DIPLEGIC GAIT
Diplegia refers to symmetrical paralysis, usually affecting either the arms or the legs. It’s the most common cause of paralysis in children and causes a different way of walking called Diplegic Gate.
If your child needs surgery or casting, our Fracture Care Clinic opens every day and you do not need an appointment. Surgery rooms get scheduled every morning, so your child receives the care and attention they need right away.
Diplegic Gait
Diplegic gait, also known as spastic diplegia, is a type of abnormal gait pattern characterized by spasticity and muscle stiffness, particularly affecting both legs. This condition typically arises from neurological disorders or injuries that affect the central nervous system. Here’s an overview covering its definition, causes, diagnosis, and treatments:
Definition:
Diplegic gait is a walking pattern characterized by increased muscle tone and stiffness in the lower extremities, predominantly affecting the legs. It’s a type of spastic cerebral palsy that results in difficulty coordinating movement, muscle weakness, and altered posture during walking.
Causes:
The primary cause of diplegic gait is damage or dysfunction of the central nervous system, particularly the brain and spinal cord. Common causes include:
- Periventricular leukomalacia (PVL): Brain injury often seen in premature infants due to lack of oxygen or blood flow to the brain’s white matter.
- Hypoxic-ischemic encephalopathy (HIE): Lack of oxygen to the brain during childbirth or perinatal period, leading to brain damage.
- Cerebral palsy (CP): A group of neurological disorders that affect movement and muscle coordination, usually stemming from brain damage during pregnancy, birth, or early infancy.
- Traumatic brain injury (TBI): Damage to the brain resulting from a traumatic event, which can affect motor control and coordination.
Symptoms:
Why do the symptoms occur?
- The symptoms arise from increased muscle tone and tightness in the muscles of the legs and hips, which can sometimes also affect the arms to a lesser degree.
What are the specific symptoms of spastic diplegic cerebral palsy?
- Individuals with this condition often experience difficulties with walking, including a tendency to cross their legs due to tightness in the muscles of the legs and hips.
What is the context of spastic diplegic cerebral palsy within cerebral palsy?
- It is a specific subtype of spastic cerebral palsy that primarily affects the lower body, specifically the legs.
How common is spastic diplegic cerebral palsy?
- Spastic diplegic cerebral palsy is a subtype of spastic cerebral palsy, which is the most prevalent form, occurring in about 80% of all cerebral palsy cases.
QUESTIONS AND ANSWERS
What is diplegic gait in children, and how does it affect their mobility?
Diplegic gait refers to a specific type of abnormal walking pattern characterized by increased muscle tone and stiffness, primarily affecting both legs. In children, it often manifests due to conditions such as cerebral palsy (CP), periventricular leukomalacia (PVL), or other neurological disorders. This gait pattern impacts mobility by causing difficulty in initiating movements, coordinating steps, and maintaining a smooth, balanced gait. Children with diplegic gait may exhibit a scissored gait, with their legs crossing over each other while walking, making it challenging to walk independently.
What are the common challenges faced by children with diplegic gait, and how can these be addressed?
Children with diplegic gait face challenges related to muscle spasticity, muscle weakness, and coordination issues. These challenges can affect their ability to walk, stand, and perform daily activities. Addressing these challenges often involves a multidisciplinary approach, including physical and occupational therapy, orthotic devices (e.g., braces), assistive walking devices, and in some cases, surgical interventions. Physical therapy aims to improve muscle strength, flexibility, and gait, while occupational therapy focuses on enhancing functional abilities and independence in daily tasks.
What are the potential treatments and interventions for children with diplegic gait?
Doctors will tailor treatment for diplegic gait to each child’s specific needs and may include a combination of therapies and interventions. Physical therapy provides a fundamental component, focusing on strengthening muscles, improving range of motion, and enhancing gait patterns. Occupational therapy helps children develop skills for everyday activities. Orthotics, such as ankle-foot orthoses (AFOs), can provide stability and improve alignment. Additionally, selective dorsal rhizotomy (SDR) surgery may provide an option in some cases to reduce spasticity. Assistive devices like walkers, canes, or wheelchairs help improve mobility and independence.
Walking differently can be a medical indication that something is wrong. Make an appointment with one of our pediatric orthopedists to ensure everything is fine.
