A little boy with cerebral palsy that unpredictably affects his body is able to occasionally walk, thanks to Botox injections into his tight muscles, parents who do physical therapy with him 4 times a day, and a very special custom-made tricycle that allows him to ride a bike like other children.
Adam Shepherd suffered a birth injury during delivery and his brain was deprived of oxygen for too long. Soon after birth, he was diagnosed with hypoxic ischemic encephalopathy (HIE) and a seizure disorder. Later, Adam was diagnosed with cerebral palsy and epilepsy and his parents were told that he would never walk or be able to sit up.
Adam’s parents, Alan and Annmarie, didn’t let the physician’s predictions deter their determination to get his body into the best shape possible. They found the best physical therapists and have Adam doing physical therapy four times a day. When the therapists aren’t available, Alan and Annmarie work with Adam at home. They say that Adam receives “constant” physical therapy and is making progress.
Adam is now four years of age. A few years ago, a bike shop built a tricycle for Adam to help him ride. Alan and Annmarie spent weeks helping Alan learn to pedal. Finally, Adam was able to ride by himself. The constant physical therapy continued, and Adam’s parents think that the foot and leg movement on the bike, coupled with the required postural control, has helped Adam learn to take his first steps. Adam’s cerebral palsy still makes it impossible to stand on certain days, but on other days, Adam is able to practice walking, which gives the little boy a lot of confidence and brings tears to his parents’ eyes. Alan and Annmarie have also noticed Adam interacting with other children more, and he even tried to play football with a group of kids, which made everyone smile.
Adam will likely need surgery to help him walk, and his parents are considering selective dorsal rhizotomy (SDR), which is a fairly new treatment for spastic cerebral palsy that physicians call “groundbreaking.” In addition, Adam’s seizures are very severe and are not responding to medications and other treatments. Alan and Annmarie are therefore considering surgical procedures to help control the seizure activity. One option they’re considering is a device that can be implanted in Adam’s chest to that can intermittently electrically stimulate a nerve called the vagus nerve. After a few weeks or months, this could greatly decrease the amount of seizures Adam has. Another surgery is removal of the part of Adam’s brain that is causing the seizures.
Regardless of the procedures Adam has to face to help his cerebral palsy, he is excited and is happy to be riding his new bike with other kids.
What Is Cerebral Palsy?
Cerebral palsy is a group of disorders that cause a child to struggle with movement. CP is caused by an injury to the motor centers of the brain while it is still developing. The brain injury causes problems with signals that go from the brain to the nerves to the muscles. This mix up in signals can cause dysfunction in almost every muscle in the body. Thus, children with cerebral palsy may have to use a wheelchair to get around, may be unable to control their bladder, and may also have difficulty drinking and eating due to poor oral-facial muscle control. Cerebral palsy affects each child differently.
Spastic cerebral palsy is the most common form of CP, affecting approximately 70 – 90% of all children who have the condition. Normally, muscles coordinate in pairs; when one group of muscles contract (tighten), the other group relaxes. This allows free movement. In spastic cerebral palsy, major complications in brain-to-nerve-to-muscle communication occur and the balanced degree of muscle tension is disrupted. Spastic cerebral palsy causes too many muscles to become active together, opposing muscle groups become active at the same time. This prevents coordinated movement. Thus, the muscles in children with spastic cerebral palsy are constantly stiff, or spastic; the children have stiff, jerky movements stemming from an abnormally high muscle tone, called hypertonia.
The main difference between spastic cerebral palsy that primarily affects the lower body (spastic diplegia) and normal body movement (gait) is the “scissor gait.” Scissor gait is characterized by the following:
- Knees and thighs cross or touch while walking
- Hips and pelvis are often locked, as if crouching
- Ankles may be turned inwards while walking
- Tip toe walking
- Arms and hands go outwards from the body to provide balance
The degree of spasticity varies widely from child to child. Balance problems and stiffness in gait can range from barely noticeable to extreme misalignments that require the child to use crutches or a cane to assist in being upright. Spasticity can be so severe that the child is relegated to a wheelchair. Above the hips, children with spastic diplegia typically have normal muscle tone and range of motion, though some spasticity may also affect the upper body. Because leg tightness often leads to instability when in an upright position, extra muscle tension often develops in the upper body, shoulders and arms due to the upper body trying to compensate for the instability of the lower body.
What Can Parents Do To Help Their Child’s Cerebral Palsy?
Early intervention will help the child have the best outcome. Children can begin physical therapy at just a couple months of age. Physical therapy is extremely important for a number of reasons. The muscle dysfunction characteristic of spastic cerebral palsy can cause the child to have serious and painful problems with tendons, joints and bones, especially the hip bones. In addition, without aggressive physical therapy, contractures can occur, which are permanently shortened muscles or joints. Contractures occur once a muscle has been too tight for too long. Once muscles and tendons become shorter, only surgery can help fix them.
Numerous methods exist to help provide appropriate physical therapy for children with cerebral palsy. There are treadmills and other workout devices that have partial or total weight bearing capability so that the child has support to remain upright and can then walk or workout. A neuro suit, also called an Adeli suit, is modeled after the space suits that astronauts wear. These suits force muscles to work and also provide support so a child can be upright. Electrical stimulation therapy, water and cycling therapy, hippotherapy, yoga and body work also provide significant benefits for children with cerebral palsy.
There are also medications that can help a child’s spasticity and control seizures. Botox injections into affected muscles greatly help the muscles relax, but this only works up until a certain point. A baclofen pump can be surgically implanted into a child’s abdomen. This pump administers baclofen, which is a muscle relaxant that has very little side effects. Anti seizure medication can be given, but these often have many side-effects and certain medications can cause harm to the brain. In most cases, the first medication that physicians give the child is Phenobarbital. Recently, a ketogenic diet has been shown by research to help reduce and even prevent seizures, which are very common in children who have CP.
