athetosis cerebral palsy
Introduction
Introduction to the hand and foot hyperkinetic cerebral palsy Hand and foot cerebral palsy refers to movement disorders or movement disorders caused by brain-based damage, which is manifested as involuntary movements that are difficult to control with will. When conscious and purposeful exercise is carried out, ineffectiveness and inconsistency increase the number of invalid movements. It occurs mostly in the hands, fingers and mouth, and occasionally can be seen on the toes, which is a non-autonomous movement. The patient's limbs and trunk muscles have a constant change in muscle tension, resulting in involuntary movements. Some patients present spontaneous rotation of the limbs, trunk and neck that are difficult to control. The facial muscles have irregular local contractions, and they have strange expressions such as "fangs and mouths" and "eyebrows". Physiological reflexes could not be induced or reflected normally, and the sputum, sputum, and Babinski signs were negative. It occurs mostly in the hands, fingers and mouth, and occasionally can be seen on the toes, which is a non-autonomous movement. There is generally no joint contracture unless there is a coexistence at the same time. Symptoms of cerebral palsy include dyskinesia, postural disorder, speech disorder, visual and auditory disorders, growth and development disorders, tooth developmental disorders, oral dysfunction, mood and behavioral disorders, and epilepsy. basic knowledge The proportion of illness: 0.001% Susceptible people: children Mode of infection: non-infectious Complications: mental retardation, speech and language disorders in children, epilepsy
Cause
Causes of cerebral palsy
Reasons before birth should be considered:
1 embryonic brain development abnormalities, such as cerebellar malformations, congenital hydrocephalus or no brain congenital malformations;
2 maternal trauma or severe infection during pregnancy, pregnancy toxemia, diabetes and radiation exposure can affect fetal brain development and cause permanent brain damage;
3 mothers with early rubella, herpes zoster, giant cell inclusion disease, toxoplasmosis, etc. can cause damage to the fetal central nervous system;
4 premature infants;
5 expired children, placental degeneration and necrosis, and premature infants can cause hypoxemia caused by fetal brain hypoxia;
6 genetic defects, family members or immediate family members have congenital genetic diseases;
7 other situations, such as parents swallowing, drinking alcohol, anemia, long-term medication.
The reasons for birth should also be considered:
1 fetal brain hypoxia, long delivery time and prenatal use of anesthetics, sedatives can inhibit fetal respiration, resulting in gas exchange disorders, umbilical cord around the neck, placental abruption, placenta previa, can cause fetal brain hypoxia. About 30% of these children have a history of neonatal asphyxia;
2 cerebral hemorrhage, birth injury, emergency, dystocia, bleeding disorders can cause intracranial hemorrhage. About 15% of these children have seizures in the neonatal period; 3 nuclear jaundice, caused by neonatal hyperbilirubinemia, is the cause of cerebral palsy.
The main reasons after birth are:
Encephalopathy caused by meningitis, encephalitis or severe infection, intracranial hemorrhage caused by head trauma, carbon monoxide poisoning and other diseases. Followed by severe malnutrition, severe dehydration and cerebral venous thrombosis. Such causes are more clear and can be diagnosed as the sequelae of a disease.
Prevention
Hand and foot cerebral palsy prevention
1. Prevent infectious diseases from happening
Newborns leave the mother to come to the human world, the development of organ viscera is still not perfect, immune function is low, and infectious diseases are easy to occur; and because the skin is delicate, the subcutaneous blood vessels are rich, the permeability of the blood-brain barrier is high, and the skin and mucous membrane are slightly If there is damage, bacteria and viruses will enter the blood circulation to grow and reproduce, which will lead to sepsis and viremia, and then become encephalitis and meningitis, which will damage the brain and cause cerebral palsy. To this end, active prevention of infectious diseases in the neonatal period is of great significance for reducing the incidence of cerebral palsy.
(1) Pay attention to protecting the skin of newborn babies
The intact skin and mucous membranes are the first line of defense against the invasion of germs. Once the skin and mucous membranes are damaged, the bacteria will take the opportunity to enter the body and cause illness. Always bathe and bathe the newborn, keep the skin clean and dry; wear the clothes for the newborn to be soft and absorbent; do not wear metal objects or insert needles on the clothes to avoid damage to the skin. When the newborn's skin is found to be damaged, erosive or purulent, it should be treated promptly.
