Spastic Diplegia: Understanding Its Symptoms and How to Effectively Manage Them

Spastic diplegia is one of the most common types of cerebral palsy.

Individuals with this type of CP experience motor impairments on both sides of their bodies evenly.

While it can mildly affect the arms, spastic diplegia generally affects the legs.

This article will help you better understand what spastic diplegia is and how to manage it. Let’s get started!

Symptoms of Spastic Diplegia

Cerebral palsy is caused by damage to the developing brain. Depending on the size of that brain damage, spastic diplegia will affect everyone differently.

Common symptoms of spastic diplegia include:

Spasticity

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As its name suggests, all individuals with spastic diplegia will experience some form of spasticity, which is when their muscles involuntarily contract.

While cerebral palsy will not worsen over time, spasticity can. If left unmanaged, spasticity can severely restrict mobility and even prevent individuals from being able to walk.

Most people with spastic diplegia will have an abnormal gait because the muscles in their legs cannot fully relax. The continuous muscle contractions will result in stiff movements and make it difficult for individuals to balance when they walk.

Common abnormal gait patterns include:

• Scissor gait (walking with the knees turned inwards)
• Tiptoeing
• Crouch gait (walking with continuously bent knees, hips, and ankles)

Weak Muscles

Motor impairments in the legs will make walking more difficult. Therefore, individuals with spastic diplegia are more likely to be physically inactive.

Our bodies build strength through everyday movements that place pressure on the joints, bones, and muscles.

Physical inactivity will cause the muscles and bones to weaken and lose density.

It’s important to understand that high muscle tone isn’t the same as muscle strength. Even though individuals with spastic diplegia will have high muscle tone, they’re likely to also have weak muscles, which increases their risk of injury.

Delayed Developmental Milestones

This combination of spasticity and weak muscles can contribute to delayed developmental milestones. This doesn’t mean that children with spastic diplegia will never be able to walk, it might just take longer for them to learn how to.

In fact, nearly 50-60% of children with cerebral palsy can walk independently. Those with more severe motor impairments can learn to use mobility aids like walkers and wheelchairs.

Spastic Diplegia Management

The brain has neuroplasticity, which is its ability to rewire itself. This is good news for individuals with cerebral palsy because it means functions affected by brain damage can be rewired to healthy areas of the brain.

The brain functions on demand, so the more you practice anything, the stronger the neural pathways for that skill will become.

Management for spastic diplegia is two-fold. First, spasticity must be managed. Then, individuals must repetitively practice moving with correct form to stimulate neuroplasticity.

Management interventions typically include:

1. Physical Therapy

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Physical therapy for individuals with spastic diplegia will focus on stretching spastic muscles, strengthening underused muscles, and walking with better form.

Gait training is a type of physical therapy that specifically concentrates on improving one’s ability to walk.

It can involve exercises in the pool or walking on a weight-bearing treadmill.

Practicing in a pool or using a weight-bearing treadmill will help relieve pressure off the joints so that you can focus on walking with correct form.

The more you practice, the more comfortable the movements will become. As you improve form, you’ll be able to bear more weight.

2. Occupational Therapy

Occupational therapy focuses on promoting independence through activities of daily living.

Individuals with spastic diplegia are generally capable of being very independent because their motor impairments mainly affect their lower limbs. This means that they can use their arms to assist with transfers, grooming, and feeding.

If motor impairments are more severe, an occupational therapist will teach patients with spastic diplegia how to use mobility aids like walkers, crutches, or wheelchairs.

3. Botox/ Muscle Relaxants

Botox and muscle relaxants are used to temporarily relax spastic muscles.

Individuals with spastic diplegia have more localized motor impairments, so direct injections are ideal over pills.

Keep in mind that Botox and muscle relaxants will not treat spasticity long-term.

Therefore, it’s essential for individuals to take advantage of the period of reduced spasticity and intensely pursue physical therapy.

4. Orthotics

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Orthotics like braces, splints, and casts are designed to help keep the body correctly aligned.

Spasticity can pull the body and cause unnecessary strain on the joints. This pressure can interfere with a child’s growth and cause serious complications like hip dislocations.

Wearable orthotics will help mildly stretch spastic muscles and promote normal musculoskeletal development.

5. Surgery

If spasticity is very severe, a doctor may suggest surgery.

Surgeries for spastic diplegia typically consist of manually lengthening and realigning the muscles or selective dorsal rhizotomy.

A selective dorsal rhizotomy is when incisions are made at specific nerve roots to permanently cut off innervation and reduce the excitability of the spastic muscle.

Surgery should only be considered if all other forms of management fail.

Living with Spastic Diplegia

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With effective management, spastic diplegia can be managed and mobility can be improved.

By focusing on relieving spasticity and walking with correct form, the brain can rewire itself to replace an abnormal gait.

It all comes down to how intensely you practice. Thousands of repetitions are required to promote neurological changes, so it’s essential to stay motivated, commit to your exercises, and trust in the process.

The more you practice, the more you’re stimulating the brain and its ability to adapt.

Hopefully, this article helped you understand what spastic diplegia is and how to manage it. Good luck!

Featured image: ©iStock.com/sweetmonster