Spastic quadriplegia is the most serious and disabling form of spastic cerebral palsy. Today, Cerebral Palsy can be managed, but not cured. However, the future holds promise for change.
Spastic refers to the muscle stiffness which accompanies the condition. Quadri—comes from the Latin for four; it means that all four quadrants of the body are affected by spastic quadriplegia. Plegia comes from the Greek term for a form of paralysis. Most patients with spastic quadriplegia cannot walk and their speech may also be profoundly affected. The limbs may be extremely stiff, yet the patient’s neck may be “floppy” meaning that they have no voluntary control of it.
Spasticity implies increased muscle tone. Muscles continually contract, making limbs stiff, rigid, and resistant to flexing or relaxing. Reflexes can be exaggerated, while movements tend to be jerky and awkward. Often, the arms and legs are affected. The tongue, mouth, and pharynx can be affected, as well, impairing speech, eating, breathing, and swallowing.
The stress on the body created by spasticity can result in associated conditions such as hip dislocation, scoliosis, and limb deformities. One particular concern is contracture, the constant contracting of muscles that results in painful joint deformities.
The pull of spastic muscles on the bones can cause severe problems. About a quarter of patients with CP develop scoliosis (curvature of the spine) and people with spastic quadriplegia are especially prone to this back deformity. Scoliosis makes walking even more difficult for the CP patient. Foot deformities are also common in spastic quadriplegia. Ankle equinus, a condition in which ankle flexibility is limited and the person walks on the toes may be present. Foot drop (sometimes called drop foot), a condition which makes it hard to raise the front of the foot, is also sometimes a problem for people with spastic quadriplegia.
People with spastic quadriplegia may have great difficulty swallowing and this can lead to respiratory difficulties if food is aspirated. Because of the swallowing difficulties, proper nutrition is also a concern. In addition, this form of CP makes the person especially prone to bladder and bowel difficulties.
Spastic CP is not a progressive disease, so its underlying neurological causes do not become more severe over time. Symptoms, on the other hand, can change in severity. Spastic CP cases are highly individualized, so treating spastic cerebral palsy is a complex undertaking. Therapy for the disorder strives to improve outcomes, using several key approaches. Increasing the patient’s mobility and making the patient more comfortable are two major goals in the treatment of spastic quadriplegia. There is no cure, but progress can be made with the appropriate care plan.
- Physical Therapy – This form of rehabilitation helps strengthen large muscle groups in the legs, arms and abdomen, striving to minimize functional physical deficiencies. Stretching, soft tissue mobilization, endurance exercises and other specialized treatments are used to enhance balance, coordination and flexibility. The goal of physical therapy is to provide as much independence to the child as possible. This type of therapy can help improve overall motor function and prevent any future complications.
- Occupational Therapy – This therapy increases strength, dexterity and coordination, fostering the highest possible level of physical functioning at home, school and on the job. Occupational therapists perform exercises that target certain muscles in the wrist, forearm, thumb and upper body. This treatment is beneficial for spastic CP because it focuses on improving motor control, bilateral coordination and upper body strength. Occupational therapists can also assess the need for various assistive devices.
- Speech and Language Therapy – With so many muscle groups and neurological mechanisms tied to communication; speech difficulties are common among spastic CP patients. Speech therapists not only address speech and language difficulties, but they also collaborate with other medical specialists, working with CP patients to improve swallowing and digestion.
- Sensory Integration – Sensory feedback provides essential information to the brain, assisting movement and coordination. Strengthening these connections can be beneficial to children with spastic cerebral palsy, reinforcing their ability to interpret and respond to sensory information.
- Massage Therapy – This form of therapy serves as an important adjunct to other therapies, particularly physical therapy. Through direct contact stimulation, massage therapists strive to improve muscle functionality, range of motion and to relax muscles. Massage therapy also supports a healthy relaxation response and provides comforting touch during a difficult time for a child undergoing multiple therapies.
- Medication – Various muscle relaxants are used to reduce symptoms of spastic CP. Age and severity of the disorder are considered when applying this class of drugs for relief. In addition to pharmacological therapy used to relax muscle groups, additional medication is prescribed, as needed, for co-occurring conditions.
- Orthopedic Surgery – In some cases, surgical intervention provides relief for muscle tightness and related symptoms. The goal of surgery is to increase joint mobility and eliminate pain, as well as mitigating severe limitations and deformity.
– R&D (Stem Cell therapy) – Stem cell transplantation for cerebral palsy is still in the early phases. More research is needed to determine how effective it could be. However, there are some clinical trials testing the effectiveness of using umbilical cord blood infusions to introduce stem cells into the body. The goal of stem cell transplantation is to protect and repair these damaged cells before they are completely useless, causing permanent damage. This could reduce the extent of mobility issues in children with CP.