App of nervous sys 2015

IFNMU
Chair of Children’s Surgery and Propаedeutics of
Pediatrics
Theme of the lecture:
AnatomoAnatomo--
PhysiologicalPhysiological
Peculiarities ofPeculiarities of
Children’s NervousChildren’s Nervous
System. Semiotics ofSystem. Semiotics of
the of the Nervousthe of the Nervous
System’s MainSystem’s Main
Diseases in Children.Diseases in Children.

Plan of the lecturePlan of the lecture
Anatomical peculiarities of the structure ofAnatomical peculiarities of the structure of
the brain.the brain.
Peculiarities of the structure of the spinalPeculiarities of the structure of the spinal
cord.cord.
Peculiarities of the functioning of thePeculiarities of the functioning of the
nervous system in children.nervous system in children.
Methods of investigation of the nervousMethods of investigation of the nervous
system.system.
Semiotics of nervous systemSemiotics of nervous system
disturbances.disturbances.

Significance of the function of central nervousSignificance of the function of central nervous
system (CNS) in a childsystem (CNS) in a child
The most important period in the formation of nervousThe most important period in the formation of nervous
system and intellect of a person is - childhood.system and intellect of a person is - childhood.
Development of nervous system is the result ofDevelopment of nervous system is the result of
interrelations of genetic factors and externalinterrelations of genetic factors and external
influences:influences:
- number and development of neurons;- number and development of neurons;
- number and development of axons and their synapses.- number and development of axons and their synapses.
The number of neurons and their morphological
peculiarities are genetically stipulated. The formation of
synaptic relations is mainly connected with external
factors - the character of caring and nutrition, bringing
up and stimuli.

Peculiarities of the development ofPeculiarities of the development of
nervous activity in childrennervous activity in children
Development of nervous system in the earlyDevelopment of nervous system in the early
childhood is decisive for the whole followingchildhood is decisive for the whole following
life, for the ability of creative activity, for thelife, for the ability of creative activity, for the
ability to study and regulate emotions.ability to study and regulate emotions.
The nervous system has a wonderful ability forThe nervous system has a wonderful ability for
the development and renovation of itsthe development and renovation of its
functions, but this potential is critically limited infunctions, but this potential is critically limited in
time.time.Only in the first 3 years of life such abilities are
considerable, and after 10 years they become fully
exhausted.

Peculiarities of the development ofPeculiarities of the development of
central nervous system (CNS) in childrencentral nervous system (CNS) in children
Critical period for the unfavourable influences are the first 18Critical period for the unfavourable influences are the first 18
months. In this time negative influence, or absence of positivemonths. In this time negative influence, or absence of positive
stimuli produce the future disturbances and diseases.stimuli produce the future disturbances and diseases.
The most dangerous for the development of the child’sThe most dangerous for the development of the child’s
intellect are combined reasons: absence of the proper caringintellect are combined reasons: absence of the proper caring
and nutrition, unfavourable hygienic and ecological conditions,and nutrition, unfavourable hygienic and ecological conditions,
presence of family stresses, lack of medicines, etc.presence of family stresses, lack of medicines, etc.
Effectiveness of influence on the development of healthyEffectiveness of influence on the development of healthy
nervous system and correction of its disturbances directlynervous system and correction of its disturbances directly
depend on the time of treatment or prophylactic intervention.depend on the time of treatment or prophylactic intervention.
The earlier the measures are taken the fuller and better is theThe earlier the measures are taken the fuller and better is the
result.result.

The most important functions ofThe most important functions of
the nervous system:the nervous system:
The main importance of the nervous system is supplyingThe main importance of the nervous system is supplying
the best adaptation of the organism to the influence ofthe best adaptation of the organism to the influence of
the environment and making its reactions as one wholethe environment and making its reactions as one whole
thing;thing;
Normal interaction of the organism with theNormal interaction of the organism with the
environmental conditions;environmental conditions;
Making the behavior according to the conditions of life;Making the behavior according to the conditions of life;
Combining and regulation of all functions of theCombining and regulation of all functions of the
organism, its organs, tissues, cells and intracellularorganism, its organs, tissues, cells and intracellular
structures;structures;
Starting action of functioning (contractions of theStarting action of functioning (contractions of the
muscles).muscles).

MorphologicalMorphological
peculiarities of the brainpeculiarities of the brain
The brain - the organ, playing important role in life activity of aThe brain - the organ, playing important role in life activity of a
person, it is the organ of adaptation to the conditions of theperson, it is the organ of adaptation to the conditions of the
environment.environment.
The mass of the brain is 10% of the body mass of a newbornThe mass of the brain is 10% of the body mass of a newborn
child (about 350-400g), in children at the age of 16-17 years -child (about 350-400g), in children at the age of 16-17 years -
2,5% of body mass (about 1300-1400g). To 2 years the2,5% of body mass (about 1300-1400g). To 2 years the
child’s brain mass is equal to that of an adult person. Differentchild’s brain mass is equal to that of an adult person. Different
areas of the brain develop unevenly (frontal and parietal partsareas of the brain develop unevenly (frontal and parietal parts
developdevelop more quickly than temporal and occipital parts).more quickly than temporal and occipital parts).
In newborns and preschool children the brain is shorter andIn newborns and preschool children the brain is shorter and
wider. Up to 4 years the growth of the brain in length, widthwider. Up to 4 years the growth of the brain in length, width
and height is almost even, and from 4 to 7 the most intensiveand height is almost even, and from 4 to 7 the most intensive
is the growth of its height.is the growth of its height.

