spastic gastrocnemius and botulin toxin

[sisone]

i wanna ask how should i strech the gastrocnemius after the botulin toxin (or if i have to strech it or not)was administrated(in the gastrocnemius muscle)...its about a boy 4 years old diagnosed with asimetric quadruplegia(right side more affected)...i just saw him once and i can tell that he walks, with whole feet on the ground...hip flexion is a little short...his parents told me that he used to walk on his toes before he had the botulin toxin...
...so i thought that i should improve dorsiflexion and strenghten the anterior muscles of the leg(like anterior tibialis and fibularis)...for that i made him walk upwards like on an inclined surface ...i also thoufght about improving hip flexion with like climbing stairs, walking over an obstacle...
...i would apreciate any other suggestions...oh another thing, he had the toxin 4 weeks ago...ty

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[estherderu]

dear Sisone,

The following recommendation is part of the Dutch Guidelines for treating children with CP:

In the treatment of gait problems in children with CP, BTX-A can be considered as treatment option as long as it is combined with exercise therapy and casks and or orthotics as follow up treatment.
this implies that:

therapy (45-60 minutes) frequency 3x week at a minimum
children should be put in stretched positions at home as well
night orthosis (6-8 hrs of stretching) needs to be part of the treatment

Training has to be functional and in various circumstances and should include all functions, sitting down, standing up, crouching, walking etc.

good luck

Esther

[sisone]

ty esther...i would really apreciate if u could suggest some books or articles that i could read about the dutch guidlines in CP...
...and about this boy i was wondering that after he had the toxin if i should point more on the functional part or the streching...but from what u told me i see that i should combined both...the thing is that his functioning its prety good...he walks really good, he can stand up all by himself, he can climb stairs...but i still have to see him and make a good assesment....so ty again..and if ill have more question i will put it here...i hope u can still answer...ty