Award-Winning Michigan Cerebral Palsy Lawyers Helping Children Affected by Hypoxic Ischemic Encephalopathy (HIE), Cerebral Palsy, Seizures & Other Birth Injuries | Serving Michigan & All 50 States
A little boy with cerebral palsy (CP) named Jack took his first steps at 6 years of age after having surgery to lengthen his Achilles tendons. Jack and his parents, Stacy and Graham, traveled from the UK to Missouri so Jack could have the surgery. Jack has numerous muscle problems caused by cerebral palsy, including contractures. A contracture is a permanent shortening of a muscle that results in the loss of normal joint movement. Jack has spastic cerebral palsy, and his spastic muscles do not grow normally. The abnormal growth and lack of proper use has caused Jack to have the contractures. Jack’s Achilles tendons were so short that he couldn’t put his foot flat on the floor to walk. His Achilles problem alone caused Jack to use twice as much energy to move around. The contractures, along with other issues caused by the spastic cerebral palsy, have made it necessary for Jack to use a walker and crutches to move around.
With aggressive physical therapy and the Achilles lengthening surgery, Stacy and Graham hope their son will learn to walk unaided. They have been working with their eager little boy, and a video of Jack taking his first steps has been shared on social media by thousands of people around the world. It is hard to miss the look of sheer excitement on Jack’s face as he tries to take his first steps since the surgery.
NATIONALLY RECOGNIZED MICHIGAN CEREBRAL PALSY LAWYERS HELPING CHILDREN FOR ALMOST 3 DECADES
The award-winning cerebral palsy lawyers at Reiter & Walsh ABC Law Centers have helped hundreds of children affected by hypoxic ischemic encephalopathy and cerebral palsy. Michigan attorney Jesse Reiter, president of ABC Law Centers, has been focusing solely on birth injury cases for over 28 years, and most of his cases involve hypoxic ischemic encephalopathy (HIE) and cerebral palsy. Partners Jesse Reiter and Rebecca Walsh are currently recognized as two of the best medical malpractice lawyers in America by U.S. News and World Report 2015, which also recognized ABC Law Centers as one of the best medical malpractice law firms in the nation. The attorneys at ABC Law Centers have won numerous awards for their advocacy of children and are members of the Birth Trauma Litigation Group (BTLG) and the Michigan Association for Justice (MAJ). In fact, Jesse is one of only 2 attorneys in Michigan to have been elected Chair of the BTLG.
If your child experienced a birth injury such as HIE, seizures, cerebral palsy or any other long-term condition, contact Reiter & Walsh today at 888-419-2229. Our award-winning Michigan cerebral palsy lawyers are available 24/7 to speak with you.
WHAT IS SPASTIC CEREBRAL PALSY?
Although the brain injury that causes spastic cerebral palsy does not get worse over time, a child’s muscle, bone, joint and tendon problems can worsen and become very painful.
Normally, muscles coordinate in pairs; when one muscle contracts, the other relaxes. This allows the muscles to do what the child wants them to do. When a child has spastic cerebral palsy, there is dysfunction in brain to nerve to muscle communication, which causes muscles to work against each other. This leads to a tightening or shortening of the joint. When the muscle fibers become short, the joints nearby can end up and remain in a fixed position. This can further decrease a child’s ability to move around. Indeed, without proper therapy and treatment, spastic muscles can cause damage to the child’s body: muscles, bones, joints and tendons can get shorter and become painful.
The sooner therapy and treatment for spastic cerebral palsy begins, the better. However, many children aren’t diagnosed with CP until they are 5 or 6 years old, when certain developmental milestones are missed.
WHAT CAUSES SPASTIC CEREBRAL PALSY?
Spastic cerebral palsy is the most common type of CP, affecting about 80% of all people with the condition. Cerebral palsy is caused by damage to the motor control centers of the developing brain. Thus, any injury that damages this part of the brain before a child is approximately 3 years old can cause CP. Many times, cerebral palsy is caused by a brain injury that occurs during or near the time of delivery. Head trauma, brain bleeds, infection and a lack of oxygen to the baby’s brain can cause CP. Listed below are some complications that, if mismanaged, can cause brain injury and cerebral palsy in a child.
Causes of Cerebral Palsy
Umbilical cord problems, such as a prolapsed umbilical cord, the cord being wrapped around the baby’s neck (nuchal cord), a short umbilical cord, and the cord being in a true knot. The umbilical cord vein is the final pathway of oxygen-rich blood traveling to the baby from the mother. Problems with the cord can cause the baby to be partially or completely cut off from her supply of oxygen-rich blood.
