Diplegia: Difference between revisions

'''Diplegia''', when used singularly, refers to [[paralysis]] affecting symmetrical parts of the [[Human body|body]]. This is different from [[hemiplegia]] which refers to [[spasticity]] restricted to one side of the body, [[paraplegia]] which refers to paralysis restricted to the legs and hip, and [[quadriplegia]] which requires the involvement of all four limbs but not necessarily symmetrical.<ref name = Shevell /> Diplegia is the most common cause of crippling in children, specifically in children with [[cerebral palsy]].<ref name = Collier /> Other causes may be due to [[spinal cord injury|injury of the spinal cord]]. There is no set course of progression for people with diplegia. Symptoms may get worse but the neurological part does not change. The primary parts of the brain that are affected by diplegia are the [[Ventricular system|ventricle]]s, fluid filled compartments in the brain, and the wiring from the center of the brain to the [[cerebral cortex]].<ref name = Interview /> There is also usually some degeneration of the cerebral [[neuron]]s,<ref name = Collier /> as well as problems in the upper [[motor neuron]] system.<ref name = Shevell />

The treatment for facial diplegia depends on the underlying cause. Some causes are usually treatable such as infectious, toxic, and vascular by treating the main problem first. After the underlying problem is cured, the facial paralysis usually will go away.{{cn|date=December 2021}}

There are several ways of getting diplegia in the arms. It is very common for people with [[Cerebralcerebral Palsypalsy]] to have diplegia of the arms. Although most people with Cerebralcerebral Palsypalsy have diplegia in their legs, some people have diplegia in their arms. Other ways of getting paralysis of both arms is through a traumatic event or injury.{{cn|date=December 2021}}[[Vulpian-Bernhardt Syndrome|Brachial amyotrophic diplegia]], a regional variant of [[ALS]], is a rare [[Motor neuron diseases|motor neuron disease]] characterized by diplegia in the arms.<ref>{{Cite journal |last1=Katz |first1=J.S. |last2=Wolfe |first2=G.I. |last3=Andersson |first3=P.B. |last4=Saperstein |first4=D.S. |last5=Elliott |first5=J.L. |last6=Nations |first6=S.P. |last7=Bryan |first7=W.W. |last8=Barohn |first8=R.J. |date=September 1999 |title=Brachial amyotrophic diplegia: A slowly progressive motor neuron disorder |url=https://www.neurology.org/doi/10.1212/WNL.53.5.1071 |journal=Neurology |language=en |volume=53 |issue=5 |pages=1071–1076 |doi=10.1212/WNL.53.5.1071 |pmid=10496268 |issn=0028-3878}}</ref>

Diplegia of the legs consists of paralysis of both legs. There are 3 levels of severity. Mild diplegia means the person can usually walk but might walk a little differently, can usually play and run to a limited extent. Moderate diplegia means the person can usually walk but with a slight bend in the knees. They usually can'tcannot run and have to use the handrails to go up and down steps. People with severe diplegia usually need crutches, a walker, or a wheelchair to be able to get around.<ref name= Interview />

Children with diplegia in the legs have a delayed growth in their leg muscles which causes the muscles to be short. This then causes the joints to become stiff and the range of motion to decrease as the child grows. “For the majority of children with diplegia, growth and development are not a problem. Children with diplegia are eventually able to walk, just normally later; they generally attend regular schools and become independently functioning adults.” <ref name= Miller />

The most common cause of diplegia in the legs is [[Cerebralcerebral Palsypalsy]]. Paralysis of the legs may also be caused by trauma, injury, or genetics, but this is very rare.<ref name= Interview />

Diplegia is usually not diagnosed before the age of 2 years yet the symptoms and signs of the earlier stages are typical and should enable the diagnosis to be made before the contractures have occurred.<ref name= Ingram /> Parents suspecting diplegia should take their child to the doctor to potentially get an earlier diagnosis.{{cn|date=December 2021}}

“This is the age at which the characteristics of diplegia become more noticeable, mainly because, unlike other children at this age, the child with diplegia is not walking.” <ref name= Miller /> By the age of three, it is important for the child to be in a specialized school environment so the child can participate in physical therapy and learn social skills. Parents should not force the child to sit, crawl, or walk a certain way during this age period. Let the child do what's comfortable for them and allow the therapist to correct this problem. If you want to help your child walk more, then push toys are recommended for walking aids. Regular exams should be done to make sure the child's legs are growing normally and he or she is not having any problems with the hip.<ref name= Miller />

“This is the age range at which the child with diplegia makes the most significant physical improvement in motor function.” <ref name= Miller /> During this time period the child makes major improvements in motor function. He or she should be in a regular school and focus on cognitive issues not therapy. A child using a walking aid for mobility to move around with the other children is not a bad thing. If a child is not walking yet, then this is usually caused by a problem in balance, muscle coordination, spasticity, or leg alignment. Each of these reasons should be looked into closely so the problem can be addressed and fixed.<ref name= Miller />

