Cerebral palsy is the most common motor disability in children and, unfortunately, frequently occurs when healthcare providers make mistakes. When your child is diagnosed with cerebral palsy, the news is devastating, and you are likely searching for answers as to how and why the condition occurred, whether it could have been prevented, and what the future holds for your child.
Below are answers to the 17 most common questions asked by parents after their child is diagnosed with cerebral palsy or if they think their child might have cerebral palsy.
What Is Cerebral Palsy?
Cerebral palsy is a group of disorders that affect a person’s ability to move and to maintain balance and posture. “Cerebral” means having to do with the brain. “Palsy” refers to weakness or tightness or other problems with using the muscles. Most people with cerebral palsy are born with it, and that is called “congenital” cerebral palsy. Cerebral palsy that starts after birth is called “acquired.”
People with cerebral palsy may have related conditions including:
- Cognitive deficits
- Developmental delays
- Excessive drooling or problems with swallowing
- Seizures
- Problems with vision, hearing or speech
- Changes in the spine (such as scoliosis)
- Joint problems
Are There Different Types of Cerebral Palsy?
There are four main types of cerebral palsy:
- Spastic Cerebral Palsy: The most common type of cerebral palsy, accounting for 80 percent of all cases. People with spastic cerebral palsy have increased muscle tone (hypertonia) in most of the muscles of the body, although some of the muscles may actually have low tone (hypotonia). As a result, their muscles are stiff and/or weak, and their movements can be awkward.
- Dyskinetic Cerebral Palsy: People with this type of cerebral palsy have difficulty controlling the movement of their hands, arms, feet and legs. Sitting and walking pose a challenge.
- Ataxic Cerebral Palsy: This type of cerebral palsy is characterized by problems with balance and coordination.
- Athetoid Cerebral Palsy: This type of cerebral palsy causes involuntary and uncontrolled movements.
Cerebral palsy that involves symptoms of more than one type is called mixed cerebral palsy.
Is Cerebral Palsy Caused by Healthcare Provider Mistakes?
Yes, it often can be. Cerebral palsy can be caused by damage to the infant’s brain, often from a lack of oxygen, which can occur when medical professionals make mistakes. Birth asphyxia is a severe lack of oxygen to a baby during childbirth. This severe oxygen deficiency is also known as birth hypoxia or intrauterine hypoxia. When the infant’s body lacks oxygen, its cells cannot work properly, and therefore birth asphyxia can often result in brain damage and even death. This brain damage is called hypoxic-ischemic encephalopathy, known as HIE.
Infants who suffer from hypoxic-ischemic encephalopathy (HIE) can end up with life-altering impairments or disabilities including cerebral palsy, cognitive deficits, and hearing and/or vision loss. Even without detectable brain damage, children who’ve had birth asphyxia are at increased risk for learning disabilities, language delays and other issues later in life.
Healthcare provider errors that can result in cerebral palsy generally fall under three categories:
- Poorly managed medical conditions of the expectant mother
- Complications during labor and delivery
- Failure by doctors, nurses and other medical professionals to properly interpret and act upon fetal heart rate monitoring during labor
How Do Medical Conditions of the Expectant Mother Put an Infant at Risk for Cerebral Palsy?
Poorly managed medical conditions of the expectant mother that can put an infant at risk for cerebral palsy include:
- Maternal hypertension (high blood pressure) — can cause placental infarction (lesions within the placenta that can impair the circulation to the fetus) and/or placental abruption (a premature separation of the placenta from the uterus that can cause an acute and potentially catastrophic loss of oxygen to the baby). Severe maternal hypertension associated with other findings is called pre-eclampsia and also can put the baby at risk and the mother at risk of developing seizures. HELLP (hemolysis, elevated liver enzymes, and low platelet count syndrome) is a particularly severe form of maternal hypertension that affects other organs and requires early delivery.
- Diabetes — can cause macrosomia (an excessively large baby making delivery difficult) and/or make the baby more vulnerable during the last weeks of the pregnancy and during labor and delivery.
