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Spiritual psychosomatic deprivation of children with cerebral palsy as the reason for the development of hospitalism and institutionalism. Iatrogenic or “acquired” cerebral palsy

The most important etiological and pathogenetic problem is hospitalism - this, if we recall the statement of the famous psychiatrist W.Auch (1963), “medicine of revolving doors”. This refers to the emergence of a large group of often re-hospitalizing patients. This problem is in DCPP.

The analysis of statistics of repeated inpatient treatment is necessary for solving various issues. But the most accurate and reliable data are in assessing the severity of the disease and the effectiveness of treatment (S.A. Dolgov, 1995). The title of the article by St. Petersburg authors D.N.Isaev and V.N.Popov (1994) is very symptomatic: “Abilitation of children brought up in a psycho-neurological orphanage of a child”. In it, the authors write that “in several hundreds of psycho-neurological homes of the child of Russia there are many thousands of children deprived of a family and in need of conditions that could provide them with optimal preparation for their future life. (Many who have visited these terrible “houses of charity” at least once, even with a strong desire, will never be able to forget the “children of the dungeons” seen there. - IS). Without targeted support, these children cannot mobilize their sometimes modest adaptation capabilities. At the same time, the organization of the habilitation process will allow patients to make the most of their natural inclinations, participate more effectively in the educational process and get involved in the social environment in the best possible way. ” Using differentiated habilitation programs, D.N.Isaev and V.N.Popov in more than 90% of children with different depths of a neuropsychic defect (mental retardation, debility, imbecile), achieved earlier formation and better consolidation of skills and abilities, more adequate processes of socialization, compared with the "traditionally existing complex of medical and educational activities." The use of these programs, the authors write at the end of the article, reduces the influence of the deprivation factors of a closed institution and thus makes it possible to identify real adaptive opportunities and stimulate them to more adequately adapt to the life of a lagging child.

Mental deprivation, writes I.O. Kalacheva (1994), associated with lack of attention, emotional deprivation, and sometimes cruel treatment of children, has acquired particular urgency in recent times and has become common. Deprivation results in psychogenic disorders leading to impaired psychosocial development of the child, mental retardation, combined with impaired formation of emotional and personal characteristics, such as affective excitability, instability, behavioral disorders, impaired adaptation, mental infantilism. These syndromes often occur on the background of early organic lesions of the central nervous system and can further lead to a delinquent behavior and the formation of psychopathy.

Of great interest in this regard is the rehabilitation center in England (London) for children suffering from cerebral palsy in combination with epilepsy and intellectual deficit, which provides for many years of patients - from 6 to 19 years! [According to statistics from domestic authors, intelligence is not disturbed only in 32.2% of patients with cerebral palsy (M.N. Nikitina, 1979), and in children with cerebral palsy with epileptic syndrome, only 11% (V.A. Klimenko, D .L.Gerasimyuk, 1992).]. The treatment in the center is combined with studies (with the wide use of computers), vocational training, a diverse cultural program with maximum adaptation to real life conditions. Children plan their own budget, buy products, prepare. The staff of the center includes neurologists, psychologists, psychiatrists, speech therapists, and high-class teachers. There are self-support groups, emergency telephone service, special educational programs (V.A. Karlov, 1996 *).

Here it is appropriate to recall the concept of institutionalism of J.Wing and D.Brown (cited from: D.Ye. Melekhov, 1974), who understand this phenomenon more broadly than hospitalism. Approaching this issue from a purely sociological point of view, they understand by institutionalization the process of changing interpersonal relations that occurs in every person who enters a relatively isolated society (including hospital sickness. - IS). The idea is that each person is surrounded by a network of social connections that determine his functioning in society (R.Alloway, P..Bebbindton, 1987; M.Dorier et al., 1987). With the weakening of these ties, in particular, with a long stay in a hospital, sanatorium or a special school, the patient develops a kind of dependence on the environment that has become familiar to him. EDKrasik and G.V.Logvinovich (1983) call such changes the syndrome of pathological adaptation in the form of patients' striving for a simplified life stereotype, mental rigidity, inability and unwillingness to change.

