Muscles in excellent tone and. What is muscle hypertonicity in adults

I. Hypotension

II. Hypertension

1. Spasticity.
2. Extrapyramidal rigidity.
3. The phenomenon of opposition (gegenhalten).
4. catatonic rigidity.
5. Decortication and decerebration rigidity. Hormetonia.
6. Myotonia.
7. Muscle tension (Stiffness).
8. Reflex hypertension: muscular-tonic syndromes in diseases of the joints, muscles and spine; stiffness of the neck muscles with meningitis; increased muscle tone in peripheral injury.
9. Other types of muscle hypertension.
10. Psychogenic muscular hypertension.

I. Hypotension

Hypotension is manifested by a decrease in muscle tone below the normal physiological level and is most characteristic of damage at the spinal muscular level, but can also be observed in diseases of the cerebellum and some extrapyramidal disorders, especially chorea. The range of motion in the joints (their overextension) and the amplitude of passive excursions (especially in children) increase. With atony, the predetermined posture of the limb is not maintained.

Diseases that affect the segmental level of the nervous system include poliomyelitis, progressive spinal amyotrophy, syringomyelia, neuropathies and polyneuropathy, and other diseases that involve the anterior horns, posterior columns, roots, and peripheral nerves. In the acute phase of a transverse spinal cord lesion, spinal shock develops, in which the activity of the cells of the anterior horns of the spinal cord and spinal reflexes is temporarily inhibited below the level of the lesion. The upper level of the spinal axis, the dysfunction of which can lead to atony, is the caudal parts of the brainstem, the involvement of which in deep coma is accompanied by complete atony and portends a poor outcome of the coma.

Muscle tone can be reduced in various types of cerebellar damage, chorea, akinetic epileptic seizures, deep sleep, during syncope, states of disturbed consciousness (fainting, metabolic coma) and immediately after death.

With cataplexy attacks, usually associated with narcolepsy, muscle atony develops in addition to weakness. Seizures are more often provoked by emotional stimuli and are usually accompanied by other manifestations of polysymptomatic narcolepsy. Rarely, cataplexy is a manifestation of a midbrain tumor. In the most acute (“shock”) phase of a stroke, a paralyzed limb sometimes reveals hypotension.

A separate problem is hypotension in infants(“flaccid child”), the causes of which are very diverse (stroke, Down syndrome, Prader-Willi syndrome, birth trauma, spinal muscular atrophy, congenital neuropathy with hypomyelination, congenital myasthenic syndromes, infant botulism, congenital myopathy, benign congenital hypotension).

Rarely, post-stroke hemiparesis (with an isolated lesion of the lentiform nucleus) is accompanied by a decrease in muscle tone.

II. Hypertension

Spasticity

Spasticity develops with any lesions of the cortical (upper) motor neuron and (mainly) the cortico-spinal (pyramidal) tract. In the genesis of spasticity, an imbalance of inhibitory and facilitating influences from the reticular formation of the midbrain and brain stem is important, followed by an imbalance of alpha and gamma motor neurons of the spinal cord. Often the phenomenon of "jackknife" is revealed. The degree of hypertonicity can vary from mild to extremely pronounced, when the doctor is unable to overcome spasticity. Spasticity is accompanied by tendon hyperreflexia and pathological reflexes, clonuses and, sometimes, protective reflexes and pathological synkinesis, as well as a decrease in superficial reflexes.

With hemiparesis or hemiplegia of cerebral origin, spasticity is most pronounced in the flexor muscles on the arms and extensor muscles on the legs. In bilateral cerebral (and some spinal) injuries, spasticity in the adductor muscles of the thigh leads to characteristic dysbasia. With relatively severe spinal injuries in the legs, flexor muscle spasm, reflexes of spinal automatism and flexor paraplegia are more often formed.

Extrapyramidal rigidity

Extrapyramidal rigidity is observed in diseases and injuries affecting the basal ganglia or their connections with the midbrain and the reticular formation of the brain stem. An increase in tone applies to both flexors and extensors (increased muscle tone according to the plastic type); resistance to passive movements is noted during movements of the limbs in all directions. The severity of rigidity may be different in the proximal and distal limbs, in the upper or lower body, as well as on the right or left half of it. At the same time, the phenomenon of "gear wheel" is often observed.

The main causes of extrapyramidal rigidity: rigidity of this type is most often observed in Parkinson's disease and other parkinsonian syndromes (vascular, toxic, hypoxic, postencephalitic, post-traumatic, and others). In this case, there is a tendency to gradually involve all muscles, but the muscles of the neck, trunk and flexors are affected more coarsely. Muscle rigidity is combined here with symptoms of hypokinesia and (or) low-frequency rest tremor (4-6 Hz). Postural disorders of varying severity are also characteristic. Rigidity on one side of the body increases with active movements of the contralateral limbs.

Less commonly, plastic hypertonicity is observed in tonic forms of dystonic syndromes (debut of generalized dystonia, tonic form of spastic torticollis, dystonia of the foot, etc.). This type of hypertonicity sometimes causes serious difficulties in making a syndromic differential diagnosis (parkinson's syndrome, dystonic syndrome, pyramidal syndrome). The most reliable way to recognize dystonia is to analyze its dynamics.

Dystonia (a term not intended to refer to muscle tone, but to a specific type of hyperkinesis) is manifested by muscle contractions that lead to characteristic postural (dystonic) phenomena.

The phenomenon of opposition

The phenomenon of opposition or gegenhalten is manifested by increasing resistance to any passive movements in all directions. The doctor at the same time makes increasing efforts to overcome resistance.

Main reasons: the phenomenon is observed with damage to the corticospinal or mixed (corticospinal and extrapyramidal) pathways in the anterior (frontal) parts of the brain. The predominance of this symptom (as well as the grasping reflex) on one hand indicates a bilateral lesion of the frontal lobes with a predominance of damage in the contralateral hemisphere (metabolic, vascular, degenerative and other pathological processes).

Catatonic rigidity

There is no generally accepted definition of catatonia. This form of increased muscle tone is similar in many respects to extrapyramidal rigidity and probably has overlapping pathophysiological mechanisms with it. The phenomenon of "wax flexibility", given "freezing postures" (catalepsy), "strange motor skills" against the background of gross mental disorders in the picture of schizophrenia are characteristic. Catatonia is a syndrome that has not yet received a clear conceptual design. It is unusual in that it blurs the line between psychiatric and neurological disorders.

