Medical Malpractice
Diplegic cerebral palsy (sometimes referred to as spastic diplegia) is one of the different types of spastic cerebral palsy (CP). There are 4 primary types of cerebral palsy: (1) spastic; (2) dyskinetic; (3) ataxic; and (4) hypotonic.
Spastic CP is the most common type and accounts for almost 80% of all cerebral palsy cases. Spastic CP is characterized by excessive muscle tightness and stiffness in certain areas of the body. There are 3 different subtypes or classifications of spastic cerebral palsy depending on the area of the body that is affected:
Hemiplegic = muscle stiffness affecting the arms and upper body
Diplegic = muscle stiffness affecting legs and lower body
Quadriplegic = muscle stiffness in lower AND upper extremities
What are the 3 Main Types of Cerebral Palsy?
There are 3 main types of cerebral palsy: (1) spastic; (2) athetoid; and (3) ataxic. Spastic is the most common type of CP and is characterized by excessive muscle tightness (hypertonia) and joint stiffness in certain areas of the body. Athetoid CP involves a combination of both excessive muscle tightness (hypertonia) and low muscle tone (hypotonia) which causes involuntary movements. Ataxic CP is the least common form. The main characteristic of ataxic CP is hypotonia and loss of balance and coordination.
What Does Diplegic Mean?
Diplegic comes from the root word diplegia which means symmetrical paralysis on both sides of the body (i.e., paralysis of both legs, etc.).
What Are the Symptoms of Diplegic Cerebral Palsy?
Children with infantile diplegic cerebral palsy are disabled by chronic tightness in their leg muscles that can significantly limit their ability to walk. Often the upper body will be entirely normal but the legs will be abnormally stiff with an extremely limited range of motion.
Many children with diplegic CP walk with what is often described as a “scissor gate.” The muscle stiffness often forces legs to turn inwards at the knees from contractions. Some children with diplegic cerebral palsy are able to walk with the assistance of special crutches or mobility aids. Those with more severe cases of diplegic CP are not able to walk on their own at all.
A recent study of children with spastic cerebral palsy found that 58% could walk on their own (with or without mobility aids).
What Causes Spastic Diplegic Cerebral Palsy?
Like all cases of CP, diplegic cerebral palsy is caused by damage to the developing brain during childbirth or pregnancy. The brain requires a constant supply of blood and oxygen to function. When the flow of oxygen or blood to the brain is interrupted during pregnancy or childbirth (even for a short amount of time) cells in the brain quickly decay and die. This is what results in cerebral palsy. There are a number of complications or events during labor and delivery that can interrupt blood or oxygen to the baby’s brain and potentially cause diplegic cerebral palsy. These include placental abruption; asphyxia; fetal distress; uterine rupture; and cord prolapse.
How Many Children are Affected by Diplegic Cerebral Palsy?
Approximately 3 out of every 1,000 babies born in the United States each year are diagnosed with some form of cerebral palsy. The United Cerebral Palsy Association estimates that a total of 780,000 people in the United States suffer from cerebral palsy. Spastic cerebral palsy is the most common form of the disorder, accounting for around 80% of all cerebral palsy cases; and diplegic CP is the most common subtype of spastic CP.
Diplegic Cerebral Palsy and PVL
This form of cerebral palsy is commonly associated with a neurological condition known as periventricular leukomalacia (PVL).
PVL is a type of brain injury that involves the death of small areas of brain tissue around the ventricles, which are fluid-filled areas in the brain. This damage can lead to the formation of cysts or cavities in the periventricular area (the area around the ventricles), which affects the brain’s white matter, or myelinated nerve fibers. These fibers are responsible for transmitting signals in the nervous system and coordinating communication between different parts of the brain and body.
The relationship between diplegic cerebral palsy and PVL is significant because the areas affected by PVL are crucial for controlling motor functions, particularly those of the legs. The damage to these areas can disrupt the brain’s ability to send proper nerve signals to the lower limbs, leading to the spasticity and motor control issues characteristic of diplegic cerebral palsy.
