What is Spastic Diplegia?
Learning that a child has cerebral palsy can be overwhelming for most parents. If your child has been diagnosed with cerebral palsy, you might be worried about whether they will grow to be independent and have a fulfilling life. While cerebral palsy is incurable, many children significantly benefit from early intervention to help them improve their ability to control their muscles, increase mobility, and become more independent. Your child’s prognosis will depend on the severity of their condition and the form of cerebral palsy they have.
The most common type of cerebral palsy is spastic cerebral palsy, which accounts for 80% of all cases diagnosed in the U.S. Spastic cerebral palsy includes three different forms that are named based on the affected areas, including spastic diplegia, spastic hemiplegia, and spastic quadriplegia. Here’s what to understand about spastic diplegia from the Philadelphia cerebral palsy law firm of Raynes & Lawn.
Understanding Spastic Cerebral Palsy
Spastic cerebral palsy is the most common type of cerebral palsy. People with this condition have increased muscle tone in one or more areas of their bodies. Spastic cerebral palsy is caused by damage to different areas of the brain during fetal development, shortly before birth, during labor and delivery, or shortly after birth.
The various forms of spastic cerebral palsy, including spastic diplegia, hemiplegia, and quadriplegia, describe the affected areas of the body. People with spastic CP may experience the following problems:
- Extremely rigid muscles
- Difficulty moving affected areas
- Difficulty moving from one position to another
- Trouble coordinating movements
- Balance problems
- Difficulty speaking or swallowing when the facial muscles are affected
Spasticity is caused by damage to regions of the brain that are responsible for controlling motor function, including the corticobulbar and corticospinal tracts. This causes improper neural signaling to the affected areas of the body.
What Is Spastic Diplegia?
Spastic diplegia is also known as spastic diparesis. It is a form of spastic CP that predominantly affects the legs. The arms might only be minimally or not at all affected. People who have spastic diplegia frequently show leg scissoring when they walk. Leg scissoring involves turning the knees inward or the knees crossing when people attempt to walk. This is caused by muscular spasticity and rigidity of the leg and hip muscles.
While the symptoms of spastic diplegia overlap with other types of CP, the following symptoms are characteristic of people with this form of cerebral palsy:
- Overly stiff, spastic leg muscles
- Jerky, exaggerated leg reflexes
- Toe walking
- Leg scissoring
Causes and Risk Factors of Spastic Diplegic Cerebral Palsy
Spastic diplegia is caused by damage to specific areas of the brain involved with motor functioning. In many cases, the cause of the brain damage resulting in spastic diplegia occurs just before, during, or shortly after birth because of a birth injury. A birth injury can be caused by multiple problems near the time of birth, including infections, oxygen deprivation, trauma, and others. In many cases, birth injuries result from medical malpractice on the part of a doctor, nurse, or another medical provider. Some examples of birth injuries and medical problems that can result in spastic diplegia include the following:
- Premature birth
- Birth of multiples
- Birth asphyxia
- Hypoxic-ischemic encephalopathy (HIE)
- Low Apgar score
- Maternal infections
- Untreated jaundice resulting in kernicterus
- Rh incompatibility
- Abnormal positioning
Medical negligence can result in spastic diplegia. Some examples of the types of medical mistakes that can result in birth injuries and cerebral palsy include the following:
- Improperly using forceps or vacuum extractors to assist the delivery process
- Applying excessive force
- Failing to properly monitor the mother and fetus
- Failing to promptly intervene at signs of fetal distress
- Failing to perform an emergency C-section when needed
- Failing to diagnose and treat the mother’s medical conditions or maternal infections
- Failing to treat infant jaundice
- Failing to diagnose umbilical cord problems
When birth injuries that later cause spastic diplegia occur, the parents might consider filing a birth injury malpractice claim with the help of a cerebral palsy lawyer.
