Types of Spastic Cerebral Palsy: Birth Injury Lawyer in Philadelphia
Cerebral palsy (CP) is the most common type of motor control disorder diagnosed in children. Children with CP experience balance and muscle problems because of damage to specific areas of the brain. The Centers for Disease Control and Prevention (CDC) reports that one out of every 345 children is diagnosed with CP.
Cerebral palsy is an umbrella term that includes multiple forms of the disorder. The major classifications of CP include spastic cerebral palsy, ataxic cerebral palsy, dyskinetic cerebral palsy, and mixed-type cerebral palsy. Out of these, spastic cerebral palsy is the most common form of the condition and comprises 80% of all children who are diagnosed. While all types of cerebral palsy can affect children and families for the rest of their lives, the cerebral palsy lawyers at Raynes & Lawn want to focus on spastic CP and how its various subtypes can affect children and their families.
What Is Spastic Cerebral Palsy?
The most common form of cerebral palsy, spastic CP causes the muscles in the affected areas to be overly stiff and rigid, which can make movements appear jerky and stiff. People with spastic cerebral palsy have hypertonia in the affected muscles, which means they have increased muscle tone. Hypertonia can make movement in the impacted areas difficult or nearly impossible. The cause of hypertonia is incorrect neural signaling from the brain to the muscles. The faulty signaling results from damage to the motor cortex of the brain.
Muscles that are impacted by spasticity appear stiffer when the affected individual tries to move the limb. The particular areas of the motor cortex and the spinal cord that are damaged include the corticobulbar and corticospinal tracts through which nerve signals are processed. In addition to spastic cerebral palsy, spasticity can also be found in people who suffer from strokes, spinal cord injuries, multiple sclerosis (MS), and traumatic brain injuries (TBIs).
Children with spastic CP might have trouble changing positions and controlling muscle groups or individual muscles to perform tasks, including speaking or handling objects. Spastic cerebral palsy is caused by a brain injury to the areas of the brain responsible for controlling movement and balance before, during, or following birth.
What Spasticity Looks Like
Children with spastic CP might have different muscle groups affected. In the affected areas, the following patterns are common.
Spasticity in the Upper Limbs
When a child has spasticity in one or both arms, the following signs might be observed:
- Elbow flexion (bent elbow)
- Wrist flexion (bent wrist)
- Finger flexion (fingers curled into a fist)
Spasticity in the elbow, wrist, and fingers can cause problems with tasks involving the arms and hands, including dressing, bathing, toileting, eating, drinking, manipulating objects, and writing. Children with spasticity in the upper limbs can also impact their ability to use their arms to balance themselves, which can cause problems with walking and standing.
Spasticity of the Lower Limbs
The following signs can be observed when a child has spasticity in one or both legs:
- Hip flexion causing the leg to lift when the child is lying or the body to lean forward when the child is standing
- Scissoring, which causes the legs to pull toward each other when walking
- Knee flexion causing problems with posture while standing
- Equinovarus foot causing the toes to point inward and downward with the heel off of the ground leading to overly tight calf muscles
Children who have spastic muscles in one or both legs might have trouble standing or sitting upright, changing positions, moving in bed, running, and walking.
Spasticity in Facial Muscles
Some children also will have spasticity in the small muscles of the face, including the facial muscles, tongue, and vocal cords. When a child has spasticity in these areas, the following signs might be observed:
- Slurred speech
- Inability to speak
- Tight, hoarse voice
- Trouble swallowing
Spasticity of the facial muscles and tongue can impact a child’s ability to use speech to communicate and cause problems with eating and drinking.
Subtypes of Spastic CP
The three main subtypes of spastic cerebral palsy include the following:
- Spastic diplegia (diparesis) – Spasticity affecting two limbs that most often impacts the child’s legs, which can cause problems with walking
- Spastic hemiplegia (hemiparesis) – Spasticity affecting one side of the body, including one leg and arm but not the other leg and arm
- Spastic quadriplegia (quadriparesis) – Most serious subtype in which all four limbs are affected together with most of the torso and body and can affect multiple bodily functions
We’ll take an in-depth look into each of these subtypes of spastic CP below.
Children who are diagnosed with spastic diplegia are normally affected in only the legs. However, the arms might sometimes be impacted instead. In children with spastic diplegia, the affected limbs are overly stiff with involuntary contractures of the muscles. Many children with spastic diplegia will have difficulty crawling and walking. They might exhibit toe walking in which they walk on their tiptoes or scissor walking with their knees crossing each other when they walk.
Children whose legs turn towards each other and cross at the knees might not be able to walk because of excessive contractions of the leg muscles. However, children with spastic diplegia might not have any effects on the muscles of the upper body and might be able to otherwise function normally.
In some cases, spastic diplegia will have associated problems, including difficulty balancing and coordinating muscles, experiencing seizures, or suffering joint contractures. Some children with spastic diplegia will also have intellectual disabilities that can range in severity.
