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Spastic Quadriplegia Cerebral Palsy Information

LAWYER HELPLINE: 1800 339 353

Spastic quadriplegic cerebral palsy is also called spastic quadriplegia and happens when a child under the age of 3 sustains a significant brain injury so that both the legs and arms are affected. In many ways it can be considered one of the worst types of cerebral palsy to have. It is worse than the related spastic hemiplegia or spastic diplegia.

In spastic quadriplegia, a large portion of the motor parts of the brain suffers from a lack of oxygen or intraventricular bleeding (bleeding in the ventricles of the brain). The cells die and do not send signals for movement or feeling of the extremities and trunk. This results in a stiffening or spasticity of the muscles so that they begin to bend the joints into unnatural positions.

Patients with spastic quadriplegia have an inability to walk in almost all cases and most have an abnormality in their speech. The legs and arms are very stiff; the neck, on the other hand, is often floppy so that the child cannot hold his or her head up without support. Kids with spastic quadriplegia are more likely to have seizures when compared to normal children or to children with other forms of cerebral palsy.

Because this is such a severe form of cerebral palsy, many children also suffer from problems with their intelligence. Some may be considered mentally retarded in a mild, moderate or severe way. Because it is difficult to communicate with these children, their intelligence may be too hard to even determine.

Congenital anomalies or the brain or severe brain damage can cause spastic quadriplegia. The problem can occur before birth when maternal toxins or infections take hold. The problem can also happen due to infant prematurity or traumatic brain injuries occurring after or during the time of birth. With spastic quadriplegia, the condition is more likely to happen when the brain has not really developed, such as before twenty weeks gestation. Even injury to the brain between 20 weeks and 34 weeks gestation can contribute to spastic quadriplegia. This is a time of great brain development and an increased susceptibility to brain damage. Easily, the entire body can be affected by brain injury at this stage of development.

Babies can also suffer from strokes - both inside and outside the womb. If a blood clot forms in the umbilical artery that supplies the baby, the brain cells are the most likely to be permanently injured resulting in spastic hemiplegia. If the blood vessels of the brain are formed in a weak state or malformed condition, strokes can develop before or after birth. Foetal strokes can result from high blood pressure in pregnancy or by infections in the mother, including pelvic inflammatory disease. When infection occurs, the body releases cytokines that are helpful in killing off the infection but do damage to delicate brain cells.

Fewer than ten percent of cases of spastic quadriplegia are caused by a lack of oxygenation of the infant at the time of birth. Still, doctors need to be aware of evidence that the placenta is insufficient or that the umbilical cord is being compressed or has ruptured. If the mother suffers from low blood pressure due to blood loss or other condition at the time of birth, this can cause poor oxygenation to the foetus just prior to birth.

Spastic quadriplegia involves stiffness of all the muscles of the extremities. This means that some muscles are pulling too hard on the joints. It can cause permanent deformities of any of the joints. It can also cause curvature of the spine or "scoliosis". About 25% of all patients with spastic quadriplegia have suffered the tug and pull of muscles of the back so that scoliosis occurs. Severe scoliosis can impact the ability of these children to ever walk.

Foot problems are also common in spastic quadriplegic cerebral palsy. A condition called ankle equines can occur which looks like extreme plantar flexion of the foot due to stiffness of the muscles of the back of the calf. The foot drops down and the patient has no choice but to walk on his or her toes.

Swallowing is very difficult for patients with spastic quadriplegia. Food can accidentally be inhaled into the lungs causing pneumonia and other lung conditions. Some kids just can't swallow enough food to get by so they need to have a feeding tube placed in order to get enough calories. In addition, the child almost always has bowel and bladder difficulties needing medical attention and alternative ways to void.

Spastic quadriplegia is often found when the child is an infant. A significant developmental delay is often noted and many children will develop seizures even before the motor problems are identified. Because spastic quadriplegia is so severe, many children are diagnosed even before they are six months old because of increased floppiness or spasticity of muscles.

The goals of treating spastic quadriplegia are to prevent contractures (permanent bending) of the joints, improve speech, attempt ambulation and maintain as much upper extremity function as possible. In most cases, independent living will not be possible due to decreased intelligence and seizures. Doctors fortunately can manage the seizure disorder with medications. Surgery may need to be done in order to correct the physical deformities of the extremities.

Much of the treatment of spastic quadriplegia involves physical and occupational therapy, using braces to prevent contractures of the joints and attempting to maximize independence. Speech therapy is often used to try and obtain intelligible speech in spite of cognitive problems and things like facial grimacing. Goals also include making the patient with spastic hemiplegia more comfortable in whatever way possible. Antispasmodic drugs are used to block the muscle spasms that can be painful and disfiguring.

There is no cure for spastic quadriplegia because the insult to the brain has already happened by the time the disorder is identified. These patients almost always need significant medical and familial support in order to be able to live in the home and obtain at least a small degree of independence.

LAWYER HELPLINE: 1800 339 353




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