(2) Keep the umbilical part of the newborn dry and clean
The umbilical part of the newborn is an important portal for the entry of germs into the body, so it should be kept dry and clean, and should not be underestimated. If mucus or purulent secretions are found in the umbilicus, the skin around the umbilical cord is red and swollen, indicating that there is an infection in the umbilicus and should be treated actively.
2. Closely observe the growth and decline of jaundice
Neonatal jaundice has physiological and pathological points. Physiological jaundice begins to appear 3 days after birth and lasts for about 7 to 10 days. (Immature children can be delayed until 2 to 3 weeks), jaundice is not very deep. . Astragalus appears prematurely, appears within 2 days after birth, and gradually deepens and lasts for a long time. It may be pathological jaundice and should be treated promptly.
3. Pay attention to the front view
The anterior iliac crest is a mirror reflecting the intracranial lesions and needs to be observed frequently. The normal anterior iliac crest is about 2.5cm × 2.5cm in size, slightly depressed or flat, with pulsation. If the anterior iliac crest is uplifted and stressed, it is seen in fever or intracranial lesions. The anterior iliac crest is completely closed between 1 and 1 year and a half. If it is closed too early (closed within 3 months), it may be brain dysplasia, too late closure, in addition to rickets, or an important manifestation of hydrocephalus .
4. Implement breastfeeding
Breast milk is not only nutritious, but also contains many immune substances and anti-infective factors, which are not available in other formulas. It has been proved that the incidence of infectious diseases such as respiratory infection, diarrhea and otitis media in children who are exclusively breastfed for 4 to 6 months is significantly less than that of artificially fed children.
5. Pay attention to prevent the occurrence of febrile seizures
High fever convulsions occur in infants from 6 months to 3 years old, and occur within 24 hours of high fever, with a prevalence of about 3 to 5%. When the body temperature drops below 39 ° C, the convulsions often stop and the mind turns clear. The duration of convulsions is as short as a few seconds and as long as a few minutes or even tens of minutes. Epilepsy and mental retardation are common in children with a febrile seizure that lasts for more than 30 minutes or relapses more than 6 times. Febrile seizures can be caused by a variety of diseases, accounting for half of the convulsions in children under 5 years of age, and the recurrence rate is about 35%. In the case of seizures, children have different degrees of hypoxia, leading to brain dysfunction, thus causing harm to the nervous system of children, especially the duration of seizures is more than half an hour or repeated authors, brain cells are more severely damaged.
Complication
Hand and foot cerebral palsy complications Complications, mental retardation, speech and language disorders, epilepsy
First, frail and sick
The length and weight of children with hand, foot and cerebral palsy are generally not up to normal standards, poor nutrition, easy to suffer from rickets, often repeated respiratory infections, diarrhea, weak winds, affecting health and physical strength, hindering physical and mental development. There are also suction, koji, difficulty swallowing, poor oral closure and runny. Late teething, learning to delay, need symptomatic treatment. In addition to providing a scientific and reasonable diet, zinc, calcium, iron and vitamin A vitamin D should be replenished in time to promote their growth.
Second, learning difficulties
About 50% of children with cerebral palsy and cerebral palsy have mild or moderate learning difficulties. Their IQ value is 70-80. Some children with cerebral palsy and cerebral palsy seem to have no major problems, but there may be reading. Difficult or difficult to calculate. Some children read and calculate very well, but it is difficult to establish the concept of shape, which leads to poor ability to draw pictures. Serious learning difficulties make children with cerebral palsy very slow to learn about walking, talking, and activities.
Third, mental retardation
Children with hand, foot and cerebral palsy often suffer from mental retardation. The incidence of mental retardation in children with cerebral palsy and cerebral palsy is as high as 75%. Since most of the assessment tests for intelligent development are based on the completion of exercise, the results measured in children with cerebral palsy often differ from the actual, often lower than those with mental retardation. In addition, children with cerebral palsy and cerebral palsy in addition to brain damage caused by dyskinesia, there may be visual, auditory, and language barriers, making it difficult to make appropriate responses or express themselves; The potential development of the body should be hindered, so that life practice during development is hindered and affects mental development. In addition, there are psychological barriers other than the trunk factors, making the test less reliable, and the actual intelligence is often underestimated. For children with cerebral palsy, the observation and understanding of the parents, as well as the physician's own observations, often contribute to the overall assessment of the child's intelligence, and can not equate the mental test results of children with cerebral palsy with mental retardation. If the movement of children with cerebral palsy improves, the practice increases and the developmental level of all aspects increases significantly.