Main reasons: catatonia syndrome has been described in non-convulsive forms of status epilepticus, as well as in some gross organic brain lesions (brain tumor, diabetic ketoacidosis, hepatic encephalopathy), which, however, needs further clarification. Usually it is characteristic of schizophrenia. Within schizophrenia, catatonia presents with a complex of symptoms including mutism, psychosis, and unusual motor activity ranging from agitated outbursts to stupor. Concomitant manifestations: negativism, echolalia, echopraxia, stereotypes, mannerisms, automatic obedience.

Decortication and decerebration rigidity

Decerebrate rigidity is manifested by constant rigidity in all extensors (anti-gravity muscles), which can sometimes intensify (spontaneously or with painful stimulation in a patient in a coma), manifested by forced extension of the arms and legs, their adduction, slight pronation and trismus. Decortication rigidity is manifested by flexion elbow joints and wrist with extension of the legs and feet. Decerebrate rigidity in patients in a coma ("extensor pathological postures", "extensor postural reactions") has a worse prognosis compared with decortication rigidity ("flexor pathological postures").

Similar generalized rigidity or spasticity with retraction (extension) of the neck and sometimes the trunk (opisthotonus) can be observed with meningitis or meningism, the tonic phase of an epileptic seizure, and with processes in the posterior cranial fossa that occur with intracranial hypertension.

A variant of extensor and flexor spasms in a patient in a coma is a rapidly changing muscle tone in the limbs (hormetonia) in patients in the acute phase of hemorrhagic stroke.

Myotonia

Congenital and acquired types of myotonia, myotonic dystrophy, paramyotonia and, sometimes, myxedema are manifested by increased muscle tone, which, as a rule, is detected not during passive movements, but after active voluntary contraction. With paramyotonia, a pronounced increase in muscle tone is provoked by cold. Myotonia is detected in the test of clenching the fingers into a fist, manifested by delayed relaxation of spasmodic muscles; repeated movements lead to the gradual restoration of normal movements. electrical stimulation muscles causes their increased contraction and delayed relaxation (the so-called myotonic reaction). Percussion (hit with a hammer) of the tongue or thenar reveals a characteristic myotonic phenomenon - a "dimple" at the site of impact and adduction thumb with delayed muscle relaxation. Muscles may be hypertrophied.

Muscle tension (stiffness)

Muscle tension is a special group of syndromes, associated by its pathogenesis mainly with spinal (interneurons) or peripheral damage (syndromes of "hyperactivity of motor units").

Isaacs syndrome (neuromyotonia, pseudomyotonia) is manifested by rigidity, which first appears in the distal extremities and gradually spreads to the proximal, axial and other muscles (face, bulbar muscles) with difficulty in movements, dysbasia and constant myokymia in the affected muscles.

Stiff-person syndrome, on the contrary, begins with rigidity of the axial and proximal muscles (mainly the muscles of the pelvic girdle and trunk) and is accompanied by characteristic spasms of great intensity in response to external stimuli of different modalities (enhanced startle response) .

Close to this group of muscular-tonic disorders are McArdle's disease, paroxysmal myoglobulinemia, tetanus (tetanus).

Tetanus is an infectious disease that is manifested by generalized muscle rigidity, although the muscles of the face and lower jaw are involved earlier than others. Against this background, muscle spasms that occur spontaneously or in response to tactile, auditory, visual and other stimuli are characteristic. There is usually severe generalized rigidity between spasms.

"Reflex" rigidity

"Reflex" rigidity combines syndromes of muscle-tonic tension in response to pain irritation in diseases of the joints, spine and muscles (for example, protective muscle tension in appendicitis; myofascial syndromes; cervicogenic headaches; other vertebrogenic syndromes; increased muscle tone in peripheral injury).

Other types of muscle hypertension include muscle stiffness during an epileptic seizure, tetany, and some other conditions.

High muscle tone is observed during the tonic phase of generalized seizures. Sometimes there are purely tonic epileptic seizures without a clonic phase. The pathophysiology of this hypertonicity is not completely clear.

Tetany is manifested by a syndrome of increased neuromuscular excitability (symptoms of Khvostek, Trousseau, Erb, etc.), carpo-pedal spasms, paresthesias. More common variants of latent tetany against the background of hyperventilation and other psychovegetative disorders. More rare cause- endocrinopathy (hypoparathyroidism).

Psychogenic hypertension

Psychogenic hypertension is most clearly manifested in the classic picture of a psychogenic (hysterical) seizure (pseudo-seizure) with the formation of a "hysterical arc", with a pseudodystonic variant of psychogenic hyperkinesis, and also (less often) in the picture of lower pseudoparaparesis with pseudohypertonia in the feet.

Muscle tone is the involuntary tension of our muscles. This process is permanent. Our consciousness and will do not control it.

Have you ever wondered how muscles tense up? What controls them? If the muscle tone is in a normal state, then we do not notice it. This is our usual state, which does not cause any discomfort. Despite the fact that we do not attach importance to this, the tone exists.

This is an important characteristic of our muscular system. It affects the state of all organs and systems. Without it, we will not be able to move normally, walk and even stand.

An important function of the skeletal muscles is to maintain their working condition. They must be in full readiness at any time, whether we are asleep or awake. And reflexively, the tone of the muscular system helps us maintain a certain position of our body.

What is the norm and what is the deviation

What is the difference between tonic muscle tension and normal? If the tension is arbitrary, then a number of muscle fibers are simultaneously activated.

Imagine that each fiber is a light bulb. During voluntary tension, the entire muscle will look like a bright fiery beam. But in the case of tonic tension, it will already resemble a sky strewn with stars. Notice the difference?

In the second case, the fibers will not all enter into work at once, but in turn: some tense up, while others rest. Thanks to this economy, the fibers can work for a very long time. In the distribution of tonic tension, the sensitivity of muscles and joints plays a decisive role.

Studies have shown that muscle tone can vary greatly from person to person. Even for one person at different points in his life, this indicator will change. For example, when we sleep, the tone is lowered. during mental or physical work it will increase, and during rest and rest it will decrease again. With a reduced tone, efficiency is lost, but a high tone will interfere with productive work.

It is curious that muscle tone can affect the state of the human psyche. As it turned out, when the tone changes, our emotions also undergo changes. Reducing it can calm a person and even put him to sleep. But mentally controlling this indicator is quite difficult.

Hypertonicity - about causes and consequences

If the muscles are in a pathologically high tone, the following signs can signal this:

• • their density increased;
  • does not leave the feeling of tension;
  • you feel tight;
  • movements are constrained;
  • you feel muscle fatigue;
  • the rate of muscle growth slowed down;
  • often there are muscle spasms with acute pain.

