What Is Spastic Diplegia?
Cerebral palsy is a group of disorders that originate in the brain and impact muscle movement, balance and posture. According to the CDC, spastic cerebral palsy, characterized by muscle stiffness, is the most common type. This can impact any or all of the limbs. The term “diplegia” indicates the involvement of both sides of the body, especially the legs. Spastic diplegia is a type of spastic cerebral palsy that impacts both legs with little or no involvement of the arms. The stiffness can originate in the hips or the legs themselves and cause difficulty walking.
- Prevalence of Spastic Diplegia in Children
- Spastic Diplegia Symptoms
- Causes and Etiology of Spastic Diplegia
- Risk Factors of Spastic Diplegia in Children
- How is spastic diplegia diagnosed in children?
- Spastic Diplegia Treatment and Prognosis
- Resources for Parents of Children With Spastic Diplegia
- How can Levin & Perconti help me if my child is diagnosed with spastic diplegia?
Spastic diplegia often occurs as a result of birth injuries due to medical malpractice. Caring for a child with spastic diplegia requires a significant commitment of time and financial resources that can be overwhelming.
The birth injury attorneys at Levin & Perconti specialize in holding negligent health care providers accountable and ensuring parents receive substantial compensation so they have the resources they need to access the most advanced therapies available.
Prevalence of Spastic Diplegia in Children
According to data compiled by the Centers for Disease Control, cerebral palsy is the most common childhood motor disability, impacting about one in 345 children in the United States. This equates to three cases per 1,000 8-year-old children. Globally, cerebral palsy occurs in one to four of every 1,000 births. It has declined in some parts of the world, indicating it is preventable.
Spastic diplegia is the most common clinical phenotype of cerebral palsy, according to Translational Pediatrics, whose 2020 study found that 35 percent of children with cerebral palsy have spastic diplegia.
Spastic Diplegia Symptoms
It is important to identify the signs and symptoms of spastic diplegia as early as possible so your child can receive the necessary interventions to develop healthy movement techniques while their muscles are developing.
Most children with spastic diplegia do not experience impaired cognitive functioning. Symptoms are primarily associated with movement.
Nearly every child with spastic diplegia experiences abnormal walking patterns due to the stiffness of their muscles. This can manifest in the following ways:
- Scissor gait – Walking while the knees are turned outward
- Walking on the toes
- Crouch gait – Walking with the knees, hips and ankles continuously bent
The muscle tightness and difficulties with walking may discourage children from engaging in physical exercise, which can create a vicious cycle of increased weakness leading to less activity, leading to more weakness, and so on. Muscle weakness exposes the child to an increased risk of injury.
Delayed Developmental Milestones
Children with spastic diplegia may take longer than other children to crawl, stand or walk. This does not mean they will never walk. As many as 50 to 60 percent of children with cerebral palsy eventually walk without assistance. If the spasticity is severe, children can be taught at a young age to walk with assistive equipment.
Impaired Growth and Development
Children can develop additional deformities in their effort to compensate for difficulties. For example, one leg may grow longer than the other if the child relies on one leg too much. This underscores the importance of early intervention and treatment.
Causes and Etiology of Spastic Diplegia
Spastic diplegia is caused by damage to the motor cortex of the brain. This causes compromised transmission of signals from the brain to the muscles. As a result, the muscles remain in a constant state of involuntary contraction.
This type of brain damage can occur during the birthing process, especially during complicated births. Fast, decisive action is often called for to ensure the infant is not deprived of oxygen during any phase of the labor and birthing process. When the infant is deprived of oxygen during the birthing process, this is called birth asphyxia.
The following conditions during birth can lead to asphyxia:
- Overuse of Pitocin, a hormone used to induce labor
- Umbilical cord compression or prolapse
- Shoulder dystocia, a condition in which the shoulders become stuck
- A blocked airway
- Prolonged Cesarean process
Hypoxic Ischemic Encephalopathy (HIE)
Hypoxic ischemic encephalopathy is a brain disorder that occurs when the body’s blood flow and oxygen levels are insufficient. Causes of HIE during or shortly after labor and delivery include the following:
- Umbilical cord issues
- Rupture of the uterus
- Excessive placental bleeding
- Abnormal fetal position
- Prolonged late stages of labor
- Low blood pressure in the mother or baby
- Severe prematurity
- Lung or heart issues
- Brain or skull trauma
If fetal distress, low heart rate or respiratory difficulties occur during or after labor or delivery, health care providers should suspect and check for HIE.
