1. Medical history: Chen ××, male, 8 years old (born in April 2001), had functional impairment of the limbs for several years. The child’s family complained that he was easily frightened after birth, had poor hand, mouth and eye coordination, and was behind in motor development. The child was delivered by fetal suction and had asphyxia at birth (Apgar score unknown), but the rest of her maternal history was unremarkable. He was treated with medication (Brain Power oral?) and home rehabilitation (mainly TCM massage). She was admitted to our pediatric rehabilitation center in August for further consultation and treatment. PE: Vital signs were stable. The general condition was acceptable, the nutritional status was moderate, and the speech was unclear. The rest of the general physical examination had no special conditions to present. Specialized examination: generalized hypertonia, slightly more on the right limb. Pointed foot, slightly pronated, mild hip flexion, unstable gait. Ashworth:Upper extremities: left and right pronator teres 1+, flexor carpi radialis 1+, flexor elbow 0~1. Lower extremities: left and right iliopsoas and adductor muscles 1~1+. Left and right N cord muscles 1＋. Right and left calf triceps muscle 2. Adductor muscle angle: 87°, left dorsiflexion angle: 90°, left N fossa angle: 125°, right dorsiflexion angle: 92°, right N fossa angle: 120°. GMFM: 89% in area IV, 75% in area V. Laboratory and imaging tests: brain CT and EEG were unremarkable. Clinical diagnosis: cerebral palsy (spastic type, quadriplegia) Functional diagnosis: motor disorder, postural disorder, language disorder, and life ability disorder 2. (2) Dysfunction: The child has increased generalized muscle tone, especially in the lower extremities, and the principle of recent treatment is to reduce generalized muscle tone, maintain and expand joint ROM, improve gait, and enhance walking ability. The main factors affecting gait are: 1) flexion pattern of both upper limbs; 2) difficulty in shoulder-pelvis rotation; 3) spasm of both lower limbs: hip flexors, adductors, knee flexors, ankle flexors and their corresponding joint movement limitation. (3) Treatment items: ① Rehabilitation programs (PT, OT, ST; TT) PT: rehabilitation programs for spasticity and its abnormal posture are: 1) passive joint movement training; 2) joint release exercises; 3) reflex inhibition; 4) muscle pulling; 5) active movement and muscle strength exercises for antagonist muscles; 6) comprehensive exercises and gait correction for related muscle groups. Training. Muscle tension control (muscle pulling), Achilles tendon pulling, squatting inclined plate, ankle dorsiflexion training for the pointed foot were performed. We also train knee stance maintenance, single leg stance training, lateral recumbent hip abduction training, seated leg lift, and stance balance. In terms of rehabilitation training, the patient had never received regular and continuous comprehensive rehabilitation training, and several large muscle groups of both lower limbs were involved in spasticity to different degrees, especially the calf triceps, and the joint movement was severely restricted. The spasticity of the typical muscle groups is non-contractile, especially the elevated muscle tone of the calf triceps, which causes impaired gait and posture, and is a prime indication for the application of botulinum toxin. The conventional dose of 200U, concentration 50u/1ml, injection location: 100U for each of the left and right calf triceps, according to the size of the muscle belly or the degree of dystonia of the three muscles, using 2:2:2 (if the muscle belly is relatively small, choose 20U/point for the medial and lateral head of the gastrocnemius muscle, can be appropriately layered, 10U point for the flounder muscle, deep injection) or 4:3:3 point injection (when the muscle belly is relatively large point selection) (medial head / flounder muscle / lateral head, 10U/point). The former may be adopted in this child. The positioning method is proposed to be a freehand positioning method. It is important that the therapist conducts formal rehabilitation after the injection to ensure the results. Therefore, it is necessary to draw up a perfect assessment and rehabilitation plan for the follow-up treatment requirements of each therapist. As far as the child’s injections are concerned, the upper extremity dystonia should not be the main conflict that needs to be solved this time, and the most obvious factors to be solved that can hinder the progress of the child’s rehabilitation, as well as the presence of a certain degree of spasticity of the adductor and N cord muscles, and the risk of treatment benefits must be assessed again. Botulinum toxin injections are not intended solely to reduce muscle tone, but rather to regain the function of these muscle groups that has been lost due to dystonia. Until we are certain that the “function” we are looking for is obtained and the patient’s upper extremity spasticity is not so severe as to interfere with care, upper extremity injections will not be considered at this time. ③Orthopedic brace ④Home rehabilitation instruction