Fourth, language barriers
Most children with cerebral palsy and cerebral palsy have different language barriers. Its manifestation can be unclear pronunciation, difficulty in articulation, language expression disorder, and even aphasia.
The reasons for the pronunciation language barrier are:
Due to brain tissue dorms, the development of the language center is affected.
After cerebral palsy, the facial, tongue, and vocal organs are involved in muscles, resulting in dysarthria.
Children with cerebral palsy may also cause or promote language disorders due to dyskinesia of the limbs, visual, auditory or mental retardation.
Children with hand-foot-acting and dysfunctional cerebral palsy are often accompanied by language disorders, followed by children with cerebral palsy with spastic quadriplegia and double sputum. Language disorders may also be associated.
Fifth, visual impairment
Children with hand, foot and cerebral palsy often have strabismus, which is more common with internal oblique, other visible nystagmus, gaze disturbance, myopia, hyperopia, etc., severe cases can be seen cataract, optic atrophy, or even blind. Strabismus is the most common abnormality of the eyeball position in spastic cerebral palsy. The incidence of optic atrophy is high in severe brain injury and spastic quadriplegia with severe mental retardation.
Sixth, abnormal psychological behavior
Children with hand, foot and cerebral palsy may have behavioral abnormalities such as self-harm, violent tendencies, sleep disorders, and personality abnormalities. The personality of children with cerebral palsy has different physiological basis and reaction pathways than normal children. The emotional stability, self-control, self-reliance and mild rationality of children with cerebral palsy are lower than normal children. Children with surface cerebral palsy are prone to emotional instability and easyness. Personality characteristics such as change, low self-control ability, strong dependence, easy impulsiveness, and strong aggression. Children with cerebral palsy have lower adaptability to society and family than normal children, and have low psychological adaptability to changes in objective environmental changes. The stability of the constitution and the stability of the individual are lower than those of normal children, showing the unsettled tendency of personality and the imbalance of development. Therefore, we must pay attention to observe the behavior of children with cerebral palsy, take effective measures to prevent the occurrence of abnormal behavior, and at the same time actively correct and avoid the symptoms worse.
Seven, epilepsy
Epilepsy is often noticed by convulsions. Convulsions not only hinder the treatment of cerebral palsy, but repeated convulsions increase the risk of brain damage and affect intelligence. The probability of epilepsy in most children with cerebral palsy is 20%-30% for infants and 40% for infants. There is a high incidence of spastic quadriplegia, hemiplegia, and pediatric malformations. Many infants have seizures in the early stage.
Drugs can often control seizures, usually require regular medication, adhere to 2-4 years, and gradually stop taking the medicine under the guidance of a doctor. Take care during the attack, protect the head, make it sideways, loosen the clothes that are too tight and easy to breathe and discharge saliva, keep the breath open, observe it next to the child, and let it rest after the attack.
Eight, oral dysfunction and dental disease
Due to abnormal muscle tension in the facial muscles and the oral and lingual muscles, the child's chewing, absorbing and swallowing difficulties, oral closure and drooling. The common cause of dental caries in children with cerebral palsy and cerebral palsy is mainly due to the unsanitary side of the tooth itself and the oral cavity. Because of bilirubin encephalopathy or other perinatal damage, enamel can be incomplete, teeth are prone to calcification, and the teeth themselves are prone to caries.
Nine, hearing impairment
Children with hand, foot and cerebral palsy are mostly sensorineural hearing impairment caused by damage to the central auditory canal. Children with cerebral palsy often show poor response to acoustics due to mental retardation, backward language development, and dyskinesia, and their hearing impairment is often overlooked. Therefore, in order to reduce disability, the child should be examined early for hearing, so as to early detection and early treatment.
Ten, eating difficulties
Many children with cerebral palsy and cerebral palsy have difficulty eating, and the performance in infancy is difficult to breathe. After a little big, it is difficult to chew, and there may be difficulty in swallowing. The throat of normal children can make the air smoothly enter the organs and lungs, making the liquid Or solid food enters the esophagus and stomach. This function of children with cerebral palsy is often unsound, so it is easy to cause food, food or liquid to enter the food reflux phenomenon in the stomach, but this phenomenon will disappear quickly. This phenomenon may persist in children with cerebral palsy. Due to the long-term reflux of gastric acid, it may cause damage to the esophageal wall and pain, and eventually lead to refusal of children with cerebral palsy.
