Cerebral palsy primarily in the legs is called spastic diplegia.
An easy way to remember this is to break it up. ‘Spastic’ refers to stiff movements, ‘di’ means two, and ‘plegia’ means paralysis (loss of muscle control).
Put it together, and you have stiff movements in two legs due to lack of muscle control.
This type of cerebral palsy will result in motor impairments primarily in the lower body, but can also affect the upper body to a much lesser extent.
How Cerebral Palsy May Affect the Legs
Spastic diplegia can vary quite a bit from person to person.
Someone with more severe cerebral palsy will probably need to use a wheelchair to get around while someone with mild CP may be able to walk independently with a slightly irregular gait pattern.
Some common gait patterns demonstrated in people with spasticity in the legs include:
- Toe walking
- Crouch gait (when the ankles, knees, and hips all stay bent)
- Scissor gait (when the knees touch or cross over one another while the feet are spread apart)
The type of gait pattern someone has depends on which muscles have spasticity. For example, tight calf muscles will pull the heels up and force people to walk on their toes.
Spastic Diplegia and Independence
Even with severely affected legs, many people with spastic diplegia are extremely independent because they can use their arms to compensate.
They can generally maintain a job, play adaptive sports, drive with car adaptations, and perform many activities of daily living all on their own.
Occupational therapy can help people with spastic diplegia optimize their ability to perform everyday tasks and increase their level of independence with more challenging activities.
Developing a strong sense of independence can help individuals with CP feel more confident in their bodies and abilities.
Managing Spasticity in the Legs
Although the brain damage that caused cerebral palsy is irreversible, it’s symptoms can be significantly reduced when managed appropriately.
Additionally, the brain is extremely adaptive. Neuroplasticity is the brain’s ability to rewire itself, meaning that functions affected by cerebral palsy can be transferred to healthier, undamaged parts of the brain and improved.
The best way to activate neuroplasticity is through massed practice. The more repetitions of an exercise or activity you perform, the stronger the rewired neural pathways become.
Many individuals with spastic diplegia learn how to effectively manage their symptoms and boost leg mobility through neuroplasticity.
Physical Therapy for Spastic Diplegia
The primary management intervention for spastic diplegia is physical therapy.
One of the main goals of physical therapy for individuals with cerebral palsy is to promote neuroplasticity through exercises designed to improve gait, relieve spasticity, strengthen underused muscles, and improve range of motion.
You learn how to perform the exercises in physical therapy, but it’s also very important to practice them at home on your own time to get the repetitions necessary to strengthen neural pathways in the brain.
Oftentimes, individuals with cerebral palsy have developed a habit of walking with an improper gait, so learning to walk with better form will likely be challenging. However, in the long run, walking with an improved gait pattern can reduce pain and inhibit further development of spasticity.
Orthotics for Cerebral Palsy in the Legs
A big part of having cerebral palsy is focusing on what you can do and working towards improvements.
For example, if you walk with an abnormal gait pattern, wearing a brace can help hold the limb in place so that you can walk more naturally. It may feel uncomfortable at first, but wearing orthotics will encourage use of proper form.
The more you practice using proper form, the more comfortable it will feel.
A physical therapist can recommend an orthotic that is appropriate for you.
Medications for Spasticity Relief
Botox and baclofen are medications that can be used to reduce spasticity temporarily.
Botox works by blocking the chemical signals that cause muscle contractions. It is directly injected into tight muscles and can relieve spasticity for several months.
Baclofen is a muscle relaxant that can be injected, taken orally, or pumped through the spinal canal.
The best way to improve motor function is to take advantage of reduced spasticity and intensively work on physical therapy exercises.
This will help boost mobility and promote neuroplasticity, benefits that will last even after the effects of the medication wear off.
Many people with spastic diplegia will have walked with spasticity their entire lives and are accustomed to it. Walking without spasticity will probably feel uncomfortable because it is a new experience.
Every time you perform a new movement, a new set of neural pathways fires together.
As you figure out how to adjust your center of gravity and continue to practice, the stronger the neural pathways will get, and the more normal it will feel.
Surgical Interventions for Spastic Diplegia
Surgery is typically only recommended when all other interventions fail to reduce spasticity.
Muscle lengthening surgeries (typically of the heel cords or hamstrings) will manually lengthen contracted muscles.
A Selective Dorsal Rhizotomy is a more permanent spasticity solution. By cutting the nerve roots, spasticity can no longer occur.
Achieving Goals with Cerebral Palsy That Affects the Legs
That’s a wrap! To help boost your motivation, let’s end this article with an inspiring CP success story.
Meet Justin, the first athlete with cerebral palsy to be signed by Nike.
On Instagram, Justin wrote:
“Growing up with a disability, the thought of becoming a professional athlete is as I have said before like the thought of climbing Mt. Everest! It is definitely possible, but the odds are most definitely not in your favor! […] I was once a kid in leg braces who could barely put on[e] foot in front of the other! Now I have signed a contract with Nike Running!”
Many people with cerebral palsy feel like certain aspirations are out of their reach and won’t even bother trying. We believe that if you’re willing to put in the work, there’s always a way to overcome your obstacles.
Justin proves that having the resilience and determination to focus on your abilities, create a goal, and work towards it can pay off.
Hopefully, this article helped you realize that people with spasticity in their legs can still be independent and live very fulfilling lives.
image credits: ©iStock.com/wernerimages/AndreyPopov