A fairly new surgery called selective dorsal rhizotomy (SDR) is helping many children with spastic cerebral palsy attempt their first steps. SDR involves locating the nerves that are malfunctioning and cutting them. When combined with aggressive physical therapy, SDR has been shown to provide incredible results in decreasing spasticity. Children have been coming from all over the world to have this groundbreaking surgery in the U.S. The drawback of SDR is that it is permanent. Tendon release surgeries and different types of hip surgeries are also common.
What Causes Cerebral Palsy?
Cerebral palsy is often caused by an injury that occurs during or near the time of delivery. Hypoxic ischemic encephalopathy (HIE) and brain bleeds/hemorrhages are significant causes of cerebral palsy. The baby is supposed to be closely monitored by a fetal heart rate monitor during labor and delivery. If a baby starts to become oxygen deprived, it will affect her heart rate and a non-reassuring heart tracing will appear on the fetal heart rate monitor. When this occurs, the physician must deliver the baby right way to prevent her from being deprived of oxygen for too long. In most cases, delivery must occur by an emergency C-section delivery.
If a baby is left in oxygen depriving conditions for too long, her brain can suffer a serious insult that causes permanent brain damage and conditions such as cerebral palsy, seizures, periventricular leukomalacia (PVL) and hydrocephalus.
Conditions that can cause the baby to suffer a lack of oxygen to her brain include the following:
- Brain bleeds and hemorrhages caused by the delivery devices forceps and vacuum extractors. These can cause trauma, clots, strokes and skull and spinal cord injuries.
- Hyperstimulation of the uterus (womb) caused by the labor drugs Pitocin and Cytotec. These drugs can cause contractions that are so strong and frequent that the uterus does not have time to adequately recharge with a fresh supply of oxygen-rich blood for the baby. Oxygen deprivation in the baby can get progressively worse when hyperstimulation occurs.
- Umbilical cord problems such as a nuchal cord (cord wrapped around the baby’s neck), prolapsed umbilical cord, short cord and cord in a true knot.
- Placenta and uterus problems such as uterine rupture, placental abruption, placenta previa and placenta accreta.
- Oligohydramnios (low amniotic fluid)
- Stroke in the baby
- Premature rupture of the membranes(PROM)
- Prolonged and arrested labor
- Preeclampsia / eclampsia
- Anesthesia mistakes
Other birth injuries that can cause cerebral palsy include:
- Infection. An infection in the mother that travels to the baby at birth can cause injury to cells in the baby’s brain, thereby placing the baby at risk of having a brain bleed. Infections that can injure a baby’s brain include chorioamnionitis, Group B strep (GBS), herpes simplex virus (HSV), Staphylococcus (staph) infections, and E coli.
- When maternal infections are passed on to the baby, the baby can get a very serious infection in her bloodstream called sepsis. Sepsis can damage the brain either by direct infection of the central nervous system or by causing inflammation in the brain. Sepsis often causes meningitis, which is inflammation of the membranes surrounding the brain and spinal cord. The most common source of meningitis is GBS. Sepsis can also cause the baby to go into septic shock, which causes a severe reduction in blood flow and blood pressure. When the blood pressure gets really low, the baby’s brain can become deprived of oxygen, which can cause permanent brain damage, cerebral palsy and seizures.
- Jaundice and kernicterus. Almost all newborns have some degree of jaundice, which is caused by elevated bilirubin levels. Bilirubin is the end product of red cell breakdown. When bilirubin gets too high, it can enter the brain tissue. Bilirubin is toxic in to the brain and it can cause a form of brain damage called kernicterus, which often causes cerebral palsy.
- Neonatal hypoglycemia. This is especially dangerous for babies who were born to mothers who have gestational diabetes. After birth, these babies have blood sugars that plummet. If this is not treated, the baby can get brain damage and cerebral palsy. Extremely low blood sugar can also cause seizures.
- Mismanagement of the baby’s respiratory status after birth. This includes failure to properly manage apnea (periods in which the baby stops breathing), failure to properly manage a baby on a breathing machine (which can cause overventilation injuries, such as hypocarbia and holes in the lung), and failure to give proper amounts of surfactant, which help with lung maturity so the baby can breathe better.
Lansing Birth Injury Attorney Helping Children Throughout the Nation
There are many attorneys in Michigan that call themselves “cerebral palsy lawyers” or “birth injury attorneys.” Jesse Reiter, president of Reiter & Walsh 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 helping children who have hypoxic ischemic encephalopathy and cerebral palsy. When Jesse and his team of attorneys take a case, they spend a lot of time getting to know the child and family they are helping so they can fully understand the child’s needs.
Jesse and his team have won many awards for their advocacy of children. Jesse is currently recognized as being one of the best medical malpractice lawyers in America by U.S. News and World Report 2014, as well as one of the 10 Best Attorneys in Michigan by Super Lawyers magazine. Reiter & Walsh ABC Law Centers is also recognized as being one of the best medical malpractice law firms in the country by U.S. News and World Report 2014.
Cerebral palsy, hypoxic ischemic encephalopathy (HIE) and birth injury cases are difficult areas of law to pursue due to the complex nature of the medical records. The award winning lawyers at ABC Law Centers have decades of experience with cerebral palsy and HIE cases. We handle cases in Michigan, Ohio, Washington, D.C. and throughout the nation and we give personal attention to each child and family we help. 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 888-419-2229. Our firm’s lawyers are available 24 / 7 to speak with you.