1. By: Jenna Plummer and Mariah McGarvey
Spastic Diplegia
By: Jenna Plummer and Mariah McGarvey

2. What is spastic diplegia?
Form of cerebral palsy
Upper extremity:
ROM above hips are typically normal
Potential for mild UE spasticity, ex. in trunk
Lower extremity:
Primarily affected in a symmetrical pattern
Hypertonia and spasticity
Difficulties with coordination and balance
Ankles present more issues than knees
Potential for hip dislocation
Potential for ambulation depends on severity of hypertonia in LE

3. CAUSES Birth injuries Maternal Neonatal asphyxia
Premature birth & low birth weight
Head injury or infection after birth
Maternal
Infections
Multiple births
Seizures, mental retardation, thyroid problems
Maternal infections: High-grade fever or rubella

4. Presentation and Clinical Ramifications
Ages 1-3:
Important to focus on 5 milestones & are they walking?
Prefer ‘W’ sitting
Ages 2-4:
Children pull themselves up to standing
May need AFO’s & prone type stander
Regular hip exams, spastic hip disease assessing for hip dislocation & eventual arthritis
standing 1-2 hrs/day as tolerated; beneficial for vestibular, balance, bone/jt development

5. PRESENTATION and Clinical Ramifications
Ages 4 and above:
Best time for therapy; 5 times/week for <30 minutes
Emphasize cognitive issues
Replace typical therapy with dance, aquatics, hippotherapy, karate
Potential for walking is determined around age 7-8
Spasticity, muscle coordination, antagonistic muscles, ataxia
Be sure not to push the child too far.

6. diagnosis Early signs:
Unusual muscle tone(~2-3 months)
Begin appearing overly floppy and then become increasingly rigid
May take a few months to 3 years for formal diagnosis
Children must 1st show signs of leg movement difficulties and developmental delays before a proper diagnosis can be made
Tests or scans? None; strictly diagnosed based on motor movement.

7. Prevalence
~3 in every 1,000 children are diagnosed with cerebral palsy
Spastic diplegia is the most common type of CP; ~24% of CP cases
Incidence: 8,000-10,000 babies born with CP each year
Estimated 746,000 individuals in the US living with CP
Let patients know they’re not alone!

8. TREATMENT Physical therapy: standard & first treatment
Stretching, strengthening, muscle relaxation techniques
Medicine: used to reduce muscle tension
Orthopedic surgery: correct deformity
Massage, yoga, chiropractic: relaxation & improved sleep

9. Which Type of Prosthesis?
Depends on what you’re trying to accomplish with patient

10. How the Prosthetic works
Floor reaction AFO had a significant kinematic gait improvements including a reduction of abnormal ankle dorsiflexion and knee flexion
Typically used for those children in ‘crouched’ position
Hinge allows for tibial advancement
Knee moments during stance were not changed in subjects wearing hinged or solid orthosis.

11. prognosis
Can be difficult to determine because of the variety of motor and neural involvement
Those with Spastic Diplegia tend to have more uniform and comparable neuromotor abilities
Assessed milestones
Motor control of sitting and crawling by the age of 2.5 were predictive of ambulatory function
In the picture, this is what they look like without prosthetic. It fixes internal rotation and provides a wider base of support to stop that “scissoring” effect

12. References
Diplegic Cerebral Palsy. Birth Injury Guide Retrieved July 5, 2016, from,
Spastic Diplegia. Brainandspinalcord.org Retrieved July 5, 2016, from
Prevalence of Cerebral Palsy. Cerebral Palsy Foundation. palsy/prevalence-and-incidence
Lucareli, P. R. G., Lima, M. D. O., Lucarelli, J. G. D. A., & Lima, F. P. S. (2007). Changes in joint kinematics in children with cerebral palsy while walking with and without a floor reaction ankle-foot orthosis. Clinics, 62(1),
Morris, C. (2002). A review of the efficacy of lower‐limb orthoses used for cerebral palsy. Developmental Medicine & Child Neurology, 44(3),
Badell-Ribera, A. (1985). Cerebral palsy: postural-locomotor prognosis in spastic diplegia. Archives of physical medicine and rehabilitation, 66(9),