From Big Medical Encyclopedia

PARALYSES, PARESIS (Greek. paralysis; synonym plegiya; grech, paresis easing, relaxation) — loss (paralysis) or weakening (paresis) of motive functions with absence or decrease in force of muscles as a result of various pathological processes in a nervous system causing disturbance of structure and function of a motor analyzer.

Types of paralyzes and paresis

Distinguish organic, functional and reflex paralyzes and paresis. Organic paralysis or paresis can develop as a result of organic structural changes of the central or peripheral motor neuron (the head or spinal cord or a peripheral nerve) arising under the influence of various patol, processes (an injury, a tumor, disturbances of cerebral circulation, inflammatory and other processes). Treat organic paralyzes or paresis, e.g., traumatic (including puerperal, obstetric, etc.), eclamptic (see. Eclampsia ), bulbar paralysis (see), recurrent paralysis (see). Emergence funkts, paralysis or paresis is connected with influence of psychogenic factors, to-rye lead to neurodynamic disturbances of c. N of page also meet hl. obr. at hysteria (see). The reflex paralysis or paresis is caused neyrodi-namichesky funkts, the frustration of a nervous system arising under the influence of, as a rule, extensive center of the defeat which topically is not connected with the developed paralysis or paresis.

On prevalence of defeat allocate a monoplegia (monoparesis) — paralysis (paresis) of muscles of one extremity and a diplegia (diparesis) — paralysis (paresis) of muscles of two extremities. Among diplegias distinguish top and bottom paraplegia (see) when muscles of both hands or legs are paralyzed; the partial paralysis of muscles of both hands or legs called by an upper or lower paraparesis. Paralysis or paresis of muscles of one half of a body are called respectively hemiplegia (see) or hemiparesis. A triplegia (triparez) — paralysis (paresis) of muscles of three extremities. A tetraplegia (tetraparesis) — paralysis (paresis) of muscles of both hands and both legs.

On character of a tone of the affected muscles distinguish sluggish, spastic and rigid paralyzes and paresis.

Depending on the level of defeat of a motor analyzer paralyzes and paresis are subdivided on central, peripheral and Extrapyramidal. Besides, allocate traumatic and eclamptic paralyzes and paresis, to-rye can be both the central, and peripheral origin,

the Central paralysis or paresis on character of a tone of the affected muscles, as a rule, happens spastic and develops as a result of organic lesion of the central motor neuron in any site of a cortical and spinal (pyramidal) way (in bark of big cerebral hemispheres, the internal capsule, a brain trunk, a spinal cord). The central paralysis is called also pyramidal paralysis. Disturbances of blood circulation, an injury, a tumor, the Demyelinating and other processes of a head or spinal cord breaking structure of a pyramidal way can be the reasons of the central paralysis or paresis. The central paralyzes are sometimes observed at children owing to various damages of a brain — vnutriutrobno, in labor, and also in the period of a neonatality (see. Children's paralyzes ). The most characteristic symptoms of the central paralysis or paresis are the muscular hypertension, a hyperreflexia, existence patol, and protective reflexes, patol, consensual movements, decrease or lack of cutaneous reflexes.

The tone of muscles at the central paralysis and paresis is raised on spastic type. Resistance of muscles more is defined in a start of motion, then sharply decreases (a symptom of «penknife»). At sharply expressed hypertension of muscles muscular and joint contractures develop. At a hemiplegia (hemiparesis) the tone of muscles raises in adductors of a shoulder, sgibatel and pronators of a forearm, sgibatel of a brush and fingers, razgibatel of a hip and shin, adductors of a hip and bottom sgibatel of foot. Thereof at patients the characteristic pose of Vernike — Mann is observed: the hand is given to a trunk, the pronirovana also is bent in elbow and hand joints, fingers of hands are bent, the leg is unbent in coxofemoral and knee joints, foot is bent in the bottom direction. As a result of a lengthening contracture of a leg gait of patients gains the nature of gait of the mower (the affected leg describes a semicircle at each step). At the lower paraparesis patients go preferential on tiptoe, crossing legs. At acute diseases of a head or spinal cord (disturbances of cerebral circulation, injuries, inf. diseases), followed by the central paralysis, the tone of muscles can be lowered owing to switching off of influence of a reticular formation (diaskhizalny paralysis).

