Human medical errors can, and often do, lead to the development of cerebral palsy (CP) in young children. When obstetricians and nurses fail to use the appropriate care during labor or delivery, children can suffer devastating forms of brain damage, trauma that in some cases results directly in serious neuromuscular disorders. Thankfully, many families can find the financial compensation they need by filing a birth injury lawsuit and pursuing accountability from the medical professionals who harmed their child.
Cerebral Palsy: A Family Of Related Disorders
Cerebral palsy is not a single medical condition, but a group of associated neuromuscular disorders. While each of these conditions is different, presenting its own particular symptoms and challenges, they all entail some level of brain impairment, which comes to affect the way a child moves and balances. In short, cerebral palsy refers to a family of impairments in motor function and body control.
Different Forms Of Cerebral Palsy
Researchers have defined three general types of cerebral palsy disorder, each characterized by the different ways in which they impact motor functioning. As we’ll see later on, a child’s eventual diagnosis often comes down to which part of their brain has suffered trauma or developed improperly.
Most cases of cerebral palsy fall under the heading of spastic CP, a condition defined by hypertonia, or an increase in muscle tone. In a medical context, the term “muscle tone” refers to muscle contraction. Thus kids with spastic-type cerebral palsy have muscles that contract too much and are resistant to stretching.
Hypertonia leads to several characteristic symptoms. Children with spastic forms of cerebral palsy often look stiff or jerky, because their muscles are too tight. This inflexibility can make moving difficult and kids with spastic CP frequently have a hard time moving their limbs. Children with spastic CP may also have difficulty grabbing hold of objects or letting them go.
Solid estimates on the incidence of spastic-type cerebral palsy are hard to find, but most research, including the data published by the US Centers for Disease Control, places the approximate range between 60% and 80% of the 8,000 to 10,000 total children diagnosed with the disorder every year.
Athetoid cerebral palsy is generally distinguished by slow and uncontrollable movements, usually in a child’s limbs and trunk. These movements are involuntary and spontaneous, rather than intentional. An associated symptom, known as chorea, refers to small, quick motions, which are themselves involuntary. Chorea, from the Greek word for “dance,” begin and end abruptly.
Athetoid-type cerebral palsy disorders can also be referred to as “dyskinetic” conditions. The involuntary movements associated with athetoid cerebral palsy can make it difficult for children to move, speak and swallow. Difficulty maintaining balance and holding the same posture is also characteristic.
Lower degrees of muscle tone are a classic sign of athetoid forms of CP, though some kids will actually have more-developed muscle tone in those muscles immediately impacted by their condition.
The least common type of cerebral palsy, ataxic forms of the disorder are marked by an absence or impairment of coordination. Children with ataxic-type cerebral palsy can appear unsteady or shaky, which can make their movements look disorganized and imprecise. Tremors are not uncommon. A child’s balance and depth perception can also be greatly diminished with this condition. Children often compensate for these challenges by developing distinctive walking styles, or gaits, that make up for their instability.
As we’ve seen, each form of cerebral palsy is characterized by a specific set of symptoms. While most children will present with symptoms from only one type of the disorder, a small group of patients, likely around 10%, exhibit a wider range of movement and balance challenges that can’t easily be fit into a single classification. These cases, known as “mixed” cerebral palsy, usually combine symptoms that would otherwise characterize spastic and athetoid forms of the condition. A blend of ataxic and athetoid symptoms is less common, but certainly possible.
How Many Kids Have CP?
Where neuromuscular disorders are concerned, cerebral palsy is very common. In fact, CP is the leading cause of childhood disability worldwide and the most common form of motor impairment experienced by children. More than 17 million people are estimated to have cerebral palsy around the world, according to the Cerebral Palsy Foundation, including about 500,000 kids and adults here in the United States.
Many children who are born with cerebral palsy are also diagnosed with associative conditions. When we talk about abnormal levels of muscle tone, difficulties in fine motor function and challenges in maintaining balance, we’re referring to the primary conditions of cerebral palsy – direct effects of the brain damage causing the disorder. Secondary conditions, on the other hand, are caused by primary conditions, but not the underlying brain damage. Difficulty feeding swallowing, along with resultant nutritional deficiencies, are one example.
Beyond these primary and secondary conditions lie associative medical diagnoses that, while not directly caused by the brain damage, appear to be more prevalent among people with cerebral palsy. Around half the children diagnosed with CP, for example, will also be diagnosed with a seizure disorder or cognitive impairment, WebMD reports. Learning disabilities are also common, as are sensory processing disorders.
Why Does Cerebral Palsy Happen?
Cerebral palsy is caused by damage to or malformation of portions of the brain that control or regulate the neurological activity related to movement and balance. In short, cerebral palsy is a condition that can be either congenital or acquired, something a baby is born with or something that happens to a baby during the childbirth process.
Is CP A Genetic Condition?
Yes, in part.
