Forms of Diplegia

Abstract

Lieterally, the word diplegia should refer to “any cerebral palsy distributed on any two limbs” (therefore including hemiplegia), but from Freud onwards (1897) this word has been commonly used to indicate “a cerebral palsy of both sides”, therefore ranging from tetraplegia to diplegia and double hemiplegia, even including non-spastic syndromes. (1862), considered the scientific father of cerebral palsy (CP), described clinical pictures that today could be defined as diplegia, but he never used this word, which was instead used by Sachs and Petersen (1890), together with the word paraplegia, in their proposal for CP classification. In Minear’s interpretation table (1956), diplegia was presented as a form of bilateral CP “paralysis affecting like parts on either side of the body”. However, starting from Ingram’s interpretation (1955), the word diplegia has been used in the clinical field when the patient’s homologous limbs are affected in a more or less symmetrical way and when the lower limbs are “significantly” more affected than the upper ones in relation to pathognomonic signs like “hypertonia”, “hyper-reflexia”, “weakness”, etc., and to motor activities like standing, walking, and manipulating: “Diplegia... as a condition of more or less symmetrical paresis of cerebral origin more severe in the lower limbs than in the upper and dating from birth or shortly thereafter”. Another discriminatory criterion proposed by Milani Comparetti (1965), which is extremely practical and clarifying when trying to distinguish diplegia from tetraplegia, is to consider the patient’s upper limbs’ ability to express an efficient support reaction through the use of suitable orthopedic devices (diplegia=tetraparesis functionally paraparesis).