There are two types of hypertension:

1. 1. Spasticity. On different groups muscle tone is disturbed in different ways.
   2. Muscle rigidity. The tone is equally high in all muscle groups.

Why does hypertonicity appear

Most often, this pathology is associated with a violation of the nervous system. It is from her that signals come, after which the muscles relax or tighten. It is she who controls their tone. Increased muscle tone can appear for various reasons:

• • cardiovascular diseases (they damage the central nervous system);
  • neurological pathology congenital;
  • due to injury, the brain or spinal cord was damaged;
  • a person has demyelinating diseases.

And the tone may depend on the psychological state. Our central nervous system often perceives all sorts of shocks and stresses as a potential threat, and sets in motion muscle tone. Slightly affect the tone and weather conditions. In warm weather, the muscles are relaxed, and the cold provokes their tension.

Types of muscle tone disorders

Muscle tone disorders:

Muscle tone is observed in most newborns. At first, this is normal. It is due to the fact that the baby after the fetal position must get used to the new position of the body. Do not be afraid if your baby has been diagnosed with muscular dystonia.

Tone is an important characteristic of the state of the nervous system of the child and his general condition. Violations of it can be a symptom of serious pathologies of the central nervous system, spinal cord and brain. For example, dystonia always accompanies elevated intracranial pressure.

Violations of tone can provoke delays in physical and mental development. Such babies later begin to crawl, sit, walk.

Therefore, it is worth showing the baby to a neurologist. Babies born prematurely, "cesareans", children with low weight are considered a special risk group.

The consequences of violations of tone for children can be different:

• • posture, gait may deteriorate, sometimes clubfoot appears;
  • hypertonicity can later turn into hyperexcitability, the child will be inattentive, study poorly, and begin to show aggression;
  • hypotension leads to physical and psychological lethargy, apathy, hypodynamia, obesity, developmental delay.

Parents should be concerned if:

• • the hips of the newborn are divorced by more than 90 degrees, this is a symptom of hypotension;
  • spreading the hips of the child, you feel excessive resistance, this is a symptom of hypertonicity;
  • a symptom of a violation of tone is an unnatural posture of the child in the crib. In pathology, it can shrink into a ball or, conversely, spread out like a frog;
  • the child does not eat well, cries for no reason, throwing his head back;
  • convulsions and fever are observed;
  • the baby does not gurgle, does not smile.

If, nevertheless, a correction of the tone is required, then therapeutic massage is most often prescribed. It is prescribed to babies after a month and a half age.

Medical therapy is rarely used. Specific treatment will depend on the causes of dystonia. Do not be afraid of massage.

The main thing is that it should be performed by an experienced and qualified children's masseur. A good professional massage normalizes muscle tone, improves blood circulation, and stabilizes the nervous system.

Good for a child simple charging:

1. 1. Stroke his back, the legs of the handle. At the same time, it is impossible to affect the lumbar region.
   2. Massage your palms, heels, fingers on legs and arms. Movements should not be strong and abrupt.
   3. After three months baby can do more difficult exercises. They can be selected by a physiotherapy specialist.

To correct muscle tone, baths with herbs (soothing collection, motherwort, chamomile), sea salt will be useful.

Diagnostic tests

Special diagnostic tests will help determine the state of tone. The first examination of the baby is carried out in the hospital. Then, every six months, parents should show the baby to an orthopedist, a neurologist. Some manipulations for such a diagnosis can be performed by the parents themselves:

1. 1. We part the hips. The baby lies on his back. You part his hips without any effort. The norm is moderate resistance. With a reduced tone, it is completely absent, and with an increased tone, it is too strong. A healthy baby should spread the legs 45 degrees on each side.
   2. We sit the baby by the arms. The baby lies on its back. Pull the baby by the wrists as if you want to sit him down. The norm is a slight resistance to extension in the elbows of the hands. With a reduced tone, there will be no resistance, with an increased tone, it is excessive.
   3. Step reflex and ground reflex. Holding under the armpits, place the baby on the changing table. To encourage you to take a step, lean forward slightly. Norma - the child stands and leans on the entire foot, his toes are straightened. While leaning forward, the baby should not cross the legs, imitates the process of walking. But after 1.5 months, this reflex fades. But with hypertonicity, it lasts longer. Symptoms of hypertonicity: pursed fingers, crossed legs. Symptoms of muscle hypotension in infants: steps on excessively bent legs (you must hold the baby under the armpits), squatting or refusing to walk.

Therapy Methods

As already mentioned, in case of violations of tone, professional therapeutic massage is often prescribed, less often - drug therapy. Most often, a neurologist prescribes a course of relaxing massage (10 professional sessions, which are repeated again after six months).

Also applies:

• • special medical gymnastics;
  • electrophoresis;
  • swimming;
  • relaxing baths with herbs (sage, valerian, motherwort, chamomile, soothing collection, needles) or sea salt;
  • in more complex cases, drugs are prescribed (vascular drugs, nootropics, diuretics).

Remember that as you reach middle age, muscle tone may drop. It won't be too much to do therapeutic gymnastics or moderate loads gym. Remember that the general condition of your body, performance and emotional state directly depend on muscle tone!

What is muscle tone?

Muscle tone refers to the physiological properties of the human body, the nature of the impact of which has not been fully studied by medicine. The transition from a state of rest to tension is possible under the influence of various factors, both external and internal, while taking into account diseases of a different nature, including diseases and malfunctions of the central nervous system.

Pathologies of muscle tone differ in types: hypotonicity and hypertonicity. Both manifestations are considered physiologically necessary for the normal functioning of the body. Muscle tension occurs subconsciously, on a reflex, which provides almost all types of movement, including maintaining the body in the desired position. Maintaining a person in constant readiness for any action is the main task of muscle tone.

What is the difference between normal tone and disturbed tone

Many parents are concerned about the question of whether everything is fine with the health of their babies, what is the state of the support systems and organs of the child's body. In order to understand the level of muscle tone, it is important to have information about what changes may indicate a violation in the system.

• • If there is an uneven distribution of tone relative to the location of the body, there are signs of dystonia on the face.
  • The presence of one-sided tension in the baby's body against the background of relaxation of the other indicates that the baby has asymmetric disorders. This is additionally confirmed by the movements of the baby: turning in the direction of hypertonicity, the child bends to the other, while there is uneven skin folds on the buttocks and thighs.
  • Constriction, with the inability to completely relax even at the time of sleep, indicates that the baby has muscle strain (hypertonicity). If the baby initially holds his head after birth, his fingers on the arms and legs are twisted intricately among themselves, a severe form of the disease is on the face.
  • If the baby does not move properly, he looks lethargic, inactive, everything suggests that the baby is prone to a form of hypotension.

