Motor exploration in the child.

Motor Exploration in the Child

Motor examination is essential in the neurological evaluation of children. It adapts to motor development according to age and allows early alterations to be identified to guide early intervention.

Inspection and Posture

• Observe spontaneous posture: frog posture suggests spastic myelopathy; Rigid extension may indicate cystic ataxia.
• Deformities such as genu valgus or varus can indicate nutritional deficiency or osteopathy.

Muscle Tone

• Active tone: evaluates straightening and traction reactions. High tone → spasticity; low tone → weakness.
• Passive tone: passive mobilization. Differentiates spastic rigidity (fluctuating resistance) from contracture rigidity (constant resistance).

Stretch Reflexes

• Patellar reflex: hyperreflexia suggests injury to the corticospinal pathway (pyramidalism).
• Clonus (persistent reflex after stimulus): sign of spinal cord injury.
• Bicipital and Achilles reflexes: they should be evaluated for asymmetry or hyporeflexia.

Segmental Force and March

• Evaluation of spontaneous walking, jumping and climbing stairs.
• Positive Gowers sign: the child relies on his legs to get up → weakness in the pelvic girdle (e.g. in neuromuscular diseases such as muscular dystrophy).

Clinical Instruments and Evidence

• The Dubowitz neonatal neurological examination It is a useful standardized tool for early screening (Wusthoff, 2013).
• The evaluation of ideal motor patterns (Vojta) provides basis for diagnosis and therapy, especially in the first months (Vojta & Schweizer).
• The early prediction of neuromotor disorders is more accurate with a combination of:
  
  • Development achievements (milestones).
  • Complete neurological examination.
  • Quality assessment of motor behavior.
• Instruments with standardized scoring and observation of motor patterns show better predictive validity for major and minor disorders (Heineman & Hadders-Algra, 2008).