Spastic Diplegia and Spastic Quadriplegia (Cerebral Palsy)

Spastic cerebral palsy is one of the most common types of cerebral palsy that stems from injuries during birth. Cerebral palsy is a condition that affects movement and posture, and is often caused by brain damage during birth. The brain damage that causes cerebral palsy is permanent and irreversible and results in lifelong disabilities. In spite of remarkable advances in medicine and technology, the incidence of cerebral palsy has not decreased. One out of 500 children is affected by this disorder. Hemiplegia, spastic diplegia and spastic quadriplegia are all types of spastic cerebral palsy.
If your child has suffered spastic cerebral palsy due to medical negligence, you may be able to seek compensation on behalf of your child. It may be emotionally and financially draining to care for a disabled child, as he or she needs constant attention and the expenses involved in providing for his or her future are prohibitive. An experienced New York birth injury lawyer can help you evaluate your options as well as help you seek maximum compensation for your significant losses.

What Causes Spastic?

The term “spasticity” refers to the increased tone or tension in a muscle. Generally speaking, muscles must have sufficient tone to maintain posture or movement against the force of gravity. At the same time, muscles also provide speed and flexibility as we move around. The command to tense or increase muscle tone goes to the spinal cord through the nerves from the muscle. The nerves tell the spinal cord how much tone the muscle has, which is why they are called sensory nerve fibers. The command that helps individuals control their muscle tone is sent to the spinal cord from nerves in the brain.
In a person with cerebral palsy, brain damage has occurred. In cerebral palsy patients, the damage often tends to be in the area of the brain that controls muscle tone and movement of arms and legs. The brain of someone afflicted with cerebral palsy is therefore not able to influence the amount of flexibility a muscle should have. The command from the muscle itself dominates the spinal cord and as a result, the muscle is too tense or spastic.
About 80 percent of cerebral palsy patients have some degree of spasticity. Spasticity may be associated with diplegic, quadriplegic or hemiplegic cerebral palsy. Spasticity may be apparent during the child’s first year of life when cerebral palsy is relatively severe. But in most cases, it is detected later. Once spasticity has developed with cerebral palsy, it cannot be completely cured.

How Does Spasticity Affect the Individual?

Spasticity has an adverse effect on muscles and joints of the extremities. This causes abnormal movements, which is particularly harmful in growing children. Some of the known effects of spasticity include inhibited movement, longitudinal muscle growth and protein synthesis in muscle cells; limited ability to stretch muscles in everyday activities; and development of muscle and joint deformities. Patients with cerebral palsy don’t have deformities of the extremities at birth, but develop them over time. Spasticity of muscles along with limitations on stretching and use of muscles during the course of everyday activities is a major cause of deformities in children with spastic cerebral palsy.

Spastic Diplegia

Spastic diplegia is a form of cerebral palsy that affects muscle control and coordination. Affected individuals have increased muscle tone, which leads to stiff or tight muscles and exaggerated reflexes in the legs. In victims with spastic diplegia, the arm muscles tend to be less affected or not affected at all. Other signs and symptoms often include delayed motor or movement milestones such as rolling over, sitting and standing, and walking on toes. Children may also exhibit a scissored gait or style of walking in such cases.
Spastic diplegia, like other forms of cerebral palsy, is triggered by brain damage. Babies born prematurely or with low birth weight are usually at a greater risk of developing cerebral palsy. Some of the common causes of spastic diplegia include maternal infections or fevers and birth injuries that occur during a prolonged or difficult labor. There is no cure and treatment options may vary depending on the severity of the symptoms displayed by each person. Treatments may include physical, occupational and speech therapy, surgery and medication.

What Are the Symptoms of Spastic Diplegia?

The symptoms of spastic diplegia vary greatly from individual to individual. It affects the arms and legs, making them stiff and contracted. However, most victims suffering from spastic diplegia tend to be affected in their legs more than arms. In some cases the arms as well as the legs may be affected too, depending on how severe the condition is. This makes crawling and walking difficult for children. So, they may walk with a wide “scissor gait.” Their legs may also turn inward and cross at the knees due to excessive muscle contractions.
Other children with spastic diplegia may not be able to walk at all. Some children with spastic diplegia may also have cognitive issues. Some of the other symptoms of spastic diplegia include:

  • Delayed motor/movement milestones
  • Walking on toes
  • Fatigue or exhaustion
  • Flexed knees
  • Crossed eyes
  • Seizures
  • Balance and Coordination issues

Spastic Diplegia and Birth Injuries

Spastic diplegia cerebral palsy may happen due to a number of reasons. However, one of the most common causes of this particular condition is injury or trauma during birth, which often occurs due to medical negligence. Birth injuries that commonly lead to spastic diplegia include:
Hypoxic-Ischemic Encephalopathy: Hypoxic Ischemic Encephalopathy (HIE) is a brain dysfunction that is caused by reduced oxygen supply to the brain and other organs and/or a low blood flow to vital organs. Encephalopathy refers to any condition that results in decreased oxygen supply and blood flow to the brain. HIE from lack of oxygen supply to the brain during birth is the leading cause of infant fatalities in the United States. It is also the primary cause of cerebral palsy for infants that may lead to lifelong disabilities.
Brain bleed: There are a number of situations that may cause an infant’s brain to hemorrhage or bleed during birth. One of the foremost causes of brain trauma during birth is improper or incompetent use of forceps or vacuum extractors by doctors. Forceps and vacuum extractors are birth-assistive tools that are used during difficult deliveries to coax or ease the baby out of the birth canal. However, when excessive pressure or force is used with these tools, the child may suffer severe injuries such as skull fractures, which may result in bleeding in the brain leading to irreversible brain damage and cerebral palsy.
Maternal infections: An infection from poor monitoring at the medical facility and negligence, which is passed from mother to baby may result in brain damage and cerebral palsy. Some specific types of infections such as chicken pox, rubella and even urinary tract infections, when not treated in the mother, may increase the risk. When a pregnant woman has an infection, her body produces proteins called cytokines, which may cause an inflammation in the baby’s brain and damage it. This might eventually result in cerebral palsy.
Breech birth: When a fetus is feet-first instead of head first, the labor and delivery may become extremely tricky and complicated. Usually when a baby is in breech presentation, a Cesarean section is performed to get the baby out with minimum risk or trauma. However, if a doctor fails to take that vital decision to perform a C-section and instead tries to deliver the child vaginally, that may prove devastating for the child.

