Spastic Diplegia in Children With Cerebral Palsy
The form of cerebral palsy known as “spastic diplegia” is one of five categories of spastic CP that help indicate what parts of the body are chiefly affected. In the case of diplegia, the lower extremities (legs, hips and pelvis) show spasticity abnormalities while the upper extremities function at a normal or near-normal capacity. Children born with this form of cerebral palsy characterize near-normal cognitive development and performance, but are frequently delayed in their ability to walk. Once they are able to walk, they commonly have a distinct scissoring gait, with legs crossing over each other in a stiff, scissor-like pattern.
already though spastic diplegia is generally considered one of the lesser forms of cerebral palsy, people who suffer from it can expect lifelong difficulty with all voluntary and passive leg movement, in addition as pain associated with muscle and joint breakdown that can rule to arthritis and tendinitis. Some forms of spastic diplegia are mild enough to consequence in barely noticeably abnormalities in balance and gait.
The cause of spastic diplegia, as with many forms of cerebral palsy, is from neonatal asphyxia, a sudden depravation of the oxygenated blood that passes to the fetus by the umbilical cord. This is sometimes combined with a pre-term birth. Spastic diplegia can also be the consequence of bladder, kidney, urinary tract, STD’s, yeast infections or bacterial vaginosis in the mother during pregnancy. These conditions can rule to infant hypoxia, which inhibits proper development of upper motor neuron function associated with movement.
Dr. William John Little’s first recorded encounter with cerebral palsy during the 1860’s is reported to have been among children displaying signs of spastic diplegia. For this reason, spastic diplegia is sometimes referred to as “Little’s Disease.” Diagnosis of spastic diplegia usually can’t be made until a child is several months or already several years old, but a child can be labeled “high risk” if they experienced birth trauma before, during or shortly after delivery. This includes prematurity of more than 3 weeks. If a child does not meet standard developmental milestones regarding movement of the legs (usually around 18 months), a preliminary diagnosis of spastic diplegia may be made. Around this time, a parent may observe a child’s legs as unusually stiff or floppy (which will little by little rule to stiffness). The cause of this is the failure of the motor neurons to properly develop muscle tone. Normal muscles function in pairs-one contracting while the companion muscle relaxes. When this function is compromised, both muscles contract simultaneously. Hypertonia is the consequence of too much muscle tone. Hypotonia is too little muscle tone.
Some of the indicators of spastic diplegia include:
1) Children often prefer sitting in a “W” position. Physical therapists will encourage sitting cross-legged or chair sitting.
2) Children may fail in early attempts to crawl, or begin crawling by pulling themselves forward with the use of their forearms, letting their legs drag behind.
3) Children who have failed to pull themselves to a standing position by age 2 and a half may require devices, such as braces, to assist with standing. Standing puts important stress on leg bones and joints, consequently promoting healthy growth.
4) Toe walking or feet-rolling–can be improved with low profile/low impact leg braces.
5) Spastic diplegia can rule to gradual hip dislocation, a condition that contributes arthritis and pain. For this reason, regular hip x-rays and exams are needed to monitor the disease.
Physical therapy, including massage therapy, is the most important treatment for any form of spasticity, aimed at training and strengthening muscles to promote healthy bone growth, balance and motor roles. There are medication that can be taken to relax tight muscles and minimize spasms. Injecting Botox into overly tight muscles has proven to provide at the minimum permanent relief. In more extreme situations, surgery can be performed to lengthen muscles. Other treatments include electrical muscle stimulation, hyperbaric oxygen therapy and hippotherapy.
If pain and spasticity are harsh enough to hinder walking, orthopedic surgery can become an option. First, it must be determined which of the 30 major muscles are causing the problem. Gait examination, a computerized diagnostic technique, is used as a guide in making
Before surgery occurs, doctors must determine which among the 30 major muscles involved in walking are causing the problem. Doctors today use a computerized diagnostic technique known as gait examination to guide them in making surgical decisions. Gait examination uses:
1) cameras that record how an individual walks
2) force plates that detect how the feet land
3) a test called electromyography that records muscle activity
4) a computer program that gathers and analyzes the data.
Using this information, doctors can precisely locate which muscles would assistance from surgery and how much improvement in gait can be expected. The timing of such surgeries is based on the child with cerebral palsy’ s motor development and age. Surgery to correct spasticity in upper leg muscles is likely to occur between ages 2 and 4, while surgery to correct spasticity in the lower muscles (hamstring, Achilles tendon) would likely occur around age 7 to 8. Orthopedic surgery had evolved into a comparatively simple procedure, often being done on an outpatient basis.
In situations of extreme spasticity and associated pain, SDR (selective dorsal rhizotomy) surgery may be required. SDR surgery involves severing specific nerves at the base of the spinal column to release stress on the targeted muscles.