Concerning the chemical composition of the brain tissue theConcerning the chemical composition of the brain tissue the
early age is characterized by gelatin like consistency, a largeearly age is characterized by gelatin like consistency, a large
amount of water, less contents of lipids and fats. With age theamount of water, less contents of lipids and fats. With age the
water amount decreases, accumulation of lipids, proteins,water amount decreases, accumulation of lipids, proteins,
especially cerebrosides takes place. The consistency becomesespecially cerebrosides takes place. The consistency becomes
solid.solid.
The cells of brain cortex in newborns keep the embryonicThe cells of brain cortex in newborns keep the embryonic
character of structure up to 5 months of life. There are aboutcharacter of structure up to 5 months of life. There are about
14-16 mld of them. They are characterized by the large14-16 mld of them. They are characterized by the large
nucleus, a large number of nucleic acids, absence of dendrites.nucleus, a large number of nucleic acids, absence of dendrites.
In pyramid cells and black substance there is no pigment. TheIn pyramid cells and black substance there is no pigment. The
cells of Purkine are absent. In older age children gradualcells of Purkine are absent. In older age children gradual
maturation of cells takes place, their number is the same as atmaturation of cells takes place, their number is the same as at
birth. In 3 months Purkine cells appear.birth. In 3 months Purkine cells appear.

The structure of neuron inThe structure of neuron in
older age children and adultsolder age children and adults
NucleusNucleus
AxonAxon
DendritesDendrites

Peculiarities of central nervous system (CNS)Peculiarities of central nervous system (CNS)
at an early ageat an early age
For the moment of birth of the child 25% ofFor the moment of birth of the child 25% of
the whole number of all types of cells of thethe whole number of all types of cells of the
nervous system are formed (neurons –nervous system are formed (neurons –
almost about 100%), to 6 months - 66%, toalmost about 100%), to 6 months - 66%, to
the end of the 1the end of the 1stst
year -90-95%;year -90-95%;
Neurons in newborns are less in sizes, theyNeurons in newborns are less in sizes, they
have less surface covered with synapseshave less surface covered with synapses
and lower potential of rest, axons are shorterand lower potential of rest, axons are shorter
and their diameter also is less;and their diameter also is less;

Peculiarities of central nervousPeculiarities of central nervous
system (CNS) at an early agesystem (CNS) at an early age
Energetic supply of neurons (ATF) isEnergetic supply of neurons (ATF) is
imperfect, during lasting activity soonimperfect, during lasting activity soon
exhaustion takes place;exhaustion takes place;
Amplitude of electrical potential of neuronsAmplitude of electrical potential of neurons
action is less, refraction phase is longer. Aaction is less, refraction phase is longer. A
nerve fiber of a newborn can take in 1 sec notnerve fiber of a newborn can take in 1 sec not
more than 4-10 impulses (in adults -300-more than 4-10 impulses (in adults -300-
1000);1000);

Peculiarities of central nervousPeculiarities of central nervous
system (CNS) at an early agesystem (CNS) at an early age
In newborns and children of an early age there is increasedIn newborns and children of an early age there is increased
amount of water in nervous cells and intercellular spaces.amount of water in nervous cells and intercellular spaces.
Relatively high contents of liquid - “physiologicalRelatively high contents of liquid - “physiological
hydrocephaly”, lateral ventricles are larger and widened,hydrocephaly”, lateral ventricles are larger and widened,
Silwey water tube is wider than in adults;Silwey water tube is wider than in adults;
- With age in cells the contents of nucleoproteids becomes- With age in cells the contents of nucleoproteids becomes
less and increase of the contents of proteins, nucleic acids,less and increase of the contents of proteins, nucleic acids,
lipoproteids takes place.lipoproteids takes place.
For the first year of life the total amount of lipids increases 3 times,
and the level of cerebrolysins - 10 times.

Peculiarities of the central nervousPeculiarities of the central nervous
system (CNS) in childrensystem (CNS) in children
The need of the cells of the brain in oxygen isThe need of the cells of the brain in oxygen is
20 times larger than that of muscular tissues,20 times larger than that of muscular tissues,
so there is increased sensitivity of brain cellsso there is increased sensitivity of brain cells
to oxygen starvation, action of toxicto oxygen starvation, action of toxic
substances, high intracranial pressure.substances, high intracranial pressure.
Chronic hypoxia, intoxications, hydrocephalyChronic hypoxia, intoxications, hydrocephaly
lead to accumulation of degenerativelead to accumulation of degenerative
processes in the nervous cells and in theprocesses in the nervous cells and in the
future - to their atrophy and death.future - to their atrophy and death.

Morphological differentiation ofMorphological differentiation of
nervous cellsnervous cells
- the growth of axons;
- their myelinization;
- branching of dendrites;
- formation of interneural synapses.
The process of differentiation of nerve
cells actually is completed up to 3 years.

Embryogenesis of the nervousEmbryogenesis of the nervous
systemsystem
The starting up of the nervous system takes placeThe starting up of the nervous system takes place
in the first week of intrauterine development fromin the first week of intrauterine development from
the external sheet of the ectoderm with a shape ofthe external sheet of the ectoderm with a shape of
modular plate, and further on - modular tube.modular plate, and further on - modular tube.
In the 4-5 week of intrauterine development beginsIn the 4-5 week of intrauterine development begins
organogenesis and differentiation of the nervousorganogenesis and differentiation of the nervous
system.system.
From the nerve tube at first 3 and then 5 brainFrom the nerve tube at first 3 and then 5 brain
vesicles are composed, from which during 2-3vesicles are composed, from which during 2-3
months all the sections of the brain are formed.months all the sections of the brain are formed.

Embryogenesis of theEmbryogenesis of the
nervous systemnervous system
For the protection and nutrition theFor the protection and nutrition the
brain rests in cerebrospinal fluidbrain rests in cerebrospinal fluid
(liquor), which begins to circulate from(liquor), which begins to circulate from
the 3the 3rdrd
month of intrauterine periodmonth of intrauterine period..