Of particular importance belongs to the influence of the family. Emotional tension in the family affects the frequency of hospitalization. Being a “weak point” in the family, a child suffering from cerebral palsy often causes family tensions and conflicts (and very often causes the family to break up), and in this case his hospitalization gives the appearance of their resolution. Thus, for some patients, return to the family is a factor contributing to returning to the hospital. Some people perceive the hospital as a safer place than the society due to heightened nervousness, intrafamily and personality conflicts, while others may be tempted by lack of social support, lack of communication, and a feeling of loneliness. Finally, living conditions in society can be worse than in a hospital. For some patients, permanent hospitalization can turn into a “life style” (W. Carpenter et al., 1985). Therefore, for example, in psychiatry, it is proposed to focus on working with the patient’s microsocial environment, use flexible resocialization programs (REDrake, MAWallach, 1989) and even formalize the criteria for hospitalization in order to artificially limit it (RASherill, 1977).

Currently, a new clinical discipline is being formed - psychogenic neurology (A.M.Vein, 1999). Perhaps, sometime, “psychogenic cerebral palsy” will also be highlighted, moreover, the theoretical background and first experience in “adult” neuroscience are already available. For example, in recent years, among the etiological factors, such as “related” to cerebral palsy diseases such as parkinsonism, parkinsonism emitted due to mental trauma is distinguished, as it is noticed that emotional stress often serves as a factor immediately preceding and “triggering” pathogenetic mechanisms this disease (VL Golubev et al., 1999). Increased spasticity, hyperkinesis, etc. is well known. in children with cerebral palsy (as, indeed, their appearance in the so-called “healthy” children and adults), even with a little excitement.

In general, it seems that it is high time to add iatrogenic and / or “acquired” (if we use the term of the great Gannushkin) cerebral palsy, formed as a result of pre-, peri-and postnatal iatrogenic effects (improper treatment, lack of adequate treatment, including - future fathers and mothers!), hospital and post-hospital disease, sociopathy, spiritual and physical poverty, mental and spiritual, psycho-emotional, sensory and motor deprivation and other gikh, usually together influencing, similar factors. Obviously, this - one might say tragic - form of cerebral palsy with the current social structure of society is almost incurable. For this - as if not existing - form of cerebral palsy there is not and cannot be true statistics, and one can only guess about its true prevalence. One thing is indisputable: in our difficult time, the number of such patients is dramatically increasing - and this is the situation not only in the DCPD ...

Unfortunately, the main attention of specialists and parents is attracted by movement disorders in children with cerebral palsy. But, trying to cure the most obvious manifestations of the disease, it is impossible to lose sight of other disorders that impede the adaptation of these patients (I.Yu. Levchenko, 1994). In the opinion of I.A. Skvortsova and T.N. Osipenko (1994), the resulting effectiveness of treatment is determined not only by the availability of correction of the functional deficit, but also by the success of retaining the achieved effect, launching its development in further ontogenesis, ensuring equal opportunities in the family and society, those. depends on solving a number of psychosocial problems.

The fight against social deprivation (social “tartization”) as a very important and independently acting pathogenetic factor is now becoming increasingly important. G.V. Yatsik et al. (1994) within the framework of the program for multipurpose non-drug rehabilitation of newborns with perinatal CNS pathology developed by the Scientific Research Institute of Pediatrics of the Russian Academy of Medical Sciences, psychotherapeutic correction of their condition through impact on a nursing mother is applied to children in the second-stage hospital. Pre-held psychological testing of the mother. Methods of rational psychotherapy, emotional and imaginative and with elements of suggestion, transmeditational influence in combination with music therapy, combined effects on the child and the mother during their contact (“kangaroo”, “skin to skin”) are used. The authors believe that psycho-emotional correction helps to improve the condition of newborns, reduces the severity of pathological neurological symptoms, activates sucking. Depending on the individual characteristics of the neurological status, music therapy for newborns was also carried out (5 programs specially compiled on the basis of classical and folk music, designed for a rhythmic-stimulating or calming effect). According to the authors, in most newborns, music therapy helps to normalize neurological status: with increased excitability, periods of excitement and tremor intensity decrease, with depressive syndrome, motor activity and sucking are activated, breathing becomes more rhythmic, and, according to monitoring, blood saturation with oxygen increases.

According to K.A. Semenova (1994), social rehabilitation is a separate and still little-studied direction in the rehabilitation of patients with cerebral palsy and other diseases of the nervous system, the updating of which is determined more and more clearly, the essence of which is the early and effective correction of the emotional-volitional sphere suffering children and adolescents motivations for life, autonomy, treatment, their preparation for social adaptation, taking into account the peculiarities of the course of the disease, the structure of the motor, mental and speech defects. Such training should be actively carried out from the first years of a child’s life, but especially by the end of the first decade, when directions of searching for his future professional opportunities may already be outlined. This path, KA Semenov emphasizes, is more significant than providing the patient with a number of technical devices that facilitate his life at a given time, but without mobilizing the will and desire for independence.

