Spastic cerebral Palsy 

Spastic cerebral palsy

is the commonest variety of Cerebral Palsy. More than 70% of children with CP are affected by Spastic Cerebral Palsy. This problem occurs due to damage to the cerebral cortex in the brain. Spastic Cerebral Palsy is defined as the condition, where the muscle in the body is spastic and lacks flexibility. Spasticity means increase tone in muscle & hypertonia. It inhibits coordinated movement in the body. In spastic variety, one side of muscle opposes the function of the other side muscle due to lack of coordination & spasticity. Initially, there will not be any contracture, joint & bony fix deformity but with the passage of time and with persistent spasticity these problems develop. The child will have problems crawling standing and walking. This spasticity can affect one extremity to the whole body. This condition will not be completely cured in the patient’s lifetime but there can be a progressive improvement in functional capability by cerebral palsy therapy treatment. Spasticity usually lessens down with therapy after 8 years of age but they may develop fixed shortening of muscles. Children suffering from Spastic CP face difficulties in simple day-to-day tasks.

Spastic Cerebral Palsy Types

Spastic cerebral palsy can affect from one extremity to all four extremities and eventually in some cases the whole body. The severity of the problem can range from a minor problem in gait to severe disability. The severity of disability depends upon the extent of the lesion in the brain.

Causes

Birth asphyxia is the commonest cause but sometimes etiology is not identifiable. Genetic causes also play a role. Very low birth weight and premature born babies are more prone to brain insult. 

Symptoms

• Spastic and tight muscle in body
• Joint contracture
• Bony deformity
• Abnormal gait pattern including toe walking, scissoring gait, crouch gait etc
• Poor coordination & poor control of muscle movements.
• Inability to perform activities of daily life
• Child can have other associated problem like drooling, difficulty in swallowing, gastro-intestinal problem of constipation and reflux, problem in speech, seizure cognition and behavioral abnormality etc.

Types of Spastic Cerebral Palsy

Monoplegic Spastic Cerebral Palsy

It is a form of paralysis where only one extremity of the body is affected.

1. Spastic Hemiplegia

where one side of the body is affected. In this variety, one side upper & lower limb is affected. The severity of the upper or lower extremities is varied.

2. Spastic Diplegia Cerebral Palsy

It primarily affects the lower part of the body including both legs. The upper limb will have only functional problems. Spastic Quadriplegia is a severe condition of Spastic Cerebral Children. In this case, both arms and legs are affected. The patient cannot stand, walk and sit properly without taking any help from someone else.

3. Spastic Triplegia

In which both lower limb and one upper limb are affected.

Spastic Cerebral Palsy Diagnosis

Treatment

Diagnosis of cerebral palsy is based on history & clinical assessment. Diagnosis can be made earliest at the age of 6 months if not showing normal development milestones. History of high-risk factor-like premature delivery < 32 weeks of pregnancy, Low birth weight <1.5kg, history of maternal infection, hypothyroidism, intake of toxic drugs, history of asphyxia, severe jaundice, encephalitis, etc increase the chances of getting cerebral palsy. History of abnormal response during birth, lack of social smile, no use of any extremity, the abnormal tone of the body, stiffness, palsy, dribbling of saliva, difficulty in sucking & swallowing, delayed milestone, history of convulsion, speech problem, and other associated medical problem, etc helps in making a diagnosis of palsy. An investigation like MRI, CT scans, and ECG are required to supplement the clinical diagnosis, to see the extent of the lesion, the severity of the problem, and to rule out other possible causes of delayed milestones.

These children require multimodal therapy which includes physical & occupational therapy, brace, walking aids, and surgery.

Therapy

Physical therapy is to improve muscle power, coordination, relaxing abnormal reflexes. Occupational therapy is being used to give training in ADL, speech therapy to improve speech. Special exercise technique like NDT, SI & CIMT is also required to manage these children. Yoga and meditation are very useful in cerebral palsy children. Traditional exercises like stretching and joint mobilization should not be used.

Special education:

To provide training in initial learning and writing skill for mainstream schooling

Brace:

AFO and gaiter are the essential braces for managing lower limb dysfunction in cp

Botulinum toxin:

Is being used for spasticity in early age child

Orthopedic surgery:

Orthopedic surgery is being used to manage fix deformity, muscle contracture, and bony deformity.