Spastic diplegia in children with cerebral palsy

The form of cerebral palsy known as “spastic diplegia” is one of five categories of spastic cerebral palsy that help indicate which parts of the body are primarily affected. In the case of diplegia, the lower extremities (legs, hips, and pelvis) show spasticity abnormalities, while the upper extremities function at normal or near-normal capacity. Children born with this form of cerebral palsy exhibit nearly normal cognitive development and performance, but are often delayed in their ability to walk. Once they are able to walk, they often have a pronounced scissoring gait, with their legs crossed over each other in a rigid scissor-like pattern.

Although spastic diplegia is generally considered one of the minor forms of cerebral palsy, people with it can expect lifelong difficulties with all voluntary and passive leg movements, as well as pain associated with muscle and joint breakdown that It can cause arthritis and tendonitis. . Some forms of spastic diplegia are mild enough to cause barely noticeable abnormalities in balance and gait.

The cause of spastic diplegia, as with many forms of cerebral palsy, is due to neonatal asphyxia, a sudden deprivation of oxygenated blood that passes to the fetus through the umbilical cord. This is sometimes combined with preterm labor. Spastic diplegia can also result from bladder, kidney, urinary tract infections, sexually transmitted diseases, yeast infections, or bacterial vaginosis in the mother during pregnancy. These conditions can lead to infantile hypoxia, which inhibits the proper development of upper motor neuron function associated with movement.

It is reported that Dr. William John Little’s first recorded encounter with cerebral palsy during the 1860s was among children showing signs of spastic diplegia. For this reason, spastic diplegia is sometimes called “Little’s disease.” The diagnosis of spastic diplegia usually cannot be made until the child is several months or even several years old, but a child may 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 leg movement (usually around 18 months), a preliminary diagnosis of spastic diplegia may be made. Around this time, a parent may notice that a child’s legs are unusually stiff or loose (which will gradually lead to stiffness). The cause of this is the failure of motor neurons to adequately develop muscle tone. Normal muscles work in pairs: one contracts while the partner muscle relaxes. When this function is compromised, both muscles contract simultaneously. Hypertonia is the result of too much muscle tone. Hypotonia is too little muscle tone.

Some of the indicators of spastic diplegia include:

1) Children often prefer to sit in a “W” position. Physical therapists will recommend sitting cross-legged or in a chair.
2) Children may fail the first few attempts to crawl, or begin to crawl by propelling themselves forward with the use of their forearms, letting their legs drag behind them.
3) Children who have not been able to stand up by age 2 1/2 may need devices, such as braces, to help them stand up. Standing places significant stress on the bones and joints of the legs, which promotes healthy growth.
4) Toe walking or foot rolling – can be improved with low profile/low impact leg braces.
5) Spastic diplegia can lead to a gradual dislocation of the hip, a condition that promotes arthritis and pain. For this reason, regular X-rays and examinations of the hip are needed to monitor the disease.

Physical therapy, including massage therapy, is the most important treatment for any form of spasticity, and aims to train and strengthen muscles to promote bone growth, balance, and healthy motor functions. There are medications that can be taken to relax tense muscles and minimize spasms. Injecting Botox into overly tense muscles has been shown to provide at least temporary relief. In more extreme cases, surgery may be performed to lengthen the muscles. Other treatments include muscle electrostimulation, hyperbaric oxygen therapy, and hippotherapy.

If pain and spasticity are severe enough to inhibit walking, orthopedic surgery may become an option. First, one must determine which of the 30 major muscles is causing the problem. Gait analysis, a computerized diagnostic technique, is used as a guide to make

Before surgery can occur, doctors must determine which of the 30 major muscles involved in walking is causing the problem. Physicians currently use a computerized diagnostic technique known as gait analysis to guide their surgical decision-making. Gait analysis uses:

1) cameras that record how an individual walks
2) force plates that sense how your feet land
3) a test called electromyography that records muscle activity
4) a computer program that collects and analyzes the data.

With this information, doctors can pinpoint which muscles would benefit from surgery and how much improvement in gait can be expected. The timing of such surgeries is based on the motor development and age of the child with cerebral palsy. Surgery to correct spasticity in the muscles of the upper leg is likely to be performed between the ages of 2 and 4, while surgery to correct spasticity in the muscles of the lower leg (hamstrings, tendon of Achilles) is probably done around age 7 or 8. procedure, which is often performed on an outpatient basis.

In cases of extreme spasticity and associated pain, SDR (selective dorsal rhizotomy) surgery may be necessary. SDR surgery involves cutting specific nerves at the base of the spine to release tension in the targeted muscles.