It is important, indicate G.V. Yatsik et al. (1994), so that the rehabilitation of children who have undergone perinatal brain damage is carried out from the standpoint of the integrity of the body (psychosomatic approach), therefore multi-purpose, complex non-drug effects on the child’s body are of particular importance. The effectiveness of rehabilitation measures depends on the correctness of the choice of rehabilitation tactics, taking into account the nature, dynamics of neurological deficit and immune defect, continuity, duration of complex rehabilitation using medical and non-drug means, adapted physical therapy (I.A. Sadekov, S.K.Evtushenko, 1994) .

Unfortunately, in real medical practice, they write GG Ibrahimov and VB Kazmin (1994), organizing the provision of treatment in a specialized medical institution is not carried out by health workers, but only due to parents' activity, and a pessimistic assessment is a provoking factor in this situation. physicians of children's clinics of the rehabilitation potential of patients with cerebral palsy, due to the lack of knowledge of the neurophysiological and biomechanical essence of this pathology, as well as the modern possibilities of kinesiotherapy, orthopedist cal and other types of corrections. One can disagree with G. G. Ibragimov and V. B. Kazmin about the fact that doctors do not know the polyclinics of the modern possibilities of rehabilitation services and note that their pessimism is often quite justified. It can also be noted that the neurophysiological and biomechanical essence of cerebral palsy, like most other neurological - and non-neurological - diseases, remains a mystery.

Within the framework of the practical health care system and in the real daily medical activities of doctors of various medical specialties, including specialists in the treatment and rehabilitation of children suffering from cerebral palsy, pharmacological approaches have been dominating for a long time and with absolute authority. This is connected, according to V.S. Repin and G.T. Sukhikh (1998), because the chemical concept of the overwhelming majority of diseases currently reigns in medicine. It is generally accepted, the authors continue, that any (or almost any) disease is an imbalance of chemical reactions resulting from molecular breakdowns. In this regard, at the first stage, the chemist was obliged to determine the molecular target, and then with the help of a medicine to correct the chemical imbalance. The concept of a chemical “target” brilliantly justified itself in the development of chemotherapy for infectious diseases, where helminths, protozoa, pathogenic microorganisms and some viruses acted as the causative agent. However, in the case of atherosclerosis, tumors, dysplasias, degenerative diseases of the neuromuscular system (and cerebral palsy. - IS), the old ideology began to slip, because these diseases had too many molecular “causes”. Only gradually, chemists and cell biologists began to realize that they were dealing with biological “chaos” in the body. Biological disorder has too many causes and effects, therefore its manifestations in cells are “many-sided”. The old concept of the drug in the form of a “magic bullet”, correcting the damaged molecular part, did not work here. “Targets” in the cells were too many, moreover, they were mobile. To such difficult situations, fundamental medicine was unprepared. For this reason, they write further VS Repin and G. T. Sukhikh, to formulate a chemical consistent concept of atherosclerosis, malignant diseases, aging, nervous diseases (and cerebral palsy! - IS) did not succeed.

The brain, as a rule, reacts extremely acutely to the endolyumbal administration of drugs: liquorodynamic disorders arise with headache, oculomotor disturbances, asymmetry of reflexes, discoordination of movements, as well as disorders of the vegetative functions in the form of cardiac and respiratory arrhythmias, temperature deviations often in the form of hyperthermia with chills and perspiration, abnormal pupillary reactions, etc., which reflects the reaction of the ependymal layer and the periventricular region as a whole to the introduction of “alien in the cerebrospinal fluid spaces of the brain (I.A.Skvortsov, 1995).

Although recently in neurology a new direction is being actively developed - preventive (preventive) neurology, the purpose of which is to prevent diseases of the nervous system (neuroprophylaxis) and strengthen the neuropsychic health of the population (N.V. Vereshchagin, 1982; OG Kogan et al. ., 1987; G.I. Tsaregorodtsev, I.A. Gundarov, 1990), prevention of cerebral palsy is a challenge to pediatricians around the world (R. Behrman, V. Vaughan, 1987).