Diagnosis:
Diagnosing diplegic gait involves a comprehensive evaluation by healthcare professionals, including:
- Clinical Assessment: Detailed medical history and physical examination focusing on gait analysis, muscle tone, strength, and reflexes.
- Neuroimaging: MRI or CT scans to visualize the brain and spinal cord, helping identify any structural abnormalities or lesions.
- Electromyography (EMG): A test to evaluate muscle activity and nerve function, providing insights into muscle spasticity and coordination.
How Does Spastic Diplegic Cerebral Palsy Differ from Other Types of Cerebral Palsy?
Spastic diplegic cerebral palsy is distinguished by symptoms that primarily affect the lower body, especially the legs. While other forms of cerebral palsy can impact different muscle groups, spastic diplegic cerebral palsy is characterized by unique features:
- Muscle Stiffness in the Legs: Children with this type often experience significant muscle stiffness or tightness in their leg muscles, which is not always the case with other cerebral palsy types.
- Exaggerated Reflexes: Heightened reflex reactions are more pronounced in the legs, leading to movements that can be unpredictable.
- Unique Walking Patterns: A hallmark of spastic diplegic cerebral palsy is the distinct walking style, known as scissor gait. This involves criss-cross walking due to the pulling together of the legs. Walking on the toes is also common, resulting from muscle tightness.
- Upper Body Functionality: Unlike other types of cerebral palsy that may affect the arms or the entire body, spastic diplegic cerebral palsy typically affects the legs more, leaving the upper body with better-functioning motor skills.
These characteristics set spastic diplegic cerebral palsy apart, offering a clearer understanding of diagnosis and treatment.
Treatment of Diplegic Gait
Individualized treatment plans are crucial, and early intervention greatly improves outcomes. Regular monitoring and adjustments to the treatment plan are essential to optimize mobility and enhance the child’s overall functional abilities. Physical therapy and orthotics are typically used to treat young children under the age of five who experience significant spasticity. Botulinum toxin injections provide treatment as well. At this point, doctors should think about the possibility of reducing general spasticity with intrathecal baclofen or dorsal rhizotomy.
Management
Managing diplegic gait involves a multidisciplinary approach aimed at improving mobility, reducing muscle spasticity, and enhancing overall quality of life. Treatment options may include:
- Physical Therapy: Designed to improve strength, flexibility, and coordination through targeted exercises and stretches.
- Occupational Therapy: Focuses on enhancing daily living skills and functional mobility, aiding in tasks like dressing, hygiene, and using assistive devices.
- Orthotics and Assistive Devices: Customized braces, orthopedic footwear, or walking aids to provide stability and support during walking.
- Medications: Muscle relaxants or antispasmodic medications may be prescribed to manage muscle stiffness and spasticity.
- Intrathecal Baclofen Therapy: A pump implanted in the abdomen delivers baclofen directly to the spinal fluid to manage severe muscle spasticity.
- Surgical Interventions: In severe cases, orthopedic surgeries may be considered to improve muscle function and gait.
Finally, treatment of a Diplegic Gait should concentrate on resolving toe walking, flexed knee gait, and severe lower extremity torsional deformities for children between 5 and 10. Also, at this age, muscle lengthening and, on occasion, the correction of torsional malalignments by surgical procedures provide doctors with additional treatments that can improve patient’s well-being. The phase between adolescence and growing maturity — between the ages of 10 and 16 — appears as the best time for final deformity adjustments to be made. Specifically, we are referring to foot stability, further muscle lengthening, and bone alignment correction.
Complications
The potential complications during pregnancy or birth that can lead to spastic diplegic cerebral palsy? The following listing provides specific conditions and complications that can arise during pregnancy or birth:
- Abnormal fetal presentation: Such as breech birth, which can complicate delivery.
- Birth asphyxia: A condition where the baby doesn’t receive enough oxygen during birth.
- Infection in the mother: Infections can affect fetal development.
- Low Apgar score: Indicating possible distress or health issues in the newborn immediately after birth.
- Newborn jaundice: A condition that can indicate underlying health problems.
- Preeclampsia: A pregnancy complication characterized by high blood pressure, which can impact the baby.
- Preterm delivery: Premature birth that can lead to various developmental issues.
- Rh incompatibility: A condition where the mother’s and baby’s blood types are incompatible, potentially causing health problems.