Decreased and increased muscle tone

Both increased and decreased muscle tone is a deviation from the norm and requires treatment of the disease. The cause of such deviations can be various diseases and malfunctions of the central nervous system.

Reduced tone can manifest itself against the background of atrophy of the musculoskeletal system, neonatal dystrophy, as a result of botulism, poliomyelitis, or congenital pathology (Guillain-Barré syndrome, myopathy). Usually, the appearance and development of hypotension is associated with various disorders of impulse transmission along nerve fibers.

Hypertonicity is a kind of marker of brain malfunction, which can manifest itself after head injuries, brain pathologies (generic, against the background of previous diseases, including infectious ones). The most common causes are meningitis, cerebral palsy, problems with the vascular system.

Hypertonicity (muscular hypertension)

Muscular hypertension is a type of lesion muscle tissue, in which they remain in good shape for a significant period of time. The physiology of the manifestation may differ depending on the factor that provoked muscle hypertension, but in general, this occurs against the background of a malfunction of the nervous system.

The changes that occur at the same time modify the organization of oxygen supply and create additional obstacles in the supply of muscles. Lack of oxygen and poor blood supply contributes to the accumulation of biochemical waste in the soft tissues.

Causes

If in children the main cause of the development of hypertonicity is a violation of the central nervous system, then in adults this manifestation can cause stress, nervous breakdowns, physical and moral exhaustion.

There can be several reasons for muscle strain in young children:

• • Parents have blood incompatibility.
  • Various complications suffered during the period of gestation.
  • Influence of the ecological environment.
  • Birth trauma.
  • genetic inheritance.

For adults, the following manifestations can become a factor that provokes the appearance of muscle hypertension:

• • Consequences of past injuries (stretching, muscle ruptures).
  • Overvoltage.
  • Reaction to a nervous breakdown, the consequences of prolonged emotional overstrain.

Symptoms

Signs by which it is possible to determine the development of muscle hypertension (hypertonicity) in a child will help to initially engage in medical procedures:

• • The child sleeps little, while he is restless.
  • When the baby lies, his head is thrown back, but his arms and legs are tucked in.
  • If you try to spread or spread the limbs of the baby, muscle resistance is felt, the child reacts negatively to the ongoing procedure.
  • When walking, the baby does not stand on a full foot, but tries to continue moving on tiptoe.
  • The child spits up more often than is normal for physiology.
  • When stroking the child's neck, muscle tension is felt.
  • The child often cries, while his head is in a thrown back position, and his chin trembles convulsively.

To determine the degree of muscle damage by hypertonicity, experts test the behavior of the baby.

• • Having planted the child, they try to spread the baby's arms to the side.
  • When holding the child upright, he tries to take a step.
  • When installing the baby on the legs, he tries to hold the desired position, stretching out on his fingers.
  • Preservation of symmetrical and asymmetric reactions, in which the work of the muscle group of one of the sides is observed (turning the head, the baby compresses those limbs where the neck turns) for more than 3 months.
  • Preservation of the tonic reflex (the limbs constantly remain tucked up in the prone position) for more than 3 months after the birth of the baby.

In adults, the symptoms of hypertonicity are expressed in the contraction of the muscle group of one of the parties. When moving or changing the position of the posture, there is a pain syndrome, and a fossil is felt on the affected areas of the muscles, a change in the color of the skin (blue) is visually observed. Additional symptoms of the disease are:

• • Temporary stiffness in the muscles reduces motor functions.
  • Permanent stiffness completely blocking the musculoskeletal system.
  • Spasms.

Consequences

With the pathology of hypertonicity in the areas of brain tissue responsible for the state of the muscular system, negative changes occur in the form of death. This can provoke the development of perinatal encephalopathy, the appearance of intracranial pressure and other negative reactions, which can subsequently be reflected in the form of:

• • Violations of the functionality of coordination of movement.
  • become the reason for correct posture and form an abnormal gait.
  • They inhibit the development of the musculoskeletal system.
  • Slow down speech work.

Hypotension (muscle hypotension)

The weakening of muscle tone occurs against the background of a condition in which all movements are difficult. The reasons for the development of hypotension in adults and children may differ, and when diagnosing the disease, specialists are guided by the symptoms of manifestations. The manifestation of muscle hypotension at the earliest development of the disease can most seriously affect the condition of the baby in the future. Neonatal dystonia and atrophy of the musculoskeletal fibers is the factor that provokes the development of the disease.

Causal diseases

In newborns, the main causes of the development of muscle hypotension syndrome are congenital diseases. The list of genetic diseases that can affect the health of the baby in the form of hypotension includes:

• • Aicardi syndrome. One of those rare manifestations when the etiology of epileptic seizures defies full explanation.
  • Down Syndrome. Pathology of the genome, expressed in a change in the number of chromosomes.
  • Syndrome Opitz - Caveggia. When the disease occurs, abnormal changes in the muscular system occur.
  • Robinov's syndrome. Congenital changes in the skeletal and muscular system: wide bridge of the nose, large forehead, etc.
  • Grizzelli Syndrome.
  • Marfan syndrome. A hereditary disease in which all the tubular bones of the skylent are elongated.
  • Rett syndrome. Congenital neuropsychiatric disease.

The listed diseases are only the main part of those modifications that occur due to hereditary genetics or as a result of the effects of other past diseases. Some of them debut throughout their lives:

• • Leukodystrophy.
  • Muscular or spinal dystrophy.
  • Hypervitaminosis.
  • Dystrophy.
  • Myasthenia.

signs

Muscular hypotension is diagnosed by the following signs:

• • Visually distinguishable signs of lethargy, which appear both in a mild form and in complete atony. When bending, passive resistance is felt, the muscular system is flabby to the touch.
  • Partial or complete absence of reflexes, movements are inactive, the tendon reflex is increased. The child cannot hold the desired position of the body, does not crawl, does not try to roll over.
  • Difficulties with feeding, which provoke the throwing of the stomach into the esophagus.
  • Work failures respiratory system(with cerebral hypotension).

It is also possible the presence of convulsions, developmental retardation, discomfort, rhythmic and rapid movement of the feet.

