Spastic Quadriplegia Cerebral Palsy

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Spastic quadriplegia cerebral palsy is a form of cerebral palsy that affects both arms and legs and often the torso and face. Quadriplegia is the most severe of the three types of spastic cerebral palsy. It requires lifelong treatment and support.[1]

What Is Spastic Quadriplegic Cerebral Palsy?

Spastic cerebral palsy is the most common form of this condition that affects muscles and movement. It is characterized by increased muscle tone. This makes muscles stiff and movements jerky and awkward.

Subtypes of spastic cerebral palsy describe the parts of the body affected. In spastic quadriplegia, the condition affects both legs and arms as well as the trunk and face in many children. 

How Severe Is Spastic Quadriplegia Cerebral Palsy?

Quadriplegia is the most severe form of cerebral palsy because it affects so many areas of the body. Children with spastic quadriplegia cerebral palsy usually cannot walk, and they are more likely to have multiple associated conditions, like speech difficulties or seizures.

A child born with this condition benefits from early interventions and treatments. However, they will need lifetime support and care.

What Causes Cerebral Palsy?

Spastic quadriplegia cerebral palsy is caused by the same conditions as any type of cerebral palsy. The overarching cause is brain damage before birth, during, or shortly after.

Many factors can play into an infant developing brain damage, including prematurity, fetal infections or stroke, maternal infections or medical conditions, exposure to toxins, or medical negligence.

During 26 to 34 weeks of gestation, the white matter of an infant’s brain is very susceptible to damage. White matter sends signals from the brain to the rest of the body and, if damaged, can lead to the entire body being affected. Lesions or holes in the white matter of the brain can lead to spastic quadriplegia.

Infants in utero can also develop brain damage from fetal strokes. In some instances, fetal strokes are caused by placental blood clots and placenta previa.

Weakly-formed blood vessels in the brain may also lead to fetal strokes. Maternal high blood pressure during pregnancy leads to an increased risk of fetal stroke.[2]

This is an unfortunate yet common issue during pregnancy, and it’s up to physicians to help monitor mothers throughout pregnancy and diagnose and treat developing problems as soon as possible.

Does Medical Malpractice Cause Spastic Quadriplegic Cerebral Palsy?

It’s often difficult or impossible to find a single cause of cerebral palsy. A doctor’s or a nurse’s negligent errors can cause brain damage that results in cerebral palsy:

• Failure to monitor fetal development
• Failure to diagnose or treat maternal conditions or infections
• Failure to monitor or act on fetal distress during labor and delivery
• Failure to order a c-section during a complicated delivery
• Using too much force when delivering a baby

Symptoms of Spastic Quadriplegia

Symptoms of spastic quadriplegia are more severe than other types of CP and can include:

• Muscles that rapidly contract and release
• Joints that cannot stretch or move
• Muscle tightness and spasticity
• Muscle tremors
• Difficulty walking and limbs scissoring
• Speech impediments/language disorder
• Seizures
• Cognitive disabilities

What Are the Early Signs of Spastic Quadriplegia Cerebral Palsy?

As the most severe type of cerebral palsy, early signs are usually obvious and easy to spot. A baby will show immediate signs of stiff muscles, such as rigid or crossed legs and arms, spastic limbs, tense muscles, and tremors. 

Babies with cerebral palsy often miss developmental milestones. These include holding up the head, rolling over, and sitting.

What Are the Complications of Spastic Quadriplegic Cerebral Palsy?

Since spastic quadriplegia can affect the child’s entire body, there is an increased risk of developing limb deformities.[3] Spastic muscles continuously pulling on the bones and joints can cause issues over time, especially if not treated properly. Other complications include:

• Scoliosis. Around one-quarter of patients with CP develop (a curvature of the spine). Those with spastic quadriplegia are more at risk for spinal problems than any other type of CP.
• Ankle deformities. Another common issue is the lower limb and ankle deformities. For instance, ankle equinus, a condition where ankle flexion is limited, is a potential complication of the spastic quad.
• Joint contractures. Another complication associated with spastic quadriplegic CP is the development of joint contractures. This permanent shortening of the muscles around a joint results from spasticity.[4]
• Malnutrition. People with spastic quadriplegia may have difficulty swallowing, leading to malnutrition or respiratory complications if food is aspirated. Poor coordination of facial muscles can also cause speech/language delays.
• Seizures. Seizures are more common in children with spastic quadriplegia than other forms of CP. That is because more of the brain has been affected. They are also more likely to have cognitive and learning disabilities.
• Constipation and incontinence. This form of CP makes the person especially prone to bladder and bowel difficulties such as constipation or bladder incontinence.

Diagnosing Spastic Quadriplegia

Spastic quadriplegia is generally diagnosed during infancy when doctors detect a significant delay in the baby’s development. It’s one of the few types of cerebral palsy in which diagnosis occurs before the child completes the first year of life.[5]

Treatment Options for Spastic Quadriplegia Cerebral Palsy

Treatment for spastic quadriplegia varies for each child, depending upon the severity of symptoms. Traditional treatment options for children with spastic CP include physical therapy, occupational therapy, speech therapy, medications, assistive devices and technology, and in some instances, surgery.

Physical Therapy

The first-line treatment for children with any form of spastic cerebral palsy is almost always physical therapy. Physical therapists aim to provide children the tools to be as independent as possible via flexibility exercises, stretching, and range-of-motion activities.

Therapists use age-appropriate toys and games to make physical therapy as enjoyable as possible.[6]

Occupational Therapy

The goal of occupational therapy is to help a child develop skills to perform daily activities and tasks as independently as possible, which helps them at home, school, and within their community.

Since children with spastic quadriplegia have limited abilities to use their arms and legs, much of the occupational therapy approach may focus on ways to strengthen and coordinate the use of their hands and fingers.

Speech Therapy

As its name suggests, speech therapy helps to improve speech and language patterns. The goal of speech therapy is to assist with oral articulation and coordination.

Some children with spastic quadriplegia have difficulty coordinating the face and tongue muscles and may have a hard time swallowing.

Therapy is needed to overcome this to whatever extent possible to eat safely. Speech therapists can also help the child use assistive communication devices to help them convey information when they cannot speak or if their speech is poorly understood. This can significantly improve their quality of life at home and in the learning environment.

Medications

Several types of medications can help treat spastic quadriplegia CP. For the relief of spasticity, doctors may prescribe muscle relaxants. They may be given orally or sometimes by injection.

Additionally, kids with spastic quadriplegia may be given medication to treat secondary, associated conditions of CP, such as epilepsy, gastric reflux, or constipation.[7]

Surgery

Surgery is the treatment of last resort for most forms of CP, but it can play a role for children with spastic quadriplegia. Many surgeries are used to correct problems with shortened muscles, dislocated joints, spinal deformities, and other issues causing pain and impairment in children with severe spasticity.

Since muscle stiffness is a large part of the reason children with spastic quadriplegia have so many health issues, Selective Dorsal Rhizotomy (SDR) may be considered an option. SDR is a surgery that helps relax the muscles and improve mobility in various areas of the body.[8]

What Is the Outlook for a Child with Spastic Quadriplegia?

The prognosis for a child with quadriplegia is worse than for other forms of CP. This type has an increased risk of more complications and associated conditions that can shorten lifespan and compromise a child’s ability to live independently.

Although there is no cure for spastic quadriplegia, therapies, medications, and surgical options have given numerous children the chance to lead more productive lives.

Contact a birth injury lawyer if you believe your child suffered harm due to medical malpractice. They can evaluate your case and help you seek compensation to cover lifelong treatment and care.