For the early age is characteristic high permeability ofFor the early age is characteristic high permeability of
hematoencephalic barrier, less marked cerebral sulcihematoencephalic barrier, less marked cerebral sulci
and gyri of the cortex, absence of many of them. To 7and gyri of the cortex, absence of many of them. To 7
years sulci become deep, longer, branching up; the gyriyears sulci become deep, longer, branching up; the gyri
- convex, wide, massive; increases the number of- convex, wide, massive; increases the number of
tertiary sulci.tertiary sulci.
In newborn children a grey substance of the brain cortexIn newborn children a grey substance of the brain cortex
is not separated from the white one, because theis not separated from the white one, because the
nervous cells are localized in the limits of whitenervous cells are localized in the limits of white
substance. But beginning with 3 years there is a strictsubstance. But beginning with 3 years there is a strict
differentiation of cortical cells. In 8 years the cortex isdifferentiation of cortical cells. In 8 years the cortex is
little difference of the cortex of an adult person, butlittle difference of the cortex of an adult person, but
morphological formation lasts up to 22-25 years.morphological formation lasts up to 22-25 years.
Morphological
peculiarities of the brain

Morphological peculiarities of the brainMorphological peculiarities of the brain
In the nerve fibers and cerebral cells of a newborn childIn the nerve fibers and cerebral cells of a newborn child
myelinization is absent and begins after the birth. The mostmyelinization is absent and begins after the birth. The most
intensive process of myelinizaton takes pace from the end ofintensive process of myelinizaton takes pace from the end of
the 1the 1stst
year - at the beginning of the 2nd year of life. Theyear - at the beginning of the 2nd year of life. The
process is finished by 3-5 years. The rate of going of nervousprocess is finished by 3-5 years. The rate of going of nervous
impulses along unmyelinated fibres is 0,6-2m/sec, whenimpulses along unmyelinated fibres is 0,6-2m/sec, when
along the myelinizated fibres it is - from 10-15 to 15-35m/sec.along the myelinizated fibres it is - from 10-15 to 15-35m/sec.
The major part of the cerebral cortex of a newborn isThe major part of the cerebral cortex of a newborn is
composed of 6 layers. The development of neurons in largecomposed of 6 layers. The development of neurons in large
hemispheres precedes the appearance of sulci and gyri. Inhemispheres precedes the appearance of sulci and gyri. In
the first months of life neurons are not only in grey but also inthe first months of life neurons are not only in grey but also in
the white substance and already by 3 years the structure ofthe white substance and already by 3 years the structure of
neurons is of little difference of neurons of an adult.neurons is of little difference of neurons of an adult.
The brain cortex supplies the high regulation of all lifeThe brain cortex supplies the high regulation of all life
supplying systems of the organism, and also complicatedsupplying systems of the organism, and also complicated
forms of speech and thinking activity.forms of speech and thinking activity.

Morphological peculiarities ofMorphological peculiarities of
the brainthe brain
Cerebellum of prolonged shape is located high.Cerebellum of prolonged shape is located high.
Differentiation of its cortex takes place in 9-11 months,Differentiation of its cortex takes place in 9-11 months,
due to this the child starts better orient in the space,due to this the child starts better orient in the space,
coordination of his movements becomes better. A fullcoordination of his movements becomes better. A full
formation of the cellular structures of cerebellum finishesformation of the cellular structures of cerebellum finishes
by 7-8 years.by 7-8 years.
Medulla oblongata is the most developed of all structuresMedulla oblongata is the most developed of all structures
of the brain. Due to this in a newborn are well expressedof the brain. Due to this in a newborn are well expressed
vegetative reactions, which secure functions ofvegetative reactions, which secure functions of
breathing, blood circulation, digestion, etc.breathing, blood circulation, digestion, etc.

Morphological peculiaritiesMorphological peculiarities
of the spinal cordof the spinal cord
The structure of the spinal cord is more completedThe structure of the spinal cord is more completed
and functionally mature in comparison with other sections ofand functionally mature in comparison with other sections of
the CNS. Cerebrospinal reflexes are formed earlier thanthe CNS. Cerebrospinal reflexes are formed earlier than
reflexes of the brain.reflexes of the brain.
The mass of spinal cord in a newborn comprises 2-6g, by 5The mass of spinal cord in a newborn comprises 2-6g, by 5
years it is doubled, by 20 years increases 8-9 times. Spinalyears it is doubled, by 20 years increases 8-9 times. Spinal
cord comprises 1% of the mass of the brain in newborns andcord comprises 1% of the mass of the brain in newborns and
2% in children of older age. The length of spinal cord is different2% in children of older age. The length of spinal cord is different
in children of different ages: in newborns it finishes on the levelin children of different ages: in newborns it finishes on the level
of II-III lumbar vertebra, in the older age - on the level of I-IIof II-III lumbar vertebra, in the older age - on the level of I-II
lumbar vertebra. The length of the spinal cord in children islumbar vertebra. The length of the spinal cord in children is
relatively larger than in adults. Cervical and lumbar thickeningrelatively larger than in adults. Cervical and lumbar thickening
of spinal cord is absent. They start to express from 3 years age.of spinal cord is absent. They start to express from 3 years age.
Myelinization of pyramidal way begins in the newborn periodMyelinization of pyramidal way begins in the newborn period
and is completed by 4 years of age.and is completed by 4 years of age.

1-Arachnoidal granulations, 2 - Chorioidal plexus,
3-A duct, connecting lateral ventricles, 4 - the third ventricle,
5-”Silvi-duct”, 6-the forth ventricle and Luschka foramen,
7- Foramen Magendi
Circulation of liquor in children

Indices of cerebrospinal fluid in children of different agesIndices of cerebrospinal fluid in children of different ages
Indices
Color and
transparency
Pressure, mm H2O
Amount of
Liquor, ml
Cytosis in
1 mcl
Type of cells
Protein, g/L
Pandi
reaction
Sugar,
mmol/L
Newborns
Xantochromic,
transparent
50-60
5
To 15-20
Lymphocytes,
Isolated
neutrophilеs
0,35-0,5
+ or ++
1,7-3,9
1-3 months
Colorless,
transparent
50-100
40
To 8-10
Lymphocytes
0,2-0,45
+
2,2-3,9
4-6 months
Colorless,
transparent
50-100
60
To 8-10
Lymphocytes
0,18-0,35
- or +
2,2-4,4
Over 6 months
Colorless,
transparent
80-150
100-200
To 3-5
Lymphocytes
0,16-0,25
-
2,2-4,4

Functional peculiarities of CNSFunctional peculiarities of CNS
in childrenin children
In children of an early age is characteristic functionalIn children of an early age is characteristic functional
weakness of the nervous system. Impulses, comingweakness of the nervous system. Impulses, coming
from receptors, cause lasting, sometimes unlimitedfrom receptors, cause lasting, sometimes unlimited
inhibition. The main vital functions of a newborn areinhibition. The main vital functions of a newborn are
regulated by diencephalon (thalamopalidary system’sregulated by diencephalon (thalamopalidary system’s
pericortical centers).pericortical centers).
As far as maturation of the cortex goes on movementsAs far as maturation of the cortex goes on movements
become more strict, purposeful; subcortical nodes staybecome more strict, purposeful; subcortical nodes stay
as regulators of the tone of muscular groups.as regulators of the tone of muscular groups.

