Nik - 7 years
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Nik was born on September 27, 2010 one month prematurely. He suffered brain haemorrhage due to difficulties during childbirth. As a consequence, he is diagnosed with hydrocephalus with inserted VP drainage.

He has had difficulty in overall development since his birth. All the time, motor developmental delay was present, mainly as a result of decreased muscle tone. At the age of 3 years, Nik was diagnosed with cerebral palsy - a mixed form. Nick was able to sit alone at that time. He could actively move to a sitting position from his sides, move on all four limbs with an appropriate dissociation of the movements in the shoulder ring. From the high kneeling, he managed to raise himself to the standing position. He could stand by holding to a firm object and was able to move on his feet with help.
In spite of the extremely small possibilities for walking independently, at the age of 4 years and 8 months he independently walked, but he needed constant control, because he was falling uncontrollably on an uneven ground. A large number of neurophysiotherapy treatments and a lot of parents' involvement in continuing training in home environment were required, as it was not possible to challenge his balance reflexes. He also had major problems with the asymmetry of the body. Centrally his tone was somewhat lower, which resulted in a increased tone distal, that is, in his feet. When Nik walked it was initially very rigid and wide-spread, on the basis of lateral interception without any apparent rotations and dissociation of the pelvis.

Nik's feet were in a prominent planovalgus position with a twisted pawn and a load almost exclusively on the first third of the foot, so that his heel was not carrying any body weight and was very narrow in shape. Somehow more pronounced on the right foot than the left. As a consequence, he had dificulties to squat and intercept by unvanted movements. The center of the body was shifted forwards. The steps were very short and as a consiquence he wasable to walk only a short distance. It was seen on the expression of the face that he was constantly a little afraid of falling.

At the age of 5 years and 10 months, he managed to walk longer distances an was able to walk up and down the hill independently. In the event of a fall, he has already mangaed to "fall on his bottom." The walk was still wide-spread. There was poor leveling of the head, and the shoulders were closed inwards. He was walking leaned forward with poor dissociation of movements in the pelvis and poor weight distribution. Medialally he load the right foot more than the left. He was able to squat very slowly and did not complete it fully.

At the age of 6 years, he started using ankle foot orthoses.

After 4 months of using the ankle ankle foot orthoses, Nik extended the step, walking became faster and more sovereign. Rotations started. The expression of fear on the face disappeared and the boy became more stable and brave day by day. His balance and reflexes improved. Uncontrolled falls were gone. Nik can use his ankle foot orthoses in his footwear in regular size, thus shifting it from shoe to shoe. During wearing it did not cause any otters or blisters, even though Nik use them for at least 4 hours a day.

After 8 months of use, the foot began to change slightly, indicating the formation of longitudinal arch and there was more weight on the heel. Nik walked even longer distances (even up to 2 hours of walking). Ascents and descents along the hill did not pose any problem.

After 11 months of use, he could begin to individually descend to the ground and stand alone from the ground, because today there are several correnct movements present in the ankle and more load is spread on his heels. This transition, however, is carried out quite cautiously and slowly, with some stimulation, but he can do it, which is a great success for us and for him.
It is noticed that the heels slowly acquire a different form due to the correct load distribution.

During the course of wearing the ankle foot othoses, due to the increased stability and more accurate distribution of the weight on the foot during the walk, the balance and intercepting reactions were significantly improved, which were actively activated during the fall. The upper body moved slightly back. His weight distribution is now much better and can keep his weight longer on one foot, so the walking steps have also improved.

After 13 months of use, Nik is completely independent when walking indoors and outdoors, even in uneven terrain. In the event of a fall, appropriate pre-emptive reactions are activated, without help it is already passed into the "bear position" and with a little help he can stand up by himself. The foot and the heel are still gaining a more correct shape. He can walk up and down the stairs independently while holding on the sides.
Date: 8.3.2018
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