Hemiplegia - tuag tes tuag taw ntawm ib nrab ntawm lub cev nrog nws ua tiav tsis muaj zog. Muaj ntau ntau yam pathology, ib tug ntawm lawv yog spastic hemiplegia nyob rau hauv cerebral palsy. Nrog hemiplegia, ib qho ntawm cov hemispheres ntawm lub hlwb raug cuam tshuam crosswise, los yog oppositely. Spastic hemiplegia manifests nws tus kheej nyob rau hauv lub zog tsis meej pem ntawm ib sab.
Kev faib tawm ntawm cerebral palsy
Hauv tebchaws Russia, kev faib tawm ntawm Semenova K. A. tau txais txij li xyoo 1974. Nws cov txheej txheem muaj qhov zoo uas nws npog tag nrho cov chaw kho mob ntawm lub hlwb puas thiab ua rau nws muaj peev xwm kwv yees rau tus neeg mob. Cov tsos mob ntawm lub hlwb puas muaj xws li kev hais lus, kev puas siab puas ntsws thiab kev txav mus los.
Raws li qhov kev faib tawm no, 5 hom kab mob hlwb raug cais:
- Hemiparetic form.
- Spastic diplegia, lossis Little's disease (spastic tetraparesis, uas ob txhais ceg raug kev txom nyem ntau dua) yog hom kab mob ntau tshaj.
- ob npaug spastic hemiplegia (xav tias qhov hnyav tshaj plaws).
- Atonic-astatic (Ferster's syndrome) - nrog nws muajcov leeg nqaij atony, txav tau khaws cia, tab sis kev sib koom ua ke tsis zoo. Kev hais lus tsis zoo hauv 60% ntawm cov neeg mob.
- Hyperkinetic daim ntawv (nrog hyperkinesis).
Spastic hemiplegia kuj yog ib qho ntawm cov kab mob cerebral palsy, nrog rau nws txhais caj npab thiab txhais ceg raug cuam tshuam rau ntawm ib sab, tab sis sab sauv sab sauv raug kev txom nyem, raws li txoj cai, ntau dua. Nyob rau hauv cov ntaub ntawv hnyav, kev hloov pauv tau tshwm sim nyob rau hauv thawj lub lim tiam ntawm lub neej, nrog rau qhov mob hnyav, cov cim tshwm sim thaum kawg ntawm lub xyoo, thaum tus me nyuam yuav tsum nquag coj cov khoom pom rau nws.
Nyob rau hauv spastic hemiplegia (CP), sab cuam tshuam yog ib txwm hypertonic, txawm hais tias hypotension tshwm sim thawj lub hlis.
Pom tus neeg mob:
- lub suab ntawm caj npab nce, thiab nws yog khoov rau hauv txhua pob qij txha;
- txhais tes ntawm cov menyuam yaus raug nias rau lub cev thiab tuav lub nrig;
- hauv cov menyuam yaus, nws muaj qhov zoo li hu ua "obstetrician's tes";
- tshuav nyiaj li cas yuav khaws lossis ncua sijhawm;
- lub taub hau tig mus rau sab noj qab haus huv thiab tib lub sijhawm tig mus rau ntawm lub xub pwg nyom;
- lub pelvis yog rub, thiab ib sab curvature ntawm lub cev tshwm sim - qhov cuam tshuam zoo li yuav luv;
- cuam tshuam ceg yog qhov ua rau ntse txuas ntxiv thiab twisted rau sab nraud;
- muscle hypertonicity muab qhov nce ntawm qhov cuam tshuam ntawm sab cuam tshuam.
Me nyuam muaj kev loj hlob qeeb:
- nws yuav taug kev tom qab 2-3 xyoos;
- gait tsis khov kho thiab tus menyuam feem ntau ntog rau ntawm qhov cuam tshuam;
- tus me nyuam tsis tuaj yeem nce ntawm ko taw, nws tsuas yog lean ntawm nws tus ntiv tes xwb.
Thiab tib lub sijhawm, caj npab yog khoov thiab tig mus rau sab hauv. Nyob rau tib lub sij hawm, khoov tes yog thim rov qab rau ntawm tus ntiv tes me me, tus ntiv tes xoo yog nias, tus txha nraub qaum muaj qhov curvature lateral (scoliosis), ko taw yog valgus (zoo li tsab ntawv "X"), Achilles tendon yog luv.
