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How Spastic Diplegia Affects Movement and Muscle Tone in Children

Spastic diplegia is one of the most common types of cerebral palsy (CP), and it primarily affects movement and muscle tone in the legs. For parents, understanding how spastic diplegia impacts their child’s daily life and what can be done to improve mobility can make a significant difference in navigating care and support.

Dr. David Siambanes provides specialized orthopedic care for children with spastic diplegia in Tampa Bay and the surrounding areas. His expertise in pediatric orthopedics, spinal deformities, and motion analysis helps families explore the most effective treatments for improving movement, comfort, and independence.

What is Spastic Diplegia?

Spastic diplegia is a form of cerebral palsy that results from damage to the part of the brain responsible for controlling movement. In spastic diplegia, this damage leads to increased muscle tone (spasticity) in the legs, while the arms may be only mildly affected or not at all.

The term spastic refers to muscle stiffness or tightness that makes it harder to move certain parts of the body. Diplegia means that the condition affects both sides, primarily both legs.

How Spastic Diplegia Affects Movement

Children with spastic diplegia often have tight muscles in the hips, thighs, and calves. This muscle stiffness can make walking, standing, and balance more difficult. Common signs of spastic diplegia include:

  • Toe walking due to tight calf muscles pulling the heels off the ground
  • Scissoring gait, where the legs cross at the knees when walking
  • Stiffness in the hips and knees, limiting the range of motion
  • Difficulty with balance and coordination, leading to frequent falls or trouble with activities like running
  • Weak core muscles, making posture and stability harder to maintain

While many children with spastic diplegia can walk, their walking may be slow, awkward, or energy-consuming. Some children may need walkers, crutches, or wheelchairs for longer distances.

How Muscle Tone is Affected in Spastic Diplegia

In spastic diplegia, the increased muscle tone means that certain muscles are always “on.” They are tighter than they should be, even when the child is at rest. This ongoing tightness:

  • Makes stretching and straightening the legs difficult
  • Can lead to joint contractures (permanent tightening of muscles and tendons) over time
  • Contributes to discomfort or pain, especially as the child grows

The uneven pull of tight muscles can also cause joint deformities, such as hip dislocation or curvature of the spine (scoliosis), if not properly managed.

Available Treatments to Improve Mobility

While there is no cure for spastic diplegia, there are many treatments that can help improve mobility, reduce discomfort, and prevent complications. The goal is to create a personalized plan that meets your child’s unique needs.

Physical Therapy

Physical therapy is one of the most important treatments for spastic diplegia. Therapists work with children to:

  • Stretch tight muscles
  • Strengthen weaker muscles (especially in the core)
  • Improve balance and coordination
  • Practice walking and other functional movements

Consistent therapy helps reduce stiffness and supports better posture and mobility over time.

Bracing and Orthotic Devices

Ankle-foot orthoses (AFOs) and other braces are often used to:

  • Support the feet and ankles
  • Prevent toe walking
  • Encourage better alignment during standing and walking

Braces are custom-made to fit your child and may be worn during the day, at night, or both, depending on their needs.

Medications and Injections

For children with significant muscle tightness, medications may help:

  • Oral medications can relax muscles, though they often affect the whole body and may cause side effects.
  • Botox injections can be used to target specific tight muscles, temporarily reducing spasticity and improving range of motion.

Botox is often combined with therapy and bracing to maximize benefits.

Serial Casting

Serial casting involves placing a series of casts on the legs to gently stretch tight muscles over time. This non-surgical approach can help improve ankle flexibility and reduce toe walking.

Surgical Options

When other treatments are not enough, surgery may be recommended. Dr. Siambanes specializes in orthopedic surgeries that can:

  • Lengthen tight muscles or tendons (such as the hamstrings or Achilles tendon)
  • Correct bone or joint deformities
  • Improve hip stability and reduce the risk of dislocation

These procedures can significantly enhance walking ability, comfort, and overall quality of life.

How Dr. Siambanes Can Help Children with Spastic Diplegia

Dr. David Siambanes is a board-certified orthopedic surgeon with fellowship training in pediatric orthopedics and spinal deformities. His passion for caring for children with disabilities has led him to become a leader in cerebral palsy treatment.

At Children’s Cerebral Palsy, Dr. Siambanes combines surgical expertise with advanced technology. As director of the Motion Analysis Center at St. Joseph’s Children Hospital, he uses 3-D gait analysis to assess your child’s walking patterns and pinpoint the specific barriers to better movement. This allows for a highly personalized approach to treatment, whether that means therapy, bracing, injections, or surgery.

Dr. Siambanes has helped countless children with cerebral palsy and spastic diplegia achieve greater independence, reduce pain, and improve their ability to participate in daily life.

Help Your Child Regain Mobility

Spastic diplegia presents unique challenges, but with the right care, children can make remarkable progress. Dr. Siambanes is dedicated to working alongside families to provide comprehensive, compassionate care every step of the way.

If you have questions about your child’s movement or muscle tone, or if you’re exploring treatment options for spastic diplegia, contact us today to schedule a consultation with Dr. Siambanes. Together, we can help your child take meaningful steps toward improved mobility and confidence.

How Spastic Diplegia Affects Movement and Muscle Tone in Children
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Research Update: Air Pollution Associated with Increased Risk of Cerebral Palsy

When it comes to cerebral palsy (CP), many families are left wondering what factors might have contributed to their child’s diagnosis. While cerebral palsy is not caused by a single event or issue, ongoing research continues to uncover potential environmental influences, including new evidence pointing to the role of air pollution during pregnancy.

