What Does It Mean if the Doctor Says My Baby Has a Motor Disorder?
People with motor disorders have unusual or involuntary movements, which result from brain damage or abnormalities. In young children, the most common motor disorder is cerebral palsy, also known as CP (1). Cerebral palsy can be caused by both environmental and genetic factors. In most cases, cerebral palsy stems from a birth injury, i.e. a medical complication or error that occurs around the time of birth and causes neonatal brain damage. If medical professionals fail to do all they can to prevent a birth injury, and this causes cerebral palsy or another permanent disability, they have committed an act of medical malpractice.
What is a motor disorder?
Different parts of the brain control different functions pertaining to motor tasks (movement). The type of motor disorder a child has depends upon the area of the brain affected and the extent of the damage. Some damages are not apparent until the child develops more. Sometimes, physicians simply diagnose the child with a motor disorder. When the child gets older, a more specific diagnosis is usually made.
How does cerebral palsy affect children?
Cerebral palsy can manifest in a multitude of ways. The severity of motor impairment can range from mild effects on one body part (such as a limb) to requiring the use of assistive technology and extensive help with daily tasks. While cerebral palsy is defined as a motor disorder, the underlying neural abnormalities sometimes result in associated conditions such as intellectual and developmental disabilities (I/DDs), visual deficits, and hearing loss. Treatments for cerebral palsy and other motor conditions vary depending on how an individual is affected (2).
Listed below are the subtypes of cerebral palsy and their defining characteristics.
- Spastic cerebral palsy. Children with spastic CP have hypertonia, or excessive muscle tone. They experience spastic reflexes (i.e. muscles contract when they aren’t supposed to), and can have difficultly with coordinated movements. They may also be at higher risk of joint deformities, scoliosis, hip dislocations, and other secondary complications (2).
- Athetoid/dyskinetic cerebral palsy. Athetoid/dyskinetic cerebral palsy, or ADCP, may involve both hypertonia (tight, stiff muscles) and hypotonia (limp muscles). Muscle tone can change frequently and may be influenced by movements or shifts in the child’s emotional state. Children with ADCP may struggle with tasks such as sitting upright, manipulating objects, walking, eating, and speaking (3).
- Ataxic cerebral palsy. Ataxic cerebral palsy is sometimes confused with the rare neurodegenerative disorder Ataxia. However, like other forms of CP, it is non-progressive, meaning that the underlying brain damage does not worsen over time. Children with ataxic cerebral palsy have damage to the cerebellum, and may have difficulty with coordination, gait, balance, and fine motor control. Movements may be jerky or repetitive. It is also common for children with ataxic CP to have vision and hearing problems (4).
- Mixed cerebral palsy. If a child’s symptoms fit into multiple types of CP, they may be said to have “mixed cerebral palsy” (2).
What are birth injuries and how do they cause motor disorders?
The term ‘birth injury’ refers to complications that occur during or near the time of birth. Motor disorders can be caused by traumatic birth injuries (i.e. excessive force on a baby’s body during the process of labor and delivery), as well as oxygen deprivation that results in a form of brain damage known as hypoxic-ischemic encephalopathy (HIE). HIE can be caused by any interruption to the physiological pathway that delivers maternal oxygen to the baby (this involves the mother’s circulatory system, uterus, placenta, and umbilical cord) (5).
The following are just a few examples of birth injuries that can cause brain trauma and/or HIE, and ultimately result in motor disorders (2). Please note that although we focus on how these problems may affect the baby, many of these birth injuries can also endanger the mother’s health:
- Abnormal fetal position/presentation
- Birth asphyxia/hypoxic-ischemic encephalopathy (HIE)
- Birth trauma
- Brain bleeds (intracranial hemorrhages)
- C-section errors and delays/failure to timely deliver
- Forceps and vacuum extractor injuries
- Low birth weight
- Maternal infections
- Meconium aspiration syndrome (MAS)
- Mismanaged fetal distress (or failure to provide proper fetal monitoring)
- Mismanaged high-risk pregnancy (or failure to diagnose a high-risk pregnancy)
- Periventricular leukomalacia (PVL)
- Placental abruption
- Premature birth
- Prolonged and arrested labor
- Twin or multiples pregnancy
- Umbilical cord problems
- Uterine tachysystole/hyperstimulation
- Uterine rupture
For a longer list of complications that can cause cerebral palsy and other motor disorders, please click here.
Are motor disorders preventable?
Motor disorders that stem from birth injuries are preventable. Prenatal care physicians and obstetricians should always be vigilant for potential complications, especially in women with high-risk pregnancies. For example, they should use a fetal heart rate monitor to check for signs of fetal distress. These are indications that a baby is being deprived of oxygen and may require immediate attention. If a baby is exhibiting signs of fetal distress or there are other reasons to believe they are in danger (for example, an abnormal fetal presentation), physicians should intervene. Some interventions are simple, such as repositioning the mother. However, in certain cases, an emergency C-section may be warranted. In some cases, physicians may attempt interventions such as an assisted delivery (use of forceps or vacuum extractors) or drug-enhanced labor when there is reason to believe these actions are dangerous.
If a baby is born with a birth injury, there may still be time to prevent permanent harm. One especially important treatment to be aware of is therapeutic hypothermia for babies with HIE. This should ideally be administered within six hours of the oxygen-depriving incident, which often means within six hours of birth (6).
Providing insufficient prenatal care, failing to monitor for signs of fetal distress, postponing necessary interventions such as emergency C-sections, and neglecting to provide therapeutic hypothermia are all forms of negligence. If these actions cause harm, it constitutes medical malpractice.