Placental abruption. This is when the placental tears away from the uterus (womb). Oxygen-rich blood traveling from the mother to the baby moves through vessels in the womb and placental and then into the umbilical cord to be transported to the baby. Problems with the uterus or placenta can significantly decrease the amount of blood traveling from the mother to the baby. In some cases, such as when there is a complete placental abruption, the baby may not be able to receive any oxygen-rich blood from the mother.
Uterine rupture. This occurs when there is a tear through all the layers of the womb. A ruptured uterus can cause severe hemorrhaging in the mother, and the baby may even spill into the mother’s abdomen. The hemorrhaging can cause the mother to lose so much blood that there is a decreased flow of blood to the baby, or the rupture may be at a spot that affects the blood circulation between the uterus and placenta.
Vacuum extraction delivery. A vacuum extractor has a small cup that is placed on the baby’s head so the physician can apply gentle traction to help move the baby out of the birth canal. This is a risky device and specific criteria must be met before the physician uses it. The pressure of the suction cup can cause a type of bleed called a subgaleal hemorrhage. This occurs when the vacuum ruptures a vein and then the vein bleeds into the space between the scalp and the skull. This can cause severe oxygen deprivation. If the bleed is not properly managed, almost half of the baby’s blood volume can end up in the subgaleal space. A vacuum extractor can also cause intracranial hemorrhages, clots, strokes, and skull and spinal cord trauma.
Forceps delivery. Forceps are a delivery device that look like salad tongs. The tongs are applied to each side of the baby’s head. Forceps must be precisely placed, and it is also critical that the physician not apply too much force. Forceps are not commonly used, so many physicians lack skill in using them. Forceps can cause trauma to the skull and spinal cord, as well as brain bleeds, clots and hemorrhages.
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 can also cause problems with the baby’s blood flow, leading to a decreased flow of blood in the brain. These dangerous infections include chorioamnionitis, Group B strep (GBS), herpes simplex virus (HSV), Staphylococcus (staph) infections, and E coli. Sepsis is an infection in the baby’s blood stream often caused by GBS and chorioamnionitis, and it can cause meningitis, which is infection of the brain / central nervous system.
Oligohydramnios. This is a condition in which the mother has low amniotic fluid. Oligohydramnios puts the baby at a significant risk of having a prolapsed or compressed umbilical cord. Oligohydramnios can also lead to meconium aspiration, which is when the baby inhales a mixture of amniotic fluid and stool into her lungs. This can cause respiratory distress and oxygenation problems.
Premature rupture of the membranes (PROM) / premature birth. PROM occurs when the water breaks before the mother goes into labor. PROM can cause umbilical cord compression, premature birth and being born before the lungs are fully developed, which can cause a lack of oxygen to the baby’s brain. PROM also increases the risk of the baby getting an infection, which can lead to sepsis and meningitis.
Prolonged and arrested labor. Contractions during labor are traumatic for the baby, and when labor is prolonged, there can be a lack of oxygen to the baby’s brain that gets progressively worse, especially if Pitocin or Cytotec are used.
Placenta previa. This is when the placenta grows close to the opening of the uterus, which can partially or completely block the mother’s cervix, which is the opening to the birth canal. If the placenta remains close to or completely covers the cervix later in pregnancy, delivery by C-section is generally required because cervical opening and uterine activity during vaginal delivery can cause severe bleeding in the mother and even the baby.
Anesthesia mistakes. Labor and delivery anesthesia mistakes can cause blood pressure problems and a hypotensive crisis in the mother. When a mother’s blood pressure drops too low, there will be a decreased supply of oxygen-rich blood going to the baby.
Fetal stroke. This is when blood vessels in the baby’s brain become blocked or restricted. Forceps and vacuum extractors can cause the baby to have a stroke, which can cause severe oxygen deprivation. Hypoxic ischemic encephalopathy (HIE) and stroke often occur together.
Preeclampsia / eclampsia. This is when the mother has high blood pressure diagnosed during pregnancy. When this occurs, there can be decreased flow of blood to the baby. There are a number of ways high blood pressure can cause this. One way is that the high blood pressure and factors associated with it cause damage to or constriction of the vessels in the placenta.
Preeclampsia also increases the risk of placental abruption. In addition, preeclampsia – or any long-term pregnancy condition that can cause a baby to be deprived of oxygen – predisposes a baby to hypoxia during the stresses of labor.