A large Canadian study published in JAMA Network Open in 2024 has revealed an important association: exposure to fine particulate air pollution during pregnancy may be linked to a higher risk of cerebral palsy in children born at full term.

What the Study Found

Researchers reviewed data from over 1.5 million mother-child pairs in Ontario, Canada. They tracked exposure to three common air pollutants during pregnancy, including fine particulate matter with a diameter of 2.5 μm (PM2.5), nitrogen dioxide (NO₂), and ozone (O₃),  based on where the mothers lived.

Out of the full-term births studied, 0.2% (3,170) of the children were later diagnosed with cerebral palsy. The study found that for every increase in PM2.5 exposure during pregnancy, there was a 1.12x higher risk of a child being diagnosed with CP. This association was slightly stronger in male infants compared to female infants.

Interestingly, the increased risk wasn’t tied to any specific week of pregnancy, which suggests that overall exposure across the full term may be significant. No similar association was found with NO₂ or O₃ exposure.

What Does This Mean for Parents?

While the idea that something in the environment may increase the risk of CP can be concerning, it’s important to understand that this research doesn’t mean air pollution causes cerebral palsy. CP is a complex condition with many contributing factors, including genetic, developmental, and environmental. Rather, this study highlights a potential risk factor and opens the door for further investigation into how we can reduce risk during pregnancy.

Even with the increased risk, the overall number of CP cases remains low. Most people exposed to PM2.5 during pregnancy do not have children who go on to develop cerebral palsy.

How Does Air Pollution Affect the Developing Brain?

The developing brain is incredibly sensitive, especially during pregnancy. Fine particulate matter like PM2.5 can cross the placenta and may interfere with brain development through inflammation, oxidative stress, or epigenetic changes. These same mechanisms are being studied in other neurodevelopmental conditions like autism and ADHD.

Although researchers are still working to understand how and why these effects occur, the findings support efforts to limit air pollution exposure as a precaution, especially during pregnancy.

Supporting Families Through Research and Care

At Children’s Cerebral Palsy, Dr. David Siambanes is committed to helping families understand both the medical and environmental aspects of cerebral palsy. As a board-certified orthopedic surgeon with fellowship training in pediatric orthopedics and spinal deformities, Dr. Siambanes has treated hundreds of children with CP, improving comfort, mobility, and quality of life through surgical and non-surgical interventions.

We remain focused on empowering families with clear, accessible information and connecting them with specialized care when it’s needed most. If you have questions about cerebral palsy or are concerned about your child’s development, we’re here to help.

Click here to request an appointment today.

Research Update: Air Pollution Associated with Increased Risk of Cerebral Palsy
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Is Cerebral Palsy Genetic? Understanding the Role of Genetics in CP

Cerebral palsy (CP) is a neurological condition that affects movement, posture, and muscle tone. For many years, CP was believed to be caused almost exclusively by birth complications or injury to the developing brain. However, recent research, including new insights from whole-genome sequencing, is changing how we understand this condition, raising the question many parents are now asking: is cerebral palsy genetic?

What Causes Cerebral Palsy?

Cerebral palsy is caused by abnormal brain development or damage to the developing brain, typically before, during, or shortly after birth. Common known risk factors include:

  • Lack of oxygen during birth (asphyxia)
  • Premature birth or low birth weight
  • Infections during pregnancy
  • Traumatic brain injury in infancy
  • Stroke or bleeding in the brain before or shortly after birth

However, despite these known causes, many cases of cerebral palsy cannot be explained by birth trauma or medical complications alone. This has led researchers to explore whether genetic factors may also play a role.

Can Cerebral Palsy Be Genetic?

Recent studies suggest that genetics may contribute to the development of cerebral palsy in a significant number of cases. A Canadian-led study published in Nature Genetics in 2024 found that more than one in ten children with CP had a gene variant associated with their condition. An additional 17% of children had variants of unknown significance that may be linked to CP after further research.

These findings suggest that for some children, genetic mutations affecting brain development may be a contributing factor to CP or increase vulnerability to brain injury before or during birth.

What Does This Mean for Families?

The discovery of a genetic link does not mean that CP is always inherited or passed down through families. In fact, many of the gene changes identified in recent studies are de novo mutations (spontaneous changes that occur for the first time in the child and are not present in either parent)

However, in some families, especially those with multiple children affected by neurological disorders, inherited genetic patterns may play a role.

At this stage, we can say that while cerebral palsy is not typically a genetic disorder, it can have genetic contributions in some cases, and these may be more common than previously understood.

The Value of Genetic Testing

As more is learned about the connection between genetics and cerebral palsy, genetic testing is becoming an increasingly valuable tool in diagnosing and managing the condition. Testing can:

  • Help explain the underlying cause of CP in certain children
  • Identify associated conditions (such as autism or epilepsy) that may share a genetic basis
  • Guide more personalized treatment and care plans
  • Provide clarity for families who may be planning future pregnancies

Dr. Siambanes’ Role in Advanced Cerebral Palsy Care

Dr. Siambanes is a board-certified orthopedic surgeon, fellowship-trained in pediatric orthopedics and spinal deformities. As director of the Motion Analysis Lab at St. Joseph’s Children’s Hospital, he helps families understand how neuromuscular challenges affect a child’s movement and function and how interventions such as bracing, physical therapy, or surgery can improve quality of life.

