Perseverance in achieving the goal, daily work can change a lot in the life of a child with cerebral palsy. Unlike ordinary children, labyrinthine and cervical tonic reflexes interfere with their development. Pathologies of vision, hearing, psycho-speech disorders, difficulties with spatial analysis and synthesis that accompany motor disorders make learning difficult. But thanks to the joint efforts of the patient himself, relatives, doctors, teachers, speech therapists, today it is possible to change the lives of many people with cerebral palsy. Those who, remaining in social isolation, without the opportunity to receive habilitation and education, used to become helpless people with severe disabilities, today they often gain independence, master professions, and create their own families.

Special child and ordinary school

Until recently, the education of children with cerebral palsy in our country, with the exception of isolated cases, was carried out in specialized boarding schools. Correctional educational institutions continue to educate children with special needs who cannot attend a regular school.

But today the right to inclusive education is enshrined in the strategic National Doctrine of the Russian Federation. Therefore, a child with motor and psycho-speech disorders, with limited ideas about the world around him, can receive an inclusive education, study in a regular, general education school.

The element of competition, the desire to be equal among equals is a great incentive for learning. Daily classes, homework, allow you to broaden your horizons, improve thinking, memory and other cognitive abilities. In addition, getting the first experience of independent living outside the home, communicating with peers, teachers, the child expands the boundaries of the spiritual world, learns to exist in society, interact with other members of the team.

And this is a great experience not only for a special boy or girl, but also for quite ordinary children. Along with mathematics, languages, biology and other sciences, they have the opportunity to receive a free lesson in kindness, mercy, compassion, and mutual assistance. Provided that adults, teachers, psychologists, who must provide support for a child with cerebral palsy in a regular school, help them figure out what is “good” and what is “bad”, they will show an example of philanthropy.

If, for some objective reason, a child with cerebral palsy cannot attend general education or correctional institutions, today there is the possibility of home schooling.

During individual homework, the teacher can devote attention and time entirely to one student. The child feels protected, and therefore more relaxed at home, so it is easier for him to concentrate on the learning process.

However, being homeschooled, he will be deprived of the opportunity to communicate with peers, life in a team, independence in decision-making, etc.

Therefore, if the condition of the child, the form of the disease and the degree of impairment allow him to receive an inclusive education, parents and other adults should do everything possible for his successful integration into the children's team.

Regional Public Charitable Organization of the Disabled "Promoting the protection of the rights of people with disabilities with the consequences of cerebral palsy" informs that it has begun the procedure for the voluntary liquidation of the organization due to the lack of funds to rent premises to continue its activities.
The information was published in the State Registration Bulletin No. 48 (506) dated 09.12.2015
Disabled people with consequences of cerebral palsy and parents of children with disabilities can apply for advice by e-mail: [email protected]

In accordance with the Classifications and criteria during the ITU, effective from February 2, 2016, new Criteria for establishing disability groups and the category of "disabled child" have been established (Order of the Ministry of Labor and Social Protection of the Russian Federation dated December 17, 2015 No. 1024n ). The Appendix to the Order contains a quantitative system for assessing the severity of persistent violations of the functions of the human body caused by diseases, as a percentage (depending on their form and severity of the course).

Cerebral Palsy Included in SCROLL diseases, defects, irreversible morphological changes, dysfunctions of organs and systems of the body ..., approved under the ICD-10 code - G80.

For you, Elena, I am enclosing a table of correlations for assessing the severity of violations in cerebral palsy in percent.

QUANTITATIVE SYSTEM
EVALUATION OF THE DEGREE OF EXPRESSION OF PERSISTENT FUNCTIONAL DISTURBANCES
OF THE HUMAN BODY CAUSED BY DISEASES,
CONSEQUENCES OF INJURIES OR DEFECTS (IN PERCENTAGE,
WITH RESPECT TO CLINICAL AND FUNCTIONAL CHARACTERISTICS
PERSISTENT DISTURBANCES OF THE FUNCTIONS OF THE HUMAN BODY)

Appendix
to classifications and criteria,
used in the implementation
medical and social expertise
citizens by federal state
medical and social institutions
examination, approved by order
Ministry of Labor and Social
protection of the Russian Federation
dated December 17, 2015 N 1024n
(Excerpts)

CEREBRAL PALSY

Note to subclause 6.4.

