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Toddler's temperament, motor development and the challenge to develop a reliable age applicable ataxia rating scale

Published:August 17, 2022DOI:https://doi.org/10.1016/j.ejpn.2022.08.003
      Neurological examination of 2 and 3 year old children may be a challenge, even for skilled paediatric neurologists. They often are not very cooperative because of anxiety for the examiner, hospital surroundings, not understanding instructions, or being just easily distracted and stop cooperating. Observation of the child's performance across the room or when playing with the child is an important part of the examination and sometimes the only alternative for a formal neurological examination. The additional challenge is that there is a wide biological variation in attaining development milestones. For example, typically developing children may start walking independently at any given time between 8 and 18 months and sometimes even later in bottom shufflers [
      • Hataaja L.
      • Belmonti V.
      • Cioni G.
      The neonatal examination and neurodevelopmental assessment.
      ]. Initially, gait is broad based, arms are raised above shoulder height and the child corrects imbalance by little side steps. When getting more experience, gait becomes narrower and the side steps and tendency to fall gradually diminishes [
      • Hataaja L.
      • Belmonti V.
      • Cioni G.
      The neonatal examination and neurodevelopmental assessment.
      ]. This physiologically immature motor behaviour matches the official score criteria for ataxia [
      • Brandsma R.
      • Spits A.H.
      • Kuiper M.J.
      • Lunsing R.J.
      • Burger H.
      • Kremer H.P.
      • et al.
      Ataxia rating scales are age-dependent in healthy children.
      ].
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