Although he does not perform genetic testing himself, Dr. Siambanes is deeply involved in guiding the comprehensive treatment of children with cerebral palsy, regardless of its cause. Whether a child’s CP is linked to a birth injury, genetic factor, or unknown cause, his goal remains the same: improve mobility, reduce pain, and support independence.

Click here to request a consultation with Dr. Siambanes today.

Is Cerebral Palsy Genetic? Understanding the Role of Genetics in CP
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Toe Walking with Cerebral Palsy: Causes and Treatments

Toe walking is a common issue seen in children with cerebral palsy, especially those with spasticity affecting the lower legs. While many toddlers briefly go through a phase of walking on their toes, persistent toe walking — particularly in children with cerebral palsy — often indicates an underlying muscular or neurological cause.

If your child is frequently walking on their toes, it’s important to understand why it’s happening and what treatment options are available. At Children’s Cerebral Palsy, Dr. David Siambanes offers expert orthopedic care to help address the causes of toe walking and guide families toward the most effective solutions.

What is Toe Walking?

Toe walking refers to a walking pattern where the heel does not touch the ground. Instead, the child walks on the balls of their feet or their toes. In cerebral palsy, this walking pattern is typically due to muscle tightness or imbalances that limit flexibility in the lower leg and foot.

Persistent toe walking can cause pain, instability, and long-term changes in foot and joint structure if left untreated. It can also affect balance, coordination, and energy levels during walking, making daily activities more difficult for your child.

Why Does Toe Walking Happen in Children with Cerebral Palsy?

Toe walking in cerebral palsy is most commonly caused by spasticity, which is the involuntary tightening or stiffness of muscles. Children with spastic cerebral palsy often have increased tone in the calf muscles (gastrocnemius and soleus), which prevents the heel from touching the ground during walking.

Other contributing factors include:

  • Shortened Achilles tendon or calf muscles
  • Poor muscle coordination
  • Weakness in opposing muscle groups
  • Balance or sensory challenges
  • Delayed motor development

Over time, untreated toe walking can lead to joint contractures (permanent tightening of the muscles and tendons), abnormal gait patterns, and even pain in the feet, knees, or hips.

When to Seek Help for Toe Walking

If your child consistently walks on their toes, especially past the toddler years, it’s worth getting an evaluation, particularly if they have cerebral palsy or other neuromuscular conditions. Early intervention can help prevent complications and support better long-term outcomes.

Signs it may be time to seek help include:

  • Toe walking that persists beyond age 2 or 3
  • Your child avoids putting their heels down entirely
  • Toe walking is accompanied by pain, falls, or poor balance
  • Tightness in the calves or reduced range of motion in the ankle
  • Toe walking that worsens over time

Treatments for Toe Walking in Cerebral Palsy

The goal of treatment is to address the root cause of toe walking — usually muscle tightness or imbalance — and help your child develop a more natural, functional walking pattern. Dr. Siambanes, a fellowship-trained pediatric orthopedic surgeon, takes a personalized approach to care based on your child’s specific needs and mobility goals.

1. Physical Therapy

Targeted stretching and strengthening exercises can help lengthen tight calf muscles and improve ankle flexibility. Physical therapists may also work on balance, posture, and walking mechanics.

2. Orthotic Devices and Bracing

Ankle-foot orthoses (AFOs) are commonly used to support proper foot alignment and prevent toe walking. Rigid or hinged AFOs can hold the foot in a more neutral position and reduce the strain on tight muscles.

3. Botox Injections

Botulinum toxin (Botox) can be injected into overly tight muscles to temporarily reduce spasticity and allow for improved range of motion. This is often paired with physical therapy or bracing to maximize results.

4. Serial Casting

In some cases, a series of casts may be applied over several weeks to gradually stretch and lengthen tight calf muscles. This non-surgical approach is especially useful when the goal is to improve flexibility without permanent intervention.

5. Surgical Intervention

If conservative treatments are not successful, surgery may be necessary. Dr. Siambanes specializes in procedures such as tendon lengthening, which can release tight calf muscles or adjust foot alignment. Surgical correction is often recommended when toe walking causes pain, impairs function, or leads to contractures.

Advanced Care with Dr. Siambanes

As the director of the Motion Analysis Center at St. Joseph’s Children’s Hospital, Dr. Siambanes uses 3D gait analysis to precisely assess walking patterns and identify the physical barriers contributing to toe walking. This advanced tool allows him to develop highly targeted treatment plans and ensure your child is receiving the most effective care.

Dr. Siambanes has performed countless procedures to help children walk more comfortably and confidently. His experience in managing cerebral palsy-related deformities, combined with his compassionate approach to care, makes him a trusted partner for families navigating complex mobility challenges.

Improving Mobility, One Step at a Time

Toe walking may seem like a small issue, but it can have a big impact on a child’s comfort, confidence, and ability to participate in daily life. With early intervention and expert care, most children with cerebral palsy can make significant improvements in their gait and overall mobility.

If your child is toe walking, don’t wait to seek support. Click here to contact Children’s Cerebral Palsy to schedule an evaluation with Dr. Siambanes and take the first step toward better movement, improved function, and greater independence.

