The child is late to start walking

Babies usually start walking around the age of one. If this hasn't happened by 18 months, ask yourself two questions: Is your child's physical development normal? Are there any developmental delays in your child in other areas?

Consider the possibility of Duchenne muscular atrophy first and seek genetic counseling before becoming pregnant again.

Cerebral palsy

This is a disease accompanied by movement disorders caused by non-progressive damage to the brain. Signs of cerebral palsy usually appear after the child reaches 2 years of age.

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Factors contributing to the development of this disease

Prenatal:

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

Perinatal:

• birth trauma;
• fetal distress;
• hypoglycemia;
• hyperbilirubinemia;
• unsuccessful resuscitation efforts.

Postnatal:

• injury;
• cerebral ventricular hemorrhage;
• meningoencephalitis;
• formation of blood clots in the cerebral veins (as a result of dehydration).

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Clinical picture:

• paralysis;
• muscle weakness and ataxia;
• delayed development;
• tendency to convulsions;
• hearing and speech disorders.

Increased muscle spasticity suggests a pyramidal disorder; uncoordinated involuntary movements and postures (dystonia) may indicate involvement of the basal ganglia, ataxia indicates cerebellar involvement. Most children have either hemiparesis or spastic diplegia: for example, the lower limbs are more severely affected than the upper, but the child appears normal until he is lifted from the crib and it is discovered that his legs are in a "cutting scissors" position (they are bent at the hip joint, adducted and rotated inward with the knees extended and the feet in plantar flexion). Such children walk with their legs wide apart.

Type I ataxic paralysis ("pure ataxia"):

• hypotonia ("a baby hanging passively in the arms of a parent");
• other neurological defects are rare;
• plantar flexors are paralyzed;
• concomitant pathology; deafness, strabismus, mental retardation (seizures are rare);
• Basically, the child develops normally.

Type II - ataxic diplegia:

• muscular hypertension;
• Other neurological defects are also common;
• the extensors of the plantar fascia are paralyzed;
• concomitant pathology: trauma, hydrocephalus, spina bifida, viral infections.

Dyskinetic cerebral palsy:

Characterized by involuntary movements, sudden disturbances in smoothness of movements, agonist/antagonist discoordination, weakened control over body position, hypotonia, hearing loss, dysarthria, difficulty with fixation of gaze. Convulsions and mental retardation are uncommon.

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Epidemiology:

• 1/3 of such children have low birth weight;
• 1/3 have visual defects;
• 1/3 have retarded mental development;
• 1/3 experience spontaneous improvement after some time;
• 1/6 of such patients subsequently live a normal life.

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Functional assessment of the child's condition

Can the baby roll over from one side to the other? Can he sit up in the crib without help? Grasp something? Move something from one hand to the other? Can he hold his head upright? Can he move his body while lying on his back in the crib, using his elbows as support? What is his IQ?

Treatment

Any manifestations of epilepsy should be treated. Various orthopedic devices should be used to prevent lower limb deformities (e.g. equinovarus, equinovalgus, hip dislocation). Cautious attempts to demonstrate the benefits of some physiotherapeutic procedures aimed at stimulating the development of nervous functions (e.g. improving balance, maintaining an upright position) have proven no more effective than simple stimulation of motor activity. Some parents have a negative attitude towards the multidisciplinary "teams" of helping such children, which are not very widespread in the UK ("these teams" put parents in a ridiculous position and constrain their activity) in favor of the Hungarian approach (Peto), when one person completely devotes himself to the sick child and uses his interaction with peers to enhance achievements and successes in all areas - manipulation, art, writing, practicing fine movements, in social contacts.