Eleven, rogue
Children with hand, foot and cerebral palsy may have difficulty controlling saliva. The baby has a rogue for about 6 months, but soon learns to swallow. It is difficult for children with cerebral palsy to close their lips, and it is difficult to swallow saliva regularly, so continuous drooling causes the mouth and chest to be always wet. At present, salivation can be effectively treated by oral massage and small surgery.
Twelve, rectal and bladder problems
Children with hand, foot and cerebral palsy cause dry stools due to less activity, which also affects diet. Early control is much easier than controlling after the elderly. Therefore, it is necessary to pay more attention to the choice of fruits, vegetables, and crude cellulose in the diet to keep the stool clear, and the rectum is regularly emptyed to form a habit. At the same time, always check to prevent the reflection of dry stool. Children with cerebral palsy have a poor ability to control the bladder compared to normal children. If the bladder can not be emptied for a long time, it is easy to cause bacterial infection of the bladder. Therefore, it is important to train urination habits and take various measures to prevent infection.
Thirteen, infection problems
Due to chewing, soaking, and difficulty in swallowing, the child cannot get sufficient nutrition, lacks trace elements, and has low immunity. Due to long-term survival in a certain fixed posture and position, and even prolonged bed rest, it is easy to cause infection of local tissues and organs, such as lung infections and urinary tract infections. Therefore, children with cerebral palsy should try their best to make balanced nutrition, enhance the body's resistance, and actively prevent and treat various infections.
Symptom
Symptoms of cerebral palsy and cerebral palsy of common hands and feet Common symptoms of dance-like hand and foot kinesis tension reduction children's psychomotor development abnormalities reflexes language development retardation reflex abnormal asymmetry tension neck reflex involuntary movement limb or trunk posture abnormal
1. Sports development is backward and active movement is reduced.
In children with cerebral palsy symptoms, motor development is characterized by gross movement and/or fine movement. There are many indicators for judging whether sports development is backward. Each movement has different performances in different years (months), but some main indicators should be mastered in clinical application.
Normal children can look up when they are 3 months old. They can actively reach out and touch the objects in 4 to 5 months. Both hands can be held on the chest. When you are quiet, you can play with your hands in front of your eyes. When you are 6 to 7 months old, you will sit alone on the hard bed and not fall. When you are 8 to 10 months, you will climb. When you climb, your upper limbs or lower limbs will move alternately. I can stand alone when I am 1 year old, and I can walk when I am 1 to 1 year old. Cerebral palsy children generally cannot reach normal pediatric levels at these ages.
In children, cerebral palsy often shows reduced movement, poor sucking ability and foraging response. Normal 3 months of babies in the supine position often have kicks, pedal-like movements, and alternate kicks. The cerebral palsy children's kicking movements are significantly reduced, and there are few alternating movements. The normal upper limb movements in 4 to 5 months are very flexible, and the cerebral palsy children's upper limb activities are also reduced. Normal children have not formed a right or left eye within 1 year of age, while the sputum type of cerebral palsy is often used only with one hand or touch, the activity of the other hand is reduced, and the hand is often clenched.
Second, abnormal muscle tone
Muscle tone is the tension of the muscles in a quiet state, and the muscle tension is understood by passively flexing, straightening, pronation, and supination. A small baby can hold his forearm and shake his hand to understand the upper limb muscle tension according to the range of motion of the hand. The lower limb muscle tension can also be measured by holding the calf to swing its foot. The tension is judged according to the range of the foot activity. When the tension is low, the range of the hand and foot movement is large when the hand is shaken, and the range of motion is small when the tension is high.
When checking the muscle tension, you can also learn by the "pull test". This test is easy to grasp. Hold the child's hands and pull it from the supine position into the sitting position. Observe the back of the head to understand the muscle tension of the neck and back.
The cerebral palsy specialist needs to be reminded that when examining muscle tension, it should be noted that some children with a longer disease duration have limited joint movement due to joint contracture, so do not mistakenly increase muscle tone.
Third, the posture is abnormal
Abnormal postures of children with cerebral palsy are various, which are related to abnormal muscle tone and delayed disappearance of original reflex. The movements of the hand and foot and the ataxia type are different from those of the sputum type. In the first year, they are often lying quietly and have almost no autonomous movement. In the supine position, their posture is opposite to that of the sacral type, which is characterized by lower limb flexion, hip abduction, and paralysis. Back dorsiflexion. When you hold up in an upright position, you can control the head in the middle position.