Toe Walking with Cerebral Palsy: Causes and Treatments
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Recognizing Hip Dysplasia Symptoms in Children with Cerebral Palsy

Children with cerebral palsy often face a range of orthopedic challenges, and one of the most common complications is hip dysplasia. This condition occurs when the hip joint does not develop properly, leading to instability, misalignment, and in some cases, severe pain.

In children with cerebral palsy, especially those with spastic quadriplegia, muscle imbalances can pull the hip out of its socket over time, increasing the risk of dislocation. Early recognition of hip dysplasia is essential to prevent pain, improve mobility, and avoid long-term complications.

Dr. David Siambanes, a board-certified orthopedic surgeon specializing in pediatric orthopedics and spinal deformities, has extensive experience diagnosing and treating hip dysplasia in children with cerebral palsy. His expertise helps children maintain comfort, improve sitting tolerance, and reduce the risk of future mobility issues.

What is Hip Dysplasia?

The hip is a ball-and-socket joint, where the top of the thigh bone (femoral head) fits into the curved part of the pelvis (acetabulum). In children with hip dysplasia, this joint doesn’t form correctly. The ball may sit loosely in the socket or move partially — or completely — out of place.

For children with cerebral palsy, muscle tightness and imbalances can pull the hip out of alignment, gradually leading to hip subluxation (partial dislocation) or hip dislocation (complete separation of the ball from the socket). Without treatment, hip dysplasia can cause chronic pain, reduced mobility, and difficulties with sitting or standing.

Why Children with Cerebral Palsy Are at Higher Risk

Cerebral palsy affects muscle tone and control, often leading to spasticity (increased muscle stiffness) or hypotonia (decreased muscle tone). In children with spastic cerebral palsy, tight muscles can pull unevenly on the hip joint, gradually leading to misalignment.

Children who are non-ambulatory or spend much of their time in a seated position, such as those with spastic quadriplegia, are especially at risk. The lack of weight-bearing activities, like walking, can limit proper hip development, making dislocation more likely over time.

Common Symptoms of Hip Dysplasia in Children with Cerebral Palsy

Hip dysplasia symptoms can sometimes be difficult to detect, especially in non-verbal children who cannot express their discomfort. However, there are signs that parents and caregivers can watch for:

1. Pain and Discomfort

Pain is often the most noticeable symptom of hip dysplasia. Children may experience:

  • Discomfort during diaper changes or when legs are moved
  • Pain when sitting, especially for extended periods
  • Crying or irritability when the hip is manipulated or under pressure
  • Pain even while at rest in severe cases

Non-verbal children may express pain through agitation, crying, or changes in behavior.

2. Limited Range of Motion

Hip dysplasia can cause stiffness in the hip joint, making it difficult to:

  • Spread the legs apart during diaper changes
  • Move the hips into different positions
  • Sit comfortably without leaning to one side

Parents may notice that one leg appears stiffer or harder to move than the other.

3. Asymmetrical Leg Positioning

Children with hip dysplasia often have one leg that appears longer or shorter due to the misalignment of the hip. Other signs of asymmetry include:

  • One hip or buttock appearing higher than the other
  • Uneven skin folds on the thighs or buttocks
  • A noticeable tilt in the pelvis when sitting

4. Difficulty Sitting or Standing

When the hip is out of alignment, children may struggle to sit upright or balance evenly while standing. In wheelchair-dependent children, poor hip positioning can make it harder to maintain an upright seated posture, increasing the risk of pressure sores and spinal curvature.

5. Audible Clicking or Popping Sounds

In some cases, the hip may make clicking or popping sounds during movement. While not always painful, these sounds can indicate that the hip is unstable or partially dislocated.

The Importance of Early Detection

If left untreated, hip dysplasia can progress to a full dislocation, leading to severe pain and further limitations in mobility. Early detection allows for less invasive treatment options and can prevent long-term complications.

Dr. Siambanes emphasizes the importance of routine orthopedic evaluations for children with cerebral palsy. Using advanced imaging techniques and the Motion Analysis Lab, he can assess your child’s gait, posture, and joint health to catch early signs of hip dysplasia before it becomes more severe.

Treatment Options for Hip Dysplasia Symptoms in Children with Cerebral Palsy

The goal of treatment is to restore proper hip alignment, reduce pain, and improve function. Treatment plans vary based on the severity of the misalignment and the child’s overall mobility.

1. Non-surgical Interventions

  • Physical Therapy can help strengthen surrounding muscles and improve hip positioning.
  • Bracing or Orthotic Devices may be used to support the hip and prevent further misalignment.
  • Botox Injections can reduce muscle spasticity around the hip, making it easier to maintain proper alignment.

2. Surgical Options

For children with significant misalignment or pain, surgery may be necessary. Dr. Siambanes specializes in procedures that relocate the hip joint and stabilize it within the socket. These surgeries are often performed between ages 7 and 12, allowing for optimal hip development as the child grows.

Surgical intervention can dramatically improve a child’s sitting balance, mobility, and overall comfort, especially for those who rely on wheelchairs or spend extended time in seated positions.

Supporting Your Child’s Comfort and Mobility

Recognizing the signs of hip dysplasia early is crucial in helping your child avoid pain and maintain as much independence as possible. If you notice any of the symptoms listed above or have concerns about your child’s hip development, don’t hesitate to reach out to a specialist.

Dr. Siambanes is committed to helping children achieve better mobility, improved sitting tolerance, and a higher quality of life. With expertise in both non-surgical and surgical treatments, Dr. Siambanes provides comprehensive care tailored to your child’s unique needs.

