Movement disorder syndrome in newborns. Syndrome of movement disorders in an infant. Little's disease or diplegia

Movement disorder syndromes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What diagnosis do you think is considered in the public consciousness almost a death sentence, which a priori makes treatment meaningless and the patient’s fate sad and tragic? Various problems with the cardiovascular system? Oncological diseases? “Incurable” hereditary pathologies? Hardly. Such ailments, of course, can ruin the life of even the most persistent and self-confident person, but with the appropriate approach and competent treatment, the problem can be dealt with one way or another (we especially note that in this case no one is talking about a complete recovery). But when cerebral palsy is detected in newborn children or infants, the world around the parents suddenly collapses to the size of a doctor’s office, who in a professional, absent voice conveys a terrible diagnosis. How does movement disorder syndrome relate to cerebral palsy, you ask? That's the point, no!

Cerebral palsy, if we discard the terminology that is complex and difficult to understand for the average person, is a complex of motor disorders caused by organic damage to the brain during intrauterine development. The movement disorder syndrome that we will talk about today is a much more multifaceted phenomenon. Domestic neonatologists and pediatricians tend to see its signs in any more or less noticeable deviation from abstract norms adopted back in the days of developed socialism. We will not discuss the reasons for this approach now, but we consider it our duty to once again remind you that movement disorder syndrome and cerebral palsy are (attention!) not the same thing.

Remember the characteristic passage from Sir William Shakespeare's play King Richard III, in which one of King Edward IV's brothers described his physical condition:

“I, who have neither height nor posture,

To whom is nature a fraud?

In return, she gave lameness and lopsidedness”?

Many particularly “advanced” pediatricians, when faced with characteristic clinical manifestations, make a diagnosis of “cerebral palsy”. This actually condemns children (most often newborns) to complete disability. Parents will be told that in this case they cannot count on any effective treatment, and massage, physical therapy sessions and various physiotherapeutic procedures can only slightly improve the baby’s condition. And, casually, they will recommend sending the baby to a special institution.

Movement impairment syndrome (hereinafter referred to as DSS for simplicity) is not a death sentence. Consequently, with adequate treatment, children most often make a full recovery. They may need regular massage sessions, observation by a neurologist, and slight limitation of physical activity in the future. But this, you see, is not at all the same as cerebral palsy. And if the parents don’t give up, everything will be fine for the child.

Symptoms

Before moving directly to the manifestations of SDN, it is worth noting that none of them can be called unique. In other words, such “symptoms” can be observed even in absolutely healthy children, so there is no need to “panic” and run to the doctor after every sneeze. On the other hand, stubbornly ignoring progressive developmental delays can lead to the most tragic results (and massage alone is unlikely to help the patient). Therefore, in this matter it is necessary to show special flexibility, trying not to go to extremes. The symptoms of SDN themselves may be as follows:

• monotonous crying for no apparent reason;
• slow visual and auditory reactions to external stimuli;
• the baby picks up toys (often it takes him several attempts to do this), but does not understand well what to do with them next. In children with various developmental disorders (note, we are not talking about SDN) this happens quite often;
• limited facial activity;
• obvious expression of emotions may be delayed (the first smile at 3-4 months is not that uncommon);
• incorrect articulation, due to which children experience late activation of speech zones (parents may hear the expected “ma”, “pa”, “ba” and “da” not at 6-8 months, but much later);
• labored breathing.

The opinion that fathers and mothers should closely monitor the baby and communicate more often with “colleagues” on specialized forums deserves special mention. It’s stupid to argue with the first part of this statement, but we would advise you to refrain from overly active discussion with the parents of other children. The adequacy of some regular visitors to children's forums is highly questionable, so do not be surprised if, for example, you are advised to treat a minor disorder or cold with heavy doses of antibiotics.

Stages of psychomotor development of children

• thalamopallidal (from birth to 4 months);
• striopallidal (up to 10 months): gradual decrease in muscle tone, increase in the number of targeted movements;
• the period of manifestation of higher cortical functions, the development of speech and complex conditioned reflexes.