Possible consequences

Although hypotension does not pose a particular danger, if the manifestation is not treated later on, it can have a number of consequences:

• • Weakened quality of the speech apparatus.
  • Weak (poorly developed) muscular system.
  • Violation of the swallowing reflex.
  • Joint problems (frequent dislocations).
  • Insufficient reflex level.
  • Problems with sound pronunciation.
  • Chronic diseases of the respiratory tract.

At what period do children have a problem with muscle development?

Problems with the muscular system in different age periods of development of children.

• • Immediately after birth. Hypotension is diagnosed using a complex of reflexes. The reason for the manifestation is the negative consequences for the period of gestation.
  • From 3 months to six months. The manifestation is diagnosed by secondary signs and reflexes, which become more stable by this period.
  • From 3 years to 7. The reason may appear against the background of past infectious diseases that modify the work of the central nervous system.

The main directions of treatment

Any violations of the muscular system require correction and treatment, in order for the problem to normalize in the future, medicine uses three main areas of medical procedures: massage, exercise therapy, swimming. Physiotherapy is prescribed in combination with any of the other types, in especially difficult cases, experts recommend drug treatment, which includes a number of vitamins and other medicinal substances.

Swimming and gymnastics with reduced muscle tone

Treatment of low tone involves the use of a set of exercises and swimming. For children, both types are allowed almost from birth. All classes can be conducted by parents, but they must first pass short course training, which will help to correctly apply exercise therapy. Therapeutic Physical Culture help to normalize low muscle tone.

Swimming lessons are conducted under the supervision of a specialist.

All types of exercises are performed smoothly, while it is necessary to adhere to a certain rhythm.

• • Hand movement. Hands smoothly rise from the bottom up and also smoothly fall. The palms of the hands are alternately placed on the child's head, making sure that the palm is straightened at the moment of application, and at the moment of lowering it is compressed into a fist.
  • Leg movements. The legs are smoothly squeezed at the knees and straightened.
  • Squat. The child is helped to perform the exercise if necessary.
  • Rolling from stomach to back and vice versa.

Older children and adults physical therapy classes you can use various gymnastic objects: ball, gymnastic stick, hoop.

Vascular tone and regulatory mechanisms

From the point of view of physiology, vascular tone is nothing more than the tension of the smooth muscles of the vascular walls and maintaining it at the proper level (in accordance with the requirements of external and internal conditions).

The tone of the blood vessels is in fact an extremely important indicator of the body's adaptive reactions to constantly changing internal conditions, as well as environmental conditions. Regulates vascular tone by the body itself ( autoregulation).

Autoregulation happens:

• • Myogenic, dependent on the state of the smooth muscles of the vascular wall;
  • metabolic, which provides fluctuations in smooth muscle tone under the influence of substances that need metabolic reactions, that is, this option is realized due to factors that bring a vasoconstriction effect (lack of oxygen - hypoxia, an increase in the level of carbon dioxide in the blood - hypercapnia, a change in the plasma level of some biologically active substances). Metabolic autoregulation is most characteristic of the vessels of the heart, brain, lungs - here it is able to withstand the narrowing effect of the central nervous system.

It should be noted that the smooth muscle layer in the arteries, veins and capillaries is unevenly expressed:

1. 1. Arteries are the richest in smooth muscle fibers, so their walls take the main care of maintaining the required diameter of the vessel and maintaining resistance to blood pressure;
   2. Venous vessels are not supplied with such developed smooth muscles, their layer is thin, not having the ability to hold the resistance of moving blood;
   3. As for the capillaries, there are no smooth muscle fibers at all, so they change their lumen, focusing more on external influences.

In order for the processes of regulation of vascular tone to go on constantly and efficiently, the body has special mechanisms:

• • Local- they are called so because they are realized on the spot, at the level of the vascular walls, which themselves act as a gland and produce BAS (biologically active substances) that have the ability to respond to changes blood pressure, mechanical irritation or the presence of medications by acting on the smooth muscle layers of blood vessels, causing the latter to relax or contract;
  • Humoral work due to a number of hormones that have a narrowing (vasopressin, thyroxine, renin), expanding (atriopeptides) or both (adrenaline);
  • nervous mechanisms can carry out their activities as a vasodilator and vasoconstrictor. The regulation of vascular tone here is provided by both sections of the autonomic nervous system - the parasympathetic one, in its area of ​​​​responsibility lies a direct expanding effect, and the sympathetic one, which can act in one or the other direction.

Figure - mechanisms of vasoconstriction (vasoconstriction):

Figure - mechanisms of vasodilation (vasodilation):

Obviously, when they say that vascular tone is increased, they first of all mean arteries, because they take on the main burden of containing blood moving under pressure, they “know how to respond” to the effects of various stimuli by changing their diameter. A venous vessel, and, moreover, a capillary one, does not possess such unique abilities.

Violation of the regulation of vascular tone forms a number of pathological changes in the work of the cardiovascular system, which, as a rule, begin with jumps in blood pressure.

Video: lecture on the regulation of vascular tone

Why does vascular tone change?

The reasons causing violation of vascular tone can be very diverse and, at first glance, not directly related to vascular activity. However, nothing happens in the body in isolation, any adverse external influence can cause the heart to beat frequently and the blood vessels to strain. That is why it is not surprising that a strong wave or a change in the climate zone (with a different atmospheric pressure) can significantly affect the tone of the vascular wall. It is hardly possible to list all the reasons for the increase or decrease in vascular tone, but we will try to highlight the most basic ones, are:

1. 1. Hereditary factor (features of the autonomic nervous system, vascular structure, human character);
   2. Social environment, psycho-emotional environment (relationships in the family, in the team, starting with children);
   3. History of the gestational period and childbirth (intrauterine hypoxia can subsequently cause the development of NCD and changes in vascular tone);
   4. Infections (including and especially - neuroinfections);
   5. Intoxication with any poisons (alcohol, drugs, salts of heavy metals, carbon monoxide, etc.);
   6. Strong emotional upheavals, chronic stress;
   7. TBI (traumatic brain injury) and other physical damage;
   8. Violation of metabolic processes: lipid, leading to the development of atherosclerosis, carbohydrate, forming diabetes mellitus;
   9. Hormonal disorders of any kind;
   10. Overweight;
   11. Sedentary lifestyle;
   12. Change of place of residence to far from the usual climatic conditions.

These factors trigger the mechanism of changes in vascular tone and contribute to the development of such pathological conditions as:

• Dystonia neurocirculatory (NCD) or vegetative-vascular (VVD);
• Angioneurosis;
• Arterial hypertension;
• Atherosclerosis;
• Diabetes.

