an-introduction-to-spastic-cerebral-palsy

Spastic Cerebral Palsy is a non-progressive neurological disorder that inhibits the development of the motor function. It is a subtype of Cerebral Palsy, which occurs due to brain damage sustained at or shortly after birth and is a lifelong condition. There are several types of Cerebral Palsy, but Spastic Cerebral Palsy is the most common. Here, we take a closer look at what Spastic CP looks like and how to diagnose it.

Understanding Spastic Cerebral Palsy

Cerebral Palsy refers to a group of neurological disorders that affect movement, muscle tone, coordination, and motor skills caused by damage or abnormalities in the developing brain. It typically occurs due to injury or infection before, during, or shortly after birth. While there is no cure for Cerebral Palsy, treatment options such as Stem Cell Therapy, Physiotherapy, Occupational Therapy, and Speech Therapy go a long way in restoring functionality and boosting the patient’s independence.

The types of Cerebral Palsy that a child might have include Spastic, Atonic, Dyskinetic, Ataxic, and Mixed. Spastic Cerebral Palsy occurs when the damage is sustained by the brain’s motor cortex. Spasticity simply means abnormal muscle tightness, or Hypertonia. The tightness occurs because the damaged part of the brain cannot send messages correctly to the muscles. Patients with Spastic Cerebral Palsy thus display stiff, jerky movements. The faster the movement, the stiffer the limb appears. This makes it harder to complete voluntary movements and even hard to speak clearly. Spastic Cerebral Palsy accounts for about 77% of all Cerebral Palsy cases.

Types of Spastic Cerebral Palsy

Spastic CP can be broken down into subtypes that more comprehensively describe the location and nature of the symptoms. Depending on where the brain damage occurrs, children with Spastic Cerebral Palsy may have different types of movement issues. These include:

  • Spastic Diplegic Cerebral Palsy: Children experience muscle stiffness primarily in the legs, and to some extent, the arms. 
  • Spastic Hemiplegic Cerebral Palsy: This diagnosis is given when the symptoms affect only one side of the body. In such cases, the spasticity tends to be greater in the arm than in the leg.
  • Spastic Quadriplegic Cerebral Palsy: In these cases, spasticity occurs in all the four limbs as well as in the face and torso. Patients may have co-occurring conditions like Epilepsy.

Causes of Spastic Cerebral Palsy

Spastic Cerebral Palsy occurs due to damage to either the motor cortex or the pyramidal tracts that connect the motor cortex to the spinal cord.

  • Motor cortex damage: Part of the cerebral cortex, the motor cortex relays messages to control voluntary movement of the body. When the motor cortex is damaged, these voluntary movements become difficult to do properly, resulting in stiff, spastic movements.
  • Pyramidal tracts damage: These tracts enable communication between the motor cortex and the spinal cord. Damage to the tracts means that the motor cortex can no longer convey messages to the spinal cord, which inhibits sensory function and movement.

The risk factors for developmental brain damage that could increase the child’s likelihood of getting Cerebral Palsy include:

  • Premature birth
  • Breech birth
  • Loss of oxygen to the newborn’s brain
  • Low birth weight
  • Infections sustained during pregnancy
  • Exposure to toxins during pregnancy
  • Blood clotting in the mother
  • Incompatible blood type between the mother and the fetus
  • Head trauma shortly after birth
  • Severe jaundice in the first few weeks after birth

Symptoms of Spastic Cerebral Palsy

Spasticity, as the name suggests, leads to contracted muscles that cause stiff, jerky movements. It may affect any muscle group in the body and vary from mild to severe. In many cases, the symptoms of Cerebral Palsy may not be evident until early childhood, as the first signs typically involve missing developmental milestones. The common symptoms observed in children with Spastic Cerebral Palsy include:

  • Inability to lift one’s head as a baby
  • Difficulty standing and walking
  • Difficulty altering one’s position in bed
  • Difficulty standing up after sitting and vice versa
  • Difficulty with fine motor skills such as buttoning a shirt 
  • Inability to fully extend joints
  • Abnormal reflexes
  • Unusual posture and gait
  • Scissoring thighs
  • Slurred speech
  • Hoarse voice
  • Excessive drooling
  • Difficulty eating and swallowing

Complications of Spastic Cerebral Palsy

While the Cerebral Palsy itself is non-progressive, the spasticity may lead to further complications in the body over time. These include:

  • Muscle atrophy from degeneration due to unuse or under-use
  • Changes to soft tissues like ligaments and tendons
  • Shortened muscles due to inability to keep up with normal bone growth, leading to contracture
  • Bone deformities such as hip dislocation or Scoliosis owing to contracted muscles
  • Muscle pain owing to abnormal activity in the spastic muscles

In addition, individuals with Spastic Cerebral Palsy are more prone to the following complications:

  • Vision / hearing impairment from the initial birth injury that caused the Cerebral Palsy
  • Bone fractures
  • Incontinence
  • Gastrointestinal disorders
  • Sleep disorders
  • Tooth and gum disorders
  • Epilepsy
  • Stunted growth
  • ADHD or other behavioral disorders

These are particularly likely in the more serious cases, such as severe Spastic Quadriplegic Cerebral Palsy. 

