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 use the legs, arms and body.
Spastic quadriplegia is generally caused by brain damage either before birth, during, or shortly after. There are many factors that can play into an infant developing brain damage, including fetal infections, maternal infections, exposure to toxins, or medical negligence.
During 26 to 34 weeks gestation, the white matter of an infant’s brain is greatly susceptible to damage. White matter sends signals from the brain to the rest of the body, and if damaged, it 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, which can lead to brain bleeding. 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 arising issues as soon as possible.
Symptoms of spastic quad include:
- Muscles that rapid contract and release
- Joints that cannot stretch or move
- Muscle tightness
- Muscle tremors and limbs scissoring
- Speech impediments/language disorder
- Inability to walk
- Seizures (sometimes within the first six months of life)
- Cognitive Issues
Since spastic quadriplegia can affects the child’s entire body, they are at risk of developing limb deformities. Spastic muscles continuously pulling can cause serious 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 primarily develop it more than any other type of CP.
Another common issue is foot deformities. For instance, ankle equinus, a condition where ankle flexibility is limited, is a potential complication of spastic quad. Another complication associated with spastic quad CP is an issue known as foot drop or “drop foot,” makes it difficult to raise the front of the foot.
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 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 happens before the child turns 1.
Treatment for spastic quad varies with each case, depending upon the severity. In most cases, there are five types of traditional treatment options for children with spastic CP, which include: physical therapy, occupational therapy, speech therapy, medications, 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 (ROM) 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 in an independent matter, which ultimately 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 occupational therapy may focus on ways to strengthen their hands and fingers.
Speech therapy, as its name suggests, is a form of therapy to help improve speech and speech patterns. The goal of speech therapists is to help with oral articulation and coordination. Some children with spastic quad are prone to drooling, and may have a hard time swallowing, which in turn affects their speech. Speech therapists teach various exercises that incorporate assistive communication devices can help improve both oral and cognitive abilities.
Children who participate in speech therapy participate in activities to clearly communicate their thoughts and ideas, socialize with loved ones and improve literacy. Speech therapy can also help chewing, breathing and swallowing difficulties. =
A number of medications can be prescribed to help treat spastic quad CP. For muscle stiffness relief, benzodiazepines may be prescribed. Other times, physicians may opt to treat muscle stiffness with injections of medication.
Additionally, kids with spastic quad may be given medication to treat secondary, associated conditions of CP, such as ADHD and epilepsy. There are a number of medications that can help control and reduce the frequency of seizures.
Surgery is the last resort/ form of treatment for most forms of CP, but it can play a large role for children with spastic quad CP. There are a number of different types of surgeries that are carried out in order to correct problems with shortened muscles, dislocated joints, and other issues that cause pain and impairment to children.
Since muscle stiffness is a huge part of the reason children with spastic quad have so many health issues, Selective Doral Rhizotomy (SDR) may be an option. SDR is a type of surgery that helps relax the muscles and improve mobility in various areas of the body. Although this form of surgery has underwent a lot of scientific scrutiny, the Children’s Hospital of St. Louis states that it’s an excellent choice, given the results it’s shown.
SDR entails removing the lamina from the vertebrae via an inch-long incision on the lower back. A rubber pad is then inserted along the spinal cord in order to separate the motor from the sensory nerves.
Although there is no cure for spastic quad, therapies, along with medications and sometimes surgery, have given numerous children the chance to lead more productive lives with lessened pain.