SWhat is spastic cerebral palsy ?

Spastic CP is among the most common forms of Cerebral Palsy. With rigid muscles, it affects as many as 50% and more of all CP cases.

In normal cases, muscles function in pairs-one to send the signal to the brain, and the other to carry the brain’s command back to the concerned body area. Both work in tandem, one following the other, to ensure the desired free movement. For e.g. any tightness of muscles is conveyed to the brain by one set of muscles via the spinal cord. In an instant, the brain sends back a message through another set of muscles to relax the tight muscles. These contracting and relaxing messages go on all the time, making for smooth muscle tone and strength.

In spastic CP, both sets of muscles become active together. Their messages flood the nervous system – the spinal cord, the nerves, the neurons etc, and virtually create a traffic jam.  This leads to tenseness in the muscle, which then blocks simple movement. In Spastic CP, the Cerebral Cortex and the Gray matter (where neurons are located) are damaged, causing the muscles to malfunction. This non-coordination of muscles affects the use of extremities. The muscles in the affected area become stiff and rigid, so much so that if forced to stretch and function, give way suddenly causing a jerky movement.

Spastic CP can be of 5-types depending on the body part affected. Its Quadriplegia, if all four limbs and torso are affected; Diplegia, for two limbs - both hands or both legs; Hemiplegia, when one side of the body is affected; Triplegia, for three limbs; and Monoplegia, when just one limb is affected by CP. The last two, Triplegia and Monoplegia are extremely rare. Diplegia is the most common of all CP cases, with normally the lower limbs affected. Outstretched and crossed over, they can give a scissor like posture, making movement impossible. Other parts of the body, like the facial areas, too can have the same spasticity as the limbs have.

Spastic CP can change with time, and if not treated right, can cause contractures, which are permanent disabilities. Some children may suffer uncontrollable shaking (Hemiparetic tremors); have urinary incontinence i.e. they are unable to control urine discharge; find it difficult to change position; have a ‘clasp-knife’ situation where they are unable to let go of something in their hand as the muscles don’t follow commands; and of course abnormal postures and deformities because of the rigid muscles.

Since it’s the rigidity of the muscles that is the culprit, an early treatment has to break this rigidity. Adopting postures to maximize their flexibility and function could reduce spasticity. Crawling has been found to be an excellent physical therapy, because it increases the weight-bearing capacity of all four limbs. Building self-esteem of the child is like half the battle won, where handling of Spastic CP is concerned. The rest falls into place easily.