Michigan Cerebral Palsy Attorneys
Helping Children in Detroit, Grand Rapids, Flint, Ann Arbor, Sterling Heights & throughout Michigan
Cerebral palsy is a motor disorder caused by damage to the brain at or around the time of birth or up to one year of age. The disorder always involves motor impairment, which can manifest in a wide variety of ways, including limitations in gross and fine motor coordination, tremors, spasticity, and/or abnormal muscle tone. Cerebral palsy does not necessarily imply that an individual has cognitive, learning or intellectual limitations, though non-physical limitations are often comorbid with cerebral palsy due to the nature of brain injury. Cerebral palsy is sometimes caused by medical negligence, where medical staff fail to follow the ‘standards of care,’ resulting in medical treatments (or lack thereof) that cause injury.
Michigan Cerebral Palsy Attorneys Discuss the Definition and Types of Cerebral Palsy
Cerebral palsy is a the most common cause of childhood disability in the U.S. It is a health condition that affects the brain and nervous system, causing muscle tone, movement, and motor skills problems. While the severity of cerebral palsy varies, it can alter a child’s life and capabilities. In children with severe cerebral palsy, an attempted voluntary movement may induce a primitive reflex, co-contraction of one type of muscle against another, and mass movements. Attempts at flexing some fingers or toes may involve all segments of the arm or leg, and extension of all the fingers may accompany extension of the wrist. Unfortunately, many cases of cerebral palsy are due to the negligence of a medical professional during labor and delivery.
There are several types of cerebral palsy, each of which manifests itself somewhat differently:
- Spastic cerebral palsy is the most common type of cerebral palsy, affecting 70-90% of all children who have CP. The muscles in children with spastic cerebral palsy are constantly rigid or spastic, which means movement is stiff and jerky. This is caused by an abnormally high muscle tone, called hypertonia, and both the legs and the arms are affected.
- Ataxic cerebral palsy: Ataxic cerebral palsy occurs in about 10% of all cases. Some children with ataxic cerebral palsy have hypotonia (low muscle tone) and tremors. Motor skills such as writing, typing, or using scissors may be affected, and balance problems (especially while walking) are common. Children with ataxic cerebral palsy also usually have difficulty with seeing and hearing.
- Athetoid/dyskinetic cerebral palsy: Athetoid cerebral palsy or dyskinetic cerebral palsy is characterized by mixed muscle tone (both hypertonia and hypotonia) and involuntary motions. Children with athetoid cerebral palsy have trouble holding themselves in an upright, steady position while sitting or walking, and they often have involuntary motions. For some children, it takes a lot of work and concentration to get their hand to a certain spot (like scratching their nose or reaching for an object). Because of their mixed tone and trouble keeping a position, these children may not be able to hold onto objects, especially small ones requiring fine motor control. In newborn babies, improperly treated jaundice (high bilirubin levels in the blood) can lead to brain damage in the basal ganglia (kernicterus), which can cause athetoid cerebral palsy.
- Mixed cerebral palsy has features of multiple types of cerebral palsy.
Cerebral palsy can affect gross and fine motor skills in both the legs and the arms (quadriparesis), either the legs or the arms (diplegia), or one side of the body (hemiparesis). Children diagnosed with cerebral palsy oftentimes also have seizures, sensory deficits (such as hearing or vision loss), and/or intellectual and developmental disabilities (I/CC) and learning disabilities. Regardless of its particular manifestation, children with cerebral palsy have special needs for costly medical, therapeutic and educational services.
