Cerebral movement disorder

Symptoms of risk are clinical signs of deviation from normal motor development resulting from damage to the central nervous system.
If symptoms of risk exist, this means that the child has sustained damage regardless of whether or not her medical history includes any risk factors. Whether or not she will have long-term consequences is another story, which we will come to a bit later.

You, as a parent, should be worried if:

• your child’s development lags more than three months behind what is expected
• your child is stiff, or it is difficult to bend her arms or legs (increased muscle tone)
• your child is flaccid (as if she were “made of butter”) and very calm, (decreased muscle tone)
• your child has tightly closed fists
• your child is over two months old and keeps her thumbs tucked inside her fists
• your child doesn’t stand on her whole foot when you lean her foot against a hard surface
• your child has differences in the movements of one side of her body in comparison with the other (very young children are neither left- nor right-handed)
• your child throws back her head and arches her body. She can do this also while lying on a surface or while she is being held in your arms
• your child throws her head back when she rolls over, or rolls over en bloc (i.e. with her whole body, without swinging her arms or legs or either her arms or legs)
• your child crosses her legs while lying on her back
• your child makes “worm-like” movements with her arms and legs; i.e. “unnatural” movements (athetoid movements)

If you, as a parent, notice any of these symptoms you should make them known to your paediatrician. An assessment of such a child’s development should be made in order to determine how much she deviates from normal development and if necessary therapy should be begun.

Cerebral movement disorder is diagnosed to a child in whom these symptoms of risk are observed. During this period the clinical picture is not yet definitive. This term is taken from the German school of development according to V. Vojta. Other equivalent terms include syndroma dystoni, high-risk or neuro-risk child.

The type of cerebral movement disorder is always indicated in parentheses because there are a number of different types, as follows:

• tetraparetic – the symptoms of risk are present in all four extremities (in both arms and legs)
• hemiparetic – the symptoms of risk are present in the arm and leg on one side of the body
• paraparetic – the symptoms of risk are present only in the arms or only in the legs and this is specified. (The pattern with symptoms of risk present only in the arms is a rare form, while the pattern with only legs is quite common)
• syndroma dystoni – the symptoms of risk that are prevalent are dystonic behaviours such as body arching, throwing the head back etc.
• the athetoid form – visible “worm-like” movements of the arms and legs are present (athetoid movements and positions)

It is very important to stress that cerebral movement disorder should under no circumstances be confused with cerebral palsy.

There are a number of possible outcomes of cerebral movement disorder, including the following:

1. the normalisation of development,
2. the retainment of minor motor disorders (“a clumsy child”, frequent falls, posture, fine motor skills, and balance disorders, etc.),
3. cerebral palsy, which can vary from very mild cerebral palsy, which borders on a minor motor disorder, to very severe cerebral palsy, which leads to complete dependence for all activities.

Cerebral palsy is the least common and least desired outcome but it is a possible outcome of cerebral movement disorder.

The outcome of cerebral movement disorders (the prognosis),depends on a number of factors including the following:

• the severity of the clinical picture (the greater the deviation from normal development, the worse the prognosis). It must be pointed out here that the severity of the clinical picture does not always have to correspond to the damage visible on ultrasound, although it often does.
• the point in time when therapy was begun (the earlier that therapy is begun, the better the prognosis)
• the quality of therapy (This topic can lead to great debates, but in any case good quality therapy has a better chance of achieving a positive outcome). We would advise parents to allow only specialists who deal exclusively with cerebral movement disorders to treat their children.
• luck. This factor can not be excluded and it actually includes all those things that can affect the outcome, but are unknown.

Parents should know that no serious expert will give a prognosis for a particular child. Prognoses are always given for a group of children with similar problems. That means that for a particular group of children the percentage that develop normally is, for example, 50%. But that also means that for a particular child it is not known which group he will fall into – the half that develop normally, or the other half.