Quantitative assessment of the severity of persistent violations of the functions of the human body due to cerebral palsy (ICP) is based on the clinical form of the disease; the nature and severity of movement disorders; the degree of violation of the grip and retention of objects (one-sided or two-sided lesion of the hand); degree of violation of support and movement (unilateral or bilateral violation); the presence and severity of language and speech disorders; degree of mental disorder (mild cognitive impairment; mild mental retardation without language and speech disorders; mild mental retardation in combination with dysarthria; moderate mental retardation; severe mental retardation; profound mental retardation); the presence and severity of pseudobulbar syndrome; the presence of epileptic seizures (their nature and frequency); purposefulness of activity corresponding to biological age; productivity of activity; the potential ability of the child in accordance with the biological age and the structure of the motor defect; the possibility of realizing potential abilities (factors contributing to the implementation, factors hindering the implementation, factors

Check with the doctors: how do they quantify (in percentage) the disorders caused by this disease in your child?

This is very important, because now, when establishing disability, the degree of severity of persistent violations of body functions is estimated as a percentage and is set in the range from 10 to 100, in increments of 10 percent.

stand out 4 degrees of severity of persistent disorders of body functions person:

IMPORTANT ADDITION

Often parents ask: But where to find out why they do not give for life? After all, there are no changes, on injections every day, transplantation is in question. When and how to achieve this?

I answer:

As for the so-called "permanent disability", then, of course, we are not talking about establishing a "lifelong" disability for a child. For parents, it is important to achieve the establishment of the category "disabled child" until the age of 18, and then - the establishment of disability "without a period of re-examination" - but already as a disabled child since childhood, because. all persons who are assigned the category of "disabled child" upon reaching the age of 18 are subject to re-examination (already in the "adult" ITU bureau). There you can seek to establish a disability group “without a re-examination period”.
Unfortunately, as the procedure for conducting the ITU is “improved” (from the point of view of officials), parents increasingly perceive it as a rather humiliating procedure, because are forced to prove that their child is disabled, and the doctors of the expert bureau assess the degree of limitation of the child's life activity in a rather biased way.

What to be guided by and what you need to know when conducting an examination of a disabled child with any disease (since 2016)?

• REGULATIONS recognition of a person as a disabled person (approved by Decree of the Government of the Russian Federation on February 20, 2006 No. 95 and those of its paragraphs that entered into force on January 1, 2016(introduced).
• SCROLL diseases, defects, irreversible morphological changes, dysfunctions of organs and systems of the body, in which a disability group without specifying the period of re-examination (the category "disabled child" until the citizen reaches the age of 18) is established for citizens no later than 2 years after the initial recognition as a disabled person (establishing the category "disabled child") (introduced).
• CLASSIFICATIONS AND CRITERIA, used in the implementation of medical and social examination of citizens by federal state institutions of medical and social examination (approved by order of the Ministry of Labor and Social Protection of the Russian Federation of December 17, 2015 No. 1024n)

In the absence of positive results rehabilitation or habilitation activities carried out by a child (citizen) before he was sent for a medical and social examination, it is possible to achieve the establishment of the category "disabled child" before the citizen reaches the age of 18: this must be issued in the direction to the ITU issued to the citizen by the medical organization providing him medical care, or in medical documents (in the case of sending a child for re-examination).

If, during the re-examination of the child, the doctor notes that the limitations of the child’s life that were noted during the first examination have not only been preserved, but they cannot be eliminated or reduced in the course of rehabilitation / habilitation measures, then the irreversibility of the child’s disease is obvious, and it can be recommended to establish disability until the age of 18.
According to the RULES, disability of group I is set for 2 years, II and III groups - for 1 year. Re-examination of disabled people of group I is carried out 1 time in 2 years, disabled people of groups II and III - 1 time per year, and disabled children - 1 time during the period for which the category "disabled child" is established for the child (paragraph 39 of the Rules).

The category "disabled child" is established for 1 year, 2 years, 5 years, or until the citizen reaches the age of 18 years. For 5 years, this category is established upon re-examination in case of achieving the first complete remission of a malignant neoplasm, including with any form of acute or chronic leukemia (clause 10 of the Rules)

When is a disability group established without specifying the re-examination period (the category "disabled child" until the citizen reaches the age of 18)?

