Cerebral palsy (CP) is a disorder that causes problems with movement, balance, posture and coordination. Babies with cerebral palsy are usually slow to roll over, sit, walk or crawl. Sometimes cerebral palsy is diagnosed soon after birth and other times, the disorder is not recognized until the child is 4 or 5 years of age, when certain developmental milestones are missed.
Cerebral palsy is caused by an injury to the developing brain, which means a child can get the disorder up until 3 years of age. Often, the brain injury that causes cerebral palsy occurs during or near the time of delivery. The most common cause of cerebral palsy during this time period is a lack of oxygen to the baby’s brain. Brain injury caused by oxygen deprivation is called hypoxic ischemic encephalopathy (HIE). Head trauma, brain bleeds and hemorrhages, infection that travels from the mother to the baby at birth, sepsis, meningitis, and failure to properly treat breathing problems,hypoglycemia and jaundice after birth can also cause cerebral palsy.
In this article, we discuss the causes, signs and symptoms of CP, its treatments, and what the short and long-term outlook may be for a child with cerebral palsy.
AWARD-WINNING MICHIGAN CEREBRAL PALSY ATTORNEYS HELPING CHILDREN AFFECTED BY BRAIN INJURIES FOR ALMOST 3 DECADES
If your baby has HIE, intellectual disabilities, developmental delays, a seizure disorder, cerebral palsy or any other long-term condition,Reiter & Walsh ABC Law Centers can help. The award-winning attorneys at Reiter & Walsh focus solely on birth injury cases and have been helping children throughout the nation for almost 3 decades. The partners of the firm, Jesse Reiter and Rebecca Walsh, were recently recognized as being two of the best medical malpractice lawyers in America by U.S. News and World Report. In fact, U.S. News and World Report has given Mr. Reiter the honor of being one of the “Best Lawyers in America” every year since 2008. ABC Law Centers is also currently recognized as being one of the best medical malpractice law firms in the nation by U.S. News and World Report. Our firm’s award-winning Michigan cerebral palsy attorneys are available 24 / 7 to speak with you.
WHAT CAUSES CEREBRAL PALSY?
Birth injuries are a common cause of cerebral palsy. A birth injury is an injury that occurs during or near the time of delivery that causes permanent damage to the child. Birth asphyxia, which is oxygen deprivation that happens during labor and delivery, is a common cause of cerebral palsy. Any condition that causes the baby to receive a lack of oxygen-rich blood from the mother can cause birth asphyxia. Therefore, if the mother is being deprived of sufficient oxygen or if she is bleeding or hemorrhaging, the baby will also be oxygen-deprived.
The baby receives all her oxygen from oxygen-rich blood delivered to her from the mother. This maternal blood travels to the baby through vessels in the mother’s womb, then through vessels in the placenta, and finally, into the baby through the umbilical cord vein. Common causes of birth asphyxia are conditions affecting the womb (uterus), placenta and umbilical cord. The causes of oxygen deprivation and birth asphyxia are listed below.
Conditions that can cause cerebral palsy include:
- Placenta previa
- Ruptured uterus (womb)
- Placental abruption
- Umbilical cord problems, such as a nuchal cord or compressed cord.
- Failure to quickly deliver a baby when fetal distress is evident on the fetal heart rate monitor (delayed emergency C-section)
- Fetal stroke
- Oligohydramnios (low amniotic fluid)
- Anesthesia mistakes, which can cause blood pressure problems in the mother, including a hypotensive crisis
- Premature rupture of the membranes (PROM)
- Prolonged and arrested labor
- Intracranial hemorrhages (brain bleeds), which can be caused by a traumatic delivery. Forceps and vacuum extractors can cause brain bleeds. Sometimes intense contractions (hyperstimulation) caused by labor induction drugs (Pitocin and Cytotec) can cause head trauma. Mismanagement of cephalopelvic disproportion (CPD), abnormal presentations (face or breech presentation), and shoulder dystocia also puts a child at risk of having a brain bleed.