Sijhawm dhau mus, cov cwj pwm no dhau los ua ntu zus. Cov leeg ntawm qhov cuam tshuam yog atrophic thiab underdeveloped.
Qhov tseem ceeb! Nyob rau hauv hemiplegia, tus me nyuam muaj tus yam ntxwv gait thiab upright posture, uas yog kho mob hu ua Wernicke-Mann txoj hauj lwm. Nws yog qhov tseeb heev los ntawm cov kab lus: "Lub tes nug, ceg mows." Qhov no yog pom vim hais tias ob txhais ceg ntawm qhov mob yog ncaj ntawm lub duav thiab lub hauv caug, khoov ntawm ko taw, tus me nyuam leans tsuas yog ntawm cov ntiv tes. Ob txhais ceg mus rau pem hauv ntej, thiab txhais tes ntawm qhov cuam tshuam, raws li nws tau, thov rau alms. 40% ntawm cov menyuam yaus uas muaj kab mob no muaj kev puas hlwb.
Tsis muaj qhov sib piv ncaj qha nrog rau qib ntawm kev txav mus los. Social adaptation nyob rau hauv xws li cov neeg mob yog txiav txim los ntawm lub degree ntawm kev txawj ntse kev loj hlob. Qhov kev pom zoo yog tias cerebral palsy tsis ua tiav, vim tias cov kab mob hlwb hauv tus kab mob no yog qhov zoo li thiab tsis kis mus. Spastic hemiplegia raws li ICD 10 muaj tus lej G81.1, qhov sib txawv ntawm qhov yug yog G80.2.
Etiology ntawm qhov tshwm sim
Yog vim li cas suav nrog:
- pab hlwb kev loj hlob;
- fetal hypoxia;
- kis kab mob hauv plab, tshwj xeeb tshaj yog kis kab mob;
- Rhesus cuam tshuam nrog tus kab mob hemolytic ntawm tus menyuam mos;
- fetal hlwb raug mob thaum yug menyuam;
- kab mobpaj hlwb thaum yau - mus txog 3 xyoos;
- fetal hlwb toxicity;
- pathological me nyuam;
- kev sib kis ntawm tus txha caj qaum thiab lub hlwb hauv tus menyuam;
- mob hlwb;
Tseem ua rau mob plab hemiplegia:
- kab mob kab mob;
- exo- thiab endogenous intoxications;
- kab mob ntshav;
- meningitis.
Txhua kis ntawm cerebral palsy yog tus kheej, thiab nws tsis tuaj yeem txiav txim siab qhov tseeb ntawm tus kabmob. Lub etiology ntawm spastic hemiplegia nyob rau hauv congenital lesions yog tshwm sim los ntawm impaired tsim ntawm central lub cev muaj zog neurons nyob rau hauv fetal kev loj hlob nyob rau hauv lub fetus.
YKev faib tawm ntawm pathology
Raws li etiology, spastic hemiplegia muab faib ua cov organic thiab ua haujlwm, congenital thiab tau txais. Organic yog manifested nyob rau hauv lub yeej ntawm lub hlwb hlwb, uas yog vim li cas paj conduction yog cuam tshuam. Nrog rau kev ua haujlwm hemiplegia, tsis muaj kev hloov pauv ntawm tes, cov leeg nqaij thiab cov reflexes nyob li qub. Daim ntawv no ntawm hemiplegia yuav ploj mus spontaneously. Raws li qhov chaw ntawm qhov txhab, cov hauv qab no yog qhov txawv:
- Ob chav spastic cerebral palsy hemiplegia - tag nrho cov ceg. Daim foos no suav tias yog qhov hnyav tshaj plaws.
- Homolateral lesion - tsom hauv lub hlwb yog nyob rau sab ntawm cov ceg tawv.
- daim ntawv tsis sib haum - tsom thiab ceg tawv hauv cov hlaws.
Kev xaiv rau cov kab mob:
- central hemiplegia - nqaij hypertonicity thiab tuag tes tuag taw;
- hla hemiplegia - caj npab ntawm ib sab,txhais ceg rau lwm tus;
- hom flaccid - sab cuam tshuam yog txo qis hauv suab;
- spastic hemiplegia - caj npab raug mob ntau dua li ceg.