Symptoms of Spastic Diplegia
Some of the symptoms of spastic diplegia include the following:
- Toe walking
- Muscular rigidity in the affected limbs
- Stiff, jerky leg movements
- Knee flexion
- Missed developmental milestones, including crawling and walking
Causes of Spastic Diplegic CP
Like other forms of CP, spastic diplegia is caused by damage to the brain during pregnancy, labor, delivery, or shortly following birth. Children who are born prematurely or who have low birth weights have a higher risk of developing CP. Approximately 10% of cases are caused by medical errors. Some examples of medical mistakes that can cause spastic diplegia include the following:
- Failing to properly monitor the fetus for signs of fetal distress
- Improper use of birth-assistive devices, including forceps and/or vacuum extractors
- Failing to perform an emergency Caesarian section when necessary
- Failing to identify, diagnose, and properly treat maternal infections or health conditions
- Failing to treat newborn jaundice, leading to kernicterus and brain damage
Some of the other causes of spastic diplegia include the following:
- Maternal seizures
- Fetal strokes
- Rh incompatibility
- Neonatal infections, including meningitis
- Maternal exposure to toxic chemicals
Treatment for Spastic Diplegia
Like other forms of cerebral palsy, spastic diplegia can’t be cured. However, children can benefit from various types of treatment that can help to increase their muscle strength, range of motion, and ability to perform the daily tasks of life independently.
Most children who have spastic diplegia benefit from physical therapy. Physical therapists work with children to help loosen their muscles, promote overall health and wellness, facilitate balance and postural improvements, build strength, and more.
Medications might be prescribed to address the symptoms of spastic diplegia and any associated conditions. Some of the types of medications that might be prescribed include muscle relaxers, botulinum toxin injections, anti-seizure drugs, and others.
Children might also require braces, walkers, and other mobility devices. If the child has limb deformities or experiences severe pain, surgery might be recommended. Some families also take their children for yoga therapy and deep-tissue massage to relax muscles and build strength.
Prognosis of Children With Spastic Diplegia
Children who receive early intervention and ongoing treatment have a relatively good prognosis. Spastic diplegic CP will not worsen over time, but associated symptoms can increase in severity without appropriate treatment.
Children with spastic hemiplegic CP are affected on one side of the body but not the other. For example, a child with spastic hemiplegia might be affected in the arm and leg on the left side but not the right or vice versa. This type of cerebral palsy occurs when damage to the brain occurs on one side but not the other. Since one side of the brain affects the opposite side of the body, the damaged area will be on the opposite side of the affected limbs.
Symptoms of Spastic Hemiplegia
The following symptoms might be observed on one side of the body in children with spastic hemiplegia:
- Finger flexion in one hand with the fingers balled into a fist
- Trouble balancing and walking
- Difficulties using the affected arm and hand to perform fine motor skills and the tasks of daily living
- Delays in achieving developmental milestones
- Favoring the non-affected hand
- Spasticity in the muscles on one side of the body
- Muscle weakness on one side of the body
- Difficulty with limb positioning while walking
- Jerky muscles on one side
- Muscle tremors on the affected side
- Poor posture while seated
The severity of the symptoms experienced by children with spastic hemiplegia will vary and can range from mild to severe. For example, while some children will need a wheelchair to get around, others will learn to walk.
Causes of Spastic Hemiplegia
Children with spastic hemiplegic CP have brain damage to the motor cortex, leading to permanent motor disabilities on the affected side of the body. The damage can be caused by brain injuries during pregnancy, labor, delivery, or shortly following birth. Among children diagnosed with the condition, around 10% acquired it because of medical mistakes made by doctors and other healthcare professionals. For example, a healthcare provider’s failure to detect and promptly intervene upon signs of fetal distress might cause a birth injury and brain damage that later results in spastic hemiplegia.
Some other causes of spastic hemiplegia include the following:
- Preterm birth
- Placental problems
- Failing to order an emergency C-section in time
- Improperly using forceps or vacuum extractors
- Failing to diagnose and treat maternal infections
- Failing to diagnose and treat infant infections
Treatment for Spastic Hemiplegic CP
Spastic hemiplegia can’t be cured, but there are multiple available treatments that can improve a child’s ability to function independently. Your doctor will devise a tailored treatment plan to address your child’s specific needs. Some of the common types of treatment that might be used include the following:
- Physical therapy
- Speech therapy
- Occupational therapy
- Strength-building exercises
- Nutritional guidance and support
- Botulinum toxin injections
There isn’t a standard approach used for treating spastic hemiplegia. Instead, your child’s plan will be tailored to meet their needs. You can expect your child to have a treatment team comprised of doctors, nutritionists, physical therapists, occupational therapists, speech therapists, and others.
Complications of Spastic Hemiplegia
Children whose spastic hemiplegia is not properly treated can suffer additional complications, including osteoporosis, fractures, osteopenia, scoliosis, and increased pain. They are also at a greater risk of malnutrition and pneumonia caused by aspiration.
Prognosis for Children With Spastic Hemiplegia
The treatment and care for children with spastic hemiplegic CP can be complex. It might take some time for the involved treatment team to determine the types of treatment that will offer the greatest benefits for your child. If your child receives the early intervention and the right treatment, they might adapt well and learn to function independently.