- Improper management of the baby’s respiratory status after birth. This includes failure to properly manage apnea (periods of breathing cessation), failure to properly manage a baby on a breathing machine (which can cause overventilation injuries, such as hypocarbia and a hole or holes in the lung), and failure to give proper amounts of surfactant, which help with lung maturity and lung compliance in premature lungs.
High bilirubin levels, improperly treated neonatal hypoglycemia, infections in the mother that travel to the baby during delivery can also cause brain damage and resultant cerebral palsy.
WHAT ARE THE SIGNS AND SYMPTOMS OF CEREBRAL PALSY?
Cerebral palsy is often suspected in a newborn when the baby has muscle problems, such as really tense muscles or excessive limpness (floppiness). Neonatal encephalopathy – especially HIE – is a common cause of cerebral palsy. Thus, a diagnosis of cerebral palsy is often made when imaging studies, such as an MRI or CT scan, are performed to assess encephalopathy. Of course, brain damage is an evolving process, so sometimes the full extent of the brain injury won’t be evident on imaging studies for weeks or months. Common signs and symptoms of cerebral palsy are listed below.
Some of the earliest signs of cerebral palsy include the following:
- Failure to breathe immediately after delivery
- Poor head position
- Baby looks weak or lacks muscle tone
- In the NICU, the baby:
- is irritable
- sleeps poorly,
- vomits frequently,
- is difficult to handle and cuddle, and/or
- has poor visual attention.
As the baby gets older, other signs and symptoms of cerebral palsy become more obvious. These are:
- Abnormal muscle tone, reflexes, motor development and coordination
- Spasticities, spasms and other involuntary movements
- Unsteady gait
- Soft tissue problems such as decreased muscle mass
- Scissor walking and toe walking
- Joint and bone deformities
- Contractures (permanently fixed, tight muscles and joints)
The effects of cerebral palsy vary widely among children. Some children have slight clumsiness at the mild end of the spectrum while others have impairments so severe that coordinated movement is essentially impossible.
Babies that have severe cerebral palsy often have an irregular posture; their bodies may be either very floppy or very stiff. Symptoms of CP may appear or change as a child gets older. Some babies do not show obvious signs right away. Classically, cerebral palsy becomes evident when the baby reaches the developmental stage at 6 ½ – 9 months and is becoming mobile, where the preferential use of limbs, asymmetry, or gross motor developmental delays can be seen.
Seizures, epilepsy, and speech and language disorders are common in children with cerebral palsy. Speech problems are associated with poor respiratory and oral-facial muscle control.
HOW IS CEREBRAL PALSY DIAGNOSED?
A diagnosis of cerebral palsy is typically made based upon a combination of findings. Babies that have normal functional development and behavior but who have mild limpness or mild stiffness and hyperreflexia should be assessed and closely observed by the medical team.
In assessing a baby for cerebral palsy, physicians look at neurobehavioral signs, such as the baby being overly irritable or excessively docile (compliant). Tongue thrusting, grimacing and poor head control are signs that motor abnormality exists, and this may or may not be coupled with the baby having a lot of stiffness in her extremities. Physicians typically screen for cerebral palsy by doing regular examinations to determine if the child is meeting developmental milestones. In addition, physicians want to see that the child’s newborn developmental reflexes (e.g., the rooting reflex) disappear between 3 and 6 months of age.
An MRI of the brain is the preferred head imaging study for diagnosis of cerebral palsy lesions in the brain. MRI abnormalities in children with cerebral palsy include hypoxic-ischemic lesions, such as periventricular leukomalacia, cortex malformations and lesions of the basal ganglia. A CT scan can also be used to help identify cerebral palsy; however, MRI can better show the timing and cause of the insult that led to the child’s cerebral palsy.
HOW CAN CEREBRAL PALSY BE PREVENTED AND TREATED?
