Question: Hi, I have a question for my nephew who is 4 year old. He had brain bleeding during his birth, as a consequence he is diagnosed with hemiparesis, his left (arm & leg) side is weaker. As a baby his parents followed doctor's advice in Bobath therapy for babies. When he was 1.5-2 years old, the best neuropediatrician we could find, told us (according to Ultrasound, CT brain scan, EMG etc.) that he will outgrow his weakness through outdoor games and sport activities. He did not recommend any special exercises, except OT. Then we saw at his age of 3, that his weakness is going worse, meaning: a gait abnormality, like, tip toe walking, contracture of the gastrocnemius/soleus muscle group (muscle spasticity), and a tight Achilles' tendon and equinus deformity. Then we visited best physiatrist and orthopedist we could find, and they gave him foot exercises and night-foot/ankle/knee orthosis and hand orthosis. We are doing our best, but it is hard with night orthosis. He is very intelligent, talkative, joyfull, goes to kindergarden, he started walking at 10 months. We are interested in possible results. We are doing our best to avoid surgeries. Is it late now to start with orthotics? Will our persistent excercises and OT reduce muscle spasticity? Will he be able to put his heel on the ground when walking, in time, to achieve flat foot position? Will his tendon and muscle stretch with exercises and orthosis? Thank you.

Thank you very very much. We can't wait to see him walking properly one day.
We were also told that a sessions in "warm" water pool can help relieve muscle. But in our place of residence, we don't have warm water pools, neither experts, therapists to practice with him in pool.
But we have swimming school on a pool for kids. Should we send him anyway to swim? They have regular trainers. Maybe that will be good additional exercise for him also?
Can he practise regular sports with other children or only sport supervised with expert-therapist (Halliwick concept) We don't want to something wrong. We don't have swimming therapist or warm indoor pool, so should we extra try anyway with regular swim treiner and rgular indoor pool?
Thank you, once more, and I wish you all the best.