Increase in tendon and periosteal jerks is followed by expansion of reflexogenic zones, emergence of clonuses of patellas, feet, brushes (see. Clonus ). On the paralyzed hand reflexes are caused patol: an analog of a reflex of Rossolimo (see. Rossolimo reflex ), a hand reflex of Bekhterev (see. Bekhtereva reflexes, symptoms ) and a symptom of the Bough (involuntary cultivation of fingers of the paralyzed hand at its passive raising up); on the paralyzed leg — patol, Babinski's reflexes (see. Babinsky reflex ), Gordon (see. Gordon reflexes ), Oppengeym, Schäffer, Zhukovsky and others (see. Reflexes pathological ); arise also protective reflexes (see) and synkineses (see).

Level of defeat of the central motor-neuron is established on the basis of localization of paralysis or paresis and its combination to other nevrol, symptoms. So, at defeat of the precentral crinkle of a cerebral cortex the hemiplegia of opposite extremities with an atony of muscles in an initial stage, the subsequent slow recovery and increase in a tone of muscles moderated by revival tendinous and decrease in belly reflexes, existence extensive patol, reflexes develops. At defeat of premotorny area on the party opposite patol, to the center, there is a spastic hemiplegia with the expressed hypertension of muscles, sharp increase in tendon jerks, clonuses, koordinatorny synkineses, patol, reflexes of flexion type and safety of belly reflexes. At distribution of the center on area of a postcentral crinkle of a cerebral cortex disorders of sensitivity join, recovery of the broken motive functions is slowed down, the muscle hyper tone decreases, imitating synkineses develop.

At damage of an upper part of the precentral crinkle there is a monoplegia of a leg, at defeat of its average department — a monoplegia of a hand (on the party opposite to the center of defeat). The hemiplegia which is observed at defeat of a pyramidal way to areas of the internal capsule is combined usually with a hemianaesthesia, the central paresis of facial and hypoglossal nerves. At localization of the center of defeat in a brainstem the central paralysis of extremities opposite to the center is combined with dysfunction of cranial nerves on the party of defeat and with conduction disorder of sensitivity in the paralyzed extremities (see. Alternating syndromes , Look paralysis, spasm ).

In the presence of the center of defeat in the bridge of a brain or in a myelencephalon the alternating syndrome can be combined with disorder of breath, disturbance of action of the heart and a tone of vessels, vomiting (see. Bulbar paralysis , Pseudobulbar paralysis ). Defeat of a pyramidal way in a spinal cord is followed by the central paralysis or paresis developing lower than the level of defeat on the party patol, the center. Defeat of a half of diameter of a spinal cord is shown by a syndrome of Bro-un-Sekara (see. Broun-Sekara syndrome ).

The flaccid paralysis or paresis on the nature of change of a tone of the affected muscles is sluggish and is observed at damage of a peripheral motor neuron (cells of front horns of a spinal cord or kernels of cranial nerves, ventral roots of spinal nerves, textures, spinal or cranial nerves). Processes can be the reasons of a flaccid paralysis or paresis infectious, infectious and allergic, degenerative patol (see. Myelitis , Neuritis , Polyneuritis , Poliomyelitis ), and also traumatic injuries of a spinal cord, textures and peripheral nerves. The main symptoms of a flaccid paralysis or paresis are an atrophy of muscles (see. Atrophy muscular ), their hypotonia (see. Tone, pathology of a muscle tone ), areflexia (see). Changes of electroexcitability of muscles (so-called reaction of degeneration) are characteristic of a flaccid paralysis and paresis. Depending on localization of defeat throughout neuron the flaccid paralysis has also other features. So, at defeat of cells of a front horn of a spinal cord fibrillar twitchings are observed; defeat of ventral roots of spinal nerves causes motive frustration on radicular type; the motive frustration arising at damage of a peripheral nerve are combined with disorders of sensitivity in a zone of an innervation of the affected nerve, and also vasculomotor and trophic frustration, especially in connection with damage of the nerves containing a large amount of vegetative fibers (e.g., median, sciatic nerves).