Risk Factors of Spastic Diplegia in Children
Multiple factors can contribute to the risk of a child developing spastic diplegia during pregnancy, but infants with the following circumstances are especially vulnerable during and shortly after the birthing process:
- Preterm birth
- Low birth weight
- Complicated labor and delivery
How is spastic diplegia diagnosed in children?
According to the Mayo Clinic, before spastic diplegia can be diagnosed cerebral palsy must first be confirmed through a brain scan, such as an MRI or cranial ultrasound. Spastic diplegia can then be diagnosed through the observation of spasticity in the legs. Additional tests may be required, such as the following:
- An EEG to rule out seizure disorders
- Blood, urine or skin tests to screen for metabolic or genetic issues
- Tests to determine any other conditions associated with cerebral palsy
Spastic Diplegia Treatment and Prognosis
Spastic diplegia is a lifelong condition. It is not considered a progressive condition, which means it does not get worse. Individuals with spastic diplegia can enjoy a high quality of life if they receive the proper treatment. Treatment approaches vary between individuals because the disorder affects muscle groups differently and to varying degrees of severity.
Effective spastic diplegia treatment focuses on neuroplasticity, a mechanism that rewires the brain to control functioning from healthy areas instead of from the damaged portions. The most effective method to promote neuroplasticity is through repetition of specific tasks. The greater the repetition, the stronger the new neural pathway will be. This can work at any age but is most effective at young ages.
Physical therapy can include the following:
- Stretching spastic muscles
- Strengthening underused muscles
- Gait training
- Balancing challenges
Occupational therapists teach individuals with spastic diplegia how to perform daily activities such as dressing, toileting and bathing. If needed, this includes teaching patients how to use assistive equipment correctly.
Muscle relaxants may be injected into the legs to provide temporary relief of spasticity in conjunction with long-term approaches.
Spasticity can interfere with growth and cause complications such as hip dislocations. Orthotics can stretch the muscles to reduce tightness and help the body maintain proper alignment. These devices also help with walking and transferring from one place to another.
Surgery may be recommended in severe cases to manually lengthen muscles, realign them or reduce the excitability of spastic muscles by permanently severing certain nerve roots.
Resources for Parents of Children With Spastic Diplegia
How can Levin & Perconti help me if my child is diagnosed with spastic diplegia?
A diagnosis of spastic diplegia may be the result of medical errors during the birthing process. As a nationally recognized law firm established in 1992, we are pioneers in the area of birth injury litigation. Our firm was among the first to handle birth injury cases, and our experience over the past 30 years has helped us develop the most effective and aggressive approach.
Dov Apfel is one of the leading birth injury attorneys in the nation, with more than 40 years of experience advocating for children with cerebral palsy and other disabilities. His landmark law review article set the standard nationally for how these cases should be handled. In 2011, he received the Dan Cullan Memorial Lifetime Achievement Award for his achievements in birth injury litigation, education and advocacy.
Our Case Results
Our attorneys never settle for less than a fair amount of compensation. We have extensive financial resources to invest in each case, and our nationwide network includes the best experts in the medical field. The leveraging of these resources combined with our unmatched knowledge of birth injury litigation has helped us achieve the following results for our clients:
- $20 million verdict for a child who suffered a brain injury due to the negligence of nurses and residents during labor.
- $16 million settlement for a child who suffered a brain injury due to negligent nursing and medical care during labor and cesarean section.
- $14 million verdict for a child who suffered a brain injury due to lack of oxygen during birth.
- $11.5 million settlement for a child with hypoxic-ischemic brain injury.
- $9 million settlement for a baby who suffered permanent brain damage as a result of a doctor’s failure to test the mother for Group B Strep Meningitis during prenatal care.
- $6.5 million for a newborn brain injury due to a lack of competent medical professionals during a neonatal resuscitation.
If your child has been diagnosed with spastic diplegia subsequent to a complicated birth, a birth injury may be the cause. Our lawyers can help you determine whether medical malpractice was involved. We take birth injury cases nationwide. Contact Levin & Perconti today for a free consultation.
Not only were they so professional but also so caring and thoughtful. It was very difficult going over the facts in our mother's case but they were so compassionate and understanding and allowed us to be with them every step of the way. We were able to sit in on the depositions and we were really able to see how hard they worked on our behalf.