Although, on the other hand, in any of the listed conditions, the tone of the blood vessels will be disturbed, which, to a greater or lesser extent, will cause suffering cardiovascular system. For example, arterial hypertension or TBI (peripheral vascular tone is increased) can cause a decrease in the tone of cerebral vessels (veins) and, as a result, the development of primary venous dystonia of the GM (cases when the venous outflow from the GM is impaired is considered a secondary form of the disease). That's how difficult it is to figure out where the cause is and where the effect is ... A vicious circle.

Blood pressure - hypertension and hypotension

An increase in vascular tone leads to a decrease in the diameter of arteries, veins and capillaries. The narrowing of the lumen of the peripheral vessels entails an excessive load on the heart muscle, an increase in blood pressure (BP), and a deterioration in tissue nutrition due to a decrease in blood flow in the organs.

Very important (and first) indicators of blood vessel tone include systolic blood pressure (normal 110 - 130 mm Hg, daily fluctuations - 30 mm Hg), the values ​​of which, in turn, are determined by:

1. 1. Stroke volume of the left ventricle (LV);
   2. The highest rate of expulsion of blood from the left ventricle;
   3. The ability of the aorta to expand.

As for diastolic blood pressure (normal 60 - 90 mm Hg, daily fluctuations - 10 mm Hg), then its level is largely determined by:

• BCC (volume of circulating blood);
• The tone of the arterial vessels of the muscular type.

The stroke volume of the left ventricle for the formation of diastolic blood pressure does not have such an important role.

In addition, the tone of individual blood vessels can be judged by such a concept as "pulse pressure" - it refers to the difference between blood pressure values ​​in systole and diastole. And, if the lower limit of blood pressure is shifted upwards, for example, the tonometer shows values ​​​​of 130/110 mm. rt. Art. (isolated diastolic pressure), then we can talk about diastolic arterial hypertension, which is also by no means harmless. A constantly tense heart in such a situation suffers serious suffering, the tone of the blood vessels is increased, their walls lose their ability to adapt, and this leads to the formation of blood clots and changes in the myocardium.

A decrease in vascular tone is said if the first beat is fixed at 90 or lower, and the last one falls below 60 mm. rt. Art. This is hypotension or hypotension. Its cause is often the failure of autonomic nervous activity, which is required to participate in the regulation of vascular tone. In such cases, the blood flows slowly through the peripheral vessels, it cannot reach the vessels of the head in a timely manner and in full in order to provide nutrition to the brain. Very often, the activity of the ANS and the tone of the blood vessels do not keep pace with the growth of the body in adolescents. A decrease in vascular tone in children with or without NCD often has syncope in clinical manifestations, so orthostatic collapse in adolescents is not considered such a rare occurrence.

Migraine

A striking example of a violation of the tone of cerebral vessels is the "disease of aristocrats" - migraine. Wild headaches that occur periodically and knock a person out of the normal rhythm of life are caused by irritation of pain receptors that are present in the walls of the vessels of the head, which provide nutrition to various brain structures.

Violation of the regulation of vascular tone and simultaneous irritation of pain receptors and leads to headache. We can say that at such a moment the following happens: the heart contracts, in sick people the vessels of the head expand sharply, in order to then also quickly reduce their diameter. When the tone is increased, the vessels stretch unnecessarily, such vibrations affect the nerve endings, “distress signals” go to the central nervous system and the cortex responds with excruciating throbbing pain (migraine attack).

In healthy people, these reactions do not go so rapidly, the tone of the cerebral vessels is restored smoothly, the nerve endings are not excited, everything goes painlessly.

Meanwhile, the body's defenses do not remain aloof from ongoing events, otherwise migraine pain would never be stopped. As soon as the central nervous system has received a signal about a change in vascular tone, they immediately begin to mobilize the defense forces - they immediately make an attempt to normalize the situation as quickly as possible. Substances are released into the blood, the range of functional duties of which includes:

1. 1. Regulation of vascular tone;
   2. Strengthening the vascular wall:
   3. Increased activity of enzymes that are involved in the elimination of the consequences of the "accident", destroying the products of disturbed metabolism

It should be noted: the sooner the body notices problems in vascular tone, the more active the defense processes go, the less time the patient's head will suffer from unbearable pain, the faster the migraine attack will disappear.

Content

Parents may sometimes notice that their children have physical development slightly behind the norm, there is a weak muscle tone. These symptoms cannot be ignored because they indicate health problems that need to be treated in time. As a rule, with such manifestations, SMD is diagnosed - muscular dystonia.

What is muscular dystonia

The word "dystonia" is of Latin origin. It translates as "violation of tone." Doctors under the term "muscular dystonia" understand a disease that affects the muscles of the baby or an adult. Deviations can be observed not only in the direction of a decrease (hypotonicity), but also an increase (hypertonicity). Muscles can be affected on one side or symmetrically on both sides. As a rule, the lower extremities are more prone to hypertonicity, and the arms are more likely to suffer from hypotonicity. The disease according to the ICD has the code G24.

Causes

Muscular dystonia syndrome is more common in infants, develops in most cases due to perinatal encephalopathy or standard brain damage during childbirth. Only in some cases does this occur even during fetal development. The baby can get such damage for the following reasons:

• detachment of the placenta;
• prolonged toxicosis of a pregnant woman;
• polyhydramnios during pregnancy;
• chronic fetal hypoxia;
• the threat of miscarriage of any nature;
• alcohol, nicotine intoxication during gestation;
• long waterless period;
• impact on the expectant mother of harmful factors;
• too rapid / protracted childbirth;
• caesarean section under general anesthesia;
• profuse blood loss during childbirth;
• entanglement of the umbilical cord inside the womb of the baby.

At the baby

In very young children, dystonic syndrome has pronounced symptoms from the very first days of life. Reduced muscle tone is easier for the baby and parents to tolerate: the child sleeps more, rarely cries. However, the baby noticeably later masters holding the head, turning over and other motor skills. The disease is accompanied by hypertonicity with the following symptoms:

• trembling of the chin;
• frequent crying;
• sleep disturbance;
• frequent regurgitation;
• anxiety.

In children and adolescents

The presence of muscular dystonia syndrome in older children (over 2 years old) indicates disorders in the functioning of the nervous system. This reason becomes a provoking factor, affects the functioning, muscle tone. With the timely detection of the disease, the prescribed treatment will be more effective. Muscle dystonia must be diagnosed by a pediatrician and a neurologist.