Extrapyramidal paralysis or paresis on the nature of change of a tone of the affected muscles is rigid and is observed at defeat pallidosh trawl system of a brain. It is caused by change of influence of this system on reticular formation (see) and disturbance cortical podkorkovo - trunk neural bonds. Extrapyramidal paralysis and paresis unlike central (pyramidal) is characterized by hl. obr. absence or decrease in a physical activity or see tsiativa (see. Hypokinesia , Movements ), decrease in rate of movements (see. Bradykinesia ), loss of consensual and automatic movements. Thereof poverty of movements (oligokinesia), a zakhmedlennost of the speech, gait with small steps with lack of the accompanying movements by hands is noted (acheirokynesis). The muscle tone at extrapyramidal paralysis and paresis is raised on plastic type and carries not springing (as at pyramidal paralysis), and wax character (resistance of muscles determined at a research of their tone remains evenly raised in all phases of the movement owing to its simultaneous increase in sgibatel and razgibatel, pronators and instep supports). Quite often the phenomenon of «cogwheel» (tolchkoobrazny rhythmic resistance to passive bendings and extensions of extremities) can be noted, and hardening of an extremity in the given situation is observed (see. Katalepsy ). Contrary to pyramidal at extrapyramidal paralysis or paresis are absent patol, reflexes and sharp increase in tendon and periosteal jerks is not noted. At the same time there is an increase postural reflexes (see).

External looking alike a flaccid paralysis, and also with a hemiplegia, a paraplegia or a monoplegia of an organic origin can have hysterical paralysis. But unlike them at hysterical paralysis lack of movements and decrease in force in extremities are not followed by changes of a tone of muscles and reflexes, trophic disturbances, changes elektrofiziol., morfol, and biochemical, indicators.

Traumatic paralyzes or paresis develop as a result of an injury of the central or peripheral nervous system and can have respectively the central or peripheral character. The most frequent reason of the central traumatic paralysis or paresis are the bruise or a prelum of a head and spinal cord. Owing to diaschisis (see) - a special type of the shock developing in nerve centers in the acute period of an injury — this paralysis can have character of diaskhizalny paralysis.

Flaccid traumatic paralysis is observed at injuries of a spinal cord, roots of spinal nerves, textures, peripheral nerves. In the cases connected with a birth trauma it carries the name of obstetric paralysis. There is obstetric paralysis as a result of an injury, most often a brachial plexus and roots forming it, at a fruit when during the rendering a manual grant in labor traction by a hand is made. Obstetric paralysis of a hand can be one - or bilateral; at the same time distinguish upper paralysis of Dyushenn — Erba (see. Dyushenna — Erba paralysis ), the lower paralysis of De-zherin-Klyumpke (see. Dezherin-Klyumpka paralysis ) and total paralysis. Obstetric paralysis of a hand quite often is followed by Bernard-Horner's syndrome (see. Bernard — Horner a syndrome ).

Flaccid traumatic paralysis or paresis can be observed at women in a puerperal period (puerperal paralysis or paresis). It comes, as a rule, after the long complicated childbirth owing to a prelum of a lumbosacral texture or its separate branches. In most cases puerperal paralysis or paresis happens unilateral, is more rare bilateral, but at the same time defeats are asymmetrical. It is shown by weakness in legs, disorder of gait, disturbance of sensitivity in a zone of an innervation of the struck branches of a texture and it is characterized by a tendency to bystry recovery of the broken functions.

Eklamitichesky paralyzes or paresis can be central or peripheral and develop in late durations of gestation or during childbirth. The central eclamptic paralyzes are caused by an acute disorder of blood circulation of a brain, is more often as a hemorrhagic stroke, less often paralyzes are a consequence of thrombosis of vessels of a brain and sine of a firm meninx. At the same time paralyzes in most cases have character of gemiplegiya. Flaccid paralyzes at an eclampsia are a consequence of impact of products of the broken metabolism on a peripheral nervous system. More often these paralyzes are observed in late durations of gestation, proceed as polyneurites and are characterized by preferential damage of distal muscles of extremities, are followed by disturbances of sensitivity and trophic frustration in a zone of an innervation of peripheral nerves.

The diagnosis

Definition of nature of paralysis or paresis and identification of their reason is closely connected with establishment of the diagnosis of the basic disease which caused development of paralysis or paresis. In diagnosis various methods clinical, laboratory, radiological, elektrofizio logical and other types of special researches are used.

Treatment of paralyzes and paresis

Treatment of paralyzes and paresis is a part of complex treatment of a basic disease. It includes use of the pharmaceuticals improving metabolism in nervous tissue, increasing the speed of carrying out nervous impulse, raising synaptic conduction, normalizing a muscle tone. The fiziobalneoterapiya, LFK, massage, orthopedic treatment are widely used.

