Pediatric quadriplegia

Cerebral palsy results from widespread brain damage of a fetus or newborn, which further leads to group of signs and symptoms. Pediatric quadriplegia is a common feature of this miserable condition. In this article, you are going to be oriented with the causes, associated symptoms and methods of its management.

What does pediatric quadriplegia mean?

“quad” means four; so this term means paralysis of the four limbs of a child. The four limbs are equally affected.

What are the causes of pediatric quadriplegia?

Normally, each cerebral hemisphere is responsible for controlling the contralateral half of the body. This fact makes it easy to expect that quadriplegia would be secondary to damage of a significant portion of the brain, particularly, the white matter.

Both the corticospinal and corticobulbar tracts are affected in pediatric quadriplegia.

This damage may occur at any time during the perinatal period, for instance prenatal, during delivery or just after birth.

Conditions that lead to perinatal brain damage:

• Fetal stroke: it occurs in the intrauterine life because of pre-eclampsia or placental blood clot or placenta previa
• Fetal infection
• Prematurity
• Infection that affects the mother during pregnancy
• Maternal intake of medications
• Exposure of the pregnant mother to toxins during pregnancy

What are the symptoms commonly associate pediatric quadriplegias?

• Speech troubles
• Language disorder
• Fits (convulsions)
• Floppy neck(Inability to support the neck)
• Weakness of muscles
• Tremors
• Stiffness of joints leading to difficult movement
• Scissoring of lower limbs, as well as, abnormal gait and walking
• Learning disability secondary to cognitive disabilities

What are the complications of pediatric quadriplegia?

• Most of the complications are secondary to spasticity (stiffness) and hypertonia. For instance: limb deformity
• Recurrent aspiration; secondary to poor tone of both of the pharyngeal and laryngeal muscles.
• Respiratory problems because of the recurrent aspiration and low immunity
• Scoliosis (lateral deviation of the vertebral column)
• Ankle equinus (limited ankle flexion)
• Abnormal speech
• Dysphagia: Difficulty in swallowing

What are the management modalities of pediatric quadriplegia?

Physiotherapy

The main concern of the treatment is the relief of stiffness. Thus, the first line treatment for children with any form of spastic cerebral palsy is almost always physical therapy. Physical therapists aim to provide children the tools to be as independent as possible via flexibility exercises, stretching, and range-of-motion activities.

Occupational Therapy

It aims at helping the child to do his daily activities at school and home, so that he can conduct his life independently.

Speech Therapy

It improves the learning abilities of the child secondary to improving his speech and language, as well as, articulation of letters and coordination of the muscles to produce words.

Speech therapy facilitates swallowing in addition to improving articulation of words. This will ease the swallowing as well as prevent aspiration.  

Medications

• Muscle relaxants may be used in order to reduce muscle stiffness
• Seizures are common, therefore, the use of anti-epileptic medications are needed.
• The child may suffer from gastro-oesophageal reflux, thus needs treatment
• Constipation.
• Local injection of botulinum toxin to relief the stiff muscles.

 Surgery

It is indicated to correct the shortened muscles, dislocated joints and spinal deformities which cause pain and impairment.

Selective Dorsal Rhizotomy may be done. It is a surgery that helps relax the muscles and improve mobility in various areas of the body. It is done by severance of selected hyperactive nerves.

Although there is no cure for pediatric quadriplegia, therapies, medications and surgical options offer chances for those children to conduct a near normal and productive lives.