Periventricular leukomalacia is more commonly seen in premature infants, whose brain tissues are more vulnerable to injury, both due to their immaturity and the increased risk of reduced oxygen and blood flow that can occur during complicated preterm deliveries.
Understanding the connection between PVL and diplegic cerebral palsy is essential for early diagnosis and intervention, which can significantly improve outcomes for affected children. Therapeutic interventions might include physical therapy to manage spasticity and improve motor function, as well as other treatments aimed at enhancing mobility and overall quality of life. Early and targeted interventions can help maximize a child’s mobility and ability to perform daily activities, providing a better foundation for growth and development despite the challenges posed by their condition.
How and When is Spastic Cerebral Palsy Diagnosed?
Although most cases of cerebral palsy occur during childbirth, a formal diagnosis of the condition is usually not made until months later. The signs and symptoms of spastic diplegic cerebral palsy become more apparent as the child begins to develop. One of the earliest indicators of cerebral palsy is when the child fails to reach certain physical developmental milestones during infancy.
For instance, children with spastic diplegic cerebral palsy may exhibit significant difficulty in certain physical movements such as rolling over, sitting up on their own, standing, crawling and walking. Sometimes an early preference for one hand or side of the body over the other can be an indication of diplegic cerebral palsy.
As the child gets older, specific hallmarks of diplegic cerebral palsy can be identified. Increased muscle tone and tightness in the lower body, particularly when executing fine motor skills, are indications of diplegic cerebral palsy. Children with hemiplegic cerebral palsy will often have stiff, bent joints at the elbows, fingers, and wrists that they are unable to relax and control. Clenched or “fisted” fingers are often observed which can make certain tasks like writing impossible. Diplegic cerebral palsy causes similar symptoms in the legs and lower body.
Tightness or flexion in the knee joints is the most notable sign as the knees will bend in from the stiffness. When diplegic CP causes tightness in the hips the legs will often get pulled upwards resulting in a forward-leaning posture. A “scissor gait” is caused by muscle tightness in the thighs causing the legs to pull together. When diplegic CP causes tightness in the lower leg muscles such as the calf, it can force the heels to pull up and give the appearance of walking on the toes.
What Are Treatment Options for Diplegic Cerebral Palsy?
Diplegic cerebral palsy is not a progressive condition so it does not get worse over time. However, once brain cells are damaged they cannot be restored or repaired. This means that there is no “cure” for diplegic CP but symptoms can decrease in severity with proper management and therapy. Management of diplegic cerebral palsy can be complicated simply because spastic CP can result in very individualized symptoms. There are various therapies used to manage and address the symptoms of diplegic CP including:
- Physical Therapy: physical therapy is the primary treatment tool for all spastic CP cases including diplegic CP. Physical therapy for diplegic CP focuses on increasing the strength and flexibility of certain muscle groups in the legs. PT tools for diplegic CO include a number of stretching routines, tissue mobilization techniques, and exercises aimed at endurance.
- Occupational Therapy: this is a more focused, fine-tuned version of physical therapy. Occupational therapy aims at increasing the level of functionality with basic tasks.
- Surgery: some children with diplegic CP may benefit from orthopedic surgery to address muscle tightness. Surgery can improve joint function and mobility. It can also eliminate painful deformities.
- Medication: prescription muscle relaxants are often used to address the symptoms of spastic CP.
There is no question that the right therapy may make a difference for some suffering from diplegic CP. One recent study in 2023 investigated the impact of two therapeutic approaches—Neurodevelopmental Treatment (NDT) and Sensory Integration Therapy (SIT)—on improving motor functions in children with spastic diplegic cerebral palsy.
The study focused on children aged 8 to 12 years, all diagnosed with spastic diplegia and at varying levels of the Gross Motor Function Classification System (stages I to III). The children were divided into two groups, with one group receiving NDT and the other undergoing SIT, in addition to their standard physiotherapy sessions. Both interventions were applied for 45 minutes daily, five days a week, over a period of four weeks.
