So the letter says:
It was a pleasure to catch up with Joshua, a three year old boy with an initial diagnosis of quadriplegic cerebral palsy, although he is behaving more like right hemiplegia. I do note that he has some slight increase in muscle tone on the left side, but the more problematic muscle tone is across the right side. On Assessment today I noted that he had quite a lot of resistance to passive stretch on the right side. In the upper limb this occurs mainly across the elbow with an initial catch at 90 degrees elbow flexion, but getting full range in extension. In the lower limb he gets catches at his right adductor, right hamstring and right calf muscles. He is also pronated in the foot, indicating tight tend-achilles on that side. He does not tolerate an ankle-foot orthotic and I think what occurs is when his gastro-soleus is stretched mid-stance it tends to push his knee into extension (the so-called plantar-flexion, knee-extension couple), which is stretching his hamstring muscle. To disengage this effect, he flexes his knee so that he is walking up on his toes while in the orthotic.
Given the findings, I think he would respond to Botulinum toxin injection into the right calf, right hamstring and right adductor muscles. I had a discussion with his mother about it today. We did have a spot on the toxin theatre list for tomorrow, but his mother preferred to think about this a little more. I think this is reasonable and in the meantime we have established a plan for stretching with the use of Zimmer splinting (for the hamstring) as well as night splinting (for the calf) to assist with this issue.
I plan to book him into the next clinic for Botulinum toxin injection. I am certainly happy to see him sooner if required.
So thats all the big words for what I said yesterday, for people that like big words :)