But do not think that this is the state of affairs only in the DCPP. For example, the etiology of parkinsonism cannot be established conclusively in about 50% of all observations, and we cannot speak of the effectiveness of treatment for this disease. According to N.V. Vereshchagin, the largest Russian angioneurologist (1996), despite the development and improvement of rehabilitation methods for patients with stroke, subject to slight severity of spontaneous recovery, as a rule, it is possible to achieve only the patient’s adaptation to an existing defect, and not its overcoming. The final document of the pan-European conciliation meeting on the management of patients with stroke, which was held in November 1995 in Helsingborg (Sweden), said that “there is little evidence that rehabilitation after 6 months. after a stroke, it can reduce speech, motor, or sensory defects. ” Equally pessimistic is the conclusion about the effectiveness of drug therapy: “no effectiveness has been proven for acute stroke for any of the methods of specific drug therapy”. В разделе о доказанных методах лечения констатируется, что “ни один из специфических или терапевтических методов лечения не получил однозначных доказательств относительно своего благоприятного влияния на пациентов с инсультом”. А ведь инсульт является одной из приоритетнейших проблем мировой медицины, на решение которой брошены, без преувеличения, лучшие медицинские умы планеты.

В итоговом документе Хельсингборгского совещания также сказано, что “ни одно из терапевтических или хирургических мероприятий не следует рутинно назначать пациентам с острым инсультом, если только его эффективность не будет показана в рандомизированных контролируемых испытаниях”. В последние годы это положение стало особенно актуально и в ДЦПологии, так как, по справедливому замечанию К.А.Семеновой (1997), появилось большое число коммерческих центров реабилитации, недоступных для большинства населения из-за высокой оплаты лечения. Кроме того, профиль и интересы таких учреждений зачастую далеки от проблем детской инвалидности. Следует однозначно заявить, что коммерческие, как правило, чисто эмпирические, научно не обоснованные и практически не проверенные – или в принципе непроверяемые – и нередко довольно дорогие лечебные или профилактические – “винегретные” – схемы лечения (авторы которых обещают обычно 100%-ный эффект), с шаткой или вовсе отсутствующей медицинской аргументацией (а “специалисты” в области коммерческой медицины, как известно, любыми способами, якобы по причине нежелания раскрывать свои “ноу-хау”, избегают яркого света научных споров) и сомнительной эффективностью, которую довольно сложно или даже невозможно обнаружить (нередко – ни подтвердить, ни опровергнуть!), никоим образом не должны внедряться в государственные детские учреждения. Можно полностью согласиться с авторами итогового документа и в том, что любые применяющиеся методы, используемые в ведении инвалидизированных больных, должны быть специфичными, целесообразными, интенсивными и индивидуально подобранными, и что не могут быть даны рекомендации по применению тех или иных специфических методов.

Абсолютно верными и актуальными и полностью приложимыми к проблеме ДЦП в частности и перинатальных энцефалопатий в целом являются также и многие другие положения Хельсингборгского документа:

- пациенту следует быть частью непрерывной цепи помощи (выделено мной. – И.С.) с момента возникновения инсульта;

- успешная реабилитация (и лечение. – И.С.) требует тесной координации между медицинскими и общественными социальными службами;

- за долговременное последующее наблюдение ответственны местные службы, которые должны обеспечивать свободный повторный доступ (выделено мной. – И.С.) пациента в реабилитационные службы;

- формирование местных ассоциаций пациентов с инсультом и их семей следует приветствовать, так как они обеспечивают поддержку пациентам и их родственникам, вносят вклад в координацию местных, региональных и национальных усилий с целью улучшения реабилитации и социальной поддержки людей, перенесших инсульт;

- в связи с тем, что не многие из реабилитационных методик проходили клинические испытания, большинство направлений в этой области носит пробный характер, а эффективность реабилитационных методов и стратегических подходов требует своей научной оценки;

- следует разработать исследовательскую методологию и изыскать ресурсы для проведения рандомизированных испытаний отдельных составляющих реабилитации, которые можно было бы легко выделить;

- следует усовершенствовать оценку исходов, основанную на восстановлении социального положения, удовлетворенности работой реабилитационных служб и удовлетворенности жизнью.