Cerebral palsy is most often characterized by:
- Unsteady gait
- Problems with balance
- Abnormal muscle tone (e.g. slouching over while sitting), reflexes, motor development and coordination
- Joint and bone deformities and contractures (permanently fixed, tight muscles and joints)
- Spasticities, spasms and other involuntary movements (e.g. facial gestures)
- Soft tissue problems, such as decreased muscle mass
- Scissor walking (where the knees come in and cross) and toe walking
Secondary conditions can include seizures, epilepsy, apraxia, dysarthria or other communication disorders, eating problems, sensory impairments, intellectual and developmental disabilities, learning disabilities, urinary incontinence, fecal incontinence and/or behavioral disorders. Speech and language disorders are common in children with cerebral palsy. Speech problems are associated with poor respiratory control, laryngeal and velopharyngeal (muscles in upper throat) dysfunction, as well as oral articulation disorders that are due to restricted movement in the orofacial muscles.
The effects of cerebral palsy fall on a continuum of motor dysfunction, which may range from slight clumsiness at the mild end of the spectrum to impairments so severe that they render coordinated movement virtually impossible at the other end the spectrum.
Premature infants are very vulnerable to cerebral palsy because their organs – especially their lungs – are not fully developed. Infections may triple the risk. Approximately 40-50% of all children who develop cerebral palsy were born prematurely. Cerebral palsy develops in approximately 5-15% of surviving very low birth weight infants, and these infants have a high risk of developing periventricular leukomalacia (PVL), intraventricular hemorrhage (brain bleed) and periventricular hemorrhagic infarction (area where blood is unable to flow, causing injury, and even death, to tissue). This typically occurs in premature babies when they receive inadequate oxygenation.
Michigan Cerebral Palsy Attorneys Discuss Cerebral Palsy Diagnosis
Cerebral palsy can be diagnosed in different ways – some babies are diagnosed with cerebral palsy shortly after birth, while other children are diagnosed when they start missing physical developmental milestones. Sometimes this can happen when parents notice that their child is holding their limbs askew or at an unusual angle, or that the child has difficulty feeding, latching, or keeping down milk or formula. In other cases, children may not be diagnosed until they are in preschool or kindergarten and are not meeting the same milestones their peers are.
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.
Cerebral palsy diagnosis can involve multiple specialists – neurologists (who focus on the children’s brain function), physical therapists or occupational therapists (who focus on the child’s ability to complete certain developmentally-appropriate tasks or activities), pediatricians (who provide general healthcare to the child), or a developmental specialist. If the child’s diagnosis is caught early, they may be referred to an Early Intervention specialist to help diagnose the severity of the cerebral palsy and recommend further steps for treatment and therapy.
Neuroimaging with CT or MRI is warranted when the cause of a child’s cerebral palsy has not been established. When abnormal, the neuroimaging study can suggest the timing of the initial damage. An abnormal neuroimaging study indicates a high likelihood of associated conditions, such as epilepsy and intellectual and developmental disabilities. Brain MRI 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.
The diagnosis of cerebral palsy often is postponed until the child is 18–24 months of age, in order to evaluate the functional status and the progression or regression of the symptoms.
Michigan Cerebral Palsy Attorneys Discuss Signs and Symptoms of Cerebral Palsy
Sometimes a baby exhibits signs and symptoms of brain damage at birth. Other times, brain damage doesn’t become apparent until much later when the child fails to meet growth and developmental milestones.
Common signs of cerebral palsy that may appear at birth or shortly after birth include:
- Low APGAR score
- Baby fails to breathe immediately after delivery
- Baby has seizures
- Baby has a very stiff body
- Baby is lethargic
- Baby required intubation and life support after birth
- Baby requires imaging of the head, including CT and MRI scans
- Baby may have birth defects, such as spinal curvature, a small jawbone, or a small head
- Baby has poor or abnormal head position
- Baby has irregular posture
- Baby looks weak or lacks muscle tone and is floppy
Symptoms may appear or change as a child gets older. Classically, cerebral palsy becomes evident when the baby reaches the developmental stage at 6 ½-9 months and is becoming mobile, where preferential use of limbs, asymmetry, or gross motor developmental delay is seen.