Spastic quadriplegia is the most severe type of spastic cerebral palsy and affects the child’s entire body. Children with spastic quadriplegic CP will exhibit effects in all four limbs and the torso, and many will also have effects in the face. Spastic quadriplegia affects many areas of the body, causing children to experience problems with walking. Many children with this form of cerebral palsy can’t walk and are likelier to have other associated conditions, including seizures and speech problems. While children with spastic quadriplegia can benefit from early treatments, they will generally require lifetime care and support.
Causes of Spastic Quadriplegia
Like the other types of cerebral palsy, spastic quadriplegia is caused by damage to the areas of the brain that control movement and balance. This damage can occur prior to birth or during or after it. Brain damage to the infant’s brain can result from multiple factors, including preterm birth, fetal strokes, fetal infections, maternal health conditions, maternal infections, toxic exposures, or medical malpractice.
Children who are born prematurely are especially at risk of developing spastic quadriplegia. Between 26 and 34 weeks of gestation, the fetus’s white matter is very delicate and susceptible to damage. The brain’s white matter is responsible for sending signals from the brain out to the other areas of the body. If it is damaged, the entire body can be affected. Holes or lesions in the brain’s white matter can cause spastic quadriplegia.
Fetal strokes can also cause spastic quadriplegia. In some cases, fetuses will suffer fetal strokes because of placenta previa and placental blood clots. Others might suffer fetal strokes because of weak blood vessels in the brain, and maternal high blood pressure can also cause fetal strokes. These are fairly common problems that can occur during pregnancy, making it important for obstetricians to carefully monitor mothers throughout pregnancy so that underlying conditions can be promptly diagnosed and treated.
Medical Malpractice and Spastic Quadriplegia
While it can be difficult to identify a single cause of spastic quadriplegic CP, medical errors made by doctors, midwives, nurses, and others can sometimes result in brain damage and this type of cerebral palsy. Some of the following actions might result in a child’s development of spastic quadriplegia:
- Failing to monitor the developing fetus
- Failing to diagnose and treat maternal conditions and infections
- Failing to monitor and intervene when the fetus shows signs of distress
- Failing to perform an emergency C-section when needed
- Using excessive force during delivery
Spastic Quadriplegia Symptoms
Children with spastic quadriplegia generally have more severe symptoms than children with other forms of cerebral palsy. The following symptoms are common in children with this type of cerebral palsy:
- Rapidly contracting muscles that also rapidly release
- Immobile, stiff joints
- Muscle spasticity
- Muscle rigidity
- Muscle tremors
- Scissoring limbs
- Difficulty walking or an inability to walk
- Speech and language problems
- Intellectual disabilities
Children who have spastic quadriplegia might show early signs of the condition. For example, a child might not be able to raise their head by two months, have stiff muscles, and fail to roll over, sit up, or crawl on time.
Complications of Spastic Quadriplegia
Since children with spastic quadriplegia might be affected throughout their bodies, they have an increased risk of developing deformities of the limbs. Spastic muscles place pressure on the joints and bones by continuously pulling at them, which can result in problems over time when they are not properly treated.
Some other complications of spastic quadriplegia include the following:
- Scoliosis or curvature of the spine
- Ankle equinus causing limited flexion of the ankle and deformities
- Joint contractures leading to a permanent shortening of the muscles surrounding the joints because of spasticity
- Malnutrition caused by trouble swallowing
- Speech problems caused by spasticity of the facial muscles and tongue
- Seizure disorders
- Learning disabilities
- Intellectual disabilities
- Incontinence and constipation
Treatment of Spastic Quadriplegia
Because of the severity of the symptoms, many parents notice signs during infancy that cause them to see their doctors. A doctor can then detect significant developmental delays and diagnose the condition. Spastic quadriplegia is one of the few forms of CP in which diagnosis typically occurs before a child reaches 12 months. The recommended treatment will depend on the child’s symptoms and their severity. Traditional treatments for spastic quadriplegia include physical therapy, speech therapy, occupational therapy, medications, mobility devices, and communication devices. If limb deformities are present, doctors might recommend surgery.
Prognosis for Children With Spastic Quadriplegia
The prognosis for children with spastic quadriplegic CP is worse than for children with other forms of the condition. This type is associated with more complications and other conditions that can reduce the child’s lifespan and interfere with the child’s ability to function independently. However, early and ongoing treatment can help facilitate a child’s functioning and ability to live a productive life.
Speak with a Lawyer for Cerebral Palsy
Learning that your child has any form of spastic cerebral palsy can be overwhelming, and you might not know what to do. Since some cases of spastic CP are caused by medical negligence, it is a good idea to consult an experienced spastic cerebral palsy lawyer at Raynes & Lawn as soon as possible after you learn of your child’s diagnosis. We can work with medical experts to determine whether your child’s condition was caused by medical malpractice and help you understand your legal options. Call us today to schedule a free consultation at 1-800-535-1797.
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