Functional peculiarities of CNS inFunctional peculiarities of CNS in
childrenchildren
To the moment of birth the sense organs are structurallyTo the moment of birth the sense organs are structurally
formed, but functionally immature.formed, but functionally immature.
The organs of vision and hearing are laid up and develop inThe organs of vision and hearing are laid up and develop in
parallel with the development of CNS. In newborns is observedparallel with the development of CNS. In newborns is observed
physiological photophobia (the first 2 weeks), strabismus -physiological photophobia (the first 2 weeks), strabismus -
heterotropia (1heterotropia (1stst
-2-2ndnd
month), nystagmus; absence of widening ofmonth), nystagmus; absence of widening of
pupils under strong painful irritants (in the 1pupils under strong painful irritants (in the 1stst
year of life), lowyear of life), low
visual acuity (keenness of sight) –(0,02- in first half year; 0,1 -visual acuity (keenness of sight) –(0,02- in first half year; 0,1 -
up to 1 year; 1,0 - to 5 years).up to 1 year; 1,0 - to 5 years).
Taste organ functions already at the time of birth, to 4,5 monthsTaste organ functions already at the time of birth, to 4,5 months
it is differentiated completely. Strict odors are differentiated byit is differentiated completely. Strict odors are differentiated by
the baby in the first months of life. Touch organ, a feelingthe baby in the first months of life. Touch organ, a feeling
enough differentiated, because irritation of the skin causes in aenough differentiated, because irritation of the skin causes in a
child a general reaction, like uneasiness. On pain irritation achild a general reaction, like uneasiness. On pain irritation a
baby reacts with local and general reaction.baby reacts with local and general reaction.

Methods of nervous systemMethods of nervous system
examinationexamination
During examination of the nervous system are widelyDuring examination of the nervous system are widely
used special methods, which help to assess the stateused special methods, which help to assess the state
and function of separate structural formations of theand function of separate structural formations of the
nervous system, and also instrumental methods.nervous system, and also instrumental methods.
Examination of the position of the baby.Examination of the position of the baby.
Examination of the head.Examination of the head.
Examination of cranial nerves.Examination of cranial nerves.
Examination of physiological reflexes.Examination of physiological reflexes.
Examination of tendon reflexes of the limbs.Examination of tendon reflexes of the limbs.
Methods of examination of vegetative nervous system.Methods of examination of vegetative nervous system.

Psychomotor development of a
child
Expresses the becoming of different areas of the nervous
system of a child in particular periods of life. The assessment
of psychomotor development of a child is carried out during
every prophylactic check up using a table, in which age
peculiarities of psychomotor development of a child are given.
Assessment of psychomotor development of a child is carried
out on the following criteria:
Motorics -purposeful manipulation activity of a child ;
Statics -fixation and holding of definite parts of the body in
necessary position;
Sensory reactions - formation of corresponding reactions on
light, sound, pain, touch;
Speech - expressive speech and understanding the speech;
Psychic development - positive and negative emotions,
formation of social age.

Peculiarities of PMD of newborn
children
For newborns are characteristic uncoordinated
athetoselike movements of extremities, rigidness
of muscles, physiological hypertonus of
muscles-benders, loud cry. Hearing is
decreased, feeling of pain is weakened.
Besides, neuro-psychic development of a
newborn child is characterized by the presence
of a number of unconditioned reflexes.

Reflexes of newborn period
1) steady life long automatisms (exist during the whole life):
Swallowing;
Tendon reflexes of extremities;
Cornea;
Conjunctive;
Orbiculopalpebrale.
2) Transitory (exist after the birth and afterwards gradually
disappear):
Oral segmentary automatisms (swallowing, seeking, palm-oral-head
or Babkin reflex);
Spinal segmentary automatisms (defense, support, automatic
walking, catching reflex of Robinson, reflexes of Moro, Kernig,
crawling reflex of Bauer, reflexes of Babinski, Halant, Peres.

Susking reflex lasts up to 10-12 months. It
can be brought about putting a baby’s
dummy on a mouth of a newborn, the
baby makes swallowing movements.

Rooting reflex - on stroking the baby’s skin in
the area of the angle of the mouth he moves
his head, moves down his lower lip and
moves his tongue to the irritant. Is kept by 3-
4 months.

Palm-mouth-head reflex (Babkin) – in pressing
with big fingers on palms in the area of the
mounds of big fingers of a baby, he opens his
mouth and bend his head forward to the breasts.
Lasts 2-3 months.
Defense reflex – if a newborn is put on his
abdomen he reflectory turns his head in side. Is
kept up to 2 months of life.

A grasping reflex - on touching the palms or
soles of the baby with fingers - he grasps them
and holds firmly, in this the child can be lifted
over the plane. The reflex lasts for 3-4 months.

Babinski reflex - on irritating
the sole of the baby on the
outside of the foot from the
heel to the base a big finger
slow straightening up of the
big finger and bending the
other fingers takes placer.
This reflex is supposed to
be physiological up to 2
years age.

Reflex of
automatic walking -
on bending the
baby’s body in a
position of
protecting reflex he
makes steps
forward. The reflex
disappears in 2
months.

Crawling reflex of Bauer -
in a position on the
abdolmen the baby tries to
lift his head and makes
crawling movements. If you
put your hands under the
baby’s feet he will actively
push off with legs from your
hands. The reflex lasts 4
months.