Schedule a Consultation Today

If you’re concerned about your child’s hip health, contact Children’s Cerebral Palsy to schedule a consultation with Dr. Siambanes. Early intervention can make all the difference in preventing pain and supporting your child’s mobility as they grow.

Recognizing Hip Dysplasia Symptoms in Children with Cerebral Palsy
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Hypotonic Cerebral Palsy: Low Muscle Tone in Children

While cerebral palsy is often associated with high muscle tone, muscle stiffness and spasticity, some children experience the opposite — low muscle tone, known as hypotonia. Hypotonic cerebral palsy affects a child’s strength, posture, and movement, making everyday activities more challenging. 

What is Hypotonic Cerebral Palsy?

Hypotonic cerebral palsy is a less common form of cerebral palsy characterized by decreased muscle tone, which makes muscles feel floppy or weak. Unlike spastic cerebral palsy, where muscles are stiff and tight, children with hypotonia have difficulty maintaining muscle control and posture due to reduced muscle tension.

This condition results from damage to the parts of the brain responsible for muscle coordination, often occurring before, during, or shortly after birth. Because muscle tone plays a key role in movement, balance, and strength, children with hypotonic cerebral palsy may experience delays in reaching developmental milestones such as sitting, crawling, or walking.

Signs and Symptoms of Hypotonic Cerebral Palsy

Children with hypotonic cerebral palsy may show symptoms early in life, often appearing “floppy” when held. Some common signs include

  • Delayed motor development: Difficulty lifting the head, rolling over, or sitting up without support.
  • Poor posture: A tendency to slump forward or struggle to maintain an upright position.
  • Weak muscle control: Arms and legs may appear limp, making movements uncoordinated.
  • Difficulty swallowing or feeding: Weakened oral muscles can make eating and speaking challenging.
  • Loose joints and hypermobility: The child may have excessive flexibility due to a lack of muscle resistance.
  • Fatigue and endurance issues: Low muscle tone can make even simple activities tiring.

How Hypotonic Cerebral Palsy Affects Daily Life

Children with hypotonic cerebral palsy often require additional support in daily activities. Weak muscle control can make standing, walking, and even holding objects more difficult. Tasks that require sustained effort, like sitting upright for long periods, may be exhausting. Some children may also experience breathing difficulties due to reduced muscle tone in the chest.

Despite these challenges, many children with hypotonic cerebral palsy can make significant progress with the right treatment and support. Early intervention is key to helping them develop strength, coordination, and independence.

Treatment Options for Low Muscle Tone in Children

1. Physical and Occupational Therapy

Therapy plays a crucial role in managing hypotonic cerebral palsy.

  • Physical therapy focuses on building strength, balance, and coordination through targeted exercises.
  • Occupational therapy helps children develop fine motor skills needed for daily activities like dressing, eating, and writing.

2. Bracing and Orthotic Support

Children with weak muscle tone often benefit from orthotic devices such as ankle-foot orthoses (AFOs) to provide stability and improve posture. These supports help prevent joint misalignment and make walking easier.

3. Speech and Feeding Therapy

If low muscle tone affects the face, mouth, or throat muscles, speech therapy can help improve swallowing, speech clarity, and oral motor function. Specialized exercises and feeding techniques may also be introduced to ensure safe and effective eating.

4. Strengthening Exercises

Engaging in activities that encourage movement, such as swimming or adapted sports, can help build muscle endurance and improve coordination. Therapy programs are often designed to make exercise fun and engaging for children.

5. Surgical Interventions

For children with severe joint instability or posture-related issues, surgical intervention may be necessary. Dr. David Siambanes is a board-certified orthopedic surgeon and fellowship trained in both pediatric orthopedics and spinal deformities. He specializes in procedures that enhance mobility and sitting tolerance, helping children maintain better posture and reduce pain. As the director of the Motion Analysis Center, he uses advanced gait analysis technology to assess movement challenges and determine the best treatment options.

The Importance of Early Intervention

Early diagnosis and treatment of hypotonic cerebral palsy can significantly improve a child’s ability to move, engage in daily activities, and build independence. With the right combination of therapy, bracing, and medical interventions, many children can achieve greater mobility and quality of life.

Dr. Siambanes is dedicated to providing specialized care for children with hypotonic cerebral palsy. Whether through therapy, orthotic support, or surgical solutions, his goal is to help every child reach their full potential.

How Dr. Siambanes Can Help

Hypotonic cerebral palsy presents unique challenges, but with the right support, children can make remarkable progress. Through expert medical care, therapy, and adaptive strategies, families can help their children build strength and confidence in their abilities.

If you have concerns about your child’s muscle tone or mobility, click here to request a consultation with Dr. Siambanes. Together, we can create a personalized plan to support your child’s development and well-being.

Hypotonic Cerebral Palsy: Low Muscle Tone in Children
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Dr. David Siambanes Honored as One of Tampa’s Doctors of the Year 2025

We are proud to announce that Dr. David Siambanes has been named one of Tampa’s Doctors of the Year 2025 by Tampa Style Magazine. This distinguished recognition highlights Dr. Siambanes’s exceptional contributions to pediatric orthopedic care, particularly in treating children with cerebral palsy.

