Understanding Causes Of Cerebral Palsy Is Crucial To Determining If Medical Malpractice Is Involved
As medical malpractice lawyer, who has worked on cases involving cerebral palsy, I've noticed a good deal of confusion regarding all aspects of CP.
Like many medical conditions, it seems like the more we study this troubling condition, the more questions we have.
I've tried to draw out some particularly useful information from trusted sources to address many of the issues I come across in cerebral palsy cases.
What is cerebral palsy?
Cerebral Palsy (CP) is a condition (CP is sometimes referred to as a group of symptoms) that can affect the brain and nervous system functions including movement, posture, learning, hearing, seeing, and thinking.
It is caused by brain injury or abnormal development of the brain that occurs before, during, or shortly after birth (brain damage occurring after age 5 is not considered cerebral palsy).
Most problems occur in the womb, but problems can happen anytime during the first two years of life as the child’s brain develops. It is estimated that almost 800,000 children and adults in the United States are living with symptoms of cerebral palsy. And, the CDC (U.S. Centers for Disease Control and Prevention) estimates that every year about 10,000 babies born in the United States will develop cerebral palsy.
What are the types of cerebral palsy?
There are actually several different types of cerebral palsy:
- Spastic – muscle stiffness and movement difficulties (occurs in 70% of children with CP)
- Athetoid (or dyskinetic) – involuntary and uncontrolled movements (occurs in 20% of children with CP)
- Ataxic – disturbed sense of balance and depth perception (occurs in 5% of children with CP)
- Mixed - (usually spastic and athetoid types are combined and may also involve severe mental retardation)
Symptoms assciated with cerebral palsy
Signs and symptoms of cerebral palsy usually present themselves during infancy or preschool years. Symptoms can vary significantly between people and range from minor clumsiness to severe spasticity (muscles are continuously contracted). In addition, the disability symptoms associated with cerebral palsy can be limited to one limb or one side of the body, or they can affect the whole body.
Symptoms of CP usually become evident before a child has reached the age of two, but they can begin as early as three months. Brain damage does not worsen after the damage has occurred; however, the symptoms may change as the individual grows and matures.
Symptoms include:
- Spasticity (stiff muscles and exaggerated reflexes)
- Rigidity (stiff muscles with normal reflexes)
- Joint contracture (joints are tight and do not open up all the way)
- Too stiff or too floppy muscle tone
- Ataxia (lack of muscle coordination)
- Athetosis (slow, writhing movements)
- Difficulty walking (walking on toes, crouched gait, scissors-like gait, wide gait)
- Tremors
- Delays in reaching motor skills milestones (sitting up alone, crawling)
- Favoring one side of body (reaching with only one arm, dragging one leg while crawling)
- Excessive drooling or difficulty swallowing
- Delays in speech development or difficulty speaking
- Difficulty with precise motions
Oftentimes, the brain problems that lead to cerebral palsy conditions can also cause additional neurological problems such as:
- Difficulty with vision and hearing
- Intellectual disabilities or mental retardation
- Speech problems (dysarthria)
- Seizures
- Abnormal touch or pain perceptions
- Dental problems
- Urinary incontinence
Causes of cerebral palsy
Oftentimes, the exact cause of cerebral palsy is unknown because it usually stems from an abnormality or problem in brain development before the child is born. Factors that can cause problems with brain development include:
• Oxygen deprivation (hypoxia)
• Fetal stroke
• Genetic defects
• Bleeding in the brain
• Infant infections (encephalitis, meningitis, herpes simplex infections)
• Maternal infections (ex. rubella)
• Traumatic head injury
• Severe jaundice
Risk Factors and Prevention of Cerebral Palsy
CP affects 2-4 of every 1,000 infants and premature babies are at a slightly increased risk of developing cerebral palsy (CP is 10 times more common in premature infants). Moreover, CP is more common in low birth weight infants (less than 3.3 pounds).
A study in the American Journal of Obstetrics and Gynecology that looked at the times of delivery of two million neonates in California over fourteen years suggests that night births are linked to an increased risk of brain disorders such as epilepsy, cerebral palsy, and encephalopathy.
Babies born between 10 p.m. and 4 a.m. were 22% more likely to develop cerebral palsy and other brain conditions because of lack of oxygen during delivery. The authors suggest that medical errors and poor staffing in hospitals overnight may account for the higher incidence of brain problems.
In many cases, the exact cause of CP is unknown, which makes prevention difficult. However, if you are having a baby, there are steps you can take to lower the risk of CP. These efforts include:
- Maintaining a healthy diet
- Proper prenatal medical care
- Review medications with your doctor
- Controlling diabetes, anemia, hypertension, seizures, and nutritional deficiencies during pregnancy
- Vaccination against diseases
- Practice good child safety (prevent head injuries)
There is no cure for cerebral palsy. However, many children benefit from physical therapy and special education. Treatment is based on the individual’s symptoms and the need to prevent complications. Usually, the earlier the treatment begins, the better chance the child has of overcoming disabilities or learning new ways to accomplish tasks.
Treatment plans should include a team of professionals (doctor, dentist, social worker, nurses, therapists (occupational, physical, and speech), and specialists for specific symptoms. Treatment plans can include self and home care, special education and schooling, glasses, hearing aids, muscle/bone braces, walking aids, wheelchairs, surgery, and medications to address seizures, spasticity, drooling, and tremors.
The good news is that most children with CP survive into adulthood. Long-term care may be required depending on the severity of symptoms, but a comprehensive care plan can help the individual be as independent as possible and reach their highest potential.
Research efforts are underway to improve the treatment and diagnosis of cerebral palsy, but ultimately, prevention is the key for curing CP. Researchers at Duke University are looking into stem cell therapy to treat cerebral palsy patients. They are hoping that the stem cells can help regenerate cells in the brain that never developed because of lack of oxygen during birth, which could alleviate symptoms.
If your child is diagnosed with cerebral palsy, there are support groups and circles that can help you cope with CP and its effects. The following organizations offer good resources:
In addition, your doctor should be a good source for local community groups. Cerebral palsy requires long-term and loving care. You should encourage your child’s independence and take an active role in advocating for your child. If you do not think your child is receiving the best possible care, you should speak up on your child’s behalf. Proper care for cerebral palsy requires that each and every professional treating your child work together to ensure the best outcome for your child.
Resources:
Seer Press News: Cerebral palsy more likely to develop in babies born during night time, study says
Seer Press News: Stem cells for treatment of cerebral palsy
HealthCommunities.com: Cerebral Palsy Signs and Symptoms
National Institute of Neurological Disorders and Stroke (NINDS): Cerebral Palsy Information Page
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