- Twin or multiple births: Present higher risks of complications during pregnancy and delivery.
By providing a comprehensive list, readers can obtain a clearer picture of the complications that might lead to spastic diplegic cerebral palsy.
Understanding the Link Between Medical Malpractice and Spastic Diplegic Cerebral Palsy
Medical malpractice can play a significant role in the development of conditions like spastic diplegic cerebral palsy, a subtype of cerebral palsy characterized by muscle stiffness predominantly in the legs.
Key Factors
- Delayed Response to Complications: During pregnancy or childbirth, complications can arise unexpectedly. When healthcare professionals fail to address these issues swiftly, it can lead to oxygen deprivation or trauma to the infant’s brain — a critical risk factor for cerebral palsy.
- Negligence in Medical Care: If a doctor or medical staff exhibits negligence, such as improper use of delivery tools, or mismanagement of the birthing process, it might result in injuries that could cause cerebral palsy.
- Inadequate Monitoring: Proper monitoring of the fetal heartbeat and maternal health is crucial. Failing to notice distress signals can lead to prolonged periods of oxygen deprivation or other harmful conditions that contribute to this disorder.
Legal Implications
When such negligence occurs, a genuine legal case may arise, allowing parents to pursue a birth injury lawsuit. This can assist with obtaining compensation to cover medical expenses and provide essential care and therapies to support the child’s needs.
Understanding these connections highlights the importance of vigilant and skilled medical care during the sensitive times of pregnancy and childbirth.
Legal Options for Families Affected by Spastic Diplegic Cerebral Palsy Due to Birth Injuries
When birth injuries result in conditions like spastic diplegic cerebral palsy, families often face significant emotional and financial challenges. Fortunately, there are legal avenues available to help secure compensation for the necessary ongoing care and support.
Understanding Medical Malpractice
At the heart of many birth injuries is medical malpractice. This occurs when healthcare professionals fail to adhere to the standard of care expected during pregnancy or delivery. Whether they didn’t act swiftly during complications or showed negligence, such actions can lead to serious health outcomes for newborns.
Filing a Birth Injury Lawsuit
If you suspect that your child’s condition is a consequence of medical malpractice, you may be eligible to file a birth injury lawsuit. This process involves:
- Consulting with a Specialized Attorney: Seek a lawyer experienced in birth injury cases, as they can evaluate the details of your situation.
- Documenting Evidence: Gathering detailed medical records, expert testimonies, and other relevant documentation can strengthen your case.
- Building a Solid Case: Your attorney will help construct a compelling argument to demonstrate the negligence or error that led to the injury.
Potential Compensation
The compensation sought through a lawsuit can cover various needs, such as:
- Medical Expenses: Current and future costs related to treatment and therapy.
- Rehabilitation: Support for services like physical therapy, which are crucial for managing cerebral palsy symptoms.
- Long-term Care: Financial assistance for ongoing care, including occupational therapy and special education requirements.
Seeking Professional Guidance
Navigating the legal system can be complex, but expert legal counsel can guide you through the process. Specialized birth injury attorneys are invaluable for handling these sensitive cases and can help ensure you receive just compensation for your child’s needs.
By pursuing these legal options, families can focus on providing the necessary support and resources for their child’s development and well-being.
Choosing Medical City Children’s Orthopedics and Spine Specialists
Always consult with your doctor if your child begins to walk differently. If you come to one of our Medical City Children’s Orthopedics & Spine Specialists offices in Arlington, Dallas, Flower Mound, Frisco, and McKinney, Texas, our pediatric orthopedic doctors will examine your child and recommend the best treatment option to repair the problem and get your child back playing.
As previously mentioned, our doctors at the Medical City Children’s Orthopedics and Spine Specialists will examine your child. By doing so, they will determine and understand the reasons for an unusual gait. At that point, the doctor will prepare an individualized treatment plan for your child if he finds the cause of the unusual gait. After correcting the problem, your child will resume his or her favorite activities. For athletes, it may take up to a year before they may resume their sport.
____________________
Footnote:
Physio-Pedia: Classification of Gait Patterns with Cerebral Palsy
Call 214-556-0590 to make an appointment.
Comprehensive services for children from birth through adolescence at five convenient locations: Arlington, Dallas, Flower Mound, Frisco and McKinney.