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Spastic Diplegia (Paraplegia) Cerebral Palsy

In the 1860s, William Little, an English physician, wrote the first medical descriptions of a disorder that affected young children which caused stiff, contracted muscles primarily in their legs and to a lesser degree in their arms. They had difficulty holding objects, crawling, and walking. Their condition which neither improved or deteriorated as they grew which was originally called Little’s disease is now known as spastic diplegia (Paraplegia) cerebral palsy.

 

Spastic cerebral palsy is caused when the brain damage occurs in the outer layer of the brain, the cerebral cortex. (This is distinguished from Ataxic C.P. which occurs in approximately 10% of the cases, caused by damage to the cerebellum which results in tremors and low muscle strength and affects motor skills like writing, typing, and balance while walking.) Spastic is the most common form of cerebral palsy which affects 70 to 80 percent of patients. Spastic cerebral palsy symptoms include increased tension in a muscle. Normally, muscles coordinate in pairs; when one group of muscles contract (tighten), the other group relaxes. This allows free movement. When complications in brain-to-nerve-to-muscle communication occur, the balanced degree of muscle tension is disrupted. Muscles affected by spastic cerebral palsy become active together which effectively blocks coordinated movement. Thus, the muscles in spastic cerebral palsy patients are constantly stiff, or spastic.

 

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Spastic diplegia CP generally affects the legs of a patient more than the arms. Patients have more extensive involvement of the lower extremity than the upper extremity which allows most patients to eventually walk. The gait of a person with spastic diplegia (Paraplegia) CP is typically characterized by a crouched gait. As a person walks one leg typically provides support while the other leg advances in preparation for its role of support limb in advance of the next step. The gait cycle (GS) describes this pattern of alternate limb support and advance. A crouched gait is where the knee is excessively flexed (bent) during stance and at the onset of push–off, which can make walking impossible without the aid of a walker. Both toe walking and flexed knees are common attributes and can be corrected with proper surgical treatment and gait analysis.

 

Many victims of spastic diplegia cerebral palsy have normal intelligence. However side effects like strabismus which is the turning in or out of one eye, otherwise known as cross-eye, affects 75% of this population which is caused by a weakness of the muscles controling eye movement. These people are also often nearsighted. If left unattended, strabismus can eventually lead to severe vision problems.

 

Experienced treatment teams for individuals with spastic diplegia CP can help determine the treatments which are best suited for them. Leg braces, gait analysis, medications like botox , hyperbaric oxygen treatment, and several other treatment methods can help remedy some of the symptoms. These teams normally include a physical therapist, pediatrician, physiatrist, neurologist and neurosurgeon, and an orthopedic surgeon.

 

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