Peres reflex - if the baby is put on
his side and move your hand from
the coccyx to the neck along the
bony parts of the spine this causes
short apnoe in the baby, then a
sharp cry, lordosis, bending of
extremities, hypertonus of the
muscles, sometimes defecation and
urination. This reflex is checked up
at the end of examination as it
causes pain in a baby. This reflex is
supposed to be physiological the
first 3-4 months of the baby’s life.

the third group of reflexes, which are formed not at once
after the birth, but in the definite months of life. These
reflexes are called determining automatisms. This group
of reflexes includes the upper and lower posotonic
reflexes of Landau, simple cervical and trunk
determining reflexes, chain determining reflex from trunk
to trunk.
The upper posotonic reflex of Landau - in a position of a
baby on the abdomen he rises his head, the upper part
of his trunk and, supporting with his hands, stays in this
position. This reflex appears at the age of 3-4 months.

Psychomotor development
Age Motility Statics Sensory
reactions
Speech Emotions
and social
behavior
1 month1 month PhysiologicalPhysiological
hypertone ofhypertone of
muscles ismuscles is
decreased,decreased,
atetoselikeatetoselike
movementsmovements
of extremitiesof extremities
fade. Expressedfade. Expressed
unconditionedunconditioned
reflexes.reflexes.
BeginsBegins
holdingholding
the headthe head
for somefor some
minutesminutes
in horizontalin horizontal
position,position,
lies on thelies on the
abdomenabdomen
at the end ofat the end of
the month.the month.
AppearsAppears
shorttimeshorttime
looking onlooking on
around thearound the
surroundingssurroundings
and hearingand hearing
fixation.fixation.
ArisingArising
simglesimgle
soundssounds
at theat the
end ofend of
a month,a month,
pronouncepronounce
vowelvowel
soundssounds
from ‘a’from ‘a’
to ‘e’.to ‘e’.
ReactsReacts
negativelynegatively
onon
strongstrong
soundsound
and lightand light
irritants.irritants.
Having seenHaving seen
a new face,a new face,
hehe
fixes on itfixes on it
for afor a
moment.moment.

reactions
Speech Emotions
and social
behavior
3 month3 month Majority ofMajority of
reflexes beginreflexes begin
to disappearto disappear
(seeking,(seeking,
Babkin,Babkin,
catching andcatching and
others).others).
Stretches outStretches out
for a toy.for a toy.
Muscular toneMuscular tone
is normalized.is normalized.
Holds theHolds the
head well.head well.
In theIn the
reaction onreaction on
soundsound
irritants andirritants and
brilliantbrilliant
subjectssubjects
appearsappears
fixing up hisfixing up his
eyes oneyes on
them, activethem, active
reaction.reaction.
Frequent,Frequent,
lastinglasting
sounds.sounds.
The firstThe first
chains ofchains of
soundssounds
“rrr”.“rrr”.
AnswersAnswers
withwith
complex ofcomplex of
excitementexcitement
onon
emotionalemotional
communicacommunica
tion. Socialtion. Social
smile.smile.

reactions
Speech Emotions
and social
behavior
4 month4 month AppearAppear
directeddirected
movements ofmovements of
arms: betterarms: better
takes a toy.takes a toy.
Turns fromTurns from
back to hisback to his
side.side.
DisappearDisappear
most ofmost of
reflexesreflexes
(Moro,(Moro,
crawling,crawling,
catching).catching).
In verticalIn vertical
positionposition
appear theappear the
firstfirst
manifestatimanifestati
ons ofons of
supportingsupporting
by theby the
legs. In alegs. In a
position onposition on
thethe
abdomen –abdomen –
confidentconfident
support onsupport on
thethe
forearms.forearms.
A complex ofA complex of
excitementexcitement
whilewhile
meetingmeeting
closeclose
relatives. Forrelatives. For
the first timethe first time
begins tobegins to
recognizerecognize
the mother.the mother.
LooksLooks
attentivelyattentively
on a toy inon a toy in
the hand.the hand.
Frequent,Frequent,
lastinglasting
singingsinging
likelike
differentdifferent
sounds.sounds.
Appear lipAppear lip
consonanconsonan
ts “m”,ts “m”,
“b”,“b”,
shouts ofshouts of
joy.joy.
LoudlyLoudly
laughs in alaughs in a
reply toreply to
emotionalemotional
oraloral
appeal.appeal.

reactions
Speech Emotions
and social
behavior
6 month6 month Actively turnsActively turns
from the backfrom the back
to theto the
abdomen,abdomen,
begins to turnbegins to turn
from thefrom the
abdomen onabdomen on
the back.the back.
CatchesCatches
purposefully apurposefully a
proposed toy,proposed toy,
puts it fromputs it from
one hand toone hand to
another.another.
In aIn a
position onposition on
thethe
abdomenabdomen
he ishe is
supportedsupported
by theby the
stretchedstretched
arms orarms or
fully openfully open
palms.palms.
Begins toBegins to
sit downsit down
throughthrough
turning onturning on
the backthe back
leaning onleaning on
the arm.the arm.
MoreMore
adequateadequate
reaction onreaction on
thethe
appearanceappearance
of theof the
mother,mother,
father or afather or a
strangestrange
person.person.
Follows withFollows with
the eyesthe eyes
after a toy,after a toy,
which fellwhich fell
down.down.
Speaking:Speaking:
consecuticonsecuti
veve
connectinconnectin
g ofg of
differentdifferent
expresseexpresse
dd
syllablessyllables
withwith
changingchanging
thethe
strengthstrength
of soundof sound
andand
stress ofstress of
the tone.the tone.
EmotionsEmotions
areare
differentiatdifferentiat
ed,ed,
stretchesstretches
his arms tohis arms to
be takenbe taken
on theon the
hands.hands.
DifferentlyDifferently
behavesbehaves
with closewith close
people andpeople and
strangers.strangers.

reactions
Speech Emotions
and social
behavior
8 month8 month Catches withCatches with
each hand aeach hand a
brick andbrick and
holds it firmlyholds it firmly
for some shortfor some short
time.time.
Crawls onCrawls on
thethe
abdomen,abdomen,
stretchingstretching
the armsthe arms
ahead.ahead.
UnassistedUnassisted
sits down,sits down,
lies down,lies down,
gets up.gets up.
After definiteAfter definite
bringing upbringing up
shows withshows with
hands “goodhands “good
bye”, with abye”, with a
nod of thenod of the
head gives ahead gives a
sign of agreesign of agree
-“yes” or-“yes” or
negation -negation -
“no”.“no”.
PrattlesPrattles
with joy,with joy,
pronouncpronounc
es thees the
soundssounds
“ba”,“ba”,
“ma”,“ma”,
“yes”.“yes”.
AdequateAdequate
emotionalemotional
reactionsreactions
on reply ofon reply of
conversatioconversatio
n. Followsn. Follows
the actionsthe actions
of the otherof the other
children,children,
laughs,laughs,
prattles.prattles.

