What Is Cerebral Palsy?
Cerebral palsy (CP) is the most common motor disability in children and is a group of disorders that affects movement, muscle tone, and posture. It is caused by abnormal brain development, or by damage to the brain during pregnancy, birth, or within the first 2 to 3 years of a child’s life.
CP may affect the whole body, or just one limb or one side of the body. It is not a progressive disorder, so the symptoms usually do not get worse, although they may change over time. Signs of CP usually start in infancy or toddlerhood, as parents notice abnormal reflexes and posture, involuntary movements, floppiness or stiffness of the limbs and trunk, and/or unsteady walking.
This disorder affects everyone differently. Common symptoms of CP include:
- Lack of balance and muscle coordination (ataxia)
- Stiff muscles with exaggerated reflexes (spasticity)
- Stiff muscles with normal reflexes (rigidity)
- Muscles being too stiff or too floppy
- Slow, writhing movements
- Tremors or involuntary movements
- Favoring one side of the body
- Difficulty walking
- Excessive drooling or difficulty swallowing
- Challenges with sucking and/or eating
- Delays in reaching motor skills milestones
- Learning difficulties
- Delays in speech or difficulty speaking
- Challenges with fine motor skills
Each person experiences cerebral palsy differently. Some may be able to walk, while others require assistive devices and/or wheelchairs. Some individuals with CP have intellectual disabilities, while others have typical (or near-typical) intellect.
Cerebral palsy may also cause related issues, such as seizures, learning disabilities, urinary incontinence, difficulty seeing and hearing, abnormal touch or pain perceptions, and mental health conditions. The specific symptoms will vary based on the type of brain damage suffered.
There are four types of cerebral palsy, classified by the type of movement disorder involved. They are:
- Spastic Cerebral Palsy: this type of CP has increased muscle tone, resulting in stiff muscles and awkward movements. Spastic CP is further described based on the body parts affected: the legs (spastic diplegia), one side of a body (spastic hemiplegia), or the whole body (spastic quadriplegia). It is the most common type of cerebral palsy.
- Dyskinetic Cerebral Palsy: people with dyskinetic CP have difficulty controlling the movements of their limbs, and often have uncontrollable movements. This type of CP often involves muscle tone that changes from too loose to too tight, potentially during a single day.
- Ataxic Cerebral Palsy: this type of CP leads to difficulty with balance and coordination. People with ataxic CP are often unsteady when they walk and have difficulty with movements that require a lot of control.
- Mixed Cerebral Palsy: some people have more than one type of CP. When this occurs, they are diagnosed with mixed CP.
CP is diagnosed through a physical exam and testing. A doctor may order a brain scan (MRI or cranial ultrasound), or an EEG if a child is having seizures. Blood tests can be performed to check for and rule out genetic or metabolic conditions.
There is no cure for cerebral palsy. However, if the condition is diagnosed early, a number of treatments and interventions may help improve a child’s quality of life and long-term prognosis. Children with CP will typically need long-term medical care and a range of therapies.
These treatments may include medications to lessen muscle tightness, treat pain and manage complications, and injections to treat tightening of a specific muscle. Physical and occupational therapy can increase a child’s strength and balance while aiding in motor development. Braces are often recommended to help a child walk and to stretch stiff muscles.
Occupational therapy can help a child with CP gain independence and help them use adaptive equipment like walkers, canes, and wheelchairs. Speech and language therapy can improve a child’s ability to speak clearly or to communicate in other ways. Recreational therapy, such as therapeutic horseback riding, can improve a child’s motor skills and aid in emotional well-being.
In some cases, surgery may be necessary to reduce muscle tightness or to correct bone abnormalities that have been caused by spasticity. This may include orthopedic surgery to place limbs in the right position or to lengthen muscles or tendons, or surgery to cut nerve fibers to reduce spasticity.
Causes of Cerebral Palsy
For many people diagnosed with cerebral palsy, the exact cause is not known. There are a number of issues that can lead to problems with brain development, including gene mutations, maternal infections, fetal strokes, bleeding into the brain, infant infections, traumatic head injury, and/or lack of oxygen at birth.
