The child starts to walk late

Infants usually start walking around the age of about a year. If this does not happen and by 18 months, ask yourself two questions: is the physical development of the child normal? Is there a backlog in the development of the child and in other areas?

First of all, think about the possibility of Duchenne's muscular atrophy, so that you can seek genetic counseling before the next pregnancy.

Cerebral paralysis

This disease, accompanied by motor disorders, caused by non-progressive brain damage. Signs of cerebral palsy manifest, as a rule, after the child reaches the age of 2 years.

[1], [2], [3], [4]

Factors contributing to the development of this disease

Prenatal:

• bleeding before the onset of labor (with hypoxia);
• X-ray irradiation;
• cytomegalovirus infection, rubella;
• toxoplasmosis;
• "Rhesus disease",

Perinatal:

• birth injury;
• fetal distress (fetal distress);
• hypoglycemia;
• hyperbilirubinemia;
• unsuccessful resuscitation measures.

Postnatal:

• injury;
• hemorrhage in the ventricle of the brain;
• meningoencephalitis;
• the formation of thrombi in the brain veins (as a result of dehydration).

[5], [6], [7],

Clinical picture:

• paralysis;
• muscle weakness and ataxia;
• belated development;
• propensity to convulsions;
• hearing and speech disorders.

Increased muscle spasticity involves pyramidal disorder; uncoordinated involuntary movements and postures (dystonia) can talk about involvement of the basal ganglia in the pathological process, ataxia indicates the defeat of the cerebellum. Most children observe either hemiparesis or spastic diplegia: for example, the lower extremities are more affected than the upper ones, while the child looks normal until it is lifted from the crib and it is not found that the legs occupy the position of the "cutting scissors" ( they are bent in the hip joint, are shown and rotated inwards with the knees and feet extended in the plantar flexion). There are such children, widely spreading their legs.

Type I atactic paralysis ("pure ataxia"):

• hypotension ("the infant is passively hanging on the hands of the parent");
• other neurological defects are rare;
• the flexors of the sole are paralyzed;
• concomitant pathology; deafness, strabismus, delayed mental development (convulsive seizures are rare);
• basically the child develops normally.

Type II - atactic diplegia:

• muscular hypertension;
• often there are other neurological defects;
• extensors of the sole are paralyzed;
• concomitant pathology: trauma, hydrocephalus, spina bifida, viral infections.

Dyskinetic cerebral palsy :

Characterized by involuntary movements, severe violations of fluidity of movements, discoordination of agonists / antagonists, weakened control over the position of the body, hypotension, hearing loss, dysarthria, difficulty with fixation of the look. Convulsive seizures and slowing mental development are uncharacteristic.

[8], [9], [10]

Epidemiology:

• in 1/3 of such children, insufficient body weight at birth is noted;
• 1/3 - visual defects;
• 1/3 - slow mental development;
• in 1/3 there is a spontaneous improvement after some time;
• in 1/6 of these patients, subsequently live a normal life.

[11], [12], [13], [14], [15]

Functional assessment of the child's condition

Can a child roll in both directions? Can he sit in bed without help? Grab something? Move any thing from one hand to another? Can I directly hold the head? Can you move your body, lying on your back in a crib and leaning on your elbows? What is his intelligence factor?

Treatment

Any manifestation of epilepsy should be treated. It is necessary to use various orthopedic adaptations for the prevention of deformities of the lower extremities (for example, equinovarus, equinovalual, hip dislocation in the hip joint). Careful attempts to demonstrate the advantage of some physiotherapy procedures aimed at stimulating the development of nerve functions (for example, improving the balance, maintaining the rectified state) were no more effective than simply stimulating motor activity. Some parents are negative about the not-so-widespread in the UK multidisciplinary "teams" helping such children ("the teams" put parents in a funny position and fetter their activity) in favor of the Hungarian approach (Peto), when one person completely devotes himself to a sick child and uses his interaction with peers to strengthen achievements and successes in all areas - manipulation, arts, writing, working out subtle movements, in social contacts.