Abnormal presentations. When a baby is not in the normal, head first position at the time of delivery, she is at risk of suffering head trauma, brain bleeds and umbilical cord problems if the physician attempts vaginal delivery. Breech presentation, transverse lie position and face presentation are some of the abnormal positions that increase a baby’s risk of suffering bleeds and cord problems.
Many times, children with cerebral palsy are diagnosed with other conditions before a diagnosis of cerebral palsy is made. Conditions that are often a precursor to cerebral palsy include the following:
- Hypoxic ischemic encephalopathy (HIE)
- Intracranial and extracranial hemorrhages (brain bleeds)
- Intraventricular hemorrhages
- Periventricular leukomalacia (PVL)
WHAT ARE THE TREATMENTS FOR SPASTIC CEREBRAL PALSY?
As discussed, it is very important to have regular therapy in order to prevent the many problems caused by spastic cerebral palsy, such as contractures, that can get progressively worse.
Physical therapy (PT) is one of the most important treatments, and there are numerous types of PT that can be given to a child. Physical therapy can involve water therapy, electrical stimulation of weakened muscles, and taping of certain muscle groups to help reeducate muscles. Of course, all types of physical therapy must be used in conjunction with range of motion and stretching exercises.
Physical therapy is aimed at promoting motor and developmental skills. Daily range of motion exercises are important to prevent or delay contractures and to maintain the mobility of joints and soft tissues. Stretching exercises are performed to increase range of motion. Progressive resistance exercises should be taught in order to increase strength. The use of age-appropriate play and of adaptive toys and games based on the desired exercises are important in order to make the therapy fun. Strengthening knee extensor muscles helps to improve crouching and stride length. Postural and motor control training is important and should follow the developmental sequence of normal children.
Occupational therapy focuses on daily life activities, such as feeding, dressing, toileting, grooming, and transfers. The goal should be for the child to function as independently as possible with or without the use of adaptive equipment.
Children who can follow directions and have spasticity of certain muscles in the wrist, forearm, or muscles that control the thumb may benefit from intensive therapy. Activity-based interventions such as modified constraint-induced movement therapy (mCIMT) and bimanual intensive rehabilitation training (IRP) can improve the child’s ability to use the impaired upper limb(s) and improve performance in personal care.
Some children with spastic cerebral palsy have involvement of the face and upper airway, causing drooling and difficulty swallowing and speaking. Speech therapy can be used to help improve swallowing and communication. Some children benefit from assistive communication devices if they have enough motor control and adequate cognitive skills.
Many children with spastic cerebral palsy have seizures. Treatment is based on the type and frequency of the seizures. Complete seizure control can often be achieved using one medication, but some children have particularly difficult to control seizures. Medication can have side effects ranging from sedation to hyperactivity. The drugs can also affect liver function and white and red blood cells, and it is not uncommon to have bone problems. Side effects are usually not harmful and resolve when the offending medication is discontinued. The goal of the physician should be for the child to become seizure free with few or no side effects.
Numerous medications can be used to decrease spasticity, facilitate movement, and prevent contractures. Among the most common medications are dantrolene sodium (Dantrium) and diazepam (Valium). Diazepam is both a muscle relaxant and a sedative. Baclofen (Lioresal) can be taken by mouth or infused continuously with an implanted pump directly in the cerebrospinal fluid (the liquid that bathes the spinal cord and the brain). Baclofen is a muscle relaxant and it is especially useful for children with spasticity in the lower legs. A muscle relaxing agent called botulinum toxin (Botox) can be injected into tight muscles to relax them. When used prudently, this procedure may prevent surgical intervention.
Selective Dorsal Rhizotomy (SDR)
Selective dorsal rhizotomy (SDR) is surgery that is performed on the lower spinal cord to reduce spasticity in the legs. During the surgery, abnormal nerve fibers are cut. The goal of SDR is to relax the muscles by identifying and cutting only those nerve fibers that contribute to spasticity. When it is followed by months of rehabilitation, SDR can improve the child’s ability to move and control her muscles. This provides long-term improvement in muscle tone because the nerves do not grow back together. SDR may reduce the need for future orthopedic surgeries.
Tendon Release Procedures
Tendon release surgery allows improved range of motion in some cases. The surgery is usually performed on the muscles of the calf or inner thigh.
Tendon release is a procedure to cut through or disconnect a tendon. The surgery normally involves cutting the tendon and allowing it to retract towards the junction of the muscle and tendon. The purpose of tendon release is to identify and surgically remove the area producing symptoms, while protecting the normal surrounding tissues and their attachments.