Fourth, the reflection is abnormal
Deep sacral cerebral palsy (knee reflex, biceps reflex, Achilles tendon reflex, etc.) is active or hyperactive, and sometimes leads to sputum and Babinski sign. Neurological reflexes in children with cerebral palsy often show that the original reflexes are delayed, and the protective reflexes are weakened or delayed.
Obvious symptoms:
Symptoms of cerebral palsy include dyskinesia, postural disorder, speech disorder, visual and auditory disorders, growth and development disorders, tooth developmental disorders, oral dysfunction, mood and behavioral disorders, and epilepsy.
(1), dyskinesia: cerebral palsy children's athletic ability is lower than normal children of the same age, sports self-control ability is poor, the degree of obstacles is only the hands and feet movements are slightly inflexible or clumsy, serious hands will not catch things The feet will not walk, there will be sharp feet (the heel does not touch the ground) scissors cloth (the legs are crossed), and some will not even turn over, will not sit up, will not stand, will not chew and swallow normally.
(2) Posture disorder: Various postures of children with cerebral palsy are abnormal, posture stability is poor, posture is awkward during exercise or at rest, left and right sides are asymmetrical, and some serious cases are often not as vertical as normal children. Straight in the middle position, but accustomed to leaning to one side, or shaking left and right.
(3) Mental retardation: Among all children with cerebral palsy, about 1/4 of children with normal intelligence, about 1/2 of those with mild or moderate intelligence, and about 4,000 with severe mental retardation.
(4) Language barrier: Most children with cerebral palsy may be accompanied by different levels of language barriers, some of which may be difficult to express words or difficult to construct, some may be unclear or stuttering, and some may also be aphasia. That is, you can understand other people's language, but you can't speak. This situation is especially large in the proportion of cerebral palsy in the hands.
(5), visual and auditory disorders: many children with cerebral palsy are accompanied by myopia or strabismus, which is more common with internal oblique, and hearing loss is more common with Xu-type cerebral palsy. Children with cerebral palsy often have difficulty distinguishing the rhythm of the sound.
(6) Growth and development disorders: Some children with mild cerebral palsy can be basically or nearly normal, but most children with cerebral palsy are shorter than normal children of the same age, and their growth and development are backward.
(7), tooth development disorders: cerebral palsy children's teeth are mostly dysplastic, tooth texture is loose, easy to sputum, the incidence of various dental diseases is higher than normal children.
(8), mouth and face dysfunction: some of the cerebral palsy children's facial muscles and tongue muscles have obvious or inconsistent contraction. As a result, the child has difficulty chewing and swallowing, difficulty in closing the mouth, and drooling.
(9) Emotional and behavioral disorders: Many children with cerebral palsy, especially the hands and feet, are more stubborn and self-willed, and their mood fluctuations are large, and they feel irritated, and some are even detached and unsocial. The abnormal behavior is as follows:
1) Forced behavior: Force yourself to do something.
2) Self-injury behavior: Hit yourself or use your head to hit the wall.
3) Invasive behavior: beating others, but less common.
(10), epilepsy: about 39% - 50% of cerebral palsy children induced epilepsy due to fixed lesions in the brain, the incidence of epilepsy in children with severe mental retardation is particularly prominent.
Examine
Examination of hand and foot cerebral palsy
1. Intelligence test;
2. EEG examination;
3. Determination of brainstem auditory evoked potentials;
4, imaging studies such as diagnosis.
Diagnosis
Diagnosis and differential diagnosis of hand and foot cerebral palsy
First, the hand and foot Xu-type cerebral palsy lesions are mainly in the basal ganglia of the brain, so there will be some related symptoms in clinical manifestations.
Second, the hand and foot Xu-type cerebral palsy mainly manifests as a sustained slow sputum-like peristalsis, which can present various abnormal postures, mainly affecting the distal part of the limb. Generally, the upper limb is heavier than the lower limb, and the symptoms are aggravated when active force and tension are relaxed. . Can also be expressed as changes in muscle tone, exercise intention and exercise results are inconsistent, there are involuntary movements, pathological reflex negative, lateral bending reflex positive, dysarthria.
Third, according to the clinical manifestations of children with hand and foot Xu-type cerebral palsy, an auxiliary examination must be done.