Fiziobalneoterapiya promotes recovery of motive function of the affected muscles, has antiinflammatory and soothing effect, stimulates processes of regeneration, interferes with development of an atrophy of the affected muscles, formation of contractures, contributes to normalization of a muscle tone.

At flaccid paralyzes and paresis in the first days of treatment on the affected extremity apply UVCh-therapy (see) and microwave therapy (see), impulse currents (see), ultrasound (see), electrophoresis (see) the pharmaceuticals having soothing effect — calcium, novocaine, etc. (see. Electrophoresis ), UF-radiation in erythema doses (see. Ultraviolet radiation ). Further for improvement of conductivity and excitability of the struck neuromuscular device apply an electrophoresis of antikholinesterazny substances (a prozerin, Galantaminum), variation magnetic field of high frequency, parafino-, an ozokerito-lecheniye in combination with electrostimulation of the affected muscles and the corresponding segments of a spinal cord. Electrostimulation (see), causing reduction of muscles, improves their blood supply and a trophicity, prevents an atrophy of muscles, strengthens an afferent impulsation that promotes recovery of the broken motive function of muscles. For electrostimulation use various impulse currents, parameters to-rykh are selected depending on weight of defeat and a condition of excitability of the neuromuscular device.

In the late recovery and residual periods apply mud cure (see) and the mineral bathtubs (sulphidic, radonic, chloride sodium, nitrogen-siliceous thermal, etc.) exerting the stimulating impact on processes of regeneration.

At the central paralyzes and paresis the fiziobalneoterapiya is entered into complex treatment in the early recovery period: at injuries of a head and spinal cord — on 2 — 3rd week, inflammatory defeats of c. N of page — on the 3rd week, disturbances of cerebral circulation — on 3 — 5th week. It is directed to improvement of blood circulation in a zone of defeat, stimulation of activity of nervous elements. For this purpose apply an electrophoresis of pharmaceuticals (an Euphyllinum, Nospanum, novocaine, magnesium, iodine, calcium) on collar and sinocarotid zones by a technique of the general influence or by an orbital and occipital technique. The technique is chosen depending on the nature of the postponed strokes or an injury, by conditions of cardiovascular system and age of patients. At inflammatory defeats of c. N of page appoint also UVCh-and microwave therapy.

The physical therapy is applied to recovery of the broken motive function, reduction of spasticity, elimination of a pain syndrome and contractures obstructing the traffic. Apply electrostimulation by impulses of the low and increased frequencies generated one - and multichannel devices. Antagonists of spastichny muscles are stimulated preferential. At the same time careful selection of motor points, parameters and force of influence is important during the procedure in order to avoid strengthening of spasticity. At easy spasticity carrying out 1 — 2 courses is recommended, at the moderated and expressed spasticity — 2 — 3 courses of electrostimulation with intervals of 3 — 6 weeks. At slight increase of a tone electrostimulation can be combined with an electrophoresis of a prozerin or Dibazolum by a technique of local impact on muscles. At early increase in a muscle tone, and also in the late recovery and residual periods electrostimulation) carry out with simultaneous use of muscular relaxants. For decrease in a muscle tone before electrostimulation carry out treatment by heat (mud, parafino-, ozokeritovy applications) or cold in combination with treatment by position of the paralyzed extremity. Cryotherapy (see) it is especially shown at sharply expressed spasticity with contractures at patients aged 60 — 65 years are not more senior.

Locally apply the harmonic modulated or diadynamic currents, an electrophoresis using novocaine to removal of pains. At joint and muscular contractures appoint thermal procedures (paraffin, ozokeritovy, mud applications, local warm trays), an electrophoresis of medicinal substances, ultrasound, impulse currents.

Dignity. - hens. treatment of patients with paralyzes and paresis is carried out in local nevrol, sanatoria, in mud and balneological resorts with sulfide, radon, chloride sodium, azotnokremnisty thermal waters (Yevpatoria, Kemeri, Odessa, Pyatigorsk, Sochi-Matsesta, Tsqaltubo, etc.) or in specialized sanatoria for patients with damages of a spinal cord. At flaccid paralyzes and paresis a dignity. - hens. treatment is shown in 2 — 6 months after the end of the acute period; at the central paralyzes and paresis — in 4 — 6 months (see. Sanatorium selection ).