Some common signs that there may have been a brain injury and damage include the following in older children:
- Delayed crawling milestones
- Delayed developmental milestones
- Delayed walking milestones
- Failure to thrive
- Increased or decreased head size
- Cognitive limitations
- Poor head control
- Poor trunk control
- Psychomotor cognitive impairment
- Roving eye movements
- Decreased muscle tone (hypotonia)
Any young child exhibiting these signs should be seen by doctors for confirmation of cerebral palsy and an appropriate treatment plan.
Michigan Cerebral Palsy Attorneys Discuss the Causes of Cerebral Palsy
The cause of cerebral palsy is brain injury. Although the disorder primarily affects the muscles, the muscles themselves are not damaged – the root cause is damage to the parts of the brain and nervous system that control and direct bodily movement. In many cases, the cause of cerebral palsy can be medical negligence – when medical staff provide substandard care that results in an injury. This can occur because medical staff did not properly diagnose or treat an underlying health condition, did not properly handle complications, or made mistakes in the NICU or during delivery that were not up to the standards of care. Examples of underlying problems that can causes cerebral palsy include:
- Birth asphyxia (hypoxic ischemic encephalopathy, HIE, or neonatal encephalopathy) due to undiagnosed or improperly treated conditions during pregnancy, labor and delivery.
- Failure to quickly deliver the baby when the following umbilical cord problems occur: cord prolapse and compression, nuchal cord (cord wrapped around the baby’s neck), short umbilical cord and cord in a true knot.
- Failure to deliver the baby in a timely fashion or failure to do an emergency C-section quickly enough: Failing to identify fetal distress can cause a devastating delay in ordering a necessary C-section. Or, an emergency C-section may be ordered but the hospital is ill-prepared and it occurs too late. These delays can prolong fetal distress, which can lead to hypoxia and/or traumatic injury of the baby.
Failure to identify fetal distress: Fetal heart rate monitors help medical staff trace a baby’s heart rate during labor and delivery. If a baby is showing signs of fetal distress, the baby must urgently be delivered. If medical staff don’t read the monitoring stiprs properly, they are missing opportunities to intervene to prevent injury. Often, this includes recognizing elevated fetal heart resting tone in between contractions or fetal monitoring errors.
Failure to manage placenta previa: Placenta previa is when the placenta partially or totally covers the cervix. If the placenta is blocking the birth canal, a vaginal birth cannot take place. As a result, when the cervical opening becomes wider and/or uterine activity occurs, the placenta previa can become hemorrhagic, causing both the mother and sometimes the baby to bleed heavily.
- Improper placement of a vacuum extractor or forceps on the baby’s head, and improper usage of these instruments. If instruments are applied unevenly to the baby’s head the strain could cause compression as well as brain bleeds and hemorrhages. Incorrect positioning of the baby can damage the spine or spinal cord.
- Failure to identify complications relating to baby’s size or position: In some situations, it is safer to deliver a baby via C-section (especially if they are macrosomia, there is suspected cephalopelvic disproportion (CPD), or if they are breech or in face presentation. There are ways to identify if complications are likely; failure to recognize these complications mean that C-section delivery attempts may be delayed, causing injury.
- Birth trauma and intracranial bleeding (brain bleeds) from prolonged labor: This often occurs when the mother has cephalopelvic disproportion (baby too large to fit through mother’s pelvis) and/or the baby is macrosomic (too large for gestational age).
- Failure to perform a prompt emergency C-section when the baby is in distress. Umbilical cord compression, uterine rupture and placental abruption are common causes of fetal distress.
- Improper administration of labor induction drugs such as Pitocin or Cytotec. Improper administration can cause placental abruption and fetal distress due to uterine hyperstimulation and tachysystole.
- Placental abruption: Placental abruptions can occur mainly in two cases: in uterine hyperstimulation (often due to the misuse of Pitocin or Cytotec), and in VBACs (vaginal birth after cesareans), where the existing uterine scar splits, causing massive bleeding, precipitous blood pressure drops, and potential brain damage to the baby.