Tampa Style Magazine’s Doctors of the Year List applauds physicians who demonstrate “years of study, dedication and determination” and who “enrich their communities with a skill set second to none.” Dr. Siambanes’s commitment to using advanced motion analysis technology to improve mobility and reduce pain in children with cerebral palsy perfectly embodies this standard of excellence. His personalized treatment plans — ranging from non-surgical interventions to innovative surgical techniques — have made a significant difference in the lives of many families navigating the challenges of cerebral palsy.

As a board-certified orthopedic surgeon specializing in pediatric orthopedics and spinal deformities, Dr. Siambanes combines expert clinical care with compassionate support for both children and their parents. His work not only enhances physical function but also empowers families by providing clear guidance and individualized solutions that improve overall quality of life.

This honor from Tampa Style Magazine is a well-deserved acknowledgment of Dr. Siambanes’s dedication to advancing pediatric orthopedic care. Parents looking for specialized, empathetic care for their children can trust in his proven expertise and unwavering commitment to their children’s well-being.

Parents interested in learning more about the specialized care Dr. Siambanes offers for cerebral palsy can click to request additional information or schedule a consultation.

Dr. David Siambanes Honored as One of Tampa’s Doctors of the Year 2025
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Holiday Travel Tips for Kids with Cerebral Palsy

The holiday season brings cherished moments with family and friends, but for parents of children with cerebral palsy, traveling can pose unique challenges. From packing essential items to planning for accessibility, a little preparation can make your holiday journey smoother and more enjoyable for everyone. Here are some practical travel tips to help you navigate holiday travel with confidence and ensure a comfortable experience for your child with cerebral palsy.

1. Plan Ahead for Accessibility

Before heading to your destination, call ahead to confirm accessibility accommodations. Whether you’re traveling by car, plane, or train, ask about facilities like accessible restrooms, elevators, or ramps. For air travel, notify the airline in advance of any special needs to ensure wheelchair access, priority boarding, or other assistance. Many airlines and transportation services have policies to make travel easier for families with disabilities, but these often need to be arranged in advance.

Helpful Tip:

Request aisle seats for more room if you’re flying, or seats near an exit for easier access if you’re taking the train.

2. Bring Essential Equipment and Comfort Items

Traveling with cerebral palsy may require additional equipment to ensure comfort and mobility. Don’t forget essentials like wheelchairs, walkers, or any braces and orthotics that your child uses regularly. Pack comfort items, such as favorite pillows, blankets, or sensory toys, to help them feel more at ease in unfamiliar surroundings.

Suggested Packing List:

  • Wheelchair or mobility device
  • Braces, orthotics, or other supportive equipment
  • Extra batteries or chargers (for powered devices)
  • Favorite comfort items (blanket, stuffed animal, etc.)
  • Portable snacks and drinks for quick energy boosts

3. Prepare Medications and Medical Supplies

If your child takes medication or has specific medical needs, ensure you have an adequate supply for the trip and bring extra, if possible. Pack medications in their original containers and place them in an easily accessible bag for quick retrieval. It’s also a good idea to carry a copy of your child’s medical information, including prescriptions and contact information for their healthcare providers.

Essential Medical Supplies:

  • Daily medications and extras
  • Emergency contact information
  • Medical documentation and prescriptions
  • Portable medical devices (like nebulizers if needed)

4. Schedule Frequent Breaks

Long periods of sitting can be uncomfortable for children with cerebral palsy, especially those with high muscle tone. Schedule regular breaks to allow your child to stretch, move, and reset. If you’re driving, plan stops at rest areas along the way. If you’re flying, consider taking walks down the aisle when safe to do so, or finding quiet areas in the airport to relax before boarding.

Pro Tip:

Allowing time for stretching or light movement during breaks can reduce muscle stiffness and make the journey more pleasant for your child.

5. Create a Sensory-friendly Environment

Holiday travel can be overwhelming for children with sensory sensitivities. Crowded airports, loud noises, and bright lights can lead to overstimulation and stress. Bring noise-canceling headphones, sunglasses, or sensory toys to help your child cope with these stimuli. Some families also find it helpful to bring a weighted blanket or lap pad, which can provide comfort and a sense of security.

Helpful Item Suggestions:

  • Noise-canceling headphones
  • Sunglasses to reduce light sensitivity
  • Weighted blanket or lap pad
  • Fidget toys for sensory engagement

6. Prepare Your Child for the Journey

Explaining what to expect during the trip can ease anxiety for many children. Talk to your child about the different parts of the journey, such as going through security at the airport, boarding a plane, or making stops along a long car ride. Visual aids, like pictures or videos of airports and airplanes, can help familiarize them with new environments and reduce any fears or uncertainties.

Tip for Younger Children:

Use a social story to walk through each step of the travel process. This can be especially helpful for children with limited communication abilities.

7. Practice Patience and Flexibility

Traveling with children often comes with unexpected changes, and for parents of children with cerebral palsy, flexibility is key. Allow extra time for each step of the journey, whether it’s passing through airport security, loading the car, or navigating a busy rest stop. Building in time for adjustments can help keep stress levels low and allow you to handle any surprises with ease.

Reminder:

It’s okay if things don’t go exactly as planned — focus on enjoying the journey and making memories along the way.

8. Know When to Ask for Help

Many airports, train stations, and other facilities offer support services for families with children with disabilities. Don’t hesitate to reach out for assistance, whether you need help with luggage, navigating the airport, or finding accessible amenities. Many people are happy to lend a hand to make your travel experience easier.

Extra Tip:

Look for programs like TSA Cares, which offers additional support for travelers with medical conditions or disabilities.