Diagnosis and Treatment

Spastic diplegia is diagnosed based on symptoms as well as blood tests, Computerized (or computed) Tomography (CT) scan of the head, Magnetic Resonance Imaging (MRI), electromyography and an electroencephalogram. The prognosis for those with spastic diplegia varies depending on the severity of their condition. Those who are severely affected may not be able to move without assistance and might require extensive care. It is important to remember that spastic diplegia is a lifelong condition and long-term care and support is often needed. The cost of medical care and therapy may add up very quickly and pose a significant financial challenge for families.

Spastic Quadriplegia

Spastic quadriplegia is another form of spastic cerebral palsy. As opposed to spastic diplegia, which typically affects only the arms, spastic quadriplegia leads to loss of use of the entire body. It is the most severe form of cerebral palsy because individuals with this condition are unable to use their arms, legs and body.

Causes and Symptoms

Spastic quadriplegia, like spastic diplegia, is caused by brain damage often during birth. The factors that lead to spastic quadriplegia are also similar such as maternal infections, excessive force used by doctors during delivery and other types of medical negligence such as lack of prenatal and/or fetal monitoring.
Another risk factor is maternal high blood pressure. This is why it is very important for doctors to monitor the mother’s blood pressure right through pregnancy and treat any issues that arise. Some of the symptoms of spastic quadriplegia include rapidly contracting muscles; joints that are unable to stretch or move; tightness in muscles; speech and language impediments; inability to walk; cognitive issues; and seizures.
A spastic quadriplegia diagnosis may be devastating because it affects the child’s entire body. This condition can also give rise to other serious deformities and health complications such as scoliosis, which is a curvature of the spine. Another common problem among those with spastic quadriplegia is deformities of the feet. They may also be more likely to have difficulties swallowing and this may lead to respiratory issues, especially if food is aspirated or inhaled. Spastic quadriplegia may lead to issues with nutrition and victims also tend to have bladder and bowel difficulties.

Treatments and Therapies

Similar to spastic diplegia, treatment for individuals with spastic quadriplegia depends on the severity of their condition. Some of the common treatments available to patients include:
Physical therapy: This is a common form of treatment for children with any type of spastic cerebral palsy including spastic quadriplegia. Physical therapists work with children to help them be as independent as possible with the help of flexibility exercises, stretching and range-of-motion activities. Therapists also use toys and games to make this process as enjoyable as possible for kids.
Occupational therapy: This type of therapy aims to help children develop skills to perform everyday tasks and activities to live as independently as possible. Since children with spastic quadriplegia have limited abilities to use their limbs, this type of therapy aims to make their hands and fingers stronger so they can perform tasks like holding objects.
Speech therapy: This helps victims improve their speech patterns. Since some children with spastic quadriplegia are likely to drool, it affects their speech. Therapists teach children exercises that help improve both oral and cognitive abilities. Speech therapy may also help children with chewing, breathing and swallowing.
Medications: There are a number of prescription drugs that help children with spastic quadriplegia and provide muscle stiffness relief. They may also receive other medications to treat secondary conditions such as epilepsy or attention deficit hyperactivity disorder or ADHD.
Surgery: This is rarely used to treat cerebral palsy, but it may sometimes help children, particularly those with spastic quadriplegia. Surgeries may help them with problems such as dislocated joints and other issues that cause pain or impairment.

Filing a Cerebral Palsy Lawsuit

If your child has suffered forms of spastic cerebral palsy such as spastic diplegia, hemiplegia or spastic quadriplegia, caused by medical negligence including your doctor’s failure to perform a Cesarean section (C-section) when there was sufficient information to know it would have been less risky, you may have grounds for a medical malpractice lawsuit. You may be able to seek compensation for damages including, but not limited to, medical expenses, lost income and wages, loss of future income, permanent injury, disability, past and future pain and suffering, etc.
The experienced New York personal injury attorneys at the Law Offices of Kenneth A. Wilhelm can help you better understand your legal rights and options, and also fight hard to recover just compensation for you. One of our clients secured a $43,940,000 verdict for a child who was diagnosed with cerebral palsy. The hospital failed to diagnose fetal distress, which led to brain damage and cerebral palsy from lack of oxygen supply to the brain. The delay in diagnosing the fetal distress and ordering a C-section delivery caused the child’s condition. Defense attorneys argued that the child’s injuries were caused by premature birth and that the obstetrical care was appropriate. The $43,940,000 verdict was eventually reduced on appeal, because the verdict was so huge.
In another case, our client obtained a $4,500,000 settlement where the doctor negligently used forceps to deliver a baby cutting oxygen supply to the child’s brain. The infant suffered from cerebral palsy as a result. The lawyers for the family were able to prove that a C-section should have been performed, which may have prevented the cerebral palsy from occurring.
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