Raws li qhov chaw nyob ntawm ob sab ntawm qhov txhab, daim ntawv spastic ntawm cerebral palsy hemiplegia tuaj yeem yog: sab xis-, sab laug- thiab ob sab.
Symptomatic manifestations
Cov tsos mob muaj xws li:
- kev hais lus tsis meej, kev puas siab puas ntsws;
- muscle hypertonicity nrog qaug dab peg;
- txo qis hauv articular reflexes nrog kev nce ntxiv hauv cov leeg thiab periosteal;
- myalgia;
- cyanosis ntawm daim tawv nqaij ntawm cov ceg thiab lawv qhov txias;
- pathological reflexes;
- kev ntxhov siab;
- tsis yeem txav ntawm ceg ceg;
- txhob ua ntsej muag luag ntxhi.
Pathological reflexes yog qhov tsis muaj qhov tsis txaus ntseeg ntawm cov kab mob me me, uas, nrog rau nws txoj kev loj hlob thiab kev txhim kho ntawm cortico-spinal tract, ploj mus ib txwm.
Nrog cerebral palsy thiab lwm yam paj hlwb pathologies, lawv nyob twj ywm tsis hloov. Muaj ntau ntau, thiab lawv txhua tus muaj npe ntawm lawv tus sau:
- flexion ko taw - Rossalimo, Zhukovsky, Bekhterev;
- extensor ko taw kos npe - Babinski, Oppenheim, Gordon thiab Schaeffer.
theem ntawm cerebral palsy
Muaj 3 theem ntawm kev mob hlwb:
- mus txog 5 lub hlis - theem ntxov;
- ntawm 6 lub hlis mus rau 3 xyoos - thawj qhov seem;
- tom qab 3 xyoos - ligresidual.
Raws li cov theem, cov tsos mob thiab cov tsos mob tseem ntxov thiab lig. Cov tsos mob thaum ntxov ntawm spastic hemiplegia hauv cov menyuam mos:
- kev loj hlob ntawm lub paj hlwb poob qab - tus menyuam tsis tuav nws lub taub hau, dov tsis tau, tsis ncab thiab tsis ua raws li cov khoom ntawm nws ob lub qhov muag;
- tsis zaum lossis nkag;
- hauv kev ua si, tus menyuam yaus siv ib txhais tes xwb, qhov thib ob yog ib txwm khoov thiab nias rau lub cev.
Cov tsos mob ntawm spastic hemiplegia hauv cov menyuam mos tuaj yeem sib txawv ntawm qhov hnyav, nyob ntawm seb lub hlwb puas tsuaj.
Qhov cuam tshuam yog tas li nyob rau hauv hypertonicity, vim qhov no, qhov txav tau dhau los ua ntse heev, jerky. Lawv tshwm sim aimlessly thiab tag nrho ntawm kev tswj. Qee qhov kev txav, ntawm qhov tsis sib xws, yog qeeb thiab zoo li cab. Cov tsos mob tseem tshuav yog lig:
- luv luv ntawm cov ceg ceg, uas ua rau scoliosis thiab curvature ntawm cov pob txha hauv plab;
- daim ntawv cog lus ntawm cov pob qij txha - lawv qhov tsis tuaj yeem;
- muscle cramps;
- vim yog cov leeg tsis sib haum xeeb, kev nqhis dej tau pom;
- ntxub qaub ncaug - qaub ncaug ntws tawm ntawm qhov ncauj tas li.
Tus menyuam tsis teb rau lub suab sab nraud - qhov no ua rau nws hais tsis tau. Kev hais lus kuj tsis zoo vim qhov tsis sib haum xeeb ntawm daim di ncauj, tus nplaig, thiab caj pas.
Speech with cerebral palsy
Spastic hemiplegia hauv cov menyuam yaus tsis tas yuav ua rau tsis muaj kev hais lus. Kev txawj ntse hauv cerebral palsy tuaj yeem sib txawv: nyob twj ywm li qub lossislag tom qab mus rau qhov tsis txaus ntseeg. Nrog kev txawj ntse txaus, cov menyuam tuaj yeem kawm hauv lub tsev kawm ntawv kev kawm dav dav thiab tom qab ntawd tau txais kev tshwj xeeb.