Traveling with Confidence and Joy

As you prepare for the holiday season, remember that thoughtful planning and a flexible mindset can help make travel more enjoyable for everyone. Dr. Siambanes and the team at Children’s Cerebral Palsy are dedicated to supporting families year-round, helping children with cerebral palsy gain greater independence and mobility through specialized orthopedic care. 

We wish you safe travels and a joyful holiday season filled with special moments together.

Holiday Travel Tips for Kids with Cerebral Palsy
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The Benefits of Cerebral Palsy Surgery

For many children with cerebral palsy, surgery can provide life-changing improvements in mobility, comfort, and quality of life. Whether it’s addressing difficulties with walking, sitting, or managing pain, surgical interventions play a critical role in correcting deformities and helping children reach their full potential.

At Children’s Cerebral Palsy, Dr. David Siambanes, a board-certified orthopedic surgeon, is leading the way in innovative surgical care for children with cerebral palsy. Fellowship-trained in both pediatric orthopedics and spinal deformities, Dr. Siambanes is deeply passionate about improving the lives of children with disabilities through expert care and cutting-edge techniques.

Why Surgery is Beneficial for Children with Cerebral Palsy

Cerebral palsy often results in muscle stiffness (spasticity), abnormal muscle tone, and other physical challenges that can lead to issues with mobility and posture. Over time, these problems can cause pain, deformities, and difficulty performing everyday activities like walking and sitting.

For some children, surgery becomes a necessary step in addressing these challenges, especially when less invasive treatments like physical therapy or orthotic support aren’t enough.

Key Benefits of Surgery for Children with Cerebral Palsy

  1. Improved Mobility One of the most significant benefits of cerebral palsy surgery is the potential for improved movement. By addressing tight muscles, abnormal gait, and joint deformities, surgery can help children walk more easily, whether it’s allowing them to take their first steps or improving the efficiency and comfort of their gait.
  2. Increased Comfort Children with cerebral palsy often experience pain due to muscle imbalances, joint deformities, or other complications. Surgery can correct these issues, relieving pain and allowing children to engage in daily activities without discomfort.
  3. Better Sitting Tolerance For children who use wheelchairs or spend much of their day sitting, surgery can significantly improve posture and comfort. By correcting spinal or hip deformities, surgical interventions help children maintain a more balanced and comfortable position, reducing the risk of pressure sores or chronic pain.
  4. Prevention of Future Complications Without intervention, the physical challenges associated with cerebral palsy can worsen over time. Surgery can prevent the progression of deformities, reduce the risk of future complications, and allow children to grow and develop with fewer physical limitations.

Dr. Siambanes: A Leader in Cerebral Palsy Care

Dr. Siambanes has dedicated his career to addressing the complex needs of children with cerebral palsy. As the director of the Motion Analysis Lab, he uses advanced technology to assess children’s gait and identify the physical barriers contributing to abnormal movement patterns. This cutting-edge approach allows him to develop highly personalized surgical plans that target the root causes of a child’s mobility challenges.

Dr. Siambanes has performed countless procedures to improve walking and sitting tolerance for children with cerebral palsy, providing lasting relief from pain and correcting deformities. His expertise extends beyond surgery, as he also plays a crucial role in the non-operative management of pediatric spine deformities through his work as the director of The Scoliosis Center at St. Joseph’s Children’s Hospital.

A Comprehensive Approach to Surgery

At Children’s Cerebral Palsy, Dr. Siambanes takes a holistic approach to care, working closely with physical therapists, orthotists, and families to ensure each child receives the most effective treatment plan. Surgery is just one part of the process; comprehensive postoperative care, including physical therapy, is essential for ensuring long-term success.

The rapid growth of the cerebral palsy clinic under Dr. Siambanes’ leadership is a testament to the demand for specialized care in Tampa and its surrounding areas. His devotion to treating the most severe cases of cerebral palsy has attracted community attention, further solidifying his reputation as a leading expert in pediatric orthopedic surgery.

A Brighter Future Through Surgery

For children with cerebral palsy, surgery can be a transformative experience that opens the door to new possibilities. From improving mobility to enhancing comfort and preventing future complications, the benefits of surgical intervention are profound. With the expertise and compassion of Dr. Siambanes and his team at Children’s Cerebral Palsy, families can feel confident that their child is receiving the best possible care.

If you believe your child may benefit from cerebral palsy surgery, contact Children’s Cerebral Palsy to schedule a consultation with Dr. Siambanes today. Together, we can help your child reach their full potential and enjoy a higher quality of life.

The Benefits of Cerebral Palsy Surgery
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Addressing High Muscle Tone in Children With Cerebral Palsy

For many parents, seeing their child struggle with muscle stiffness and tightness can be difficult and confusing. High muscle tone, also known as hypertonia, is a common symptom in children with cerebral palsy and significantly impacts their mobility and comfort.

What is High Muscle Tone?

High muscle tone refers to the increased stiffness or tightness in muscles, making it difficult for a child to move freely. In children with cerebral palsy, this occurs because the brain sends abnormal signals to the muscles, causing them to contract more than necessary. As a result, everyday movements, like reaching for a toy or taking a step, can become challenging or even painful.

How High Muscle Tone Affects Movement

Children with high muscle tone often have muscles that are constantly tight, even when they’re at rest. This stiffness can make simple tasks — like walking, holding objects, or even sitting — more difficult.

