What to Do If Your Child Has Been Diagnosed with CP
Cerebral palsy is an umbrella term referring to a group of disorders that affect a child’s ability to move and maintain posture and balance. The National Institutes of Health (NIH) defines cerebral palsy as a group of neurological disorders appearing in infancy or early childhood that permanently affect muscular coordination, balance, and body movement. Cerebral palsy is the most common motor disability in childhood.
Cerebral palsy is the result of damage to the baby’s brain either during pregnancy, at the time of labor and delivery, or shortly after birth. This brain damage is permanent but non-progressive, so the damage to the brain does not worsen over time. However, the clinical expression of the symptoms may change as the child grows and brain matures.
Children with cerebral palsy or CP have motor impairments which can range from mild to very severe. They may also have cognitive (thinking) or intellectual impairments, speech impairments, seizures, and problems with vision and hearing.
There is currently no cure, and children who are diagnosed with cerebral palsy will have it all their lives. Therapy and rehabilitation may be of great benefit to a child with cerebral palsy. Researchers are developing methods to manage symptoms and enhance quality of life for children with cerebral palsy.
Causes of Cerebral Palsy
All forms of cerebral palsy are the result of damage to the baby’s brain. There are different causes of brain injury and cerebral palsy, including: lack of oxygen to the baby’s brain during labor and delivery, trauma, prematurity, or infection. Although some cases of cerebral palsy are not related to birth issues, an estimated 20% of all cases are the result of complications encountered during labor and delivery, many of which are preventable. Medical negligence, and a failure to provide the accepted standard of care during labor and delivery, is the cause of permanent brain injury and cerebral palsy for many children with the disorder.
Lack of Oxygen - Perinatal Asphyxia and Hypoxic-Ischemic Encephalopathy or "HIE"
Lack of oxygen during labor and delivery is a major cause of cerebral palsy. It is also preventable with proper medical care.
Inside the mother’s body, the developing baby is in the mother’s uterus. The uterus is a muscular organ, similar to a rubber ball that can stretch and contract. There’s an organ called the placenta on the inside wall of the mother’s uterus and it attaches to the baby through the umbilical cord. Blood flows through the umbilical cord between mother and baby. The exchange of oxygen, carbon dioxide, and nutrients between mother and baby occurs in the placenta.
There are times during labor and delivery when the baby may not get enough oxygen either because there is too little oxygen in the bloodstream (hypoxemia) or because the blood flow to the baby is reduced (ischemia). When the oxygen supply to the tissues of the baby’s body becomes too low (either because of hypoxemia or ischemia), the tissues develop hypoxia. Hypoxia (lack of oxygen) can be caused by uterine contractions, compression or kinking of the umbilical cord, dangerous conditions such as uterine rupture or placental abruption, poor oxygen exchange or delivery from mother to baby through the placenta, as well as other things.
When the baby’s oxygen level drops low enough that the baby develops hypoxia, that baby is at risk for injury. Left untreated, hypoxia can progress to birth asphyxia (absence of oxygen) and acidosis. Acidosis is an abnormal and very dangerous chemical imbalance in the brain tissue that can cause injury to the baby’s brain, called hypoxic ischemic encephalopathy or "HIE." This brain damage is permanent and may result in seizures, neonatal encephalopathy (abnormal neurologic function) and, as the child ages, cerebral palsy.
There are different events or complications which can deprive a baby of adequate oxygen. Here are some of the known complications that can cause injury to a baby’s brain and result in cerebral palsy:
- Umbilical cord problems
- Uterus problems
- Uterine rupture
- Uterine hyperstimulation or Tachysystole
- Uteroplacental insufficiency
- Placental problems
- Delay in performing cesarean section
Trauma can cause injury to the baby’s brain. Some common causes of traumatic injury are injuries related to operative vaginal deliveries:
- Vacuum extraction delivery injuries
- Forceps delivery injuries
- Brachial plexus injury and Erb’s palsy
Trauma can cause skull fractures, bleeding in the brain, and hypoxic-ischemic brain damage resulting in cerebral palsy.
Infections, which can be caused by a variety of viruses or bacteria, are also a known cause of injury to a baby’s brain. Some types of infection that have been linked with cerebral palsy include:
- Viral infections
- Chicken pox
- Bacterial infections
- Group B Strep
Group B streptococcus (group B strep or GBS) is a very dangerous type of infection that can be passed from mother to baby during labor and delivery.
If the baby develops an infection, that infection can lead to sepsis, meningitis, or encephalitis, all of which can be very dangerous and cause brain injury leading to cerebral palsy.
Premature or preterm birth can increase the risk of cerebral palsy, particularly in infants with very low birth weight (<1500 g). In preterm very-low-birth-weight infants, cerebral palsy is often associated with:
- Periventricular leukolamacia (PVL)
- Intraventricular hemorrhage (IVH)
- Bronchopulmonary dysplasia (BPD)
Types of Cerebral Palsy
There are different classifications of cerebral palsy depending on the parts of the body that are affected, the types of motor abnormalities, and the severity of the abnormalities.