reactions
Speech Emotions
and social
behavior
1010
monthmonth
The number ofThe number of
purposefullpurposefull
movementsmovements
increases:increases:
composes acomposes a
pyramid, putspyramid, puts
the toys inthe toys in
their places,their places,
etc. “Pincer”etc. “Pincer”
catching -catching -
takestakes
somethingsomething
with a thumbwith a thumb
and indexand index
finger.finger.
He can beHe can be
takentaken
supportedsupported
on oneon one
hand.hand.
Crawls onCrawls on
surfaces ofsurfaces of
differentdifferent
height,height,
manymany
childrenchildren
can standcan stand
supportedsupported
with somewith some
subject.subject.
MoreMore
expressedexpressed
and enrichedand enriched
are theare the
indicatedindicated
things.things.
Repeats theRepeats the
movementsmovements
of adultof adult
people,people,
“Speaks on“Speaks on
the phone”,the phone”,
“Mixes the“Mixes the
porridge”.porridge”.
ThrowsThrows
away a toy.away a toy.
The firstThe first
wordswords
appear,appear,
which thewhich the
childchild
understandsunderstands
. In the. In the
vocabularyvocabulary
there arethere are
somesome
words.words.
CorrectlyCorrectly
repeats therepeats the
words saidwords said
by an adultby an adult
person.person.
DifferentiatDifferentiat
ed mimicaled mimical
movementsmovements
, voice, voice
reactions.reactions.
Reacts onReacts on
everythingeverything
new. Playsnew. Plays
withwith
childrenchildren
with onewith one
toy.toy.

reactions
Speech Emotions and
social behavior
1212
monthmonth
Can playCan play
with toyswith toys
duringduring
an houran hour
or more.or more.
WalksWalks
along thealong the
furniture,furniture,
assistedassisted
on oneon one
hand orhand or
unassisteunassiste
d at all.d at all.
Fulfills moreFulfills more
and moreand more
complicatedcomplicated
demands ordemands or
requests,requests,
understandinunderstandin
g them.g them.
More andMore and
moremore
demonstratiodemonstratio
ns ofns of
reactions onreactions on
thethe
surroundingssurroundings
..
The first wordsThe first words
appear, whichappear, which
the childthe child
understands. Inunderstands. In
the vocabularythe vocabulary
there are somethere are some
words.words.
CorrectlyCorrectly
repeats therepeats the
words said bywords said by
an adultan adult
person.person.
Voabulary - 8-Voabulary - 8-
10 words.10 words.
Gives a toy toGives a toy to
another child,another child,
doing this hedoing this he
smiles or laughssmiles or laughs
and prattles.and prattles.
Seeks the toys,Seeks the toys,
which arewhich are
hidden. Onhidden. On
request herequest he
embraces theembraces the
parents, waitsparents, waits
for some praise,for some praise,
confirming hisconfirming his
success by asuccess by a
close person.close person.

On the results of assessment of psychomotor
development of a child tactics is determined for
the following medical observation. If a child
fulfills all the actions characteristic for his age, it
is necessary to carry on consultation on the care
with the aim of development. If the child cannot
fulfill the proposed actions or there is delay in
appearing new skills, the mother must be taught
how to carry on studies with the child aimed at
development and how to use additional
stimulations for producing skills, which are
underdeveloped.

The doctor’s tactics according to the results of a
child’s psychomotor development assessment
Results of assessment Tactics
The indices of psychomotorThe indices of psychomotor
development are indevelopment are in
accordance with the child’saccordance with the child’s
age.age.
he following observation.he following observation.
Consultation on the care withConsultation on the care with
the aim of development.the aim of development.
Determined delay ofDetermined delay of
developing skills in a child ofdeveloping skills in a child of
1 month in the first year of1 month in the first year of
life.life.
Consultation on the careConsultation on the care
aimed at development andaimed at development and
carrying on correctioncarrying on correction
training. Repeated check uptraining. Repeated check up
in 1 month. If the revealedin 1 month. If the revealed
delay lasts by the repeateddelay lasts by the repeated
check up, there is a need incheck up, there is a need in
of a children’s doctor-of a children’s doctor-
neurologist’s consultation.neurologist’s consultation.

Results of assessment Tactics
Delay in arising the skills of 3Delay in arising the skills of 3
months in children at the agemonths in children at the age
from 1 to 2 years.from 1 to 2 years.
Consultation about the care aimedConsultation about the care aimed
at development and carrying onat development and carrying on
correction training.correction training.
Repeated check up in 1-3 months.Repeated check up in 1-3 months.
If determined the delay lasting,If determined the delay lasting,
there must be the children’s doctor-there must be the children’s doctor-
Delay in arising the skills of 6Delay in arising the skills of 6
months in children at the agemonths in children at the age
from 2 to 3 years.from 2 to 3 years.
Consultation on the care aimed atConsultation on the care aimed at
development.development.
Repeated check up in 2-6 months.Repeated check up in 2-6 months.
If the revealed delay is lasting, thereIf the revealed delay is lasting, there
is a need in children’s doctor-is a need in children’s doctor-
The doctor’s tactics according to the results of a
child’s psychomotor development assessment