In adults

A decrease in muscle tone in adults occurs due to a malfunction in the functioning of neural connections within the basal ganglia. They are located deep in the brain, are responsible for controlling any movement, maintaining correct posture. An acquired increase or decrease in muscle tone in an adult can manifest itself for the following reasons:

• brain tumor;
• stroke;
• cerebral paralysis;
• brain injury;
• infection;
• chorea of ​​Huntington;
• lead poisoning;
• oxygen starvation;
• Wilson-Konovalov disease;
• drug treatment;
• encephalitis.

Primary (idiopathic) dystonia in most cases is transmitted from parents. The manifestations of the disease can vary widely among members of the same family. The disorder can manifest itself when performing some specific tasks, for example, writing by hand. Deterioration of the condition can occur when taking medications from certain groups of drugs. Doctors say that this disease does not affect cognitive abilities (communication skills, memory).

Types of disease and their symptoms

As the main diagnosis, hypertension or hypotonia of the muscles can be made in infancy. In adults, it manifests itself more often at the age of 40-60 years. Adolescents are much less likely to experience such a disease. Doctors divide this disease into two types:

1. Primary - manifests itself against the background of a genetic predisposition. It is diagnosed when other diseases, neurological damage are not capable of causing this syndrome.
2. Secondary SMD - a disorder occurs against the background of the underlying condition. In most cases, it is caused by neurological injuries, genetic damage that affects the nervous system.

The syndrome can have different degrees of manifestation. Specialists, based on the severity of symptoms, distinguish several stages of the condition in dystonic syndrome:

1. The first stage - it is characterized by a slight tension in the muscles, but the tone relatively quickly returns to normal.
2. The second is that the signs are more noticeable during movement, after some time and during rest.
3. The third is clearly noticeable physical disorders that occur due to prolonged muscle spasms (the foot, spine, cerebral palsy, torticollis are bent).

Muscle hypertonicity

Increased tone in this syndrome is characterized by excessive tension of the extensor, flexor muscles. Signs can be mild or pronounced, for example, the child only resists a little while changing clothes or does not give the opportunity to control his body at all. The main manifestations of hypertension in a child include:

• disturbing dream;
• tightly pressed legs, arms to the body;
• causeless crying;
• the head is thrown back;
• babies who have begun to walk move on their toes;
• disturbing dream;
• legs are strongly separated to the sides;
• movement resistance;
• attempts to roll over always only on one side;
• frequent vomiting.

Doctors say that there is no reason to panic when diagnosing muscle hypertension in infants. By six months, the syndrome, as a rule, disappears without a trace, the development of the child continues in the usual direction. Nevertheless, if you suspect muscular dystonia, you should definitely conduct an examination and seek advice from your doctor. You may need to undergo treatment.

Muscle hypotension

The reverse state of the above syndrome is muscular hypotension. Instead of increased activity, the child has lethargy, weakness on the part of this system. Often parents are glad that their baby is very calm, but it should be remembered that this may be a sign of dystonia that has begun. The main symptoms include:

• the baby does not hold his head well;
• lack of desire to move;
• sleeping too much;
• little crying, almost always calm;
• unable to hold anything in his hands.

How to treat impaired muscle tone

Treatment of SMD, as a rule, includes several directions at once and is complex. In infants, they first try to get by with only a general therapeutic massage, so as not to load the weak body with medicines. If the desired effect in eradicating the syndrome cannot be achieved, then the doctor's recommendations should not be abandoned. It is necessary to use all methods of treating this disease, which include:

• gymnastics;
• physiotherapy;
• baths;
• taking medications;
• special massage.

This syndrome is not a sentence, it responds well to treatment, especially in the early stages. If the course is successful, it is necessary to continue to be observed by a specialist for a long time in order to respond in time with the development of a relapse, the possible negative consequences of the disease. The main task of parents is to carefully monitor the behavior and condition of their child and contact a specialist in time if they suspect the development of muscular dystonia.

Video

The most difficult thing to determine muscular dystonia in young children who are not yet able to say anything. Important factor successful treatment of this syndrome is a timely appeal to a specialist, so it is important to understand how the disease manifests itself. The video below details the signs of SMD, methods of its treatment, gives the opinion of the famous pediatrician Komarovsky and an example of a simple massage for the disease.

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Muscle tone is essentially the degree of muscle elasticity and resistance that accompanies passive flexion or extension of the limbs. Muscle tone is due to various factors. First of all, it depends on the state of the muscles, peripheral nerve fibers and impulses. The ability of muscles to contract when overcoming a certain load is an important indicator of human health. It is absolutely normal that even in a relaxed state, the muscles are in some tension. As a result of diseases and damage to the nervous system, muscle tone can change. One or another type of violation leads to its decrease or increase. In accordance with this, hypo- and hypertonicity of the muscles are distinguished.

Increased muscle tone can be:

• spastic;
• rigid.

A distinctive feature of the spastic type is unevenness, selectivity. The cause of its occurrence are violations that affect the components of the pyramidal system. In this case, we are talking about a chain of neurons whose main task is to transmit motor commands addressed to skeletal muscles. Due to the fact that the central neuron in this system is damaged, spastic hypertonicity develops. Making movements of a passive nature occurs with difficulty, but this is characteristic of the very beginning of the action. In the future, these manipulations are performed quite easily. When making movements at a fast pace, such symptoms are more noticeable. Since there is damage in the motor center of the brain, the violation affects not one muscle, but their combination, for example, the flexor/extensor group of the feet. It is in this that the selective and uneven nature of this type of hypertonicity is manifested. Factors due to which it can occur are represented by strokes, brain injuries, various disorders of the nervous system, meningitis, sclerosis, hypoxia, phenylketonuria and other diseases.

Rigid increased muscle tone is also called plastic. It manifests itself if the extrapyramidal nervous system. This system includes brain structures and nerve pathways that are directly involved in both the regulation and control of motor manipulations. As a result of this, a motor reaction is organized when laughing or crying, a certain posture in space is maintained, and so on. A distinctive feature of the rigid variety is that the difficulty in performing passive motor manipulations is permanent, resulting in spasm of all muscles. The limbs freeze in the positions they were given. In some cases, a damaged pyramidal and extrapyramidal system can lead to a mixed type of hypertonicity. As a rule, the cause of this pathology are brain tumors.

