Three months ago, we first saw the visiting Rehabilitation Team from the Adelaide Women's and Children's Hospital, who specialise in seeing children with Cerebral Palsy. At that time, they recommended Botox injections to reduce Joshua's spasticity (high muscle tone). They do not do the Botox here until the child is 2 years old, so he was booked into the clinic this week since he turned 2 last month he can now have the botox.
So the plan was that today he was to see the Rehab Team again, and the Botox would get done on Wednesday if we were going ahead with it. This would have involved putting him under general anaesthesia and injecting his muscles with the toxin. Needless to say, I was anxious about the whole thing and the timing was not the greatest being that I am pregnant and my due date was last week, so either way you look at it, we would have been dealing with this and a newborn, or dealing with this and me being heavily pregnant with the potential to go into labour at any minute. Neither option is too appealing really.
So we took him back to see the team today and we had an extremely positive appointment. They were very happy to see the progress that Joshua has made over the last three months, and in fact, his muscle tone has improved so much since they last saw him, that they are no longer recommending the Botox treatment at this time. This is really a relief to me right now! The Doctor basically said that even though he does have high tone, he doesn't think that the tone itself is going to be his biggest obstacle. That his challenges are more to do with motor planning than with muscle tone. By that he means, the way he plans out movements in his brain... an obvious example is the fact that Joshua crawls with a bunny hop crawl rather than the normal reciprocal kind of crawl. In other words, his brain is planning out weird ways of doing things rather than what we would consider the normal or correct way of doing it, and he sees that as being a bigger problem than the actual muscle tone.
He also said that sometimes, what are initially seen as being big obstacles (In our case, the high tone, the marked preference for using only one side of his body) can decrease over time as the child gets older and the fact that Joshua is moving well, using both hands (even though they are not equal) and getting better with those things at 2 years old is extremely positive. What can sometimes happen is that as the child's bones grow, the muscles have trouble growing with them because they are too tight, and in that situation, we may consider botox at some time in the future but not right now. He thinks his AFOs are enough to take care of the tone in his ankles, and his right heel not touching the floor all the time is not a huge issue. They said it is the case because the knee is tighter but that hopefully, the longer he is on his feet and walking, the more that will improve.
Basically, they are really happy with Joshua's progress and Joshua was showing off in his walker and doing a bit of standing on his own, the Doctor kind of said that he will need his walker for a bit but who knows what he will do from there. And "Is he going to walk in the next year, well we don't know, we just have to wait and see" and I was like Um yeah he definitely is. The physio from Adelaide said he thought he was pretty close to being able to take independent steps, and that is what I think too! And when you see him showing off with his walker it makes you think it is more a confidence thing... the walker gives him confidence, he just needs to get brave enough to try on his own.
So overall a super positive appointment, and they have said they don't want to see him back at the visiting clinic until early next year. :)