Hypoxic ischemic encephalopathy (HIE) is a common cause of cerebral palsy. If HIE is quickly diagnosed and treated, cerebral palsy can be prevented in the child, or the cerebral palsy may be less severe. The treatment for HIE is hypothermia (brain cooling) treatment. During brain cooling treatment, the baby’s core body temperature is cooled to just a few degrees below normal for 72 hours. The cooling is done with a cooling blanket or cool cap. The key with HIE treatment is that it must be started within 6 hours of the time the insult to the baby’s brain occurred. This means that in most cases, a neonate with HIE must be treated within 6 hours of birth.
The best way to prevent cerebral palsy is to prevent birth injuries. Oxygen deprivation and birth asphyxia can be prevented during labor and delivery by carefully examining the fetal heart tracings on the heart monitor. When a baby is suffering from a lack of oxygen to her brain, it will be evident on the fetal heart monitor as a non-reassuring tracing. When non-reassuring tracings occur, the baby must be quickly delivered to get her out of the oxygen-depriving conditions. An emergency C-section delivery is usually the fastest and safest way to deliver a baby who is in distress.
Prevention of maternal infection, avoidance of brain bleeds in the baby, proper management of the baby’s breathing after birth, and prompt treatment of sepsis, hyperbilirubinemia (jaundice) and hypoglycemia are also important for the prevention of cerebral palsy.
When a baby has cerebral palsy, treatment and therapy should be started right away. The sooner the baby begins physical therapy and other treatments to help muscle function, the better. Babies can begin physical therapy by two months of age or sooner.
WHAT WILL MY CHILD’S LIFE BE LIKE?
Children with cerebral palsy can live as long as children who don’t have the disorder. There are numerous types of therapy and assistive devices that can greatly improve a child’s motor function and help prevent the muscle, bone, joint and tendon deterioration that often occurs without proper therapy and treatment. Selective dorsal rhizotomy (SDR) is a groundbreaking surgery that can help children who have spastic cerebral palsy. During this surgery, nerve fibers that are causing the spasticity are cut, leaving only the properly functioning nerves. SDR is helping many children with spastic cerebral palsy take their first steps.
Children with severe forms of CP may need help with breathing, feeding and going to the bathroom for the rest of their lives and may never be able to walk. For children who are unable to speak or use their hands, there are computers that can track the child’s eyes and speak for them. These devices are a great way for children with severe cerebral palsy to be able to communicate and control their environment.
HOW CAN A MICHIGAN CEREBRAL PALSY ATTORNEY HELP MY CHILD?
The award-winning Michigan cerebral palsy attorneys at Reiter & Walsh ABC Law Centers focus solely on birth injury cases and have been helping children throughout the country for almost 3 decades. The attorneys believe that any person whose negligence causes a child to be afflicted with cerebral palsy should be held responsible. Reiter & Walsh are very passionate about helping children obtain the compensation they need for lifelong treatment, therapy and a secure future, and they take a lot of time getting to know each child and family they are helping so they can fully understand the child’s needs.
Michigan cerebral palsy attorney Jesse Reiter, president of ABC Law Centers, is the only attorney in Michigan who has spent his entire 28+ year career focusing on birth injury cases, and most of his cases involve children with cerebral palsy. Jesse helps children in Michigan and throughout the nation, and he spends a great deal of time getting to know the child and family he is helping so he can completely understand the child’s needs. Jesse has won numerous awards for his advocacy of children, and he is currently recognized as being one of the best medical malpractice attorneys in America by U.S. News and World Report 2015, as well as one of the 10 Best Attorneys in Michigan by Super Lawyers magazine.
Cerebral palsy is a difficult area of law to pursue due to the complex nature of the disorder and the medical records that support it. The Michigan cerebral palsy attorneys at Reiter & Walsh ABC Law Centers have decades of experience with cerebral palsy cases. To find out if you have a case, contact our nationally recognized birth injury law firm to speak with one of our attorneys. We have numerous multi-million dollar verdicts and settlements that attest to our success and no fees are ever paid to our firm until we win your case. Email or call us at (888) 812-6009. Our firm’s award winning Michigan cerebral palsy attorneys are available to speak with you 24 / 7.
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