Spastic paralysis of both legs and mild involvement of upper limb due to over use
A. 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.
B. 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.
C. Older child able to sit but with abnormal pattern
Abnormal pattern of sitting:
I. W sitting
II. 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’t
allow 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
D. 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.