Nws nyuaj rau cov menyuam muaj mob kom hais lub suab tsis zoo, vim tias cov leeg nqaij koom nrog cov txheej txheem hais lus yeej ib txwm nyob hauv hypertonicity.
Feem ntau qhov muag tsis pom kev - myopia thiab strabismus. Nyob rau ib feem ntawm cov hniav - nquag caries, qhov chaw tsis raug ntawm cov hniav, enamel pathology. Kev tswj tsis tau ua haujlwm ntawm cov leeg hauv plab hauv plab ua rau tsis tuaj yeem tso zis thiab tso zis.
Feem ntau cerebral palsy yog txuam nrog qaug dab peg. Cov me nyuam zoo li no yeej ib txwm muaj kev phom sij heev thiab koom nrog lawv niam lawv txiv thiab cov saib xyuas. Qhov no yuav tsum tau coj mus rau hauv tus account thaum ua raws li tus me nyuam adaptation. Nws twb tau hais tias kev mob hlwb tsis zoo zuj zus tuaj, txawm tias cov niam txiv feem ntau xav li ntawd. Vim li cas? Vim tias tus menyuam loj hlob tuaj thiab cov tsos mob yuav tshwm sim ntau dua, piv txwv li, nws muaj teeb meem nrog kev kawm. Cov tsos mob tsis nce: tus me nyuam me, yog li nws tsis pom zoo kom txog thaum nws kawm taug kev, noj, thiab lwm yam.
mob mus txog ib xyoos
Cov theem ntawm kev loj hlob ntawm tus me nyuam nrog spastic hemiplegia zoo li no:
- thawj lub lis piam thiab hli - qaug dab peg, tus menyuam tsis tsa lossis tuav nws taub hau;
- kev nqus nqus, nce salivation;
- thaum muaj hnub nyoog 4-5 hli, tus menyuam mos tsis hnov tsw sab nraud, tsis tig taub hau, tsis ntsais, tsis hum;
- tsis quav ntsej txog cov khoom ua si thiab tsis ncav cuag lawv;
- ntau tshaj 7 lub hlis - tsis zaum,tsis dhuav;
- tsis txhob sim nkag;
- thaum tus menyuam muaj hnub nyoog tshaj ib xyoos, nws tsis sim nce thiab nqis, tsis hais dab tsi;
- txog li 12 xyoos ntawm hnub nyoog siv feem ntau ntawm ib txhais tes, strabismus feem ntau tshwm sim;
- kev nyuaj, tsis tuaj yeem sawv ntawm ko taw, tsuas yog ntawm tus ntiv taw xwb.
Qhov tseem ceeb! Tus me nyuam mob tsis paub txog nws qhov tsis xws luag - anosognosia.
ntsuas ntsuas
Kev kho mob tshwm sim yog qhov tshwj xeeb dhau los ua nyuaj rau kev kuaj mob. Tab sis lub pathology yuav tsum tau sib txawv. Txhawm rau ua qhov no, koj yuav tsum paub txog cov etiology, sau cov keeb kwm kom tiav thiab cov ncauj lus kom ntxaws, ua ib qho kev ntsuam xyuas lub cev thiab kev kuaj mob paj hlwb nrog kev ntsuam xyuas.
Lab tests:
- UAC and OAM;
- ntshav biochemistry;
- kev kawm ntawm CSF tom qab lumbar puncture;
Instrumental research:
- electromyography;
- CT thiab MRI ntawm lub hlwb;
- doppler;
- EEG.
MRI tuaj yeem nthuav tawm atrophy ntawm cortex thiab subcortex ntawm lub hlwb, txo qhov ntom ntom ntawm cov teeb meem dawb thiab nws cov porosity.
Txoj Cai Kev Kho Mob
Kev kho tus me nyuam uas muaj mob cerebral palsy hemiplegia yuav luag tag nrho nyob ntawm qhov ua rau tus kab mob. Niaj hnub no, nws raug pom zoo los ua kev kho mob thaum ntxov, txawm tias lub sijhawm mob hnyav, hauv tsev kho mob. Txhua txoj hauv kev pom zoo txuas ntxiv tom tsev.