- Liver problems, including cholestasis — cholestasis is generally an indication for early delivery as babies do not tolerate labor well.
How Do Complications During Childbirth Put an Infant at Risk for Cerebral Palsy?
Complications during childbirth can put an infant at risk for cerebral palsy caused by birth asphyxia. These complications include:
- What’s known as the three P’s of labor: passageway (route the baby takes through the mother’s pelvis, cervical opening and birth canal); the baby’s size and position in the uterus and the direction the baby is facing (passenger); and strength and frequency of contractions (power)
- Prolonged dilatation and prolonged descent during labor; arrest of dilatation and/or descent
- Nuchal cord — the umbilical cord wraps around the newborn=s neck and can decrease oxygen supply to the baby
- Cord compression —theumbilical cord circulation is interrupted during the course of labor, often during the pushing phase
- Cord prolapse — the umbilical cord leaves the uterus before the baby, thereby acutely interrupting the flow of oxygen through the cord
- Placental abruption —the placenta detaches prematurely from the uterus; this also can compromise the blood and oxygen supply to the baby
- Breech delivery (also known as breech birth) — the child comes out of the uterus foot-first or buttocks-first rather than head-first
- Occiput posterior (OP) versus occiput anterior (OA) head position at delivery: “sunny side up” face instead of normal facing down
- Shoulder dystocia — when the baby’s head has been delivered, but the baby’s shoulders get stuck behind the mother’s pelvis
- Improper use of forceps and vacuum extractors can cause physical trauma to the baby and bleeding into the brain, known as supratentorial or subgaleal hemorrhages, which can lead to cerebral palsy.
- Premature births occurring before 37 weeks of pregnancy and especially before 32 weeks of pregnancy also put babies at risk for brain bleeding such as intraventricular hemorrhage (IVH) resulting in cerebral palsy and, in some cases, may be preventable with proper medical care.
How Does Failure to Properly Interpret and Act upon Fetal Heart Rate Monitoring Cause Cerebral Palsy?
Fetal heart rate monitoring allows healthcare providers to assess whether an unborn baby is receiving sufficient oxygen during childbirth. Fetal monitoring and monitoring of uterine contractions can be done either externally, by wrapping a pair of belts around the mother’s abdomen, or internally by attaching a small electrode to the baby’s head and inserting an intra-uterine pressure catheter once the mother’s amniotic sac is ruptured and her cervix is dilated 2-3 centimeters.
Reassuring baseline heart rates are within a normal range of 110-160 with accelerations and no repetitive decelerations.
If the heart rate is high, called tachycardia, the baby’s heart may be working faster than normal to compensate for low oxygen levels. If the heart rate is low, called bradycardia, the baby may not be receiving enough oxygen. Tachycardia and bradycardia may be signs that the baby is in distress and at risk for permanent brain injury due to lack of oxygen and a caesarean section may be necessary.
Repetitive decelerations including variable decelerations (consistent with nuchal cord or cord compression) and late decelerations (consistent with placental dysfunction) — particularly if associated with other non-reassuring signs such as decreased variability and/or tachycardia or bradycardia — may be an indication for urgent/emergent delivery.
When medical professionals fail to properly interpret and act upon crucial data provided by the fetal heart rate monitor and the baby’s oxygen deprivation is severe and prolonged, cerebral palsy may occur.
What Do the Apgar Scores Mean?
At the 1 and 5 minute marks after birth, all babies undergo a quick assessment of their well-being that is known as an Apgar score. The following five conditions are scored 0 to 2, with 0 signifying the worst medical state, and 2 signifying the best:
- Heart rate
- Respiration
- Muscle tone
- Reflex response
- Color
The scores for each condition are added together. At the 1-minute mark, the total Apgar score is interpreted as follows:
- Between 7 and 10 — the baby requires only routine post-delivery care
- Between 4 and 6 — the baby requires breathing assistance, which can include suctioning the nostrils, massaging the baby and administering oxygen
- 3 or less — the baby requires lifesaving measures such as resuscitation
At the 5-minute mark, a total Apgar score between 7 and 10 is considered normal; a score of 6 or lower means further medical intervention such as admission to the neonatal intensive care unit (NICU) for further support and evaluation or hypothermia treatment may be warranted.