- Failure to identify and treat infections in the mother, which can infect the baby at birth and cause sepsis and meningitis. Transplacental infections may account for as many as 5% to 10% of the cases of cerebral palsy. Some infections can ascend the cervix, penetrate the placental membranes and infiltrate the amniotic fluid. These infections can cause changes in the placenta that interfere with its capacity to deliver oxygen and nutrients to the baby. Other infections can be transmitted by delivery and affect the baby after birth. The most significant complications of untreated, prolonged infection are premature rupture of the membranes (PROM), chorioamnionitis (an inflammation of the fetal membranes, amnion and chorion, due to a bacterial infection), preterm labor, prematurity, neonatal sepsis and meningitis. The most common viral and bacterial infections include: herpes, rubella, toxoplasmosis, cytomegalovirus, group B strep, and varicella.
- Failure to diagnose and treat neonatal hypoglycemia
- Failure to treat jaundice, resulting in kernicterus: Severe jaundice can lead to excessive levels of bilirubin in the blood. When too much bilirubin is in the blood, it becomes toxic to brain tissue and can cause severe damage.
- Failure to identify and treat seizures following delivery.
- Ruptured uterus: A uterine rupture occurs when the forces and stress of uterine contractions associated with attempted vaginal delivery cause the uterus to tear open, potentially expelling the unborn baby into the mother’s abdomen.
- Mismanaged preeclampsia: Pregnant women with this condition have high blood pressure. This can cause a decrease in blood flow from the mother’s placenta to the baby, which can deprive the baby of oxygen.
- Breech birth: If a baby is in the breech position (feet or buttocks-first), it is more likely they will have an umbilical cord accident. Often, it is safest to deliver breech babies via C-section to reduce the risk of umbilical cord compression or or prolapse.
Prematurity: Premature babies are more fragile and often have underdeveloped lungs that can cause oxygenation and ventilation problems. Medical staff should advise mothers of ways to prevent premature birth such as progesterone and cerclage, and protect the baby’s brain and lungs using betamethasone or magnesium sulfate. In Detroit, approximately 14.3% of all births are preterm.
Periventricular leukomalacia (PVL): Babies born before 37 weeks that weigh less than 3 ½ pounds are 20 to 80 times more likely to develop cerebral palsy than full term babies. This is due to the many complications from which many preterm babies suffer such as brain bleeds and periventricular leukomalacia (PVL). In most cases, doctors should make every effort to delay pregnancies in order to prevent premature delivery. Approximately 60-100% of babies with PVL are diagnosed with cerebral palsy. Studies have discovered that 75% of premature infants who died shortly after birth had PVL. Untreated hypotension, hypoxemia, acidosis, infection, and hypocarbia/overventilation in ventilated premature babies can cause PVL – all preventable if appropriately treated.
Post-term pregnancy: After 37 weeks, the surface area and function of the placenta starts to deteriorate. This means the placenta is less able to supply sufficient blood and oxygen to the baby, which poses an increased risk for hypoxic ischemic injury. In addition, post-mature babies have an increased risk of cord compression and meconium aspiration, which also can cause severe oxygenation problems. And when a baby is very large, a vaginal delivery can be difficult, which may prompt the physician to use forceps or vacuum extractors, which increase the chances of head trauma. A C-section also is more likely when a baby is large, and this poses addition risks of hypoxic and/or traumatic injury.
Premature Rupture of Membranes (PROM): PROM happens when the amniotic sack burst or developed a hole more than one hour before labor begins. This places the baby at risk for infection.
Traumatic birth: In some cases, especially with prolonged labor and instrument-assisted delivery, there may be trauma to the baby’s brain. This is sometimes externally apparent and sometimes not externally apparent, as in the case of brain bleeds. For example, if a baby has been stuck in the pelvis for a prolonged period of time, there may be trauma due to compressive head molding and/or hyperstimulation due to Pitocin or Cytotec. It is important that medical staff identify when a baby is at risk of trauma in order to avoid it.
