The Plan

We have hit the ground running and are kicking off 2021 with a bang!

The type of cerebral palsy (CP) Elliott has is hemiplegia/hemiparesis spastic CP. Spastic CP is by far the most common type with about 70-80% of cases. People with hemiplegia/hemiparesis mean that one side of the body is affected and the spasticity can include stiffness, permanently tightened muscles and abnormal walking.

Due to the nature of where the stroke took place in Elliott’s brain at birth, cerebral palsy has affected the right side of his body. That is why we are, and have been, in occupational therapy services for his right hand since he was a baby. This is also why the CP is focused only in his right ankle/leg.

As he has gone through growth spurts, his brain has not sent the appropriate signals to the muscles in his right leg so his leg muscles get very tight with spasticity and tone. This has also meant that over time the muscles in his right leg won’t grow at the same rate and the left side of his body will have to do a lot of overcompensating.

This is where the intervention comes into play.

First up, botox. Yes you read that right- BOTOX. My two year old son is getting botox before his mother… All joking aside, the botox is intended to loosen the muscles in his calf so that he can put his foot fully on the ground and the doctors can more easily move his leg into an optimal position. 90 degrees is the ‘optimal’ position, which at present he is probably around 130 degrees. By getting the foot in this position, it will help to re-train his brain to send the right signals to his leg so he can put full weight down on his foot and use the leg appropriately.

Second up, serial casting. This is just like a cast you would get when you break your leg. The cast will get put on two weeks after the botox takes place because that is when the leg muscles are most malleable from the botox and can be most easily maneuvered. The casting will most likely last about 3 weeks, with a new cast put on every week.

Third up, brace. This is long term. Elliott will get fitted for a brace after about two weeks of the casting, as his leg should be in more of a 90 degree position by this point. The brace will be worn around the clock with the exception of bath and bed time. It will go from his foot up to under his knee.

This whole process leading up to a brace will be about 6 weeks and then the brace will be a permanent fixture until about 6 or 7 years old. At that point, he will have grown enough to be eligible for a surgery. I don’t know the details of the surgery at this point, but I do know that they would likely cut his achilles tendon to help the muscles grow to their full potential. Time will tell as we get closer to that point in years to come and how he responds to the brace and treatments.

Overall, this is very much a give and take of all these treatments. It is not a one and done. Botox may need to happen again, and same with casting. We will know how his body responds to the treatments once we start them, which will give us a better plan of what to expect. Only time will tell.

Be faithful in small things because it is in them that your strength lies

Mother Teresa