Spastic Diplegia

Spastic paralysis of both legs and mild involvement of upper limb due to over use
Very young child
Will show low tone in legs initially, so he will not be able to do bottom up exercises, bridging
turning over etc. although this child may use both arms in midline, but he will feel difficulty
in exploring his legs.
Treatment
Improve the tone at this stage by exercises and positioning.
I. Bottom up exercises

Improve abdominal tone

II. Bridging exercises

Extensor tone

III. Turning over facilitation

IV. Proper positioning in order to improve tone.

Older child(not able to sit, spasticity is developing)

Abnormal pattern likely to develop is flexion at knee and hip, adduction, internal rotation at
hip, planter flexion at ankles. In severe cases scissoring may take place
Treatment
 Abduct and external rotate the legs, extend hip and knees. Gradually hip is extended and
trunk is elongated, when somewhat spasticity decreased then make sitting with open legs. Be
careful about heel position.

Older child able to sit but with abnormal pattern

Abnormal pattern of sitting:

1. W sitting

2. Sitting with scissor legs

Solutions
First inhibit the abnormal pattern i.e. abduct, externally rotate and extend the legs.
Then introduce movements slowly forward and backward and sideways.
Next roller sitting then inclined sitting with rollers.
 Important points
 To avoid W sitting, try to use bench/block/special chair with leg separator. Don’tallow
this child for prolonged sitting on floor because it will cause development of W sitting.
 In bench sitting, give a chance to play openly right and left above the body e.g. try to
catch something above the head level. In this way trunk will be elongated. But don’t
compromise on leg position, legs should be separated and heels should be on ground
during activity.
 Proper classroom position is important to keep legs open and feet on the floor. Straps and
cushions may be used for this purpose.
A. Child who can stand and walk with crossed legs
I. First inhibit crossed leg pattern against a wall. After sometime, give antigravity flexion of
one leg e.g. kicking a ball, rolling something with foot. This activity should be tried with
each leg.
II. Then proper gait training can be tried i.e. weight bearing pelvis should be in protraction
while mobile pelvis should be in slight retraction.
III. And leg balance keeping other leg in abduction and external rotation
IV. All sorts riding type activities are helpful in this case.