Hypoxic-ischemic encephalopathy (HIE) (birth asphyxia): HIE is a diagnosis referring to brain damage caused by oxygen deprivation. HIE can cause cerebral palsy by damaging the brain responsible for sending signals to the muscles. HIE can result from a number of complications that are not appropriately treated by an obstetrician or other medical staff. These complications may include umbilical cord injuries, abnormalities or conditions with the placenta, uterine rupture, undetected or untreated problems in the mother (such as preeclampsia or infection), and difficult labor and delivery due to a baby’s size or position.
Failure to properly treat insufficient cervix: Insufficient cervix (formerly known as ‘incompetent cervix’) is an anatomical abnormality where the cervix – normally closed throughout the pregnancy until labor starts – opens due to pressure from the developing fetus. If not appropriately treated by the physician, the baby will be born very prematurely. There are ways to help keep the cervix closed, including cerclage and progesterone.
If any of these events occurred and your child was diagnosed with cerebral palsy, contact the Michigan cerebral palsy attorneys at Reiter & Walsh today at (248) 593-5100.
Michigan Cerebral Palsy Attorneys Discuss Treatments and Therapies for Cerebral Palsy
While cerebral palsy is a non-progressive disease, the symptoms can sometimes worsen over time as children grow and hit puberty. Intensive therapy and rehabilitation can often help mitigate some of the physical symptoms of cerebral palsy, though in some situations – and depending on the child’s unique health history – surgical or medication interventions may be recommended to the child by their medical professionals. Therapy and medical interventions can help reduce muscle stiffness, reduce the risk of contractures, and help teach certain muscle groups to coordinate with each other. There is a wide variety of available interventions for cerebral palsy, including:
|Orthopedic surgery||Physical therapy||Recreational therapy||Neurosurgery (SDR)|
|Eye surgery for conditions such as strabismus||Neuropsychology||Speech therapy and AACs||Occupational therapy|
|Pediatric rehabilitation medicine||Assistive technologies, braces and orthotics||Botox injections for spasticity||Nutrition and diet plan counseling|
|Tendon release surgery||Special camps||Animal therapy||Behavioral Therapy|
|Baclofen pump implantation for spasticity||Therapeutic Electrical stimulation (TES)||Medication for seizures and spasticity||Complementary and Alternative Therapies such as HBOT|
Michigan Cerebral Palsy Attorneys Explain Cerebral Palsy Prevention
There is increasing evidence that antenatal administration of magnesium sulfate to women with preterm labor decreases the incidence and severity of cerebral palsy in their babies, without affecting mortality. Magnesium sulfate has a neuroprotective effect, and can help protect the baby’s brain while in the mother’s womb. In addition, research indicates that babies who are given hypothermia treatments (also known as brain cooling or body cooling therapy) within the first 6 hours of life have a decreased chance of having cerebral palsy, or may have a less severe form of the disorder.
Michigan Cerebral Palsy Attorneys: Free and Confidential Case Review
If your child has cerebral palsy, and you want a second look into why your child has this diagnosis, it is always worth looking into. The birth injury attorneys at Reiter & Walsh ABC Law Centers would be happy to provide you with a free consultation to see whether medical malpractice played a role in your child’s disabilities. Your information is always kept 100% confidential, and you will never be charged out-of-pocket.
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- Cerebral palsy. American Academy of Pediatrics. http://www.healthychildren.org/English/health-issues/conditions/developmental-disabilities/Pages/Cerebral-Palsy.aspx. Accessed Sept. 28, 2010.
- Ashwal S, et al. Practice parameter: Diagnostic assessment of the child with cerebral palsy: Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Practice Committee of the Child Neurology Society. Neurology. 2004;62:851.