Increased Symptoms in son's CP

[MommyKK]

My son is almost 7 yrs old.  He was diagnosed just last year with mild cerebral palsy.  He has spasticity in both ankles (more right than left) and now wears braces that keep him from toe walking and consequently tripping so much.  When I took him to the specialist they pushed his toe back in such a way that his foot would start to vibrate.  This they labeled clonus.  I never really saw him do this unless the doctor, physical therapist or I pushed his toe up in that same way.  Last time we saw the doctor they said they wanted to leave him in the braces and didn't need to see him back for two years.  This was fine by me, because the hospital is 2.5 hours away.

Lately, though, he has been complaining that his legs "fall asleep" often and I've started to notice this clonus response when no one is doing anything to his feet.  I've seen it when he is pedaling his bike, and even when he's just sitting.  His foot seems to do a little dance on the floor.  He also sometimes says that his legs hurt because they were asleep.

To add to the mix, he has ADHD, for which he is on Focalin and day and night time incontenence issues that may be related to the ADHD, the CP, or simply to imaturity.

I'm not sure if these new symptoms are something that I should be concerned about.  Should I just consult with his local pediatrician?  Should I take him back to the hospital to see the doctor there?  Also, while the neurology department diagnosed him with CP, they just referred us to the orthopedic for treatment, so his treating doctor at the hospital is not a neurologist.  Could these symptoms be evident of a progression in his illness or are they even relevent?  

Any insight would be greatly appreciated.  I really feel in the dark on this subject and at a real loss living so far from anyone who specializes in it.

Thanks,

MommyKK

[Dr. A. Srivastava]

Hi, Thank you for your question. Yes, they are the same by profession and you may consult either of them. Hope this helps.

[MommyKK]

Thank you for your response.  I'm still pretty confused about all of this, but I will call the pediatrician tomorrow and set up an appointment to talk to him about a referral back to the neurology department at Hopkins.  

Is a physiotherapist different from a phiscal therapist?  I hope it's something we have around here.

Thanks again.

[Dr. A. Srivastava]

Hi, Thank you very much for your question; although it is quite difficult for me to give you a precise opinion here without being able to examine your son, but I would try to provide you some relevant information about his health concern. I would recommend a physiotherapist consultation in this regards. Physiotherapy of spasticity focuses on maintaining muscle & joint motion while maximizing control of the arms & legs and improving mobility of extremities. Therefore, the basis of the treatment is recovery of the movement control and to improve voluntary movement that can take up to one year.  The next step in managing spasticity involves alcohol & botulinum toxin injections to the nerves and muscles to blocks paralyzed nerves. Some other medications to prevent repetitive contractures could be suggested. I would recommend you to see a neurologist who can evaluate the details of your son’s case and could better determine the insight of his situation.  In addition, it will be best if he would also visit a physiotherapist as soon as possible to let him/her assess his spasticity.  Hope this helps.