Joshua Rotenberg, MD MMS
Board Certified in 
Neurology - Children/Adolescents 
 Sleep Medicine for All Ages
Sleep Apnea Testing for Adults & Children

About Cerebral Palsy

We offer the following Cerebral Palsy related resources for your reference:

Ataxia - National Ataxia Foundation (NFA)
Autism - Autism Society
Brain Injury - Brain Injury Association Inc. – Brain Trauma Foundation
Brain Tumor – American Brain Tumor Association (ABTA) – National Brain Tumor Foundation – Children’s Brain Tumor Foundation
Cerebral Palsy – United Cerebral Palsy

Cerebral Palsy patient information from the American Academy of Neurology

AAN Patient Guidelines

Brain Injury  Brain Injury Association Inc.   - Brain Trauma Foundation


Botox Program  - adapted from Kennedy Krieger Institute  Here

Children, adolescents & adults with limited functional range of motion due to spasticity or dystonia are evaluated and treated with botulinum toxin when appropriate. An intervention plan is designed to address the specific needs of each patient in collaboration with the family and the patient's therapists.

The appropriate patient is one who has a clearly identified muscle or group of muscles that interferes with progress in therapy or that makes caring for the patient more difficult. Examples include tight hip muscles that put the patient at risk for hip dislocation or tight elbow muscles that make reaching more difficult. There are many other circumstances in which botulinum toxin is useful and these can be addressed on a case by case basis.

Botulinum toxin is manufactured under the trade names. Although the medicine is made from the same substance that causes food poisoning, it is very safe and almost no serious adverse effects have been reported following its administration in the vast majority of cases. The effect is temporary and usually lasts between three to six months.

The treatment is given by intramuscular injection and is likely to be anxiety producing for the patient. The following recommendations can lessen the discomfort of the procedure:

  • A cream or vapo-coolant spray to numb the skin surface can be placed on the injection sites.
  • Music, a favorite blanket, or any item that is normally comforting to the patient are welcome.

The discomfort involved is approximately the same as the discomfort associated with immunizations. Unlike immunizations, there is usually no swelling or aching at the injection site. Children can return to their normal activities.

You may begin to see results 24 hours after the injection, but usually not for two or three days. Maximum effects are seen between one and two weeks after the injection and will probably last for several months. A follow up appointment to measure the effects of intervention is scheduled when feasible and appropriate.

Examples of possible changes include improved range of motion, greater ease in stretching, improved tolerance to wearing braces, developmental gains (e.g., crawling, standing) or specific gait changes. Every patient is different and outcomes will vary. When the treatment begins to wear off, you should discuss with your doctor whether repeated injections are the appropriate treatment in achieving your therapeutic goals.

An effective treatment is almost always associated with an ongoing therapy program that builds upon the relaxation in tone. Therefore, physical or occupational therapy should be arranged before the treatment. It is often helpful to have the patient's therapists contact the treating physician before the treatment so they can discuss the treatment goals.


The primary goal is to improve the functional range of motion through focal relaxation of targeted muscles using injections of botulinum toxin. Specific goals may include the following:

  • Improve gait
  • Improve upper extremity function
  • Prevent deformity
  • Improve positioning
  • Delay surgical intervention
  • Decrease pain
  • Improve tolerance of splints
  • Improve hygiene
  • Decrease burden of care


Dr. Rotenberg has used this modality for treatment over 10 years. Hundreds of patients have been treated. Dr. Rotenberg serves patients in the Houston medical Center, Memorial City and San Antonio.

Dr. Rotenberg administers botox with conscious sedation or under anesthesia in San Antonio and Houston.


To make a referral or request an initial evaluation:
Call our office for an appointment 713-464-4107.

Congenital diplegia
Congenital quadriplegia
Neurological disorders
Spastic hemiplegia
Abnormal muscle tone
Limited joint movement

Growth References for Children with Quadriplegic Cerebral Palsy

These population specific references for children with quadriplegic cerebral palsy will facilitate uniformity in your clinical appraisal of growth and nutritional status. Deviations in growth may be the first or only signal of a more serious underlying health problem that requires assessment. This chart will also help you to educate families about the issue of growth and aid in evaluating the efficacy of your intervention strategies.

The estimate of ideal body weight is in part determined by the severity and topography of cerebral palsy. For those children with quadriplegia, ideal body weight should accommodate the principles of assuring good health by maintaining adequate fat and muscle stores and allow for ease in daily physical care and management.

Download Cerebral Palsy Growth Charts:

Cerebral Palsy Growth Charts Boys: 0-10 years (4 pages) *
Cerebral Palsy Growth Charts Girls: 0-10 years (4 pages) *

*Note: Above links require Adobe Acrobat Reader

To request high-quality, printed versions of these growth charts please with your full name and mailing address.

General Neurological Resources

Professional Organizations and Governmental Agencies

  • Child Neurology Society CNS
  • Medline search engine PubMed
  • On-Line Mendelian Inheritance In Man - OMIM

News and Information

Dr. Rotenberg's Pediatric Blog -
Houston Pediatric Specialist Blog -
Dr. Rotenberg's Sleep Medicine Blog -

Hospitals Served

Texas Children's Hospital
Children's Memorial Hermann Hospital
Memorial Hermann Memorial City
Texas Woman's Hospital
Healthbridge Children's Hospital
Guadalupe Valley Regional Hospital
North Central Baptist Hospital
The Methodist Hospital - San Antonio

I would like to find out more information about my child.......from

Many parents have very important and difficult to answer questions about their or their child's neurological disease. Where is a reliable and informative place to obtain these answers?

First, the MOST INFORMED OPINION can only be obtained in person, and NOT over the Internet. If you feel that have more questions, please ask & ask again. Write down your questions and ask in a follow-up appointment. 

Second, beware of where you are getting information over the Internet. There is a concern that much information provided over the Internet is incorrect, unfounded in fact, or at times untrue . Be sure to use RELIABLE sources, typically from Medical Societies, or from Parent/Patient Organizations. In general, most of the listed sites have valid information, although it is impossible to account for every Web Page link.

Third, YOU have access to the medical literature. Although difficult to read, you can browse the medical literature th rough PubMed or GratefulMed. The abstracts (short form) of most articles are available on the Internet, and longer forms of the articles can be ordered.



Note: Dr. Rotenberg has found these sites useful in the past. These links are provided as a public service.  But, neither Dr, Rotenberg nor Texas medical & Sleep Specialists can accept responsibility for content viewed by clicking an external link. Dr. Rotenberg does personally endorse the content of these sites.

Dr. Joshua Rotenberg - Texas Medical & Sleep Specialists, PLLC
Board Certified
American Board of Psychiatry & Neurology - with Added Qualifications in Sleep Medicine
 and Special Qualifications in Child Neurology. 
902 Frostwood Suite 210
Houston, TX 77024
(713) 464-4107

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