Hemiplegia tsuas yog ib qho mob xwb, nws yog ib qho tseem ceeb kom tshem tawm qhov ua rau ntawm pathology, yog li ntawd, ua ntej ntawm tag nrho cov, cov tshuaj tau sau tseg los txhim kho lub paj hlwb.trophism nyob rau hauv cov ntaub so ntswg thiab conduction ntawm impulses los ntawm neurons. Cov no yog Baclofen, Mydocalm, Dysport thiab lwm yam.
Nws dhau los ua qhov tseem ceeb los kho cov hlab ntsha hauv txoj hauv kev, so cov leeg nqaij thiab txo qis spasticity. Cov no suav nrog:
- neuroprotectors, neurotrophics, vasoactive agents;
- tshuaj tua kab mob;
- kev kho kom muaj zog: B vitamins, antioxidants, cholinesterase inhibitors;
- muscle relaxants.
Nrog rau cov kab mob no, cov leeg nqaij so tau siv sijhawm ntev. Lawv tsis ua rau cov hlwb puas, tab sis nyiam kev kho dua tshiab. Rau kev cuam tshuam ncaj qha rau cov kab mob caj dab, zaws, qoj ib ce kho mob, thiab kinesitherapy yog siv.
Sim kom ua tiav txoj haujlwm physiological ntawm cov ceg tawv, tig hauv txaj, ua kom tsis muaj zog hauv cov pob qij txha txhawm rau txhim kho cov qog ntshav tawm thiab cov ntshav ncig.
Txhua yam no yog tsim los tiv thaiv cov leeg nqaij atrophy thiab contractures, bedsores. Tsis tu ncua xws li cov neeg mob siv cov neeg sawv cev - lawv pab tus menyuam sawv. Ntxiv rau lawv, lawv siv cov neeg taug kev, cov neeg sawv cev, lub cev qoj ib ce, lub tsheb kauj vab.
zoo heev thiab siv dav siv lub cev:
- barotherapy;
- magnetotherapy;
- electromuscle stimulation;
- laser kho.
Txoj kev tsis yog ib txwm muaj kev cuam tshuam:
- reflexology;
- kev kho mob;
- phytotherapy;
- kev kho dej.
Cov me nyuam mob xav tau kev hloov pauv, tshwj xeeb tshaj yog tias lawv yog sab xis nrog kev puas tsuaj rau sab xis.
Tus menyuam yuav tsum kawm siv txhua hnubcov khoom. Chav tsev uas nws nyob, koj yuav tsum hloov kho kom ntau li ntau tau rau nws. Prosthetic thiab orthopedic pab kuj xav tau.
Ntawm no ntau yog nyob ntawm niam txiv thiab kev pab ntawm kws kho mob hlwb. Nco ntsoov mus kawm nrog tus kws kho mob hais lus. Qhov hnyav ntawm etiology ib txwm txiav txim siab txog qhov kev tshwm sim ntxiv. Qhov txiaj ntsig zoo ntawm kev kho mob yog kev hloov pauv ntawm hemiplegia mus rau hemiparesis.
Tsis muaj kev tiv thaiv tshwj xeeb. Tsuas yog cov lus qhia dav dav tuaj yeem muab tau. Tus poj niam cev xeeb tub yuav tsum:
- mus ntsib kws kho mob;
- txiav luam yeeb thiab cawv;
- eat rationally;
- kev tawm dag zog tsis tu ncua nrog tus menyuam muaj mob;
- tiv thaiv koj tus kheej ntawm lub hlwb thiab txha caj qaum;
- kho neuroinfections hauv lub sijhawm;
- mus ntsib thiab ua haujlwm nrog koj tus kws kho mob hlwb tsis tu ncua.
Qhov txiaj ntsig zoo ntawm hemiplegia yog kev hloov ntawm tus menyuam mus rau lub xeev ntawm hemiparesis. Kev rov ua kom tiav tsis tshua muaj. Qhov kev tshwm sim phem tshaj plaws yog rau cov neeg uas raug kev txom nyem los ntawm ob lub hemiplegia. Cov neeg mob zoo li no feem ntau tau txais thawj pab pawg neeg tsis taus, vim lawv tsis muaj peev xwm ua haujlwm rau lawv tus kheej thiab txav mus los.