Tendon release is commonly done to relieve tightened or shortened muscles (contractures), allow relaxation of joints, and decrease irritation caused by friction. Sometimes the tendon is re-routed to maintain muscle function.
A femoral osteotomy (also called varus osteotomy, varus derotational osteotomy and hip osteotomy) is a surgical correction done on many children with subluxation (the ball of the hip slowly pulls out of its position in the socket) and dislocation (the ball is completely out of the socket) of the hips due to cerebral palsy. The thighbone (femur) is typically cut just below the hip joint and redirected back into place. Most all varus osteotomy procedures involve implanting a plate and pins to hold and fix the osteotomy. Usually, children are placed in spica casts for 4-8 weeks after surgery. A splint or brace may then be used for several months after the surgery. Bracing and therapy schedules must be adhered to. The expectation is that walking will be improved, and for children that are unable to walk, sitting will be improved.
Hip Surgery: Osteotomy
The main factor in hip problems is the muscle imbalance caused by spasticity. Specifically, tight adductor muscles pull the femur, improperly producing a rotation of the hip. This causes the ball of the hip to move slowly out of the socket. Walking actually helps the femur sit properly, which is why children who do not walk are at a high risk of having hip problems.
Hip subluxation / dislocation can be prevented or delayed with early and aggressive treatment. By the time a child is 2 years of age, there is a need to begin close examination of the hips. The dislocation is gradual, so the hips should be x-rayed and assessed by an orthopedic surgeon every six months.
If a child’s hips appear to be dislocating – even a small amount – hip muscle release surgery can be performed. These muscle and tendon releases can prevent the hip from dislocating. Muscle releases are also done along with the osteotomy if one hasn’t been previously done.
Hip Surgery: Hip Muscle Releases
The adductors are muscles that pull on the bones and bring them closer to the middle of the body. They are located on the inside of the thighs. When adductors are too tight, they make the legs scissor, which can pull the ball of the hip out of the socket. Muscle releases are an attempt to prevent the hips from dislocating. In a child who is able to walk, this might be done because the feet cross while walking, which often occurs when a child has spastic cerebral palsy. This is called a scissor gait.
In hip muscle release surgery, selected muscles of the groin are cut and allowed to retract. The muscles chosen to be cut depend on the exact problems the child is having, the extent of the spasticity, and if the child can walk or not. Some surgeons transfer the heads of some muscle groups more toward the rear of the body to help extend the hip.
The hamstrings can be lengthened or cut at the same time as the other muscles are cut. The hamstrings are the large muscle group located on the backside of the thigh. The two groups of muscles, one on the inside and one on the outside of the thigh, can become tight and contracted. Children who sit in a wheelchair all of the time are at risk for developing these contractures. When contractures occur, the child’s legs may be so tight she will not be able to lie down flat. These tight muscles can contribute to hip subluxation, hunched posture and poor positioning. Contractures can also lead to serious spinal problems.
MICHIGAN CEREBRAL PALSY LAWYERS HELPING CHILDREN THROUGHOUT THE NATION FOR ALMOST 3 DECADES
If you are seeking the help of a cerebral palsy lawyer, it is very important to choose a lawyer and firm that focus solely on birth injury cases. Reiter & Walsh ABC Law Centers is a national birth injury law firm that has been helping children for almost 3 decades.
Attorney Jesse Reiter, president of ABC Law Centers, has been focusing solely on birth injury cases for over 28 years, and most of his cases involve hypoxic ischemic encephalopathy (HIE) and cerebral palsy. Jesse is currently recognized as one of the best medical malpractice lawyers in America by U.S. News and World Report 2015, which also recognized ABC Law Centers as one of the best medical malpractice law firms in the nation. The lawyers at ABC Law Centers have won numerous awards for their advocacy of children and are members of the Birth Trauma Litigation Group (BTLG) and the Michigan Association for Justice (MAJ).
If your child was diagnosed with a birth injury, such as cerebral palsy, a seizure disorder or hypoxic ischemic encephalopathy (HIE), the award-winning cerebral palsy lawyers at ABC Law Centers can help. We have helped children throughout the country obtain compensation for lifelong treatment, therapy and a secure future, and we give personal attention to each child and family we represent. Our nationally recognized birth injury law firm has 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 Reiter & Walsh ABC Law Centers at 888-419-2229 for a free case evaluation. Our firm’s award-winning Michigan cerebral palsy lawyers are available 24 / 7 to speak with you.