Causes of increased muscle tone

Muscle hypertonicity in adults is not in all cases associated with pathology, a characteristic feature of which is the persistence of its increase. Sometimes it is associated with physiological causes:

1. Tired, tense muscles. Performing work for a long time period, the muscles lose energy, which leads to the freezing of the muscle fiber in a contracted state.
2. The duration of being in an uncomfortable or monotonous position. Since in such a situation the entire load is associated with a certain type of muscle, spasm occurs, as with overstrain. Very often, the appearance of such a spasm in the neck muscles is observed in people who have been sitting at the computer for a long time. Hypertonicity of the back muscles in adults is often found in those who work in the garden for a long time.
3. Protective response to pain. In this case, we are talking about the occurrence of pain syndrome, spastic hypertonicity as a kind of reaction, for example, damage to the spine leads to spasm of the corresponding muscles.
4. bruises, back pain. In the presence of pathologies of the spinal column, there is an increase in pain.

Muscle hypertonicity syndrome accompanies many different diseases. For example, it can be observed when:

• acute circulatory disorders of the brain, which leads to ischemic and hemorrhagic stroke;
• tumors of both the spinal cord and the brain;
• craniocerebral injuries;
• spastic form of torticollis;
• bruxism;
• dystonic syndrome;
• hepatic encephalopathy;
• infections of the central nervous system;
• multiple sclerosis.

If such a condition for an adult is a deviation, then for a newborn it is within the normal range. It has to do with the position of the baby in the womb. Prolonged intrauterine stay in the fetal position is accompanied by close contact of the limbs, chin and torso, which leads to muscle tension in the fetus. clenched fists, bent legs, tilting the head - all these are signs of hypertonicity of a monthly baby.

Preservation of muscle tension at the age of six months is a serious reason for contacting a qualified specialist.

Symptoms and treatment

Like any disease, muscle hypertonicity has its own symptoms. Increased muscle tone in adults is characterized by:

• tension, immobility;
• discomfort during movement;
• muscular stiffness;
• spontaneous active movements;
• increased tendon reflexes;
• a slow process of relaxation of muscles that have undergone spasm.

In addition, hypertension calf muscles in adults, it manifests itself as walking on "toes". This indicates the advanced nature of the disease with childhood. The occurrence of seizures is directly related to the tension of any muscle. With any mechanical impact, a person experiences severe pain. Hypertonicity of the muscles of the legs in adults as a result of prolonged stress leads to impaired blood circulation, the formation of painful seals.

Hypertonicity in newborns is characterized by:

• restless, short sleep;
• pretension of the upper and lower extremities;
• tilted back position of the head;
• resistance that accompanies attempts to breed the upper, lower limbs of the baby;
• painful response to various stimuli, such as light;
• frequent spitting up.

In the presence of the described signs of increased muscle tone, you should consult a doctor: a therapist or a neurologist. The rapid achievement of positive results of treatment is ensured by the timeliness of contacting a specialist. At the first stage of treatment, the underlying disease that provoked an increase in muscle tone is overcome. The second stage is corrective and aimed at facilitating therapy.

Muscle hypertonicity can be treated with:

1. relaxing massage;
2. physiotherapy exercises;
3. electrophoresis;
4. paraffin applications;
5. swimming;
6. drug treatment.

The main purpose of drug treatment is to minimize pain, normalize the functioning of the central nervous system. In each case, drug therapy may be associated with:

• relief of symptoms;
• reduction of spasmodic phenomena;
• facilitation of movement.

Similar goals are achieved with the use of muscle relaxants, neuroleptics.

Timely diagnosis of muscle hypertonicity, compliance with the treatment prescribed by the doctor, regular physical exercise will help to overcome the disease in short time and reduce the risk of possible complications.

Muscle tone - involuntary, constantly changing in intensity muscle tension, not accompanied by a motor effect. Muscle tone creates preparation for movement, provides resistance and elasticity of muscles. Maintain balance and posture. Muscle tone has 2 components - plastic and reflex. Plastic tone is muscle tension, its turgor, which is preserved under conditions of denervation. This term defines the tone of individual muscle cells, depending on the characteristics of their structure, the exchange of in-in, blood and lymph circulation, the content of comp. fabrics.

Reflex tone - reflex muscle tension caused by its stretching, i.e. stimulation of proprioreceptors. Muscle tone is influenced by the spinal reflex apparatus, afferent innervation, reticular formation, vestibular centers, cerebellum, red nucleus system, basal nuclei, etc. To judge the state of muscle tone, direct palpation of the muscles of segmental areas of the body is performed. However, the determining factor is the study of muscle tone through passive movements in the flexors and extensors, adductors and abductors. Hypotension and muscle atony occurs with peripheral paralysis or paresis (violation of the efferent section of the reflex arc when the nerve, root, cells of the anterior horn of the spinal cord are damaged), damage to the cerebellum, brain stem, corpus striatum and posterior cords of the spinal cord. Distinguish between spastic and plastic hypertension. Spast-th - increase. muscle tone in the flexors and pronators of the arm and in the extensor and adductors of the leg (with damage to the pyramidal tract). With spastic hypertension, during repeated movements of the limb, muscle tone does not change, and sometimes decreases, with plastic hypertension, muscle tone increases. With spastic hypertension, there is a symptom of a “penknife” (an obstacle to passive movement in the initial phase of the study), with plastic hypertension, a symptom of a “gear wheel” (feeling of tremors during the study of muscle tone in the limbs). Plastic hypertension is an increase in muscle tone, uniform in both flexors and extensors, in pronators and supinators.

2.7.Peripheral paralysis.

In periphral paralysis (PP), damage can involve the anterior horns, several anterior roots, and peripheral nerves. PP is characterized by: 1) hypotension and muscle atony. 2) hypo- and areflexia. 3) hypo- and muscle atrophy. 4) neurogenic muscular degeneration with the reaction of degeneration.

When the anterior horns are affected, the muscles innervated from this segment suffer. Often in atrophying muscles, rapid contractions of individual muscle fibers and their bundles are observed - fibrillar and fascicular twitches, due to irritation by the pathological process on dead neurons.

The defeat of the anterior roots gives the same picture. Damage to the plexus har-Xia periph with paralysis of one limb in combination with pain and anesthesia, as well as autonomic disorders in this limb. In case of damage to the periphery of the nerve, paralysis of the muscles of the inner nerves by this nerve is observed, in combination with sensory disturbances. Damage to many peripheral nerves leads to widespread sensory, motor and vegetative disorders, most often bilateral, mainly in the distal segments of the extremities. Patients complain of paresthesia and pain. Disturbances in the type of "socks" or "gloves", flaccid paralysis of muscles with atrophy, trophic disorders on the skin are revealed.