Symptoms/Signs of Spastic Diplegic CP
Spastic diplegic CP primarily affects the legs. In more severe cases, however, the upper limbs might also be impaired but to a lesser extent. While the symptoms of this condition can vary from individual to individual, the following symptoms are common among people who have spastic diplegia:
- Hypertonia of the leg muscles (stiffness)
- Atrophied muscles
- Toe walking
- Leg scissoring
- Delays in reaching developmental milestones
- Spasticity or jerky movements
- Poor balance
- Unsteady movement
Children with more severe cases might also have intellectual disabilities, seizures, crossed eyes, and sensory losses. However, most children with spastic diplegia have normal intellectual functioning and can learn to walk independently. Others might suffer more severe impairments and might require mobility devices, including wheelchairs, walkers, crutches, or canes.
By identifying the signs that your child might have cerebral palsy early, you can ensure your child receives early treatment. Early intervention and treatment can help to reduce the effects of motor function problems and can help your child avoid forming poor motor skills.
Here is some more information about the most common symptoms of spastic diplegia.
Involuntary Muscular Contractions (Spasticity)
All children who have spastic diplegia experience involuntary muscular contractions of their legs, which are called spasticity. This happens because of brain damage to the motor cortex, which disrupts neural signaling from the brain to the child’s muscles in the lower limbs. As a result, the muscles of the lower limbs stay contracted involuntarily.
Spasticity of the muscles is the cause of other secondary complications, including pain, growth problems, and abnormal patterns of walking. While the damage to the brain won’t worsen over time, spasticity that is left untreated can grow worse. If it is not properly treated, spasticity can severely impact the child’s mobility and lead to an inability to walk.
Abnormal Patterns of Walking
Most children with spastic diplegia exhibit abnormal patterns of walking. Abnormal gaits are caused by the inability of the children’s leg muscles to fully relax because of their spasticity. The constant contractions cause stiff movements that make it hard for affected individuals to walk and maintain balance.
The following abnormal patterns of walking are common in people with spastic diplegia:
- Scissor walking
- Toe walking
- Crouch walking or walking with the ankles, hips, and knees continuously bent
Children with severe muscular spasticity in their legs might refrain from physical activity. Since we build strength by moving every day in such a way that pressure is placed on muscles, bones, and joints, a lack of regular physical activity can cause the muscles to atrophy and weaken, which can result in increased injury risk.
Delays in Meeting Developmental Milestones
Infants and toddlers progress through a series of developmental milestones, which are steps in development that should happen at specific ages. Muscle weakness and spasticity can combine to make children fail to reach certain developmental milestones on time, including walking, crawling, and standing. While the children might have motor delays, it doesn’t mean that they won’t ever be able to achieve them. It might just take more time for them to reach the delays. With time and appropriate treatment, more than half of children who have CP will eventually walk independently. Children who have more severe forms of the condition might be taught to use mobility devices, including wheelchairs and walkers, to increase their ability to function independently.
Growth and Development Abnormalities
Some children with spastic diplegia can develop distortions and abnormalities in their limbs because of the pressure placed on their bones, joints, and muscles. For example, a child might have one leg that is shorter than the other because of increased pressure on the muscles in the shortened leg.
Treatment and Early Intervention for Spastic Diplegia
Infants who suffer birth injuries might be classified as having a high risk of developing cerebral palsy. However, it can take months or years before a child might be formally diagnosed. This is because the condition affects the child’s motor functioning, so the symptoms might not be apparent until the child starts to miss different developmental milestones. It can take longer to diagnose children whose conditions are less severe. To make a diagnosis, doctors must distinguish spastic diplegic CP from other conditions that can also cause spasticity such as neurodegenerative problems.
By getting prompt treatment and early intervention, you can help your child to improve their quality of life. Spastic diplegia can range in severity and affect the leg muscles differently, making it important to obtain a tailored treatment plan for your child.
Treating spastic diplegia often involves a team of professionals, including doctors and several different types of therapists. The primary goal of treatment is to encourage the brain to rewire its circuitry and make adaptive changes through its natural neuroplasticity. The brain’s neuroplasticity can enable the brain to be rewired so that functions that would normally be controlled by damaged areas can be instead rerouted to healthy areas of the brain.