Physiotherapy exercises and massage at the central and flaccid paralyzes and paresis improve blood circulation and a trophicity of muscles in the affected extremities, prevent development of contractures, recover the movement, develop compensatory movement skills, exert recreational impact on an organism of the patient. LFK and massage are shown in early terms of a disease. From the first days begin to apply special laying of the paralyzed extremities. At a hemiplegia and a hemiparesis, arise-shchikh as a result of an ischemic stroke, begin treatment with situation with 2 — the 4th day of a disease; at a hematencephalon — on 6 — the 8th day (if the condition of the patient allows to carry out this treatment). Laying on spin is carried out in the pose opposite to Vernike's pose — Mann: a shoulder take aside at an angle 90 °, the elbow and fingers are unbent, the brush is supinated and is kept from the palmar party by a splint; all extremity is fixed in the given situation by means of sacks with sand. The paralyzed leg is bent in a knee joint at an angle 15 — 20 °, under a knee enclose the roller from cotton wool and a gauze. Foot is given the provision of a dorsiflexion at an angle 90 ° and hold it in this situation a wooden support. Laying on spin is periodically alternated to laying on a healthy side; at the same time the paralyzed extremities bend in elbow, coxofemoral, knee and talocrural joints and stack on pillows. Position of the patient on spin and a healthy side is changed by each 1V2 — 2 hours. Along with treatment by situation appoint massage. From receptions massage (see) recommend stroking, grinding, easy puddling and not discontinuous vibration. Massage at the central paralysis shall be selective: muscles with the raised tone mass, applying stroking at slow speed, and their antagonists — by stroking, grinding and easy superficial puddling at more bystry speed. At a flaccid paralysis make stroking of all extremity in the beginning, then mass the paralyzed muscles, and their antagonists only stroke. Massage is begun with proximal departments of extremities and out daily within 10 — 15 days, and its duration gradually increases from 10 to 20 min.; a course of treatment — 30 — 40 sessions (if necessary it can be repeated in 2 weeks). Also pointed and reflex and segmented massage is shown. Along with massage apply the passive movements. They will be out separately for each joint (on 5 — 10 movements in full and slow speed), since proximal departments of extremities both on healthy, and on the struck party. The passive movements are carried out by the methodologist or the patient by means of a healthy extremity.

For recovery of motive function the active gymnastics has major importance. At the central paralyzes and paresis start it on 7 — the 10th day from the beginning of a disease at an ischemic stroke, at a hematencephalon — on 15 — the 20th day. It is reasonable to begin it with exercises in deduction of an extremity in the situation given it. After the patient learns to carry out these exercises and to hold an extremity, carry out active gymnastics at first for those muscles, the tone to-rykh is not raised. Development of active movements is carried out by means of the facilitated exercises with use of special devices: frames with system of blocks and gamachok, a slippery surface, a tension spring, gymnastic apparatus. Then appoint active free exercises for the healthy and affected extremities, including using special devices for fastening and unfastening of buttons, setting and unleashing of tapes, etc.

Training of patients begin to sit at an ischemic stroke in 10 days from the beginning of a disease, and at hemorrhage in a brain — in 3 — 4 weeks. Training of the patient for walking begin it in situation lying, and then sitting, and fulfill the exercises imitating walking. When the condition of patients allows to get up, they begin to be trained in standing at both legs, alternately at a healthy and sore leg, walking on site, with the instructor, then in a special carriage, by means of a three-basic crutch, on a trace path, a ladder. During all course LFK at the central paralysis carry out also a set of exercises, directed to elimination patol, synkineses. It is reasonable to carry out gymnastic exercises at a flaccid paralysis in a bathtub or the pool with warm water. Duration of course LFK in each separate case is individual and can vary of 3 — 4 weeks up to 2 — 3 months and more, and sometimes and several years that depends on character patol, the process which caused developing of paralysis or paresis.

Orthopedic treatment can be conservative and operational. Conservative treatment as independent is shown usually in the absence of data on a break or a prelum of a nervous trunk and is carried out using prosthetic orthoses, footwear, plaster, plastic and other removable tires, special beds and other means. Its purpose — partial compensation of the lost motive function. Operational treatment of paralyzes is carried out by hl. obr. at an anatomic break of a nerve (partial or full), a prelum or crush of a nervous trunk and at inefficiency of conservative treatment. Operative measures are made directly on nerves with imposing primary or secondary nervous seam (see), carrying out neurolysis (see); on sinews and muscles — change, plastics of muscles, transossalny tenodesis (see); on joints — operations on fixing of a joint in the constant fixed situation (see. Artificial ankylosis ) and an artificial bone brake by training for the purpose of restriction of mobility in a joint (see. Arthrorisis ).