Phases of development of children's motor skills

• SDA: spontaneous motor activity (from the first days of life to 8-9 weeks);
• monokinetic (2-5 months): independent control of limb movements;
• dromokinetic (5-12 months): the baby’s motor behavior becomes conscious, and any movements receive a specific goal (reach out to a toy, take this or that object);
• cratikinetic (from 12 months): final normalization of muscle tone, transition to “adult” motor skills, significant improvement in coordination of movements.

Types of movement disorders in SDN

1. Hypotonia (decreased tone) of muscles. The problem is most common in newborns, although with serious disorders it can also be diagnosed in older babies.

2. Muscle hypertonicity, leading to a significant decrease in motor activity. The most characteristic clinical manifestation is a delay in the development of grasping ability (we have already talked about this when discussing possible symptoms of SDN). In addition, parents may notice that the child is not able to maintain balance for a long time, and if he is placed on his legs, he does not rely on the entire area of ​​​​the foot, but only on his toes. It is also worth understanding that massage for muscle hypertonicity (and it is most often prescribed by pediatricians) in itself cannot help the baby and treatment in this case must be comprehensive.

3. A child (even a fairly “adult” one) is very reluctant to assume a vertical position, preferring to crawl, and when this does happen, he often falls.

4. Cerebellar syndrome. Spontaneous incoordination problems can occur from time to time in all children, but if the problem is observed much more often than the theory of probability allows, one should consider how “random” they are. After all, it is quite possible that a touching baby, who repeatedly loses his balance when walking, is seriously ill.

5. TLR (tonic labyrinthine reflex) in children. It is manifested by a whole complex of disorders, among which the following symptoms have the greatest diagnostic value:

• an “adult” child, lying on his back, is unable to sit up, stretch his arms forward or tilt his head;
• it is difficult for a baby lying on his stomach to turn onto his side or back;
• Children with SLI have a persistent reluctance to assume a sitting position.

6. SSTR (symmetrical neck-tonic reflex). Leaning on his knees, the baby cannot transfer the center of gravity to his hands. This condition is called in neurology the “pointing dog pose”: the head is tilted forward, the hands are clenched into fists, and the arms are bent. All this leads to the fact that the baby’s muscle tone in the joints of the legs increases significantly. SSTD requires qualified complex treatment (massage, exercise therapy sessions, various procedures), and the sooner it is started, the better.

Treatment

Prevention

• do not forget about the benefits of therapeutic massage, because SDN is much easier to prevent than to deal with it later;
• give your baby “complete freedom” of action, without limiting him to the narrow confines of the cradle (of course, within the limits of what is permitted);
• If possible, give your child a separate room where he, and not you, will set the rules and procedures.

Patient, 66 years old.

Diagnosis: condition after surgical treatment of intervertebral hernia of the lumbar spine. Dear Lyudmila Petrovna, Irina Igorevna and all the clinic staff. Thank you very much for the warm welcome, for the effective treatment, the ability to give clear recommendations, advice after completing the course of treatment in your clinic, dear Lyudmila Petrovna! Good luck to you all, health, good luck and prosperity in all your endeavors.

With lots of best wishes, your patient, Kurgan.

Helpful information

Do your joints hurt?

Movement disorder syndrome in newborns

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

The causes of perinatal damage to the central nervous system can consist of a state of hypoxia as a result of hemolytic disease of the newborn, for example, due to Rhesus conflict, intrauterine infection, disruption of the utero-placental - fetal blood flow. Movement disorder syndrome in children may be the result of obstetric trauma. Movement disorder syndrome is often accompanied by a child’s mental or physical developmental delay, for example, slowing or impaired articulation and facial expressions. Movement disorder syndrome in the newborn occurs in 5% of children. The main risk groups are: borderline age of the mother (under 18 and over 35 years), pathology of the placenta (premature abruption, placenta previa), rapid or long labor, bad habits of the mother during pregnancy and breastfeeding. Diabetes mellitus in the mother during pregnancy, multiple births and polyhydramnios, taking medications that have a direct or indirect effect on the fetus.

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

Movement disorder syndrome in newborns: signs

Movement disorder syndrome in children has the following symptoms: as a rule, it is detected from the first weeks or even days of a child’s life and proceeds along 2 main paths.