Hypertonia can vary in severity, but common signs include:

  • Muscle stiffness: Muscles that feel tight and are resistant to movement.
  • Abnormal posture: The child may seem to always be in an awkward or strained position.
  • Difficulty with joint movement: Trouble bending or straightening the knees, elbows, or wrists.
  • Toe walking: A common issue where the child walks on their toes due to muscle tightness in the legs.
  • Limited range of motion: Difficulty moving limbs through their full range, such as raising arms or kicking legs.

What Causes High Muscle Tone?

High muscle tone in cerebral palsy is caused by damage to the parts of the brain that regulate muscle control. This damage typically occurs before, during, or shortly after birth. The effect of hypertonia varies from child to child, with some experiencing mild stiffness while others struggle with more severe muscle rigidity. Hypertonia can be triggered by various factors, including:

  • Premature birth: Premature babies are at a higher risk of brain injury that may lead to high muscle tone.
  • Infections during pregnancy: Conditions like cytomegalovirus or toxoplasmosis can increase the likelihood of cerebral palsy and hypertonia.
  • Lack of oxygen: When a baby’s brain doesn’t receive enough oxygen during labor or delivery, it can result in damage, leading to hypertonia.
  • Birth complications: Difficulties during delivery, such as prolonged or complicated labor, may cause brain damage, leading to hypertonia.
  • Genetic factors: In some cases, cerebral palsy and hypertonia can be inherited through genetic factors.

Types of High Muscle Tone in Children with Cerebral Palsy

Children with cerebral palsy experience high muscle tone in different ways depending on the type and severity of their condition:

  • Spastic Cerebral Palsy: The most common form, where high muscle tone leads to stiff, jerky movements.
  • Dystonia: A type of cerebral palsy where muscle tone can fluctuate between being too high or too low, causing unpredictable movements.
  • Rigidity: A more severe form where muscles are stiff and resist all movements, making it difficult for the child to function.

Depending on the type of high muscle tone a child has, their treatment plan may include physical and occupational therapy, medication, or surgery.

Managing High Muscle Tone in Cerebral Palsy

There are several approaches to managing high muscle tone, each aimed at improving comfort, increasing mobility, and preventing complications like joint deformities. Treatments often involve a combination of therapies, medications, and sometimes surgery, depending on the severity of the hypertonia.

Physical Therapy

cerebral palsy physical therapy

Physical therapy is a critical part of managing high muscle tone. A physical therapist works with your child to perform exercises that can stretch tight muscles and improve flexibility. The goal is to help reduce stiffness and improve movement, enabling your child to engage more easily in everyday activities.

Medications and Injections

  • Oral Medications: These can help relax the muscles and reduce stiffness. However, the effects vary, and medications must be monitored closely for side effects.
  • Botox Injections: Botox is often injected into specific muscles to reduce spasticity temporarily, making movement easier for several months at a time.
  • Baclofen Pumps: For more severe cases, a surgically implanted pump can deliver medication directly to the spinal cord, reducing muscle tone throughout the body.

Orthotic Devices

Braces and orthotic devices, such as ankle foot orthoses (AFOs), can provide support to stiff muscles and joints. These devices help keep the limbs in proper alignment, preventing deformities and improving the child’s ability to walk or move more efficiently.

Surgical Options

In cases where high muscle tone severely affects a child’s ability to move or function, surgery may be considered. Surgeries like tendon release or selective dorsal rhizotomy aim to relieve tightness and spasticity by lengthening muscles or cutting certain nerves to reduce muscle tone.

Physical Therapy and Exercises

Physical therapy is often the first line of treatment for managing hypertonia. Therapists work with children to develop strength, flexibility, and range of motion. The goal is to improve muscle control and reduce stiffness, allowing the child to move more freely. Some common therapeutic interventions include:

  • Stretching exercises: Gentle stretches can help loosen stiff muscles, reduce pain, and increase flexibility.
  • Strengthening exercises: Building muscle strength in unaffected areas helps children compensate for weakness caused by hypertonia.
  • Functional training: Activities that focus on improving everyday movements, such as walking or grasping objects, can enhance a child’s ability to perform daily tasks.
  • Aquatic therapy: Water-based exercises can help children with cerebral palsy improve balance, coordination, and muscle control.

The Importance of Regular Monitoring

As your child grows, their muscle tone and needs will change. Regular check-ups with a board-certified orthopedic surgeon with training in pediatric orthopedics, like Dr. Siambanes, are essential for ensuring that treatments are adjusted as needed. This ongoing care helps prevent complications like joint deformities or worsening stiffness, which could hinder mobility further.

Helping Your Child Thrive with High Muscle Tone

Living with hypertonia is challenging, but there are many ways to help your child overcome obstacles and lead a fulfilling life. Providing emotional support and staying involved in their care plan can make a big difference. Celebrating small victories, like improved movement or reduced stiffness, helps encourage your child’s progress and builds their confidence.

Personalized Care for Children with Cerebral Palsy

Every child with cerebral palsy is unique, and managing high muscle tone requires a personalized approach. By working closely with healthcare professionals, including pediatric orthopedists and therapists, you can ensure that your child receives the best possible care. At Children’s Cerebral Palsy, we are dedicated to providing comprehensive treatment plans that address both the physical and emotional needs of children with high muscle tone, helping them reach their full potential.

Click here to request an appointment. 

Addressing High Muscle Tone in Children With Cerebral Palsy
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