How can motor disorders be treated?
Treatment for motor disorders often involves a combination of therapies, medications, and surgeries. The following are some common examples of treatments for motor disorders.
Physical therapy for motor disorders
The main goal of physical therapy, or PT, is to promote motor and developmental skills. Physical therapy for children with cerebral palsy and other motor disorders can improve strength, balance, flexibility, and much more. It can maximize the child’s abilities and minimize negative symptoms such as pain.
Occupational therapy for motor disorders
Occupational therapy focuses on developing the skills needed for daily living, 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 assistive technology.
Speech therapy for motor disorders
Some children with motor disorders have issues with speaking and communication. This may result from dysarthria (difficulty speaking due to muscle weakness) and/or apraxia (difficulty speaking because signals from the brain are not properly transmitted to the necessary muscles) (7). Speech therapy can be used to help improve not only speaking, but also swallowing and drooling problems. Additionally, some children benefit from augmentative and alternative communication (AAC) devices.
Recreational therapy for motor disorders
Incorporation of play into a child’s treatment program is important. The child should view physical and occupational therapy as fun, not work. Caregivers should seek fun and creative ways to stimulate children, especially those who have a decreased ability to explore their own environment.
Medications for motor disorders
There are many different types of medications that can be used to treat motor disorders. Some of the most common include:
- Anticholinergic medications: These drugs can help to decrease involuntary muscle movements and excessive drooling.
- Anticonvulsant medications: Many people with motor disorders also have seizure disorders. Anticonvulsants can inhibit seizure activity.
- Antidepressants: The physical and/or cognitive limitations imposed on people with motor disorders often lead to feelings of frustration and sometimes more serious mental health concerns such as depression. In certain cases, antidepressants may be a necessary complement to therapy and other measures to promote mental and emotional wellbeing.
- Anti-inflammatory medications: Anti-inflammatories can be used to manage pain symptoms in people with motor disorders.
- Muscle relaxants: These can treat spasticity, increase range of motion, and inhibit excessive muscle contractions. Two very important muscle relaxants are botox and baclofen. Botox is injected by a medical professional and can be effective for several months before an additional injection is needed. Baclofen (Lioresal) can be taken orally, transdermally, or through an intrathecal baclofen pump.
Surgeries for motor disorders
Although motor impairments like cerebral palsy are not curable, there are many surgeries that can improve health and quality of life. It is important to note that some of these surgeries require extensive post-operative rehabilitation and care in order for the patient to reap the benefits of the procedure itself. Therefore, surgical intervention should be considered a complement to, rather than a replacement for, other forms of treatment and therapy.
Some types of surgery that may benefit people with motor disorders include the following:
- Insertion of intrathecal baclofen pump: Please see “medications.”
- Gastroenterology surgery: Some people with motor disorders struggle with chewing, swallowing, or digesting food. In certain cases, gastroenterologic surgery may be necessary to alleviate these issues.
- Neurosurgery: There are certain procedures that can improve the symptoms of motor disorders by addressing the root neurological problems. These surgeries involve modifying connections in the nervous system. One example is selective dorsal rhizotomy (SDR), which is a surgery that may help people with spastic cerebral palsy.
- Orthopedic surgery: Orthopedic surgeries can help to improve musculoskeletal abnormalities. For example, some children need muscle release procedures in order to treat hip subluxation.
- Pulmonary surgery: Pulmonary surgeries can improve issues with breathing, swallowing, and/or drooling.
Birth injury attorneys helping children with motor disorders
In some cases, birth injuries and motor impairments occur as a result of medical malpractice. Parents of children affected by malpractice may choose to pursue justice through a birth injury lawsuit.
The award-winning attorneys at ABC Law Centers (Reiter & Walsh, P.C.) focus exclusively on birth injury law, and have an in-house medical team that provides valuable insight into these cases. Contact us today to begin your free case review. In fact, you pay nothing throughout the entire legal process unless we win your case. You can reach out to us in any of the following ways:
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- Cerebral Palsy (CP). (2018, March 09). Retrieved September 11, 2019, from https://www.cdc.gov/ncbddd/cp/data.html
- Cerebral Palsy (CP). nd. Retrieved September 11, 2019, from https://www.abclawcenters.com/practice-areas/types-of-birth-injuries/cerebral-palsy/
- Athetoid/Dyskinetic Cerebral Palsy. nd. Retrieved September 11, 2019, from https://www.abclawcenters.com/cerebral-palsy/cerebral-palsy-overview/athetoid-dyskinetic-cerebral-palsy/
- Ataxic Cerebral Palsy. nd. Retrieved September 11, 2019, from https://www.abclawcenters.com/cerebral-palsy/cerebral-palsy-overview/ataxic-cerebral-palsy/
- How Do Babies Breathe in the Womb, and How Do They Become Oxygen-Deprived? nd. Retrieved September 11, 2019, from https://www.abclawcenters.com/frequently-asked-questions/how-do-babies-breathe-in-the-womb-and-how-can-fetuses-be-deprived-of-oxygen/
- Therapeutic Hypothermia for Babies with Hypoxic-Ischemic Encephalopathy (HIE). nd. Retrieved September 11, 2019, from https://www.abclawcenters.com/practice-areas/treatments-and-therapies-for-birth-injuries/hypothermia-cooling/
- (n.d.). Dysarthria. Retrieved from https://www.asha.org/public/speech/disorders/dysarthria/