Low Apgar scores may be indicative of birth hypoxia or asphyxia, which can cause cerebral palsy.
What Is the Significance of a Cord Blood Gas/Cord pH?
A small sample of blood may be taken from a baby’s umbilical cord immediately following delivery. A normal cord pH ranges from 7.18 to 7.38. A more detailed study called arterial blood gases (ABG) can also be done in the hospital lab. A low cord pH and/or abnormal ABGs may be consistent with hypoxic brain injury which can cause cerebral palsy.
What Are the Signs That My Child Might Have Cerebral Palsy?
A delay in reaching motor or movement milestones (such as rolling over, sitting, standing, or walking) can be an early sign that a child might have cerebral palsy. Note that there can be many reasons why a child misses milestones, and you should discuss your concerns with a pediatrician.
Similarly, infants and children with cerebral palsy may exhibit other deficits and delays such as poor feeding or delayed or absent speech. Again, these problems may be attributable to cerebral palsy or other issues, so you should discuss with your pediatrician.
How Is Cerebral Palsy Diagnosed?
As part of routine pediatric care, physicians will track a child’s growth and development over time and screen for developmental delays. If they suspect a problem, they will use brain-imaging technologies and other advanced tests including:
- Head ultrasound to obtain images used for a preliminary assessment of the brain, often in newborn infants
- CT scan of brain
- Magnetic resonance imaging (MRI) to obtain detailed 3-D or cross-sectional images of the brain
- Electroencephalogram (EEG) to record the electrical activity of the brain and look for possible seizure activity
- Laboratory tests to screen for metabolic problems
Is Cerebral Palsy Curable?
There is no cure for cerebral palsy, but early, comprehensive treatment can significantly improve a child’s life after diagnosis.
How Is Cerebral Palsy Treated?
Treatment for cerebral palsy can include:
- Physical therapy
- Occupational therapy
- Speech and language therapy
- Recreational therapy
- Additional therapies such as aqua therapy, equine therapy and others
- Medications to reduce muscle tightness, treat pain and manage complications related to spasticity and other symptoms
- Surgery to sever tendons to relax spastic muscles and reduce pain
How Can Early Intervention Services Help My Child with Cerebral Palsy?
Early intervention (EI) services are available under our nation’s special education law — the Individuals with Disabilities Education Act (IDEA) — and can significantly improve the outcome for children with cerebral palsy.
Early intervention is available to children from birth through 36 months who are afflicted with cognitive, motor and movement delays even if they have not been diagnosed with cerebral palsy, as well as to children with a cerebral palsy diagnosis. Depending upon the child’s needs, early intervention might include family training, counseling, and home visits; occupational, physical and/or speech therapy; hearing loss services; health, nutrition, social work and assistance with service coordination; assistive technology devices and services; and transportation.
Before early intervention starts, an Individual Family Service Plan (IFSP) is developed by a team, which includes the parents and all providers who work with the child and the family. The IFSP describes the child’s present level of development, the family’s strengths and needs and the specific services to be provided to the child and the family.
Whether (and how much) parents must pay for early invention services depends upon a number of factors including their state of residency, income level, and whether the services are covered by their health insurance. Funds obtained from a lawsuit can be used to pay for early intervention and can, consequently, significantly improve the child’s long-term outlook.
What Is an Individualized Education Plan?
In addition to early intervention, the Individuals with Disabilities Education Act (IDEA) also mandates that public school systems provide services free of charge to school-aged children (ages 3 through 21) with developmental disabilities. These services include special education; related services such as physical, occupational, and speech therapy; and supplementary aids and services, such as adaptive equipment or special communication systems.