The first way is the formation of motor disorders with a predominance of muscle hypnosis of the flexors and extensors of the limbs, convulsive readiness, increased tendon reflexes, as well as the possible appearance of pathological reflexes or long-term preservation of unconditioned reflexes. Tremors (shaking) of the arms, legs and chin may occur when crying, or the baby may scream. The second way is muscle hypotonia with the development of muscle flaccidity, decreased tone, inhibition of tendon reflexes and spontaneous motor activity. It can be combined with difficulty in speech and mental development, poor facial expressions and articulation, late appearance of a smile, delayed visual-auditory reactions and a weak monotonous cry.

Parents should monitor such babies very carefully and be sure to consult a neurologist.

Movement disorder syndrome in infants: treatment

Movement disorders syndrome: treatment includes mandatory observation by a neurologist with the prescription of basic medications (Vit E, nootropics, etc.). Mandatory in the treatment of movement disorder syndrome in a newborn is the prescription of physiotherapy methods in the correction of basic movement disorders.

Rehabilitation of children should begin immediately after diagnosis. Movement disorder syndrome: treatment should include a comprehensive prescription of medications, physiotherapy, and massage. You can get help in providing modern methods of physical therapy at Belozerova’s hardware therapy clinic “M-Clinic”. Massage is also very important in the treatment of the consequences of perinatal damage to the central nervous system. It can be both relaxing and tonic, depending on the predominance of the first or second variant of the disease.

Correcting a child with this syndrome is also important in terms of the child’s social adaptation in society, because difficulties in pronouncing words and poor emotions create great difficulties in everyday life.

Our specialists treat all of the listed diseases using proprietary methods; do not deny yourself the opportunity to be healthy.

Our clinic uses only advanced equipment and innovative treatment methods

Often in the medical records of newborn children you can see the abbreviation PEP, which frightens young mothers. The term “perinatal encephalopathy” itself was proposed in 1976 and comes from four Greek words: the prefix “peri” - located near, at something, “natus” - birth, “pathos” - disease and “enkefalos” - brain.

The perinatal period is the time from the 28th week of pregnancy to the seventh day after birth (up to the 28th day in premature babies), and encephalopathy is a term that refers to various brain pathologies.

Thus, PEP is a kind of collective diagnosis to designate neurological disorders in newborns, and the specific symptoms, causes and severity of this condition may vary.

In the international classification, there are various types of encephalopathy, their names indicate the cause of the disease (for example, hypoxic or diabetic encephalopathy), but there is no perinatal form, since this term only indicates the time interval for the appearance of disorders.

In recent years, domestic pediatric neurologists are also increasingly using other diagnoses, for example, perinatal asphyxia and hypoxic-ischemic encephalopathy.

The intrauterine development of the brain and nervous system as a whole is influenced by various unfavorable factors, in particular the health of the mother and the state of the environment.

Complications can also occur during childbirth.

1. Hypoxia. When a child in the womb or during childbirth lacks oxygen, all body systems suffer, but primarily the brain. The cause of hypoxia can be chronic diseases of the mother, infections, incompatibility by blood group or Rh factor, age, bad habits, polyhydramnios, malformations, unsuccessful pregnancy, unsuccessful childbirth and many others.
2. Birth injury, causing hypoxic or mechanical injuries (fractures, deformations, hemorrhages). Injury can be caused by: weak labor, rapid labor, poor fetal position, or obstetrician error.
3. Toxic lesions. This group of reasons is associated with bad habits and the intake of toxic substances during pregnancy (alcohol, drugs, some medications), as well as with environmental influences (radiation, industrial waste in air and water, heavy metal salts).
4. Maternal infections– acute and chronic. The greatest danger is posed by infection of a woman while carrying a child, since in this case the risk of infection of the fetus is very high. For example, toxoplasmosis, herpes, rubella, and syphilis rarely cause symptoms of an infectious disease in the fetus, but cause serious disturbances in the development of the brain and other organs.
5. Developmental and metabolic disorders. These can be congenital diseases of both mother and child, prematurity of the fetus, and developmental defects. Often the cause of PEP is severe in the first months of pregnancy or gestosis in the last.