Assessments of gross motor function, balance, and gait parameters were conducted before and after the interventions using the Gross Motor Function Measure-88 (GMFM-88), Pediatric Balance Scale, and specific gait analysis tools. The results showed statistically significant improvements in the group receiving Sensory Integration Therapy (Group B) across all measured parameters—gait, balance, and gross motor skills—indicating that SIT was particularly effective in this cohort.
The findings suggest that SIT, which focuses on helping children better process and integrate sensory information to improve motor output, may have significant benefits for children with spastic diplegia, potentially more so than NDT in some aspects.
Can You Walk if You have Spastic Diplegic Cerebral Palsy?
Children with the more severe cases of spastic diplegic cerebral palsy may not be able to walk at all and require a wheelchair. Others with more moderate cases may be able to walk independently but require the use of a mobility aid. The most recent studies indicate that at least 58% of children with spastic CP are able to walk independently and the remaining 42% require a wheelchair.
Can Mild Spastic Cerebral Palsy Get Worse Over Time?
Spastic cerebral palsy is not a progressive disorder so it does not get worse over time. However, an individual’s specific symptoms may change over the course of their lifetime. Without treatment and proper management, the symptoms from a mild case of spastic CP can potentially become more problematic over time.
Diplegic Cerebral Palsy Malpractice Lawsuits
Malpractice lawsuits in cases of diplegic cerebral palsy typically involve the following claims:
- Negligent monitoring: Failing to adequately monitor fetal heart rate during labor can lead to a failure to detect distress, including conditions that could lead to hypoxia (lack of oxygen), which can damage the brain.
- Improper delivery techniques: Excessive use of force during delivery or incorrect use of instruments like forceps or vacuum extractors can cause physical trauma to the infant’s head, leading to brain injury.
- Delay in performing necessary procedures: Delays in performing a C-section or other interventions when the fetal heart tracings make clear that the baby is in fetal distress.
- Inadequate response to maternal health issues: Mismanagement of maternal health issues such as infections, preeclampsia, or gestational diabetes, which can impact fetal health and lead to conditions like cerebral palsy.
Settlements & Verdicts for Diplegic Cerebral Palsy
There are many medical malpractice lawsuits involving cerebral palsy. But few reported opinion mention the type of CP. Below are summaries of reported settlements and verdicts in cases involving diplegic cerebral palsy. So all we have is verdicts from over 10 years ago.
- Norfleet v. Harbor Hosp. Inc. (Maryland 2012) $21 million: Plaintiffs alleged that doctors and hospital negligently failed to monitor for signs of fetal distress during labor and failed to perform an emergency c-section delivery. The child was diagnosed with spastic diplegic cerebral palsy. Defendants denied any liability and insisted that they met the applicable standard of care. A jury in Baltimore City awarded plaintiffs $21 million.
- Plaintiff v. Defendant (California 2004) $4.2 million: Several hours into labor signs of significant fetal distress were observed by nurses including severe, persistent fetal bradycardia and membranes ruptures. In response, the nurses at the hospital call the OBGYN at home and told him he needed to come in and deliver the baby. It took the doctor 20 minutes to get to the hospital at which point an emergency C-section delivery was performed. The baby was sent to the NICU with a diagnosis of hypoxic-ischemic encephalopathy. The baby was eventually diagnosed with spastic diplegic cerebral palsy. The parents sued the hospital and doctor for malpractice for failing to be prepared to perform an emergency c-section, The case was settled for $4.2 million.
Contact Miller & Zois About Diplegic Cerebral Palsy
If you have a child that was recently diagnosed with diplegic cerebral palsy, it may be the result of medical negligence during labor and delivery. The birth injury lawyers at Miller & Zois have a long track record of delivering results for clients. We will fully investigate your case and tell you whether or not you have a claim for malpractice. Call us at 800-553-8082 or get a free online consultation.