At the permanent expressed losses of functions of nerves in terms of St. 2 years after an injury and impossibility or inefficiency of an operative measure on nerves orthopedic operations are shown. So, e.g., for the purpose of substitution of function of the paralyzed deltoid muscle at children 6 years are more senior make operation of a miolavsanoplastika of a trapezoid muscle. Operation consists in cutting off of a trapezoid muscle from a clavicle and a scapular awn together with a periosteum, podshivaniya to it a mylar prosthesis, to-rogo fix other end in an upper third of a humeral bone. The pro-national ionic contracture of an extremity is eliminated by means of detorsionny osteotomies of a shoulder and bones of a forearm. At a flaccid paralysis of an extremity sometimes carry out a tenodesis of a radiocarpal joint.

At high defeat of a sciatic nerve function of the muscles innervated tibial and the general fibular by nerves drops out. At the same time the copular device of foot is weakened, there comes sharply expressed atrophy of bones and excessive mobility in talocrural and small joints of foot. Apply an artificial ankylosis, an arthrorisis, a tenodesis of joints of foot to recovery of an oporosposobnost of an extremity. E.g., at the expressed valgus or varus installation of foot apply the artificial ankylosis of an ankle joint which in nek-ry cases is combined with a subcollision artificial ankylosis.

The bridge-like artificial ankylosis on Vredena consists in single-step short circuit of an ankle joint and cross joint of a tarsus (shoparov of a joint) with preservation of mobility in a tarsus-plusnevykh joints (a lisfrankovy joint) by means of the sliding bone transplant from a crest of a tibial bone. The artificial ankylosis of Opel — Dzhanelidze — Lortiuara consists in short circuit of talocrural, subcollision and collision and calcaneonavicular joints. For restriction of excess mobility at the dangling horse foot the back arthrorisis according to Campbell is recommended; at calcaneal foot — a front arthrorisis on Meath-breytu.

Damage of a superficial fibular nerve leads to loss of function of group of fibular muscles. In these cases tendon grafting of a front tibial muscle on the outer edge of foot is shown. Damage of a deep fibular nerve leads to loss of function of the muscles unbending and supinating foot. For their compensation tendon grafting of a long fibular muscle on an inner edge of foot is shown. Damage of the general fibular nerve involves loss of function of the muscles unbending, supinating and proniruyushchy to stop. At the same time most often resort to a tenodesis by means of sinews of the same paralyzed muscles, to-rye fix in the lower third of a tibial bone. Operation of separate change of a gastrocnemius muscle on the back of foot consists in allocation of a sinew of a soleus muscle, its cutting off at the place of an attachment to a hillock of a calcaneus and fixing to the back of the second or third plusnevy bones. The sinew of this muscle is extended by means of a mylar tape.

At paralysis of a beam nerve tendon grafting of an elbow sgibatel of a wrist on an extensor tendon of fingers, and sinews of a beam sgibatel of a wrist — separately on an extensor tendon and an abductor of a thumb of a brush can be executed. This operation in 1898 for the first time was carried out by F. Frank. One of its modifications is operation Osten-Sakena — Dzhanelidze: cross tendon grafting of an elbow sgibatel of a wrist on long a razgibatel of a thumb of a brush and the long muscle which is taking away a thumb of a brush, and a sinew of a beam sgibatel of a brush — on a razgibatel of fingers.

In the postoperative period the immobilization of an extremity by means of tires, splints, functional is made orthoses (see), and in some cases — distraktsionno-compression devices (see). Feature of an immobilization is fixing of an extremity in the situation providing the minimum tension of the operated nerves, muscles or sinews. Its duration is defined by terms of an union of these educations or terms of formation of an anchylosis or bone callosity (at bone operations).

