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.
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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.
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.
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.
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.
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.
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Footnote:
Physio-Pedia: Classification of Gait Patterns with Cerebral Palsy
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