The above factors can cause various types of disease. The most common are the following:

• hemorrhagic form, caused by bleeding in the brain;
• ischemic, caused by problems with blood supply and oxygen supply to brain tissue;
• dysmetabolic is a pathology of metabolism in tissues.

Symptoms and prognosis

Immediately after birth, the child’s well-being is assessed using a ten-point Apgar scale, which takes into account heartbeat, breathing parameters, muscle tone, skin color, and reflexes. Scores of 8/9 and 7/8 are given to healthy newborns without signs of perinatal encephalopathy.

According to research, the severity and prognosis of the disease can be correlated with the scores obtained:

• 6–7 points – mild degree of impairment, in 96–100% of cases recovery without the need for drug treatment and without further consequences;
• 4–5 points – average degree, in 20–30% of cases leads to pathologies of the nervous system;
• 0–3 points – severe, most often leading to serious impairment of brain function.

Doctors distinguish three stages of encephalopathy - acute (during the first month of life), recovery (up to six months), late recovery (up to 2 years) and the period of residual effects.

Neonatologists and obstetricians speak of encephalopathy if a child under the age of one month has the following syndromes:

1. Nervous system depression syndrome. Characterized by lethargy, decreased muscle tone, reflexes, and consciousness. Occurs in children with moderate severity of the disease.
2. Comatose syndrome. The child is lethargic, sometimes to such an extent that there is no physical activity. Cardiac activity and breathing are inhibited. Basic reflexes (searching, sucking, swallowing) are absent. This syndrome occurs as a result of hemorrhage, birth asphyxia, or cerebral edema and leads to the need to place the child in intensive care with the connection of an artificial respiration apparatus.
3. Increased neuro-reflex excitability. Anxiety, shuddering, frequent, unreasonable crying, similar to hysterical, poor sleep, arms and legs. Premature babies are more likely to have seizures, for example at high temperatures, until they develop. This syndrome is observed in mild forms of PEP.
4. Convulsive syndrome. Unmotivated paroxysmal movements of the head and limbs, tension in the arms and legs, shuddering, twitching.
5. Hypertensive-hydrocephalic syndrome. Characterized by an increase in the amount of cerebrospinal fluid and an increase in intracranial pressure. At the same time, the head circumference grows faster than normal (more than 1 cm weekly), and the size of the large fontanel also does not correspond to age. The child's sleep becomes restless, there is monotonous prolonged crying, regurgitation, throwing back of the head and bulging of the fontanelle, as well as characteristic trembling of the eyeballs.

During the recovery period, perinatal encephalopathy is accompanied by symptoms:

1. Convulsive syndrome.
2. Syndrome of increased neuro-reflex excitability.
3. Syndrome of vegetative-visceral changes. Due to the pathological functioning of the autonomic nervous system, the child experiences delayed weight gain, regurgitation, disturbances in breathing rhythm and thermoregulation, changes in the functioning of the stomach and intestines, and “marbling” of the skin.
4. Hypertensive-hydrocephalic syndrome.
5. Movement impairment syndrome. Normally, up to a month old, a child’s limbs are semi-bent, but easily unbend, and then immediately return to their original position. If the muscles are flaccid or so tense that it is impossible to straighten the legs and arms, then the cause is decreased or increased tone. In addition, limb movements must be symmetrical. All this interferes with normal motor activity and purposeful movements.
6. Psychomotor development delay syndrome. The child begins to raise his head, roll over, sit, walk, smile, and so on later than normal.

About 20–30% of children diagnosed with PEP recover completely; in other cases, complications develop, depending on the severity of the disease, completeness and timeliness of treatment.

Perinatal encephalopathy can lead to the following consequences:

• attention deficit disorder;
• delayed speech and mental development, brain dysfunction;
• epilepsy;
• Cerebral palsy (cerebral palsy);
• mental retardation;
• progressive hydrocephalus;
• vegetative-vascular dystonia.

Diagnostics

Perinatal encephalopathy is diagnosed by a pediatrician and pediatric neurologist based on examination data, tests and examinations of the child, as well as information about pregnancy, childbirth and the health of the mother.