Spastic Cerebral Palsy:
Spastic cerebral palsy is the most common type of cerebral palsy. Children who have spastic cerebral palsy may look stiff and their movements may be jerky and uncontrolled. Spasticity is a form of hypertonia, or increased muscle tone. In cerebral palsy, the spasticity is caused by damage to the brain’s motor cortex before, during, or shortly after birth.
Normally, muscles have enough tone to maintain a person’s posture or to move with appropriate flexibility and speed of movement. The commands from the brain to tense and increase muscle tone or to relax and decrease muscle tone travel between the brain and the muscles on nerves. In order for muscles to function normally, the commands back and forth must be well coordinated. In a child with cerebral palsy, there is damage to the parts of the brain that control this coordination of nerve impulses and movement and, as a result, many of the muscles are too tense or spastic.
The spastic forms of cerebral palsy have variable expression. They may be symmetric, which means that both sides of the body (left and right) are affected or asymmetric where only one side (right or left) is affected. They may involve one or more extremities - arms, or legs, or both.
- Spastic quadriplegia: The most severe form of cerebral palsy. Marked motor impairment of all four limbs and the high association with mental retardation and seizures. The muscles of the child’s trunk are affected, so the child may have poor trunk and head control and difficulties sitting independently. The muscles of the face and mouth may also be affected, and the child may drool. Swallowing difficulties are common and may lead to aspiration pneumonia.
The most common lesions seen on pathologic examination or on MRI scanning are periventricular leukomalacia and multicystic cortical encephalomalacia. Neurologic examination shows increased tone (hypertonicity) and spasticity in all extremities; and decreased spontaneous movements, brisk reflexes, and plantar extensor responses. Flexion contractures of the knees and elbows are often present by late childhood. Associated developmental disabilities, including speech and visual abnormalities, are particularly common in children with spastic quadriplegia.
- Spastic diplegia: A form of spastic cerebral palsy that affects the legs more than the arms. The legs have increased spasticity and often run in and cross at the knees, causing a scissor-type gait. The first indication of spastic diplegia is usually noted when an affected infant begins to crawl. The child uses the arms in a normal reciprocal fashion but tends to drag the legs behind more as a rudder (commando crawl) rather than using the normal four-limbed crawling movement.
- Spastic hemiplegia: A form of spastic cerebral palsy that affects the muscles on one side of the body. The arm is often more involved than the leg and difficulty in hand manipulation may be obvious by age 12 months. Walking is usually delayed until 18–24 months. Spasticity is apparent in the affected extremities, particularly the ankle. An affected child often walks on tiptoes because of the increased tone, and the affected upper extremity assumes a dystonic posture when the child runs.
About one third of patients with spastic hemiplegia have a seizure disorder that usually develops between ages 1–2, and approximately 25% have cognitive abnormalities including mental retardation. A CT scan or MRI study may show an atrophic cerebral hemisphere with a dilated lateral ventricle opposite to the side of the affected extremities.
Athetoid or Dyskinetic Cerebral Palsy:
Athetoid cerebral palsy, also sometimes called choreoathetoid, dyskinetic, or extrapyramidal cerebral palsy, is less common than spastic cerebral palsy. Children with this form of cerebral palsy have variable movement that is involuntary or uncontrollable.
Involuntary dyskinetic movements include:
- Dystonia: A repetitive or twisting motion.
- Athetosis: Slow, continuous, involuntary movements causing the child to appear restless.
- Chorea: Irregular, unpredictable movements.
Children who have athetoid cerebral palsy typically have low muscle tone (hypotonic) with poor head control and marked head lag. They may develop increased variable tone with rigidity and dystonia over several years. Feeding may be difficult, and tongue thrust and drooling may be prominent. Speech is typically affected. Seizures are uncommon, and intellect is preserved in many children.
Athetoid or dyskinetic cerebral palsy is the result of damage to the basal ganglia of the brain. The basal ganglia is a control center or switchboard that reads messages from the brain’s movement center and the spinal cord. When the basal ganglia is damaged, the body cannot regulate voluntary movements.
Ataxic Cerebral Palsy:
Ataxia is the least common form of cerebral palsy. Children with ataxic cerebral palsy appear very uncoordinated, clumsy, unstable, or jerky. Language skills, motor development, and motor milestones may be delayed. Speech typically is slow, jerky, and explosive. Ataxic cerebral palsy is not common and must be distinguished from progressive neurodegenerative disorders, which may have some of the same clinical features.
Ataxia results from damage to the cerebellum of the brain, which is the part of the brain that controls balance.
Mixed Cerebral Palsy:
Some children may have symptoms of more than one type of cerebral palsy. For example, spastic-dyskinetic cerebral palsy is a common type of mixed cerebral palsy.
What Are the Early Signs of Cerebral Palsy?
There is no master test to diagnose cerebral palsy. Cerebral palsy is a clinical diagnosis based on observation of the physical symptoms. Radiological studies of the brain, including CT or MRI, may demonstrate damage to the brain consistent with the physical symptoms.
