By: Jenna Plummer and Mariah McGarvey Spastic Diplegia By: Jenna Plummer and Mariah McGarvey

What is spastic diplegia? Form of cerebral palsy Upper extremity: ROM above hips are typically normal Potential for mild UE spasticity, ex. in trunk Lower extremity: Primarily affected in a symmetrical pattern Hypertonia and spasticity Difficulties with coordination and balance Ankles present more issues than knees Potential for hip dislocation Potential for ambulation depends on severity of hypertonia in LE

CAUSES Birth injuries Maternal Neonatal asphyxia Premature birth & low birth weight Head injury or infection after birth Maternal Infections Multiple births Seizures, mental retardation, thyroid problems Maternal infections: High-grade fever or rubella

Presentation and Clinical Ramifications Ages 1-3: Important to focus on 5 milestones & are they walking? Prefer ‘W’ sitting Ages 2-4: Children pull themselves up to standing May need AFO’s & prone type stander Regular hip exams, spastic hip disease assessing for hip dislocation & eventual arthritis standing 1-2 hrs/day as tolerated; beneficial for vestibular, balance, bone/jt development

PRESENTATION and Clinical Ramifications Ages 4 and above: Best time for therapy; 5 times/week for <30 minutes Emphasize cognitive issues Replace typical therapy with dance, aquatics, hippotherapy, karate Potential for walking is determined around age 7-8 Spasticity, muscle coordination, antagonistic muscles, ataxia Be sure not to push the child too far.

diagnosis Early signs: Unusual muscle tone(~2-3 months) Begin appearing overly floppy and then become increasingly rigid May take a few months to 3 years for formal diagnosis Children must 1st show signs of leg movement difficulties and developmental delays before a proper diagnosis can be made Tests or scans? None; strictly diagnosed based on motor movement.

Prevalence ~3 in every 1,000 children are diagnosed with cerebral palsy Spastic diplegia is the most common type of CP; ~24% of CP cases Incidence: 8,000-10,000 babies born with CP each year Estimated 746,000 individuals in the US living with CP Let patients know they’re not alone!

TREATMENT Physical therapy: standard & first treatment Stretching, strengthening, muscle relaxation techniques Medicine: used to reduce muscle tension Orthopedic surgery: correct deformity Massage, yoga, chiropractic: relaxation & improved sleep

Which Type of Prosthesis? Depends on what you’re trying to accomplish with patient

How the Prosthetic works Floor reaction AFO had a significant kinematic gait improvements including a reduction of abnormal ankle dorsiflexion and knee flexion Typically used for those children in ‘crouched’ position Hinge allows for tibial advancement Knee moments during stance were not changed in subjects wearing hinged or solid orthosis.

prognosis Can be difficult to determine because of the variety of motor and neural involvement Those with Spastic Diplegia tend to have more uniform and comparable neuromotor abilities Assessed milestones Motor control of sitting and crawling by the age of 2.5 were predictive of ambulatory function In the picture, this is what they look like without prosthetic. It fixes internal rotation and provides a wider base of support to stop that “scissoring” effect

References Diplegic Cerebral Palsy. Birth Injury Guide. 2016. Retrieved July 5, 2016, from, http://www.birthinjuryguide.org/cerebral-palsy/types/diplegic/ Spastic Diplegia. Brainandspinalcord.org. 2016. Retrieved July 5, 2016, from http://www.brainandspinalcord.org/spastic-diplegia/ Prevalence of Cerebral Palsy. Cerebral Palsy Foundation. http://www.cerebralpalsy.org/about-cerebral- palsy/prevalence-and-incidence http://www.cerebralpalsy.org/information/mobility/orthotics Lucareli, P. R. G., Lima, M. D. O., Lucarelli, J. G. D. A., & Lima, F. P. S. (2007). Changes in joint kinematics in children with cerebral palsy while walking with and without a floor reaction ankle-foot orthosis. Clinics, 62(1), 63-68. Morris, C. (2002). A review of the efficacy of lower‐limb orthoses used for cerebral palsy. Developmental Medicine & Child Neurology, 44(3), 205-211. Badell-Ribera, A. (1985). Cerebral palsy: postural-locomotor prognosis in spastic diplegia. Archives of physical medicine and rehabilitation, 66(9), 614-619.