Положениям Хельсингборгского документа созвучны принципы построения реабилитационной программы, изложенной В.Л.Найдиным (1972) и Е.В.Шуховой (1979):

- реабилитационные мероприятия начинаются с первых дней заболевания и проводятся непрерывно при условии этапного построения программы;

- реабилитационные мероприятия должны быть комплексными, разносторонними, но однонаправленными (имеется ввиду единство биологических и психосоциальных методов воздействия);

- реабилитационная программа должна быть индивидуальной для каждого больного в зависимости от нозологической формы, характера течения заболевания, возраста больного и пр.;

- заключительным этапом реабилитационной программы должны являться профессиональная ориентация и трудоустройство реабилитированного. Для детей – это возвращение в обычную школу.

Авторы подчеркивают, что все участники выполнения реабилитационной программы – врачи различных специальностей, педагоги-воспитатели, специалисты по труду, лечебной физкультуре, психологи, логопеды и др. – должны отчетливо представлять себе задачи, которые надо разрешать в каждом отдельном случае. Для этого все они должны быть хорошо осведомлены о сущности патологического процесса, функциональном и органическом звене его, физиологических механизмах нарушения функций, особенностях и длительности восстановительного периода, возможных осложнениях патологического процесса, основах реакции восстановления и компенсации и пр. Необходимо также знание современных методов лечения и диагностики, технических достижений, помогающих решению вопросов восстановительной и заместительной терапии, конструированию приспособлений для облегчения выполнения двигательных актов, работе на специальных станках и пр.

Справедливо замечание В.Д.Трошина (1991), что деятельность врача любой специальности должна оцениваться с позиций реабилитационного эффекта. Показателен анализ 5807 случаев детской неврологической инвалидности, позволивший К.В.Эдигарашвили и соавт. (1994) выявить комплекс инвалидизирующих факторов: запоздалая диагностика (57,2%) и, как следствие, поздно начатая терапия (52,2%), нерегулярное (31,4%), несоответствующее и непреемственное лечение (17,7%), низкий социально-бытовой уровень. Недаром большинство специалистов демографическую ситуацию в Росси оценивают как критическую. Отрицательный прирост населения, обусловленный низкой рождаемостью и высокой общей смертностью, по прогнозам демографов сохранится и после 2000-го года (Г.М.Бордули, О.Г.Фролова, 1997).
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Духовно-психосоматическая депривация детей с ДЦП как причина развития госпитализма и институционализма. Ятрогенный или “нажитый” ДЦП

