What Does It Mean if the Doctor Says My Baby Has a Motor Disorder?
Motor Disorder Attorneys Serving Michigan, Ohio, D.C. & All 50 States
Motor disorders are disorders of the nervous system that cause abnormal and involuntary movements. These disorders are caused by damage to the motor system, often the basal ganglia. Cerebral palsy (CP) is an example of a motor disorder, and spastic cerebral palsy is by far the most common type of CP. Often, birth injuries, which are injuries that occur during, or near the time of delivery, are the cause of the brain damage that causes cerebral palsy and other motor disorders.
- What is a motor disorder?
- How do birth injuries cause motor disorders?
- What complications cause birth injuries?
- What treatments are available for birth injuries?
- How can I get legal help for a birth injury?
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 injured and the extent of the damage. Children with motor disorders experience an abnormal flow of message transmission from the brain to the nerves to the muscles. This can cause involuntary muscle movement as well as an inability to control voluntary muscle movement, which can make the child struggle with movement and balance. Sometimes physicians simply diagnose the child as having a movement disorder. When the child gets older, a more specific diagnosis is usually made.
Listed below are common motor disorders and what they mean for the child.
Spastic cerebral palsy. This occurs when injuries damage parts of the motor pathway that control voluntary movement. When a child has spastic CP, the muscles receive improper nerve signals and contract when they aren’t supposed to. The muscles become tense and short when they should be relaxed an unflexed. This prevents coordinated movement. Children can have stiff, jerky movements stemming from the really high muscle tone, which is called hypertonia. Spasticity may not be present at all times. It can be brought on when the child moves really quickly or receives certain stimulation.
Dyskinesia, or dyskinetic cerebral palsy. Also called athetoid cerebral palsy, children with this type of movement disorder have mixed muscle tone. This means they have both hypertonia (tight, stiff muscles) and hypotonia (limp muscles), which can make it very difficult for a child to simply hold herself in an upright, steady position for sitting and walking. In addition, these children usually have a lot of involuntary movements. For some kids with dyskinetic cerebral palsy, it takes a lot of work just to get their hand to a certain point, such as when reaching for a cup. These children may also have difficulty holding onto objects, especially really small ones, such as a toothbrush or pencil.
High bilirubin levels, which cause jaundice, can cause dyskinetic cerebral palsy. This occurs when the medical team fails to treat excessive bilirubin levels and the bilirubin enters the brain (basal ganglia). Bilirubin is toxic to brain tissue and can cause a form or brain damage called kernicterus.
Ataxia, or ataxic cerebral palsy. Ataxia is caused by damage to the cerebellum and it causes a lack of coordination, often causing the child to have jerky movements. Children with ataxia often have difficulty writing, typing, and using scissors. Since balance is affected, many children with ataxic cerebral palsy have trouble walking. It also is common for these kids to have vision and hearing problems.
Dystonia. Dystonia causes a child’s muscles to contract involuntarily, causing uncontrollable repetitive or twisting movements of the affected body part. The child’s symptoms may be mild, moderate or severe and may interfere with the child’s ability to perform everyday tasks.
Physicians divide dystonia into categories such as generalized, focal and segmental. In focal dystonia, one part of the child’s body is affected. Generalized dystonia affects most or all of the body. In segmental dystonia, two or more adjacent areas of the body are affected.
The impact of dystonia on a child’s quality of life varies depending on the part of the body affected, the type of dystonia, and the severity of the muscle contractions. Areas of the body affected may include:
- Hand and forearm. Some forms of dystonia only occur when the child is conducting a repetitive activity.
- Face, head and neck. In craniofacial dystonia, the child’s face, head or neck muscles are affected by contractions. Oromandibular dystonia affects the jaw movement or tongue and may cause slurred speech or problems swallowing.
- Eyelids. Rapid blinking or involuntary spasms causing the child’s eyes to close can make the child unable to see.
- Neck. When a child has cervical dystonia, contractions cause her head to twist and turn to one side, or pull forward or backward, which can be painful.
- Vocal cords. Certain types of dystonia impact muscles that control vocal cords, causing a tight or whispering voice.
What are Birth Injuries and How Do They Cause Motor Disorders?
In order to understand birth injuries, it is important to have an understanding of how the baby receives oxygen in the womb. In the womb, the baby’s oxygen comes from oxygen-rich blood she receives from her mother. This blood travels from the mother, through vessels in the womb and placenta (called the uteroplacental circulation), through a vein in the umbilical cord, and then into the baby’s circulatory system.
Transport of oxygenated blood to the baby follows this order: mother’s circulatory system –> womb (uterus) –> placenta –> umbilical cord –> baby. Thus, if there are problems in any part of this chain, the baby can be deprived of sufficient oxygen, which can cause brain damage due to a lack of oxygen getting to brain cells. Common problems that cause birth injuries are complications that affect the womb, placenta or umbilical cord. If the uterus ruptures, the mother could lose so much blood from hemorrhaging, and the vessels that carry blood to the placenta can be so damaged, that only a very small amount of oxygen-rich blood travels to the baby. A placental abruption can cause the baby to be deprived of oxygen to varying degrees. If the placenta separates at the point in where the umbilical cord is attached, the baby could be completely cut off from her supply of oxygen. Similarly, if the umbilical cord becomes compressed or impinged upon, which can occur in umbilical cord prolapse or when the cord is wrapped around the baby’s neck, the baby can be deprived of some or even all of the oxygen-rich blood traveling to her from the mother.