Neuroplasticity is best promoted through repetitive, specific tasks. The more a child practices a skill, the more the neural pathways involved with it will become stronger. Since children’s brains have a higher degree of neuroplasticity than those of older children or adults, early intervention is important. However, even adults have the ability for their brains to adapt, so people might improve by undergoing treatment regardless of age.
The most common forms of treatment used for spastic diplegia are described below.
Physical therapy is a major treatment used for children with spastic diplegia. The goal of physical therapy in treating spastic diplegia is to reduce the impact of muscular spasticity in the legs. Children might work to stretch spastic muscles, build strength in their underused muscles, and learn to walk with an improved gait.
One type of physical therapy that is frequently used with children who have spastic diplegic CP is gait training. This therapy works to improve the child’s ability to walk. The child might practice exercises while walking on a treadmill or in a swimming pool. The activities help to relieve excess pressure on the joints, allowing the children to concentrate on improving their form. They also help to reduce the likelihood the children will fall and injure themselves, which can help children to feel more confident with practicing increasingly challenging skills.
Physical therapists who work with children with spastic diplegia typically incorporate fun activities and games to maintain the children’s interest. This can make physical therapy fun for children and help them to fully engage in therapy. It can also help parents to encourage their children to practice their newly learned skills at home. Physical therapy is effective because it helps to stimulate the brain through repetition. The child’s neuroplasticity can be activated the more they practice so that they can strengthen their skills through new neural connections.
Occupational therapy is another common type of treatment used with children who have spastic diplegia. This type of therapy helps children to gain more independence in performing the activities of daily life. Since children with spastic diplegic CP mostly have impairments in their lower limbs, they are generally able to become fully independent. In occupational therapy, they might learn how they can use their arms to help by dressing, toileting, and transferring into and out of chairs, beds, sofas, and other surfaces.
If a child has severe motor impairments, the occupational therapist and the physical therapist might work to teach the child how to use mobility devices, including wheelchairs, walkers, or crutches. Occupational therapists might also help children learn how to use other types of adaptive equipment to increase their ability to function independently.
Muscle relaxers and Botox might be prescribed to block neural signals that cause the child’s muscles to tighten. These medications might help by providing temporary relief from spasticity while delaying the progression of contractures. Since spastic diplegia primarily affects the legs, muscle relaxers and/or Botox will typically not be orally administered. Instead, doctors might directly inject these drugs into the affected muscles. During the period of reduced spasticity, children should be encouraged to pursue intense physical therapy to gain long-term improvements.
Orthotic devices can help children to keep their bodies in proper alignment and might include casts, splints, and braces. Spastic muscles can pull the child’s body out of alignment and place excessive strain on their joints. The increased pressure might cause problems with the child’s ability to grow and create serious complications such as dislocation. Orthotic devices mildly stretch the muscles and give the child more support to prevent their muscles from tightening more. They can also help by increasing the child’s stability while walking and transferring.
Surgery might be recommended for children with spastic diplegia to realign and lengthen the muscles. It might also involve selective dorsal rhizotomy, in which incisions are made at specific nerve roots. This can permanently reduce the spasticity of a muscle. Surgery will typically only be recommended when the spasticity is severe.
Medical Malpractice and Spastic Diplegia
It is important to note that not all cases of cerebral palsy are caused by medical negligence. In many cases, the exact cause of a child’s condition won’t be known. However, spastic diplegic CP is sometimes caused by the careless actions of a medical provider near or at the time of birth. In this type of situation, you might have grounds to file a malpractice lawsuit against the responsible parties.
To prove a medical malpractice case, you will need to prove the following elements by a preponderance of the evidence:
- There was a provider-patient relationship.
- The provider’s treatment fell below the standard of care expected of a reasonably competent provider in the same practice field and geographic region.