The forecast

the Forecast depends on character patol. process, depth and prevalence of defeat of a motor analyzer and compensatory opportunities of an organism. At the central paralyzes and paresis which developed owing to disturbance of blood circulation, the volume of movements increases in process of recovery of a blood-groove. At the central paralyzes and paresis caused by the cortical center of defeat, the movements are recovered quicker and more stoutly in comparison with the paralyzes caused by defeat of the internal capsule. At the flaccid paralyzes and paresis which developed owing to an injury of a brachial plexus in labor, the movements in the affected extremities are recovered within 1 — 2 years.

At the flaccid paralyzes and paresis caused by defeat of peripheral nerves at inefficiency of conservative treatment resort to reconstructive operation. After nerve operations recovery of their conductivity happens not earlier than in 5 — 6 months.

Orthopedic joint, muscles and sinews operations provide only partial recovery of function of the paralyzed extremity.

Bibliography: Badalyan L. O. Children's neurology, M., 1975; Bogolepov N. K. Disturbances of motive functions at vascular damages of a brain, M., 1953; B about about r au-dinsky D. K., With box of ohms of piece A. A. and Shvarev A. I. The guide to a practical training by nervous diseases, page 27, JI., 1977; R. R Is harmful. Practical guidance on orthopedics, JI., 1936; Kolesnikov G. F. Electrostimulation of the neuromuscular device, Kiev, 1977; Kreymer A. Ya. and about l d e of l m and M. G. Klinik's N and complex therapy of diseases of a nervous system, page 69, etc., Tomsk, 1978 - M. B. and Fedorov E. A. Crawl. Main neuropathological syndromes, M., 1966; Livshits A. V., In about l-kov G. M. and Gelfand V. B. Kliniko-elektrofiziologichesky researches of a spastic syndrome and its neurosurgical treatment at patients with damage of a spinal cord, Vopr, neyrokhir., century 5, page 36, 1976; The multivolume guide to surgery, under the editorship of B. V. Petrovsky, t. 10, page 79, M., 1964; Moshkov V. N. Medical physical culture in clinic of nervous diseases, M., 1972; Experience of the Soviet medicine in the Great Patriotic War of 1941 — 1945, t. 20, page 442, M., 1952; Stolyarova L. G. and Tkachyov G. R. Rehabilitation of patients with postinsultny motive frustration, M., 1978; A. V Triumphs. Topical diagnosis of diseases of a nervous system, L., 1974; Tsivyan Ya. L. About operational treatment of paresis and paralyzes at a scoliotic disease, Vopr, neyrokhir., No. 2, page 29, 1973; Chaklin V. D. Fundamentals of operational orthopedics and traumatology, page 595, M., 1964; The P e M. D. and Mikhaylov's r-face of T. A. Organization and some features of orthopedic treatment of children with cerebral spastic paralyzes, in book: Vopr, travmat, and the orthoitem, under the editorship of. Ya. N. Rodina, etc., page 38, Saratov, 1972; Schmidt E. B. Syndromes of defeat of a premotorny and motor zone at gunshot wounds of a skull, Vopr, neyrokhir., t. 6, No. 3, page 40, 1942; Sh t of e p e of N-g of e r A. E c. Physiotherapy exercises at paralytic diseases at children and teenagers, Kiev, 1972; Bailey H. Love R. J. Short practic of surgery, p. 284, 466, L., 1975; Colton of Page L., Ransford A. O. a. Lloyd-Ro-b e r t s G. C. Transposition of the tendon of pronator teres in cerebral palsy, J. Bone Jt Surg., y. 58-B, p. 220, 1976; Gilroy J. Meyer J. S. Medical neurology, p. 455, N. Y. a. o., 1975; Hamilton D. Some experience with paraplegia in a small hospital in Nepal, Paraplegia, v. 15, p. 293, 1978; Handbook of clinical neurology, ed. by P. J. Yinken a. G. W. Bruyn, v. 1 — 2, Amsterdam a. o., 1975; Rainer H. t)ber die Behandlung spastischer Lahmungen am Unterschen-kel mit Schwellstromimpulsen, Therapie-woche, Bd 25, S. 5576, 1975; V a n G i j n J. The Babinski sign and the pyramidal syndrome, J. Neurol. Neurosurg. Psychiat., v. 41, p. 865, 1978; Die zereb-ralen Durchblutungsstorungen des Erwach-senenalters, hrsg. v. J. Quandt, S. 308, 793, B., 1969.

L. O. Badalyan; M. I. Antropova (hens.), M. V. Volkov, P. Ya. Fishchenko (injuries.), G. S. Fedorova (LFK).