Here are possible options (clause 13 of the RULES):

1. Not later than 2 years after the initial examination - when the limitations of the child's life are associated with diseases, defects, dysfunctions of the organs and systems of the body according to the LIST of diseases.

2. Not later than 4 years after the initial recognition of the child as a disabled person - if it is found impossible to further eliminate or reduce the degree of limitation of the child's life activity in the course of rehabilitation or habilitation measures.

Practice has shown that over 4 years, doctors and ITU experts who can draw up and insist on the implementation of a program for additional examination of a child accumulate facts confirming the irreversibility of his disease.

3. Not later than 6 years after the initial establishment of the category "disabled child" - in the case of a recurrent or complicated course of a malignant neoplasm in children, including any form of acute or chronic leukemia, as well as in the case of the addition of other diseases that complicate the course of a malignant neoplasm.

4. Perhaps this is also the case with the initial recognition of the child as disabled(as we mentioned above) - in case of revealing the impossibility of eliminating or reducing the limitation of his life before it is sent for a medical and social examination, i.e.

Diseases that cannot be cured by modern methods have been identified,

There are documents confirming the lack of positive dynamics of the rehabilitation/habilitation measures carried out.

The main thing is that now, using the LIST of diseases, defects, irreversible morphological changes..., you can solve this issue 2 years earlier, saving the child and yourself from numerous procedures. The LIST includes 23 groups of the most common diseases and defects that cause disability, and on the basis of which (already upon re-examination) you can insist on establishing a disability for a child before he reaches the age of 18 years.

Probably, few people have not heard of such an increasingly common congenital disease as cerebral palsy or cerebral palsy. Usually, such a diagnosis is made even during pregnancy for an unborn baby, but this does not mean at all for him and his parents that they have signed a verdict. It is known that people suffering from cerebral palsy often become successful programmers, lawyers, psychologists, and so on, cerebral palsy is just a physical deviation from the norm that can be fought. Of course, it can be very difficult to overcome cerebral palsy on your own, which is why the most important place in the process of caring for such a baby and its treatment is occupied by state assistance.

The diagnosis of cerebral palsy refers to the list of diseases that imply disability registration. Many parents are afraid of this status and do not want to legitimize it, which becomes a rather serious mistake on their part. It is known that constant and competent care, complex therapy, massages, medicines, special simulators - all this can help the child achieve greater mobility of the limbs, and the sooner the child begins to receive such assistance, the greater the chance that he will walk almost like any other person. .

The necessary medications and complexes of diverse therapies are quite expensive, and disability registration removes some of the problems. A disabled child with cerebral palsy has the right to receive from the state not only a special pension, but he is also entitled to a certain list of other guarantees.

Benefits and pensions for a child with cerebral palsy

The average amount of benefits that a family with a disabled child receives every month is about 20,000 rubles. This amount includes not only the pension directly due to a disabled person (about nine thousand rubles), but also some social payments, such as a monthly payment, which can be replaced by a free sanatorium or medicines, travel expenses, and so on, as well as social payments to parents who do not work in order to provide care for a sick child with cerebral palsy and other types of social benefits.

For a family with a special child, such a monthly amount cannot be superfluous, because the child needs medicines, special shoes, clothes, and special exercise equipment for homework. Therefore, parents should not refuse to register a child with a disability in his own interests, especially since, in addition to cash payments, the state offers families of children with cerebral palsy and other types of assistance.

Guarantees for disabled children with cerebral palsy

Of course, like any other child with a disability, such special children are entitled to free education, higher education on preferential terms, free books, free transportation, and so on. But until a certain point, the most important is the medical care that the state will provide to such a baby.

First of all, a child with cerebral palsy has the right to participate in a rehabilitation program. It includes not only free medicines, but also much more. So, for example, a child with cerebral palsy has the right to undergo annual treatment in a sanatorium, undergo free courses of physiotherapy, massage, and once every few months undergo a course of physical therapy on specially designed simulators.

Also, as part of the program to help children with cerebral palsy, families of such children can receive special shoes from the state free of charge, vehicles, if the child cannot walk independently, home exercise equipment and other orthopedic equipment necessary for the child.