Before these services can start, a team of individuals — including parents, teachers and others —must develop an Individualized Education Plan (IEP). The IEP establishes reasonable learning goals for the child and sets forth specific services the school district will supply. By law, the IEP must be reviewed at least annually to assess whether the annual goals are being achieved and revised if necessary.
Will Cerebral Palsy Affect My Child’s Intellectual Abilities?
Some people with cerebral palsy will have difficulty speaking, and others may have intellectual deficits. However, many patients with cerebral palsy have normal intelligence.
What Type of Adaptive Equipment Can Help My Child with Cerebral Palsy?
Adaptive equipment and assistive technology can help better a child’s quality of life by improving mobility, communications, the ability to perform daily living activities and the ability to engage in the joys of childhood play. Examples of adaptive equipment and assistive technology include:
Mobility
- Wheelchairs
- Standing equipment (standers)
- Powered scooters
- Gait trainers
- Walkers
- Leg, wrist, finger splints (orthotic devices)
- Canes
- Car seats
- Adapted vehicles
- Stair glides
- Mechanical lifts
Communications
- Hearing aids
- Writing instruments adapted for easier grip
- Communication boards
- Eye-tracking devices to operate computers and electronic speech-generating devices
- iPads, tablets and other electronic devices with apps that can help children communicate and learn
Daily Living Activities
- Toilet chairs
- Bath chairs
- Eating utensils
- Supportive vests
- Ramps and grab bars
Play
- Chunky crayons and markers for easier grip
- Bicycles and tricycles that are specially designed to promote balance and increase range of motion
- Any toy that encourages fine and gross motor skills, stimulates speech, promotes movement and allows interactions with other children
What Happens If My Child Is Diagnosed with Cerebral Palsy?
The severity of cerebral palsy varies from case-to-case, with patients requiring various levels of treatment and assistance. Not every case is attributable to healthcare provider errors, and it is important to rule out other causes such as metabolic or genetic factors.
If your child has cerebral palsy, you may have a medical malpractice claim against healthcare providers who caused this birth injury. The malpractice claim is for the harm your child has suffered, and for the cost of care and treatment for your child.
The lawyers at Feldman Shepherd Wohlgelernter Tanner Weinstock & Dodig LLP are pursuing medical malpractice claims for children suffering from cerebral palsy. The lawsuits filed on behalf of cerebral palsy victims and families seek damages for medical bills, loss of earning potential, pain and suffering, and loss of the pleasures of life.
A sampling of recent results achieved by Feldman Shepherd attorneys Carol Nelson Shepherd, Daniel S. Weinstock, Patricia M. Giordano, G. Scott Vezina and Carolyn M. Chopko in cerebral palsy cases includes:
- A $78.5 million verdict in Philadelphia for a child who suffered severe spastic quadriplegic cerebral palsy as a result of an 81-minute delay in performance of an emergency cesarean section delivery.
- A $30.5 million verdict in Georgia for a child who suffered a severe hypoxic ischemic brain injury leading her to develop spastic quadriplegic cerebral palsy, developmental delays, and a seizure disorder as a result of a delay in performance of an emergency cesarean section.
- A $16 million settlement in Philadelphia for negligent management of labor and delivery causing cerebral palsy. The case presented a tragic example of the second-class care poorer citizens sometimes receive in the city of Philadelphia. As part of a program to supply physician coverage for “underserved” areas of the city, the United States of America (through an affiliated entity) selected and provided an obstetrician who had numerous other prior malpractice claims against him.
- A $16 million verdict for a child with severe cerebral palsy caused by a catastrophic placental abruption that occurred at 39 ½ weeks gestation during a high-risk pregnancy. Feldman and Shepherd argued that the standard of care required the maternal fetal medicine doctor to deliver the child at 38 weeks’ gestation, or term.
If you or a loved one has been injured and would like to speak with a Feldman Shepherd attorney, please contact us.