Diagnosing Spastic Cerebral Palsy

If a child is displaying symptoms of Spastic Cerebral Palsy, they should promptly be taken to the clinic for a diagnosis. The doctor will assess the location and severity of the spasticity by checking how well the child can control voluntary muscles and whether there are any contractures inhibiting them from performing normal daily tasks. The doctor may also physically check for any stiffness or pain in the muscles and joints to understand how that is affecting the child’s range of motion.

Once a diagnosis has been reached, the child can benefit from a tailored treatment program depending on the nature of their symptoms. Treatment options include:

  • Physiotherapy: This aims to increase the child’s range of motion and make it less painful. A variety of flexibility and stretching exercises may be recommended to enhance mobility and work the joints. The therapist may recommend using suitable toys and rewards to make it more enjoyable.
  • Occupational Therapy: This enables a child with Spastic CP to complete daily activities at home, at school, and elsewhere. Therapists recommend exercises that focus on wrist and finger movement to improve coordination and strength. In some cases, they may recommend aids such as special writing tools or adaptive scissors.
  • Speech Therapy: This improves control over oral movements and thus facilitates speaking and swallowing. Therapists focus on improving mouth and tongue movements to help children articulate more clearly, drool less, chew their food properly, and swallow safely without risk of choking. This not only improves communication abilities but also assists with proper nutrition as the child learns to eat meals safely.

FAQs

  • When is CP usually diagnosed?

In general, a diagnosis of Cerebral Palsy can be obtained when the child is one or two years old. However, if the symptoms are mild, it may take a few years longer.

  • What is the differential diagnosis for Cerebral Palsy?

The differential diagnoses for Cerebral Palsy include intellectual disability, metabolic neuropathy, metabolic myopathies, traumatic peripheral nerve lesions, and vascular malformations of the spinal cord.

  • Can a child with Spastic CP walk?

Children with Spastic Cerebral Palsy tend to have stiff, jerky movements that make moving around tough. Nonetheless, around 50-60% of children with Spastic CP learn to walk independently, while around 10% learn to walk with a mobility device.

  • Who is most at risk for Cerebral Palsy?

Some of the risk factors for Cerebral Palsy include low birth weight, premature birth, complications during delivery, multiple gestations, infections sustained by the mother during pregnancy, and exposure to toxic chemicals during pregnancy.

  • What part of the brain is damaged in spasticity?

Spasticity occurs due to disrupted communication in either the cerebral cortex, which controls movement, or the brainstem where the spinal cord and the brain are connected.

  • What is the mildest form of Cerebral Palsy?

In some cases of Spastic Perebral palsy, the damage to the brain is relatively minor which means that motor impairments are mild. Usually, such children’s gait and daily activities are not hindered too much, and they can function without assistive devices.

  • Who is a spastic child?

Simply put, children with Spastic CP have unusually stiff muscles owing to continuous contraction. This makes movements and speech difficult for them

  • What does Cerebral Palsy feel like?

The common symptoms that children with Cerebral Palsy experience include impaired movements, unsteady gait, unusual posture, and spastic or floppy limbs.

  • Which muscles are spastic in CP?

The stiff muscles in Spastic Cerebral Palsy may appear in the upper body, the lower body, or both. They may manifest on one side of the body, or on both sides.

  • Why does Spastic Cerebral Palsy always cause high muscle tension?

In children with Spastic Cerebral Palsy, muscles have an abnormally high tone, known as Hypertonia. As a result, all the muscles become active together, leading to continuous stiffness or tightness and a lack of voluntary coordinated movement.

While a diagnosis of Spastic Cerebral Palsy can be challenging, remember that early detection and treatment can prove to be highly beneficial for your child’s future. From flexibility exercises, stretching the stiff muscles, to Speech Therapy that improves communication skills and enables safe swallowing, there are several treatment and therapy options to help your child with Spastic CP enjoy a functional, independant life.

Dr Na'eem Sadiq is a respected stem cell specialist at Plexus, and a prominent neurologist in Bangalore. He studied neurology and clinical neurophysiology in London, and worked with some of the most prestigious medical institutions in England, and the Middle East. He completed his MBBS at Bellary Government Medical College, and a postgraduate degree in psychiatry from NIMHANS in Bangalore.

Dr Na'eem has perfected his knowledge and expertise in Continuing medical education (CME), and training in tissue culture, Stem Cell Therapy, and neurology. Dr Na'eem Sadiq possesses an undying passion to improve people’s lives. This led to the creation of Plexus, a neuro and Stem Cell Research centre in Bangalore in neurosurgery, and neurorehabilitation.