Signs of cerebral palsy vary because there are different types of cerebral palsy which range from mild to severe. Babies with known obstetric complications at or near the time of labor and delivery - or who have symptoms of abnormal neurologic function shortly after birth - are at risk of developing cerebral palsy and should be monitored closely. Early intervention with appropriate therapies may minimize the impact of injury.
Early signs, or neurologic or behavioral abnormalities, include:
- Excessive lethargy (tiredness or sluggishness) or irritability
- Poor feeding
- Poor sleeping
- Vomiting frequently
- Poor visual attention or tracking
As the child grows and develops:
- Motor tone in arms or legs may be increased or decreased
- Poor head and/or trunk control
- Delays in or inability to roll over, sit up, or crawl
In a child with cerebral palsy, the early signs usually appear before the age of 3. Those signs include:
- Lack of muscle coordination in performing voluntary movements
- Exaggerated reflexes
- Dragging one foot or leg while walking
- Crouched or scissored gait
- Walking on the toes
- Too stiff or too floppy muscle tone (hypotonia or hypotonic)
- Hearing loss
- Impaired vision
- Bladder or bowel control problems
- Abnormal sensations and pain
Prognosis for a Child with Cerebral Palsy
At present, there is no cure for cerebral palsy. Cerebral palsy is the result of damage to the baby’s brain. This damage is permanent and static. Although the actual damage doesn’t get worse over time, as the child grows and the brain and nervous system mature, signs and symptoms may increase and change. Complications can develop as the child ages.
The degree to which the child is affected depends largely on the location of the brain injury and the severity of the injury. Many children with cerebral palsy are of average or above average intelligence and attend school with other children their ages. Many are able to improve their motor skills and communication abilities with surgery, medications, or supportive devices.
Children with severe cerebral palsy may not be able to walk or ambulate on their own, may require wheelchair assistance, or be completely dependent on assistance from others to move. Severely affected children may require feeding tubes for nutrition, suctioning of their own saliva due to the inability to swallow, and 24-hour- a-day supervised care for all activities of daily living.
Treatment for Cerebral Palsy
Although cerebral palsy can’t be cured, symptoms can be treated to improve the child’s quality of life. The sooner treatment begins, the better the child’s chances of overcoming developmental disabilities. Muscle control for many children with cerebral palsy can be improved through early intervention, surgery, medications, and supportive treatments.
Treatments may include:
- Physical therapy
- Speech therapy
- Occupational therapy
- Medications to control seizures
- Medications to relax muscle spasms
- Pain medication
- Surgery to release tight muscles
- Surgery to correct anatomical abnormalities
- Braces and orthotic devices
- Rolling walkers and wheelchairs
- Voice synthesizers and other communication aids
When Is Cerebral Palsy Usually Diagnosed?
When something goes wrong during labor and delivery, parents are not always told the significance and may not understand that their child has suffered a severe injury with lasting consequences. There are tests that can be run to gather information about the cause and extent of the potential damage. Having this information as early as possible can be very important in obtaining proper medical treatment to minimize damage to the baby’s brain.
Many times, the extent of the damage becomes more apparent later on. If the child is delayed or does not reach normal developmental milestones, that may indicate a brain injury and predict future developmental problems. A diagnosis of "cerebral palsy" is usually not made at the time of birth, but later in the child’s development as the physical and cognitive deficits become more apparent.
Contact a Cerebral Palsy and Birth Injury Attorney
After a diagnosis of cerebral palsy, early intervention and treatment could make a significant difference in your child’s future quality of life. As a parent, you are undoubtedly concerned about providing the very best care that your child deserves, now and in the future.
Cerebral palsy is often caused by birth injuries resulting from negligent medical care. It is important to speak with a birth injury attorney or cerebral palsy lawyer as soon as possible after diagnosis to determine if your child has a medical malpractice claim and needs legal protection.
Case Review at No Cost or Obligation
If you would like to know if your child’s cerebral palsy was caused by preventable medical errors, please contact birth injury attorney Laura Brown. Consultations are free - and there is no obligation. Call (214) 974-4121 or email Laura Brown directly at Brown@TrialFirm.com.
Cerebral Palsy Case Results
Gross Settlement/Verdict: $5,800,000.00
Injury: Oxygen Deprivation During Labor & Delivery Resulting in Brain Damage & Cerebral Palsy
- A contingent (%) fee charged on the successful recovery resulted in a fee of $1,441,584 and $33,666.12 in litigation expenses which were reimbursed by the client out of the gross settlement amount.
Note: If any of the cases listed here had been unsuccessful, the law firm would have paid all of the expenses for the case without being reimbursed by the client and would have received $0 dollars in attorney's fees.
- Cerebral Palsy Blogs
- Medical Negligence and the Risks of Cerebral Palsy
- Cerebral Palsy (CP) - CDC
- Cerebral Palsy Information from the Mayo Clinic