Instrumental methods of CNSInstrumental methods of CNS
examinationexamination
Craniography – is used for determining the defects of the cranial bones, changesCraniography – is used for determining the defects of the cranial bones, changes
in its internal shape, pathological disturbances in the brain, congenital failures ofin its internal shape, pathological disturbances in the brain, congenital failures of
development. In specialized institutions often are used methods of contrast X-Raydevelopment. In specialized institutions often are used methods of contrast X-Ray
of the brain and spinal cord. Pneumoencephalography, ventriculo- ; angiograpgy.of the brain and spinal cord. Pneumoencephalography, ventriculo- ; angiograpgy.
Exoencephalography- based on the ability of intracranial structures, which haveExoencephalography- based on the ability of intracranial structures, which have
different acoustic resistance, partially beat off directed on them ultrasound.different acoustic resistance, partially beat off directed on them ultrasound.
Neurosonography.Neurosonography.
Ultrasound dopplerography.Ultrasound dopplerography.
Electroencephalography.Electroencephalography.
Reoencephalography – registration of changes of electrical resistance of the brainReoencephalography – registration of changes of electrical resistance of the brain
during going on through it changing current of high frequency and lowduring going on through it changing current of high frequency and low power.power.
Electrical resistance and conductivity of tissues depend on their bloodElectrical resistance and conductivity of tissues depend on their blood
filling, so this method is directed on the study of cerebral bloodfilling, so this method is directed on the study of cerebral blood
circulation.circulation.
Computerized tomography, nuclear-magnetic resonance tomography –Computerized tomography, nuclear-magnetic resonance tomography –
for diagnostics of tumors, abscesses, hematomas.for diagnostics of tumors, abscesses, hematomas.

Neurovisualization of brain structures with a
method of magnetic resonance tomography
(MRT)

Neurovisualization of brain
structures with a method of magnetic
resonance tomography (MRT)

Patient C., 2 months. Sagittal projection of the brain.Patient C., 2 months. Sagittal projection of the brain.
Grey and white substance of the brain have no differentiation.Grey and white substance of the brain have no differentiation.
Hypoplasia of cerebellum.Hypoplasia of cerebellum.

Hemimegalencephaly - uneven enlargement of the sizes ofHemimegalencephaly - uneven enlargement of the sizes of
brain hemispheres, occipital lobe is located to the right ofbrain hemispheres, occipital lobe is located to the right of
medial line in 1,8 cm.medial line in 1,8 cm.

Laboratory methods of researchLaboratory methods of research
general blood analysisgeneral blood analysis
lumbar puncturelumbar puncture

Methods of investigation ofMethods of investigation of
vegetative nervous systemvegetative nervous system
investigation of local dermographism.investigation of local dermographism. HachureHachure
irritation of the skin is done with a dull subject. Inirritation of the skin is done with a dull subject. In
5-20 sec on the site of irritation appear lines with5-20 sec on the site of irritation appear lines with
the color which depends on the vascularthe color which depends on the vascular
reaction. White dermographism indicates on thereaction. White dermographism indicates on the
increased tone of sympathetic section ofincreased tone of sympathetic section of
nervous system, red color - parasympathetic.nervous system, red color - parasympathetic.
White dermographism disappears earlier (in 8-White dermographism disappears earlier (in 8-
10 sec), the red one can be wide and lasts up to10 sec), the red one can be wide and lasts up to
3 min and more.3 min and more.

It is important to remember !!!It is important to remember !!!
A general mental development of aA general mental development of a
child in 50% is going on in the first 4-5child in 50% is going on in the first 4-5
years of life;years of life;
in 30%- from 5 to 8 years;in 30%- from 5 to 8 years;
the resting 20% - from 8 to 17 yearsthe resting 20% - from 8 to 17 years ofof
age.age.

Syndrome of consciousnessSyndrome of consciousness
disordersdisorders
Some kinds of consciousness disorders areSome kinds of consciousness disorders are
differentiated:differentiated:
- Dizziness- Dizziness - the most widespread kind of paroxysmal- the most widespread kind of paroxysmal
violation of consciousness. Mechanism – acute violationviolation of consciousness. Mechanism – acute violation
of cerebral blood circulation with the development ofof cerebral blood circulation with the development of
deep hypoxia. Characteristic are: loss of consciousness;deep hypoxia. Characteristic are: loss of consciousness;
sharp paleness of skin covering; slow respiration.sharp paleness of skin covering; slow respiration.
- Somnolency- Somnolency – the baby is lying with closed eyes– the baby is lying with closed eyes
unchanging the position forunchanging the position for long time. Contact islong time. Contact is
possible with the use of sharp and strong irritationpossible with the use of sharp and strong irritation
(bright light, strong sound).(bright light, strong sound).

Syndrome of consciousnessSyndrome of consciousness
disordersdisorders
- Sopor-- Sopor- a sick child is lying still, amimical,a sick child is lying still, amimical,
does not react on irritations.does not react on irritations.
Unconditioned reflexes are kept.Unconditioned reflexes are kept.
Coma –Coma – a full loss of consciousness, absence ofa full loss of consciousness, absence of
active movements, loss of sense, loss ofactive movements, loss of sense, loss of
reflectory functions, absence of reaction onreflectory functions, absence of reaction on
external stimuli, violation of respiration,external stimuli, violation of respiration,
cardiovascular system activity and homeostasis.cardiovascular system activity and homeostasis.

Hydrocephaly syndromeHydrocephaly syndrome
This is enlargement of ventricular system of the brain andThis is enlargement of ventricular system of the brain and
subarachnoidal areas due to enlarged amount of liquor. Liquorsubarachnoidal areas due to enlarged amount of liquor. Liquor
in the brain is connected with its hyperproduction and disorderin the brain is connected with its hyperproduction and disorder
of its resorption. Disorder of liquorodynamics can be connectedof its resorption. Disorder of liquorodynamics can be connected
with anomalies of the CNS, inflammation of meninges, traumas.with anomalies of the CNS, inflammation of meninges, traumas.
The main clinical symptoms are: enlargement of the headThe main clinical symptoms are: enlargement of the head
volume, thinning of the bones of the skull. Paresis, tremor ofvolume, thinning of the bones of the skull. Paresis, tremor of
extremities, atrophy of visual nerve and some others. There isextremities, atrophy of visual nerve and some others. There is
decrease of protein in the liquor.decrease of protein in the liquor.
Hydrocephaly can be congenital and acquired. In congenitalHydrocephaly can be congenital and acquired. In congenital
hydrocephaly there are multiple anomalies of the facialhydrocephaly there are multiple anomalies of the facial
skeleton: facial skeleton is decreased, the forehead is high.skeleton: facial skeleton is decreased, the forehead is high.
There is marked vascular reticulum, the skin is thin, stretched.There is marked vascular reticulum, the skin is thin, stretched.
The child is lagging in psychic development. At the same timeThe child is lagging in psychic development. At the same time
there can be high development of some psychic functions:there can be high development of some psychic functions:
mechanical memory, talent to music, drawing, etc.mechanical memory, talent to music, drawing, etc.