  1. Cerebral palsy as an autoimmune inflammation. Pathology of ICS (immuno-competent system) for cerebral palsy
    Many authors write about the possibility of forming an inflammatory process of an autoimmune nature in the brain of children who subsequently suffer from cerebral palsy (K.А.Semenova, 1968, 1972, 1984, 1994, 1996; N.I. Popova, 1974, 1978; V.D.Levchenkova , 1983; GG Shanko, E.S. Bondarenko, 1990, etc.). Both experimentally and in the clinic of cerebral palsy, a correlation was shown between the characteristics of the CNS lesion and the nature of the changes.
  2. Cerebral palsy as a disability and as encephalopathy
    Cerebral palsy as a disability and how
  3. Some neurophysiological mechanisms of development of motor disorders in cerebral palsy
    Some neurophysiological mechanisms of development of motor disorders in
  4. Prematurity and cerebral palsy
    Many authors point to a clear connection of spastic type of cerebral palsy with low birth weight. According to J.Foley (1992), a combination of low birth weight with an increased risk of cerebral palsy is observed in 44% of children, while half of them show a tendency to develop particularly severe forms of the disease. S. Atkinson, FJStanley (1983) report that from 43 to 50% of children with cerebral palsy were born with low birth weight.
  5. Review review. Issues of etiopathogenesis of cerebral palsy (CP), 2010
    Abstract review of the state of the problem according to the literature until 1999. Summary: various definitions of cerebral palsy, brain and movement organization, ontogenesis, cerebral palsy as a disability and as encephalopathy, etiology of cerebral palsy, cerebral palsy and hereditary diseases, intrauterine infections, cerebral
  6. Histopathology for Cerebral Palsy
    According to V.V. Amunts (1997), the study of the individual variability of the morphological parameters of cytoarchitecture of the cortical fields of the large brain and deep structures is necessary, first of all, in the topical diagnosis of the pathological process and surgical interventions, when accurate knowledge of the variation of their size and structure is required. people. In the XIX-XX centuries. microscopic
  7. Definitions of Cerebral Palsy
    According to current ideas shared by most scientists, paralysis cerebralis infantilis, cerebral palsy - cerebral palsy is a group of central motor impairments (cortical-subcortical syndromes) in which acute and / or neonatal, perinatal and / or early neonatal development occurs or chronic etiological effects
  8. Cerebral palsy and hereditary diseases
    In general, MO Gurevich (1937) wrote, the inferiority of the child associated with various diseases of the parents is a very important predisposing factor for the development of cerebral paralysis. This is confirmed by the fact that in children with cerebral palsy, the inferiority of other organs is also often observed: congenital heart defects, kidney agenesis, various developmental defects and
  9. The effectiveness of treatment and rehabilitation of patients with cerebral palsy
    Older authors wrote that the treatment of cerebral palsy was “not very fruitful” (M. O. Gurevich, 1937). More than 60 years later, the situation has not changed. I.A. Zavalishin and V.P.Barkhatov (1997) in their review of the problem of spasticity state with bitterness that the treatment of paresis is still an almost unsolvable task. According to these authors, despite significant advances, neurochemical and pathophysiological
  10. Формы ДЦП
    а) Спастическая диплегия (синдром Литтла) – наиболее часто встречающаяся форма церебрального паралича. Для нее характерны двигательные нарушения в верхних и нижних конечностях, причем больше поражаются ноги. Обнаруживается у детей уже в первые месяцы жизни. Тонус экстензоров повышен, ноги вытянуты, сухожильные рефлексы высокие. У некоторых детей имеются легкие атетоидные движения в дистальных
    Constant dynamic control over the neuropsychic development of the child, the organization of activities aimed at achieving the maximum mental health of the individual is an essential component of the work of the pediatrician. Under conditions of ripening of the cerebral cortex during the period of early childhood and the preschool period (up to 6 years), the mental development of the child is closely related to
  12. Pathogenesis of perinatal traumatic damage to the nervous system. Birth injury and cerebral palsy
    Mechanical trauma of the fetal head, as a rule, is accompanied by a violation of cerebral circulation, hemorrhage in the brain. Most often, hemorrhage occurs due to rupture of the sagittal or transverse sinus, which in most cases causes the death of the fetus. When subarachnoid hemorrhage or hemorrhage as a result of rupture of small vessels of the brain, or, finally, per diapedesum
  13. Pathological anatomy and clinicopathologic comparisons for cerebral palsy
    There are different points of view on the clinical and pathological correlations in cerebral palsy. When examining pathological-anatomical data, MO Gurevich (1937) wrote, it should be borne in mind that since in most cases children do not die from the initial process in the acute stage, the pathologist usually deals with the residua of long-running processes that look like cicatrices, cysts, parencephaly,
  14. Etiology of cerebral palsy
    The etiology of infantile cerebral palsy is diverse: infectious, somatic and endocrine diseases of the mother, toxicosis of pregnancy, pathology of the umbilical cord and placenta, anomalies of labor, obstetric operations, immunological incompatibility of the mother and fetus, etc. Among the causes of cerebral palsy are harmful effects during the period of childbirth, second place are
  15. Диагностика ДЦП
    Диагностика детского церебрального паралича основана на твердом знании основных этапов психомоторного развития ребенка. Важно помнить, что патологическая постуральная активность, спастическая гипертония нередко отчетливо выявляются только к 3-4-месячному возрасту, а иногда и позже. Поэтому большое значение имеют наблюдения за детьми, особенно в случаях с неблагоприятным акушерским анамнезом, учет
  16. Лечение ДЦП
    Лечение детского церебрального паралича должно быть комплексным и начинаться с первых недель жизни ребенка. Мозг ребенка раннего возраста пластичен и обладает большими компенсаторными возможностями, поэтому лечение, начатое в период формирования статических и локомоторных функций, дает наиболее благоприятные результаты. Моторная деятельность у ребенка раннего возраста в основном рефлекторная, а
  17. Этиология ДЦП
  18. Pathology of glands and internal organs in cerebral palsy
    It is known that disorders of the activity of the endocrine glands and the pathology of mineral metabolism play no less a role in the pathology of the brain than in diseases of other organs. Many authors consider the participation of the thyroid gland in the development of pathological processes in the stri-pallidar system undoubtedly. It is known that pallidum already in the normal brain contains a lot of salt deposits. WITH
  19. Pathological changes in cerebral palsy
    Pathological changes in the nervous system are diverse. In 30% of children, there are abnormal brain development - microgyria, pachyhyria, heterotopies, hemispheric underdevelopment, etc.
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