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Paraplegic Cerebral Palsy: Causes, Expectations, and Management

what is paraplegic cerebral palsy

Paraplegic cerebral palsy isn’t often acknowledged because it’s commonly mistaken for or grouped together with diplegic cerebral palsy.

Diplegic cerebral palsy affects both sides of the body (predominantly the legs, but can also affect the arms to a lesser extent).

In contrast, paraplegic cerebral palsy is when only the legs are affected.

This article is going to help you understand what to expect and how to manage paraplegic cerebral palsy.

Let’s get started!

Causes of Paraplegic Cerebral Palsy

Paraplegic cerebral palsy is caused by damage to the brain before or during birth, or in early childhood.

Common causes include:

  • Premature birth
  • Bleeding in the brain
  • Seizure
  • Head trauma
  • Oxygen deprivation
  • Abnormal brain development
  • Brain infections

What Does Paraplegic Cerebral Palsy Look Like?

paraplegic cerebral palsy management

©iStock.com/JNemchinova

Paraplegic cerebral palsy is characterized by stiff movements in the legs due to spasticity (continuous and involuntary muscle contractions).

Depending on the severity of the damage to the brain, children with paraplegia may or may not be able to walk.

Those that can walk will likely walk with an abnormal gait pattern.

Examples of abnormal cerebral palsy-related gait patterns include:

  • Tiptoeing
  • Foot-dragging
  • Scissoring (knees pressed together or crossing each other with feet pointed inwards)
  • Crouch gait (knee, hip, and ankle flexion without extension)
  • Jump gait (knee and hip flexion with tiptoeing)

Managing Paraplegic Cerebral Palsy

child with paraplegic cerebral palsy gettting physical therapy

©iStock.com/olesiabilkei

Once a child learns to walk with an abnormal gait, it’s very difficult to correct because it has become habit.

The earlier management interventions are put in place, the easier it will be to improve your child’s gait.

Typically, a combination of multiple management interventions works best.

The first step is to manage spasticity.

Baclofen

Baclofen is a muscle relaxant used to temporarily reduce spasticity.

It can be administered:

  • orally in the form of a pill
  • directly into the muscle by injection
  • through an intrathecal pump for continuous delivery

Baclofen injections are ideal for those with paraplegia because taking it orally or through an intraspinal pump will cause the medication to affect the entire body.

Botox

Botox is a nerve blocker that is directly injected into spastic muscles for longer spasticity relief than baclofen.

Typically, the effects of Botox last anywhere between 3-6 months.

This creates a window of opportunity where individuals with CP can practice walking with minimal spasticity and correct their abnormal gait patterns.

It’s definitely easier said than done, but by taking advantage of reduced spasticity and consistently walking with correct form, children with cerebral palsy can train their brains to rewire themselves (neuroplasticity) and replace the abnormal gait pattern.

Learn more about Botox »

Bracing

Bracing helps keep your leg in place and prevents spastic muscles from further contracting and comprising form.

It will also help mildly stretch spastic muscles, even when you’re not actively exercising.

Surgery

In cases of severe spasticity where all other management interventions fail, surgery may be recommended.

Some of the most common surgeries for spasticity include selective dorsal rhizotomy (which involves cutting the nerves that innervate the spastic muscle) and muscle lengthening surgeries.

Because of it’s risky and invasive nature, surgery may not be ideal for children and should be postponed as long as possible.

Gait Training

Last and most importantly is intensive gait training.

Gait training is a type of physical therapy that specially focuses on improving walking ability.

Spasticity treatment will allow your child to walk with proper form, but it will not teach your child how to walk.

Only through intensive gait training can children learn how to:

  • walk with correct form
  • increase their range of motion
  • strengthen underused muscles
  • reduce the excitability of spastic muscles

Neuroplasticity allows the brain to reassign affected functions to undamaged regions of the brain, but extensive repetition is required.

Living with Paraplegic Cerebral Palsy

spastic paraplegia cerebral palsy

People with paraplegic cerebral palsy have normal functioning of their heads, necks, arms, hands, and torso.

This enables a lot of independence. They can maneuver a wheelchair, perform activities of daily living, and participate in many activities with little to no adjustments.

It requires a lot of hard work and effort but training your brain to replace an abnormal gait pattern is possible because of neuroplasticity.

Hopefully, this article helped you better understand what paraplegic cerebral palsy is and what you can do to manage it.

Good luck!

Featured image: ©iStock.com/sweetmonster

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