CraniostenosisCraniostenosis
Pre-time closing of osteo and parietal sutures leading toPre-time closing of osteo and parietal sutures leading to
decrease of the skull, its deformation, high intracranialdecrease of the skull, its deformation, high intracranial
pressure. Is met very frequently - 1:1000.pressure. Is met very frequently - 1:1000.
Pathogenesis - violation of metabolism, causingPathogenesis - violation of metabolism, causing
accelerated bony synthesis, violation of vascularizationaccelerated bony synthesis, violation of vascularization
of bones and meninges.of bones and meninges.
Clinical picture - headaches, congestion phenomena inClinical picture - headaches, congestion phenomena in
eye bottom. Exophthalm can take place. Convulsions,eye bottom. Exophthalm can take place. Convulsions,
high liquor pressure – up to 500mm/Hg..high liquor pressure – up to 500mm/Hg..

Craniostenosis -Craniostenosis - in craniogram markedin craniogram marked
thinning of the bones of the skull withthinning of the bones of the skull with
increased finger like grooves is seenincreased finger like grooves is seen

Encephalitic syndromeEncephalitic syndrome..
Develops as a consequence of encephalitis -Develops as a consequence of encephalitis -
inflammation of the brain. In this inflammatory changesinflammation of the brain. In this inflammatory changes
in neurons and nerve fibers take place. Disorder of thein neurons and nerve fibers take place. Disorder of the
brain can be the result of toxic or allergic disorder of thebrain can be the result of toxic or allergic disorder of the
walls of cranial vessels.walls of cranial vessels.
Etiologic factor - viruses or microorganisms.Etiologic factor - viruses or microorganisms.
Clinical picture - headaches, vomiting, failure ofClinical picture - headaches, vomiting, failure of
cardiovascular and respiratory systems. High arterialcardiovascular and respiratory systems. High arterial
pressure. Psychic disturbances can also be present.pressure. Psychic disturbances can also be present.

Meningeal syndromeMeningeal syndrome
This syndrome can develop in meningitis. Meningitis areThis syndrome can develop in meningitis. Meningitis are
differentiated as purulent (meningococcus,differentiated as purulent (meningococcus,
pneumococcus) and serous (viral).pneumococcus) and serous (viral).
Clinic - headaches, vomiting, hyperestasis, stress,Clinic - headaches, vomiting, hyperestasis, stress,
pulsation of a large vertex.pulsation of a large vertex.
Positive meningeal symptoms of Kering, rigidity ofPositive meningeal symptoms of Kering, rigidity of
occipital muscles. upper, medium and lower ofoccipital muscles. upper, medium and lower of
Budzinski, Lesazh, Bechterev (in percussion ofBudzinski, Lesazh, Bechterev (in percussion of
zygomatic arc headache increases and pain grimacezygomatic arc headache increases and pain grimace
appears on the face).appears on the face).

Syndrome of neurotoxicosisSyndrome of neurotoxicosis
Meningeal syndrome can be observedMeningeal syndrome can be observed
also in neurotoxicosis - unspecific reactionalso in neurotoxicosis - unspecific reaction
of CNS on toxins, which are in theof CNS on toxins, which are in the
organism. Most frequently this syndromeorganism. Most frequently this syndrome
develops in children of an early age due todevelops in children of an early age due to
excessive permeability of hemato-excessive permeability of hemato-
encephalic barrier.encephalic barrier.

Children’s cerebral paralysisChildren’s cerebral paralysis
(CCP)(CCP)
The name comes from that in CCP the moving activity isThe name comes from that in CCP the moving activity is
violated. Besides, hearing, eyesight are decreased.violated. Besides, hearing, eyesight are decreased.
There are defects in speech, lagging in psychicThere are defects in speech, lagging in psychic
development.development.
CCP can be: spastic, dyskinetic, ataxic, mixed.CCP can be: spastic, dyskinetic, ataxic, mixed.
Spastic type of CCPSpastic type of CCP – strong contraction of muscles is– strong contraction of muscles is
prevailing. Mostly are violated the lower extremities.prevailing. Mostly are violated the lower extremities.
There is crossing of the legs.There is crossing of the legs.
Little syndromeLittle syndrome - spastic diplegia is the most- spastic diplegia is the most
widespread type of CCP. Frequent disturbance of thewidespread type of CCP. Frequent disturbance of the
lower extremities. The baby cannot take a toy. Psychiclower extremities. The baby cannot take a toy. Psychic
development is violated.development is violated.

Children’s cerebral paralysisChildren’s cerebral paralysis
(CCP)(CCP)
Diskinetic type of CCPDiskinetic type of CCP – presence of quick ,– presence of quick ,
uncoordinated movementpurpousless movements,uncoordinated movementpurpousless movements,
accompanied with increase of muscular tone. Clinicalaccompanied with increase of muscular tone. Clinical
manifestation mostly concerns the upper extremities.manifestation mostly concerns the upper extremities.
Partial manifestations -tremor, rigidity, dystonia. InPartial manifestations -tremor, rigidity, dystonia. In
dystonia there is hypertension of muscles, especially ofdystonia there is hypertension of muscles, especially of
the trunk muscles.the trunk muscles.
-- Ataxic type of CCP - violation of coordination,Ataxic type of CCP - violation of coordination,
nistagm.nistagm.
- In the mixed type in patients- In the mixed type in patients there is combination ofthere is combination of
several types of disorders, characteristic of cerebralseveral types of disorders, characteristic of cerebral
paralysis.paralysis.

Semiotics of psychomotor
development disturbances

Thank you for your attention !!!Thank you for your attention !!!

App of nervous sys 2015

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