Cerebral palsy is the name for a condition in which brain damage has disrupted normal muscle functioning. For accuracy of diagnosis and treatment, researchers have divided the condition into nine different forms; some individuals with CP have something referred to as mixed cerebral palsy. The three forms of spastic CP, spastic diplegia, spastic hemiplegia, and spastic quadriplegia, are the most common. Spastic quadriplegia is the most serious and disabling form of spastic cerebral palsy.
Spastic quadriplegia affects the entire body. 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.
Distinct Symptoms of Spastic Quadriplegia
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. Seizures are common in spastic quadriplegia.
This type of CP can significantly affect the intelligence. People with spastic quadriplegia may have mental retardation, ranging from moderate-to-severe. Because of the communication difficulties which often accompany this disorder, the person’s IQ level may be difficult to assess.
Causes of Spastic Quadriplegia
Spastic quadriplegia is caused by extensive brain damage or by congenital malformations in the brain. Many factors, including maternal and fetal infections and exposure to toxins, can cause the unborn baby’s brain to develop abnormally. The brain is especially susceptible to abnormal development during the first twenty weeks of pregnancy.
During the twenty-sixth to thirty-fourth week of pregnancy, the white matter of the baby’s brain is very susceptible to damage. The brain’s white matter sends signals within the brain and to the rest of the body, so when it is damaged, it can significantly affect the entire body. Spastic quadriplegia and other forms of cerebral palsy may be caused by periventricular leukomalacias—holes or lesions in the white matter.
Unborn babies may also suffer brain damage from strokes which cause bleeding in the brain. Fetal strokes are sometimes caused by blood clots in the placenta which obstruct blood flow. Weak or mal-formed blood vessels in the brain can also cause fetal strokes and so can circulation abnormalities.
The mother’s health can also impact her unborn baby’s health. The babies of women who have high blood pressure during pregnancy have a greater risk of stroke; maternal high blood pressure is a common problem and it needs to be closely monitored for both the woman’s and the child’s sake. Maternal infections, particularly inflammatory pelvic disease, can cause fetal strokes.
Maternal infections caused by viruses can infect the uterus and placenta. Immune cells called cytokines increase in response to infection and produce inflammation to fight the problem; unfortunately, while inflammation is part of the infection fighting process, it can also damage the baby’s brain.
Lack of oxygen to the baby’s brain can also cause damage. Doctors originally thought that lack of oxygen due to a difficult deliver caused most cases of CP; researchers now think that less than ten percent of CP cases are caused by a lack of oxygen during delivery. A lack of oxygen can occur at any point in the pregnancy and it is more likely to cause damage in utero. Rupture of the womb, damage to the umbilical cord or the placenta can cause lack of oxygen and so can severe maternal low blood pressure.
Possible Complications of Spastic Quadriplegia
Because spastic quadriplegia affects the person’s entire body, it can lead to several types of limb 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.
Age at Diagnosis
Spastic quadriplegia is usually diagnosed in infancy when physicians or parents notice a significant delay in the baby’s development. Some infants with spastic quadriplegia may experience seizures before they are six months old; other people with the disorder never develop seizures.
Treatment of Spastic Quadriplegia
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 life can be made easier for the patient through a combination of various treatments.
As with the other forms of CP, spastic quadriplegia is always treated with physical therapy. The goal of physical therapy is to strengthen the limbs and to prevent contractures—a condition in which the muscles becomes so stiff that they will not move and actually cause the limb to bend and become deformed. There are many methods of physical therapy
Medicines are used to reduce spasticity in spastic quadriplegia. Medications are also used to control the seizures which sometimes accompany this disorder. Surgery may sometimes be used to repair limb deformities and allow the patient to move more easily.
Alternative forms of medicine such as massage therapy help improve the quality of life for some spastic quadriplegia patients. Caution should be used when considering alternative therapies for CP, since unscrupulous individuals may offer so-called “cures” which may be unsafe. Quality alternative treatments are helpful, but they are not cures for spastic quadriplegia. If you want to seek out alternative treatments, do so only with the advice of a qualified physician and choose a professional provider to administer the therapy.
“Ankle Equinus: in CP” Wheeless’ Textbook of Orthopaedics. Retrieved March 29, 2009 from the World Wide Web: http://www.wheelessonline.com/ortho/ankle_equinus_in_cp
Banta, John V. “Cerebral Palsy, Myelodysplasia, Hydrosyringomylia, Rett Syndrome, and Muscular Dystrophies” in Spinal Deformities: the comprehensive text. Ronald L. Dewald, ed. New York: Thieme, 2003.
“Cerebral Palsy: Hope Through Research” National Institute of Neurological Disorders and Stroke. Retrieved March 27, 2009 from the World Wide Web: http://www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_palsy....
“Cerebral Palsy” March of Dimes. Retrieved March 28, 2009 from the World Wide Web: http://www.marchofdimes.com/pnhec/4439_1208.asp#types
“Cerebral Palsy” MayoClinic.com Retrieved March 27, 2009 from the World Wide Web: http://www.mayoclinic.com/health/cerebral-palsy?DS00302
“Foot drop” The Mayo Clinic. Retrieved March 30, 2009 from the World Wide Web: http://www.mayoclinic.com/health/foot-drop/DS01031