All these types of state assistance, subject to the recommendations of doctors and the boundless love of parents for their child, can help the baby quickly adapt to life, learn to walk and live a full, albeit not so active, life.

Parents of a disabled child - overcoming the path. Care in grief, obsession, work. And the happiness of a child is such a thing for which any game is worth the candle.

- a phenomenon that seems rare to a simple layman. Unfortunately, this belief is not true. There are 5-6 children with cerebral palsy per thousand healthy children, and their parents, who were preparing to teach the baby to walk, write down his first word, send him to kindergarten, and then to school, love him and are proud of him, face a terrible shock. Their child is disabled. As it is now customary to say - "special child".

Whatever the degree of damage to his body, in any case, he is deprived of something that a normal child has by birthright.He won't be able to walk. Or use one hand. Or clearly pronounce the words and stand firmly on your feet without crutches.

He will never go to school with ordinary children, and if he does, who knows how he will be treated there, he may not come out with a reason for pride, all his life he will need supportive therapy, people who can to help him.

Parents of a child with a disability are afraid of this prospect. They begin to blame themselves and each other. Parents start calling friends, looking for sympathy, or, on the contrary, bury themselves in their own home.
Only a few of them are able to objectively perceive the current situation and provide the child with the right upbringing.

Usually parents go to two extremes and follow two paths that differ in appearance, but are equally vicious.

Path one: leaving in grief

Having stepped on this path, parents slowly sink into the abyss of their pain, and the child, as its source, is rejected by them. They immediately deny him the possibility of rehabilitation, it seems impossible for them to have an outcome in which he can live a relatively normal life. Parents try to communicate less with him - to remember their failure less - and reduce the child to the rank of an object that is embarrassing to show guests.

Usually such children grow up as independent and as unsocialized as possible. Deprived of the acceptance of parents at a very young age, deprived of a normal human society, they hardly integrate into society and sometimes cannot do it at all.

Path Two: Obsession

On this path, parents, on the contrary, decide to sacrifice themselves to the child, but they understand his needs completely wrong, forever underestimating him. If a child stretched out his hand and took a mug - well done. If he wrote a few crooked letters in cursive - he is a hero and he has calligraphic handwriting. There is an eternal reassessment of the child and he grows up spoiled, confident that the whole world revolves around him.

Such children are also difficult to socialize, like the victims of the first path. Faced with the world, they are afraid of the slightest difficulties, demand discounts for their disabilities and barely survive.

Naturally, both of these paths are infinitely vicious and only destroy the life of the child, despite the fact that the second looks like the path of caring and loving parents. In fact, this is not at all the case. For truly loving parents, there is a third way.

Way three: work

To no matter how we are inspired that children are cute, children are prestigious, children will fill life with meaning and bring joy to it, in fact, everything is much more complicated. Children scream and need to be potty trained. Neighbors complain about them, they get sick, do not finish their porridge and act up. Therefore, first of all, the parents of a special child need to be prepared - their life will not look like advertising posters, they themselves will not look like a happy family from an advertisement for juice or milk.

They have to work - long, difficult, painstaking, requiring effort and effort. Work, which is complicated by the lack of normal conditions for the disabled and an adequate attitude towards them. Many friends will drift away. Many friends will look with pity.

Pity is the worst scourge of people with disabilities.

But the happiness of a child is such a thing for which any game is worth the candle!

The third way is taken by parents who are interested in their child no matter what. They begin to study special literature on pedagogy, find contacts of parents of the same children in order to support each other, and they treat the child almost like an ordinary baby.
A little more specific than other children, but no more.

It follows from this that no one dances around him, they demand as much from him as he can, and encourage his independence. They talk to the child. They play educational games because of its capabilities. Reward for his small victories, but do not overestimate them.

Eating with a spoon is not a victory. Getting to the bathroom and washing yourself is quite a victory, especially for a child who cannot walk.

In addition, there is another important aspect. The child is not deprived of society. Any human being must be able to survive in society. No one develops normally without social relationships.

Therefore, the child is not kept within four walls - he is taken out for walks, to events where he has a chance to make friends, if possible, he is sent to a kindergarten, where he can learn to live in a team.

In general, the third way is to treat the child as normal, with only some features that cannot be ignored. Usually this approach brings much better results than the first two.