Various genetic factors likely play a role in many cases of the neuromuscular disorder, a fact evidenced by a growing body of medical evidence that suggests cerebral palsy is, at least in part, a heritable condition.
Twins, for example, who are genetically similar (though not identical), have an increased risk of developing cerebral palsy if their siblings have the disorder, according to research in the British Medical Journal. Another clue, which we’ve already touched on in brief, is that many children born with cerebral palsy have associated congenital disorders, which certainly have genetic mutations as a contributing cause.
None of this, however, suggests that cerebral palsy is entirely genetic.
Birth Injuries During Labor & Delivery
Current research indicates that a substantial proportion of cerebral palsy cases are caused primarily by episodes of oxygen deprivation experienced during labor or delivery. Why this should be the case is simple to explain. When a developing child suffers a lack of oxygen, their brain cells are starved of vital nutrients. Longer periods of birth asphyxia can lead to widespread brain damage, including trauma to those portions of the brain that control motor function. This form of brain injury is usually referred to as hypoxic-ischemic encephalopathy:
- hypoxic – decreased oxygen in the blood
- ischemia – decreased blood flow to the brain
- encephalopathy – brain damage
In many cases, this brain damage directly impacts the extrapyramidal system, a group of neurons that pass through two regions of the brain involved in voluntary movements and motor function, the basal ganglia and cerebellum. Cerebral palsy is a common result.
Cerebral Palsy & Medical Negligence
Most cases of cerebral palsy are the result of malformations in brain tissue that begin in pregnancy. These cases, referred to as “congenital” forms of the condition, can be hard for doctors to explain. While scientists have suggested a number of hypotheses to describe cerebral palsy disorders that start during fetal development, none have yet risen to the level of a scientific theory:
- maternal infections that cross the placental barrier
- maternal blood conditions, like an overactive immune system, that can hurt a developing baby’s blood cells
- issues with the child’s nerve cell fibers
In many of these circumstances, there’s almost nothing a physician could to stop CP from developing. That’s not always the case, though.
A minority of CP cases, around 10% to 20%, can be explained by birth injuries that children suffer during the childbirth process. In some, but not all, of these cases, medical negligence is the root cause of a child’s cerebral palsy.
Foremost among these causal factors is hypoxic-ischemic encephalopathy, the form of brain damage we mentioned earlier. Oxygen deprivation during labor or delivery is a primary contributor to brain damage in infants. It is often caused by improper medical interventions.
Jaundice & Kernicterus
Jaundice is a common but serious medical condition that develops in newborn infants. After a child is delivered, their kidneys usually don’t work properly yet. This leads to a build-up of bilirubin, a waste product usually filtered out of body fluids, which can turn a child’s skin and eyes yellow. Jaundice almost always resolves on its own, but in some cases, excessive levels of bilirubin can become life-threatening.
Particularly severe cases of jaundice can even lead to brain damage, in a condition known as kernicterus. Doctors and nurses must watch carefully for signs of jaundice, applying the proper treatments when necessary. A failure in this regard can lead to cerebral palsy.
How Brain Damage Impacts Diagnosis
Most forms of brain damage that we colloquially know as “palsies” impact a person’s muscle control, reflex responses, coordination skills and muscle tone in some way, but the unique symptoms that any one child will experience hinge on where their brain has suffered injury:
- Spastic cerebral palsy – damage to the brain’s motor cortex. Most neural signals that trigger movements begin in this area of the brain.
- Athetoid cerebral palsy – damage to the basal ganglia, structures that sit deep inside the brain. Basal ganglia act something like way-stations, shuttling neural information from the brain to the spinal cord. These organs are especially important in controlling voluntary movements, ones that we intend to make.
- Ataxic cerebral palsy – damage to the cerebellum. This portion of the brain works to refine and balance the body’s fine motor skills, along with coordinating balance and simultaneous motions between different body parts.
Doctors define cerebral palsy as a “nonprogressive” condition. That means a patient’s underlying brain injuries don’t get worse as time passes. Many children, though, undergo changes in their symptoms as they grow up. Some effects of the disorder can seem to worsen, while others resolve.
Can CP Be Cured?
There is currently no cure for cerebral palsy. Powerful therapeutic options, however, can help children overcome some of their challenges and build on their existing abilities.
How Is CP Treated?
Cerebral palsy treatment usually takes a team approach. Most researchers – and families – agree that children with CP are better served by receiving treatments from a number of professionals, working in tandem, rather than one family doctor. Likewise, there’s no catchall treatment regimen that will be appropriate for all children with cerebral palsy. Any plan should be adapted to serve the best interests of the unique patient in question.
With that being said, most families find the help of occupational therapists and physical therapists helpful. Children with severe disabilities may need a broader array of experts, including pediatric neurologists and speech and language pathologists. Surgery may also be indicated, especially for kids with spastic-type cerebral palsy disorders. Some procedures can help loosen up their muscles.