- The provider’s substandard treatment proximately or directly caused your child’s birth injury and resulting spastic diplegia.
- You and your child suffered calculable damages.
To win your case, you will need to prove each of the above-listed elements. If you prove some, but not all, of the elements, you won’t win your malpractice case.
Before you can file a malpractice claim in Pennsylvania, you must first have a medical expert review the medical records. The expert must provide an opinion that the doctor’s care deviated from the expected standard and likely caused your child’s injury. Your attorney will file a certification that your case has been reviewed by a medical expert at the time they file your lawsuit.
Damages in a Spastic Diplegia Lawsuit
The available damages in a spastic diplegia malpractice lawsuit will vary from case to case and will depend on multiple factors. In general, however, the available damages in cases involving cerebral palsy can be substantial because of the ongoing care the child will need.
Damages are monetary awards to negligence victims and include both economic and non-economic damages. Your economic damages are the pecuniary losses you have or will suffer in the future, including such things as your child’s past and future medical expenses, therapy expenses, mobility aid expenses, lost wages, and others.
Non-economic damages are awards for intangible losses that are not as easily valued. Some examples might include your child’s physical pain and suffering, emotional distress, disability, reduced quality of life, and more. Pennsylvania does not place a cap on recoverable compensatory damages in a medical malpractice claim.
If the provider’s actions were particularly outrageous, punitive damages might also be available. These are damages that are meant to punish defendants who have acted in an especially reckless manner and are payable on top of any compensatory damages. Pennsylvania limits punitive damages to no more than twice the plaintiff’s compensatory damages.
Statute of Limitations
It’s important to understand the statute of limitations for filing medical malpractice claims. In Pennsylvania, you must file a claim no later than two years following your child’s injury. However, the limitations period does not begin to run until the date you discover your child’s cerebral palsy was caused by medical negligence or when you reasonably should have discovered it.
If you don’t file a claim for your child, they will have two years from the date they turn age 18 to file a claim. The limitation period is tolled for minors until they reach adulthood.
While figuring out the statute of limitations might sound relatively straightforward, multiple complexities can be involved. You should reach out to an experienced cerebral palsy lawyer at Raynes & Lawn as soon as you learn that your child has spastic diplegia to avoid the potential statute of limitation issues. If you miss the relevant period, your claim will be barred, which means you won’t be able to recover compensation for your losses.
How Do I Find Cerebral Palsy Lawyers Near Me?
Speaking to an experienced attorney as soon as possible after you learn about your child’s diagnosis is critical. Getting help early can help your attorney find and preserve important evidence to support your claim, including all relevant medical records and witnesses. When you are searching for an attorney, it is important to choose someone in your area who has substantial experience litigating cerebral palsy malpractice cases. This is because of the difficulty of litigating these cases. Medical malpractice claims involving cerebral palsy can be more difficult to prove because the cause of CP is generally unknown and insurance companies aggressively litigate against claims because of the substantial monetary amounts involved.
The Pennsylvania Birth Injury lawyers at Raynes & Lawn have fought for the rights of families in medical malpractice cases involving cerebral palsy for more than five decades and have successfully recovered billions of dollars for their clients. To learn more about your rights, schedule a free consultation today by calling 1-800-535-1797.
For the general public: This Blog/Website is made available by the law firm publisher, Raynes & Lawn, for educational purposes. It provides general information and a general understanding of the law but does not provide specific legal advice. By using this site, commenting on posts, or sending inquiries through the site or contact email, you confirm that there is no attorney-client relationship between you and the Blog/Website publisher. The Blog/Website should not be used as a substitute for competent legal advice from a licensed attorney in your jurisdiction.
For attorneys: This Blog/Website is informational in nature and is not a substitute for legal research or a consultation on specific matters pertaining to your clients. Due to the dynamic nature of legal doctrines, what might be accurate one day may be inaccurate the next. As such, the contents of this blog must not be relied upon as a basis for arguments to a court or for your advice to clients without, again, further research or a consultation with our professionals.