The most effective and modern diagnostic methods are the following:

1. Neurosonography (NSG) is an ultrasound examination of the brain through the fontanel to identify intracranial damage and the condition of brain tissue.
2. Electroencephalogram (EEG) – records electrical potentials of the brain and is of particular value in diagnosing PEP with convulsive syndrome. Also, using this method, it is possible to establish the asymmetry of the brain hemispheres and the degree of delay in their development.
3. Doppler ultrasound to evaluate blood flow in the tissues of the brain and neck, narrowing or blockage of blood vessels.
4. Video monitoring. Video recording is used to establish spontaneous movements.
5. Electroneuromyography (ENMG) is electrical stimulation of a nerve to determine if there is a violation of the interaction between nerves and muscles.
6. Positron emission tomography (PET), based on the introduction into the body of a radioactive tracer, which accumulates in tissues with the most intense metabolism. It is used to assess metabolism and blood flow in various parts and tissues of the brain.
7. Magnetic resonance imaging (MRI) is the study of internal organs using magnetic fields.
8. Computed tomography (CT) is a series of x-rays used to create a complete picture of all brain tissue. This study makes it possible to clarify hypoxic disorders that are not clearly identified in NSH.

For diagnosis, NSG and EEG are the most informative and most often used. Without fail, the child must be sent to an ophthalmologist to examine the fundus, the condition of the optic nerves, and to determine congenital disorders.

It is worth noting that, according to various sources, in Russia perinatal encephalopathy is diagnosed in 30–70% of newborns, while according to foreign studies, only about 5% of children actually suffer from this disease. There is overdiagnosis.

The reasons for this may be failure to comply with examination standards (for example, diagnosing increased excitability in a child examined in a cold room by strangers), attributing transient phenomena (for example, throwing up limbs) or ordinary signals of needs (crying) to pathology.

Treatment

The central nervous system of newborns is plastic, capable of development and recovery, so treatment of encephalopathy must begin as early as possible. It depends on the severity of the disease and specific symptoms.

If brain dysfunction is mild or moderate, the child remains on home treatment. In this case, use:

• individual regime, calm atmosphere at home, balanced nutrition, lack of stress;
• assistance from correctional teachers, psychologists, speech therapists for alalia and dysarthria
• massage and physical therapy to normalize tone, develop motor functions and coordination of movements
• physiotherapy;
• herbal medicine (various sedatives and herbs to normalize water-salt metabolism).

For severe motor and nervous disorders, delayed development of the child and other PEP syndromes, medications are used. The doctor prescribes medications, as well as other treatment methods, based on the manifestations of the disease:

1. For movement disorders, dibazole and galantamine are most often prescribed. With increased muscle tone - Baclofen and Mydocalm to reduce it. These drugs are introduced into the body, including using electrophoresis. Massage, special exercises, and physiotherapy are also used.
2. If PEP is accompanied by convulsive syndrome, the doctor prescribes anticonvulsant drugs. For seizures, physiotherapy and massage are contraindicated.
3. Delayed psychomotor development is a reason for prescribing drugs to stimulate brain activity and increase blood circulation in it. These are Actovegin, Pantogam, Nootropil and others.
4. For hypertensive-hydrocephalic syndrome, herbal medicine is used, and in severe cases, Diacarb is used to accelerate the outflow of cerebrospinal fluid. Sometimes part of the cerebrospinal fluid is removed through a puncture of the fontanel.

For the treatment of PEP of any severity, B vitamins are prescribed, as they are necessary for the normal development and functioning of the nervous system. In many cases, swimming, baths with salt or herbal remedies, and osteopathy may be recommended.

Perinatal encephalopathy is one of the most common diagnoses among pediatric neurologists. This is due to the fact that PEP is a collective term denoting disorders of the child’s brain in the perinatal period, which have various causes, including the health of the mother, the course of pregnancy, the absence of congenital diseases, complications during childbirth, ecology and other circumstances.

Symptoms can be different, relating to disorders of the nerves, muscles, internal organs, metabolism, therefore, for an accurate diagnosis, the doctor must not only examine the child, but also collect the entire history regarding the health of the mother and father, complications during pregnancy, labor, and also order additional examinations.

