Spastic Quadriplegia Cerebral Palsy
Spastic Quadriplegia, also referred to as spastic quad or spastic quad CP, is a form of cerebral palsy that means the “loss of use of the whole body.” It’s the most severe of the three types of spastic cerebral palsy, marked by the inability to control and use the legs, arms, and body.
Spastic quadriplegia is generally caused by brain damage either before birth, during, or shortly after. Many factor 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 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 a heightened risk of fetal stroke. This is an unfortunate yet common issue during pregnancy, and it’s up to physicians to help monitor mothers throughout pregnancy, as well as diagnose and treat developing problems as soon as possible.
Symptoms of spastic quadriplegia are more severe 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
- Cognitive disabilities
Since spastic quadriplegia can affect the child’s entire body, there is an increased risk of developing limb deformities. Spastic muscles continuously pulling on the bones and joints can cause issues over time, especially if not treated properly. Around 1/4 of patients with CP develop scoliosis (a curvature of the spine). Those with spastic quadriplegia are more at risk for spinal problems than any other type of CP.
Another common issue is lower limb and ankle deformities. For instance, ankle equinus, a condition where ankle flexion is limited, is a potential complication of spastic quad. Another complication associated with spastic quad CP is the development of joint contractures. This permanent shortening of the muscles around a joint is a result of spasticity.
People with spastic quadriplegia may have great difficulty swallowing, and this can lead to malnutrition or respiratory complications if food is aspirated. Poor coordination of facial muscles can also cause speech/language delays.
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.
In addition, this form of CP makes the person especially prone to bladder and bowel difficulties such as constipation or bladder incontinence.
Age of Diagnosis
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.
Treatment for spastic quad varies with each case, 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.
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.
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 quad 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, 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 muscles of the face and tongue and may have a hard time swallowing. Therapy is needed to overcome this to whatever extent possible in order to eat safely. Speech therapists can also help the child to use assistive communication devices to help them convey information when they are not able to speak or if their speech is poorly understood. This can significantly improve their quality of life at home and in the learning environment.
Several types of medications can be prescribed to help treat spastic quad CP. For the relief of spasticity, muscle relaxants may be prescribed. They may be given orally or sometimes by injection.
Additionally, kids with spastic quad may be given medication to treat secondary, associated conditions of CP, such as epilepsy, gastric reflux or constipation.
Surgery is the treatment of last resort for most forms of CP, but it can play a role for children with spastic quad CP. There are many types of surgeries 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 quad 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.
Although there is no cure for spastic quadriplegia, therapies, medications and surgical options have given numerous children the chance to lead more productive lives.