Certain risk factors increase the risk of a baby being born with cerebral palsy. Some types of infections and exposures during pregnancy are associated with CP, such as German measles (rubella), herpes, syphilis, toxoplasmosis, Zika virus, and cytomegalovirus. Exposure to toxins like methylmercury during pregnancy can also cause brain damage.
After birth, a baby may develop brain damage due to certain health conditions or infections. For example, if jaundice is left untreated, a type of brain damage known as kernicterus may occur. Bacterial meningitis, viral encephalitis, and bleeding into the brain (usually caused by a prenatal stroke) may also lead to CP. A breech presentation at the start of labour, low birth weight, multiple babies, and prematurity are also risk factors for CP.
While it is not always possible to know what caused a child’s cerebral palsy, in some cases, it can be directly linked to a birth injury. Medical negligence in prenatal care, the labour and delivery process, and postnatal care can directly cause CP. This may include:
- Failure to diagnose and treat maternal infections during pregnancy;
- Oxygen deprivation (asphyxia) during the birthing process, which may be caused by excessive contractions or an umbilical cord issue;
- Prolonged labour without intervention via Caesarean section (C-section) delivery;
- Brain injury or skull factors related to the use of forceps or a vacuum during delivery; and/or
- Failure to appropriately diagnose or treat a health issue after birth, such as severe jaundice leading to kernicterus.
Hypoxia, or oxygen deprivation, is a leading cause of CP in babies. Severe or prolonged hypoxia can lead to decreased blood supply to the baby’s organs, called ischemia. This can result in permanent injury to the baby’s brain and other vital organs.
Hypoxic-ischemic encephalopathy (HIE) is a condition involving injuries to a baby’s brain caused by lack of oxygen (“encephalopathy” simply means brain sickness). Babies with these types of injuries may later develop permanent neurologic conditions such as CP.
Doctors are responsible for meeting the standard of care for their profession. If they fail to monitor for signs of fetal distress or the fetal heart rate, provide subpar prenatal care, or engage in other forms of medical negligence, then they may be held financially liable for the injuries that a child or mother suffers as a result.
Can I File a Lawsuit If My Baby Has Been Diagnosed with Cerebral Palsy?
If your child has cerebral palsy that was caused by medical malpractice or medical negligence, then you may be able to file a legal claim against the person or persons responsible for their condition. This may include filing a lawsuit against the doctor(s), nurses, hospital, and/or any other medical professionals who failed to meet the standard of care for prenatal and postnatal care, or for labour and delivery.
In Canada, a law firm can help you determine if you have a potential claim against the healthcare providers involved in your baby’s care. The process starts with a free consultation, where your birth injury law firm will listen to your story and inform you of your legal rights and options for moving forward with a cerebral palsy case.
The lawyer will then begin an investigation to determine if there was negligence in your case, and if so, whether that negligence caused harm to your baby. To answer these questions, the law firm will obtain the medical records for your pregnancy, delivery, and post-birth hospitalization. An injury lawyer will then carefully review and analyze these records to determine if your child’s cerebral palsy could have been caused by birth trauma or other form of medical negligence.
If a healthcare professional involved in your or your baby’s care committed medical malpractice, then you may be able to obtain compensation. While money cannot make your family whole again, it can help to fund the best medical treatment and services for your child. Damages in a birth injury claim may include compensation for the cost of future care, lost earning capacity or loss of income, pain and suffering, loss of the ability to form an interdependent relationship, and for the parents’ time and expenses.
For example, a settlement or award at trial may cover expenses such as modifications to the home to make it accessible, therapy, equipment, and the cost of establishing a trust to invest and manage the funds received in a birth injury lawsuit. In some cases, damages can be used to fund monthly and/or yearly payments for the life span of the child to ensure that he or she is receiving the care they need over their lifetime. Significantly, there are some limits on damages for non-pecuniary damages (like pain and suffering). There are also differences between the various provinces across Canada.