Movement disorder syndrome in infants is a disease in which the baby experiences disturbances in motor activity (decreased or increased), weakened muscle strength and muscle dystonia.

Most often, this disease affects infants aged two to four months. The risk of getting this disease increases if the child has suffered hypoxia (oxygen starvation) or brain injury. Like many other diseases, movement disorder syndrome (MDS) is divided into several types.

Types of DSN

• Muscle hypertonicity – increased muscle tone. The child is unable to maintain balance for a long time.
• Muscle hypotonia is decreased muscle tone. This type of SDN also applies to older children.
• Cerebral palsy – .
• Cerebellar syndrome is a disorder of the work and functions of the cerebellum. (Drunken gait).
• TLR - tonic labyrinthine reflex. Children cannot move to a sitting position and cannot roll over from one side to the other.

Causes

1. Complications during childbirth. Quite often, an impatient obstetrician-gynecologist, in order to speed up the process of the birth of a child, begins to push the baby out, using force, which has an adverse effect on the fetus, injures it, as a result of which the baby receives SDN.
2. If the mother suffered from oxygen starvation (hypoxia) during pregnancy or the child during childbirth, then you can be sure that the baby will receive SDN.
3. Nervous system infection. The source of this infection is a sick mother, who infects the fetus through the placenta.
4. Improperly formed apparatus of the musculoskeletal system.

It is very important to diagnose SDN as early as possible. Therefore, a young mother must take full responsibility to monitor the health and behavior of her child, especially in the first months of his life.

Symptoms

• Weak muscle strength is the main symptom of the disease. All the baby’s movements occur “in slow motion.” The child cannot hold his head, neck, or raise his arms and legs without assistance.
• The baby is not able to take pathological positions. Difficulty, almost impossible, in flexion and extension of the upper and lower and upper limbs. The child cannot bend his fingers.
• The monotony of crying and screaming is also a characteristic sign of movement disorder syndrome.
• The facial expressions of a sick child are significantly different from the facial expressions of a healthy child. She is quite poor, the baby starts smiling late. For example, if a healthy baby begins to please his parents with his smile in the first month of life, then a baby suffering from motor impairment syndrome shows a smile at best - at three months of age.
• Visual and auditory reactions are significantly delayed.

Treatment

Osteopathy is an alternative to official medicine. It is a gentler way to treat DSD in children than drug and invasive treatment. The therapeutic effect is achieved through massage of the internal organs, in particular by influencing the desired points of the body.

Massage and physical therapy. Children under the age of one year must undergo at least 4 courses of physical therapy and massage. One course consists of at least 20 sessions, the session consists of a certain set of therapeutic exercises. In the intervals between courses, parents should massage their child themselves.

To perform massage procedures, it is necessary to use ointments. A specialist should tell you which ointment you should buy for your baby.

To obtain the desired result, special attention must be paid to the lower extremities. Before starting the exercises, wrap your baby’s feet in wool clothes. After finishing gymnastic exercises, you can make boots from paraffin or baths with boiled oats.

Your child’s attending physician must carry out special diagnostics that help specifically determine the types of disorders. (Sitting, walking, crawling, etc.)

Having made the results on this basis, the neurologist can prescribe a number of homeopathic medicines and formulate the child’s diet. In particular, with SDN, the baby should eat foods containing vitamin B. Or prescribe injections.

Reflexology. This type of treatment is most effective if the child has delays in the development and maturation of the nervous system.

Prevention

Provide your child with complete freedom of action (Do not overdo it. Safety rules have not been canceled.) Do not limit him to a narrow cradle. If possible, it would be a good idea to provide the baby with a separate room. The child must develop, have an interest in life, in learning about the world around him. Provide him with more objects to explore: bright toys, colorful pictures, etc.

Another important and useful for the development of the nervous system of children is barefoot walking, gymnastics, therapeutic massage without fail. Exercises on a large ball () also have a positive effect in the prevention of SDN.

Play finger games with your child as often as possible, touch him, and walk on textured surfaces.

Modern mothers perceive the diagnosis of “motor disorder syndrome” as a death sentence, despair and give up. This is the wrong reaction! This disease is curable and must be fought. And if you really love your child, you will never give up, but will fight for your child’s health to the end.