“By the time a child reaches this age the rate of physical improvement has leveled off in areas such as balance and coordination, and it’sit's a good idea to refocus the child’s attention away from additional physical improvement and toward intellectual learning.” <ref name= Miller /> During this time period a child should lean away from physical therapy and do more outdoor or social exercises such as sports and adaptive P.E. Usually by age 8-10 a child has reached maximum walking ability. This will usually decrease a little when a child hits puberty and gains height and weight because walking becomes harder during this changing period. Any significant problems in walking should be addressed with surgery at this stage.<ref name= Miller />

“During this time period of a child’s development, a major issue is separating from the family.” <ref name= Miller /> Parents should learn how to cope with their child growing up and give them more freedom and independence. Teenagers need to make their own decisions and learn from them. One way to do this is for parents to compromise and let the child make smaller decisions so they feel important. Parents should also understand that their child may regress in walking some from increase in height and weight. Going back to therapy during puberty is recommended so the teenager can adjust to the increase in height and weight and not regress as much.<ref name= Miller />

In 1890 Sachs and Peterson first referenced to the term diplegia, along with the word [[paraplegia]], for their cerebral palsy classification. In 1955 the word diplegia was used in the clinical field to describe a patient whose limbs were affected in a symmetrical way. This included limbs on the same side of the body thus including [[hemiplegia]]. Later in 1956 diplegia was presented as a form of bilateral Cerebralcerebral Palsypalsy affecting like parts on either side of the body. In 1965 Milani Comparetti distinguished diplegia from [[tetraplegia]] by considering the patient's upper limb's ability to express a sufficient support reaction. Thus diplegia usually refers to just symmetry of one body part or limb, as the legs, or arms. While tetraplegia or [[quadriplegia]] refers to paralysis of all 4, both arms and legs.<ref name= Ferrari />

{{reflist|refs = <ref name= Shevell >{{cite journal |author=Shevell MI |title=The terms diplegia and quadriplegia should not be abandoned |journal=Dev Med Child Neurol |volume=52 |issue=6 |pages=508–9 |date=June 2010 |pmid=20030685 |doi=10.1111/j.1469-8749.2009.03566.x |doi-access=free }}</ref>

<ref name= Collier >{{cite journal |author=Collier, J.S. |title=President's Address: The Pathogenesis of Cerebral Diplegia |journal=Proc R Soc Med |volume=17 |issue=Neurol Sect |pages=1–11 |date=October 1923 |pmc=2201420 |pmid=19983791|doi=10.1093/brain/47.1.1 }}</ref>

<ref name= Ferrari>{{cite book |author1=Ferrari, A. |author2=Cioni, G. |author3=Lodesani, M. |author4=Perazza, S. |author5=Sassi, S. |title=Forms of Diplegia The Spastic Forms of Cerebral Palsy |publisher=Springer |location=Milan |year=2010 |pages=293–330 |doi=10.1007/978-88-470-1478-7_15|chapter=Forms of Diplegia |isbn=978-88-470-1477-0 }}</ref>

<ref name= Figueroa>{{cite journal |vauthors=Figueroa JJ, Chapin JE |title=Isolated facial diplegia and very late-onset myopathy in two siblings: atypical presentations of facioscapulohumeral dystrophy |journal=J. Neurol. |volume=257 |issue=3 |pages=444–6 |date=March 2010 |pmid=19826857 |doi=10.1007/s00415-009-5346-5 |s2cid=26271989 }}</ref>

<ref name= Boyd>{{cite journal |vauthors=Boyd RN, Morris ME, Graham HK |s2cid=23824032 |title=Management of upper limb dysfunction in children with cerebral palsy: a systematic review |journal=Eur. J. Neurol. |volume=8 |issue=Suppl 5|pages=150–66 |date=November 2001 |pmid=11851744 |doi=10.1046/j.1468-1331.2001.00048.x}}</ref>

<ref name= Miller>{{cite book |author1=Miller, F. |author2=Bachrach, S.J. |title=Cerebral Palsy A Complete Guide for Caregiving |publisher=Johns Hopkins University Press |year=2006 |edition=2nd |isbn=978-0801883552 |url=httphttps://www.persianculturearchive.org.au/uploadsdetails/content/thcc/CerebralPalsy/CerebralPalsyCareGivingGuide.pdfisbn_9780801883552 |access-date=2015-04-07 |archive-url=https://web.archive.org/web/20150413023454/http://www.persianculture.org.au/uploads/content/thcc/CerebralPalsy/CerebralPalsyCareGivingGuide.pdf |archive-date=2015-04-13 |dead-urlaccess=yesregistration }}</ref>

<ref name= Bottos>{{cite journal |vauthors=Bottos M, Feliciangeli A, Sciuto L, Gericke C, Vianello A |title=Functional status of adults with cerebral palsy and implications for treatment of children |journal=Dev Med Child Neurol |volume=43 |issue=8 |pages=516–28 |date=August 2001 |pmid=11508917 |url=http://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0012-1622&date=2001&volume=43&issue=8&spage=516 |doi=10.1017/s0012162201000950}}</ref>

{{Cerebral palsyMovement and othergait paralyticsymptoms and syndromessigns}}