In short, damage to or complications with the womb, placenta or umbilical cord can cause the baby to be severely deprived of oxygen. These complications sound scary since we cannot see the fetus and these very important structures. However, modern technology allows the medical team to detect oxygen deprivation caused by problems with the umbilical cord, placenta or womb. The oxygen deprivation manifests as fetal distress on the fetal heart rate monitor. If the baby’s heart rate is very closely monitored during labor and delivery, physicians can quickly deliver her at the first signs of distress in order to prevent her from experiencing a lack of oxygen to her brain, brain damage, and birth injuries, such as hypoxic ischemic encephalopathy (HIE) and cerebral palsy.
The key to a safe labor and delivery is the ability to closely and skillfully monitor a baby’s heart rate and promptly deliver the baby if a non-reassuring heart rate (fetal distress) occurs. In fact, it is against the standard of care for a hospital to hold itself out as a labor and delivery unit and then fail to have the capacity to quickly deliver the baby by emergency C-section if she gets in trouble.
In addition to labor and delivery fetal heart monitoring technology, ultrasounds that are performed during prenatal visits allow the physician to detect umbilical cord, placenta and uterus problems so that close monitoring and a C-section can take place if the condition warrants prompt delivery. Babies are also given extensive tests during prenatal visits that examine the baby’s heart rate in different scenarios.
Brain bleeds and hemorrhages can also cause damage to the motor system of the brain. Conditions that increase a baby’s risk of experiencing a brain bleed during delivery include use of forceps and vacuum extractors, the labor induction drugs Pitocin and Cytotec, abnormal fetal positions such as breech and face presentation, cephalopelvic disproportion (CPD), macrosomia and shoulder dystocia.
Birth injuries caused by a lack of oxygen to the brain and / or brain bleeds include the following:
- Hypoxic ischemic encephalopathy (HIE)
- Cerebral palsy
- Seizure disorders / epilepsy
- Intellectual disabilities and developmental delays
- Periventricular leukomalacia (PVL)
These birth injuries are all associated with motor disorders, and cerebral palsy is an actual motor disorder.
What are the Complications that Can Cause a Birth Injury?
Listed below are some complications that can occur during or near the time of delivery. If these complications are mismanaged by the medical team, the child can have permanent brain damage and resultant motor problems, cerebral palsy, seizure disorders and intellectual disabilities.
Complications that can cause a birth injury include:
- Placental abruption
- Ruptured uterus (womb)
- Preeclampsia / eclampsia
- Placenta previa
- Umbilical cord problems, such as a nuchal cord (cord wrapped around the baby’s neck), umbilical cord prolapse, short umbilical cord, and cord in a true knot
- Failure to quickly deliver a baby when fetal distress is evident on the fetal heart rate monitor (delayed emergency C-section)
- Oligohydramnios (low amniotic fluid)
- Premature rupture of the membranes (PROM) / premature birth
- Prolonged and arrested labor
- Intracranial hemorrhages (brain bleeds), which can be caused by a traumatic delivery. Forceps and vacuum extractors can cause brain bleeds. Sometimes intense contractions (hyperstimulation) caused by labor induction drugs (Pitocin and Cytotec) can cause head trauma. Mismanagement of cephalopelvic disproportion (CPD), abnormal presentations (face or breech presentation), and shoulder dystocia also put a child at risk of having a brain bleed.
- Hyperstimulation caused by Pitocin and Cytotec can also cause oxygen deprivation that gets progressively worse.
- Fetal stroke
- Improper management of anemia (low red blood cell count), which can cause the baby to lack the capacity to carry oxygen to the cells and tissues in the body, including brain cells.
- Brain infection such as meningitis, which can be caused by infections in the mother that travel to the baby at birth. These maternal infections include the following: Group B Strep (GBS), herpes simplex virus (HSV), urinary tract infection (UTI), bacterial vaginosis (BV) and chorioamnionitis.
- Untreated or improperly treated high bilirubin levels (jaundice) that cause a form of brain damage called kernicterus.
- Anesthesia mistakes during delivery, which can cause blood pressure problems in the mother, including a hypotensive crisis.
What are the Treatments for Motor Disorders?
Treatment for motor disorders involves a team of healthcare professionals. Children with motor disorders need aggressive and consistent physical therapy and occupational therapy so they can perform everyday activities and be as independent as possible. These children also usually need speech therapy and recreational therapy, and some children need surgery to help make their muscles more functional. Many children with motor disorders also have seizures, so seizure treatment is often needed as well.
Listed below are some of the common treatments and therapies for motor disorders.
The main goal of physical therapy is to promote motor and developmental skills. Daily range-of-motion (ROM) exercises are important to prevent or delay contractures (permanent shortening of muscles) that are caused by spasticity and to maintain the mobility of joints and soft tissues. Stretching exercises are performed to increase ROM. Progressive resistance exercises should be taught in order to increase strength. The use of play and adaptive toys based on the desired exercises are important in order to make the therapy fun and get the child’s full cooperation. Strengthening knee extensor muscles helps to improve crouching ability and stride length. Postural and motor control training is crucial and should follow the normal developmental sequence of children; head and neck control should be achieved, if possible, before advancing to lower body control.
Children and their parents often enjoy hippotherapy (horseback-riding therapy) to help improve the child’s muscle tone, ROM, strength, coordination, and balance. Hippotherapy offers many social, cognitive, physical, and emotional benefits.
Physical therapy is crucial when a child has had surgery to help correct spasticity; it helps the child obtain maximum benefit from surgery.
Occupational therapy should focus on daily activities, such as feeding, dressing, toileting, grooming, and transfers. Occupational therapy also focuses on the upper body. 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. One study found that more benefits were seen from intensive treatment than in the standard treatment; in mCIMT, grasp improved, and, in IRP, spontaneous use in bimanual play and activities of daily living in younger children increased.
Some children with motor disorders 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 some motor control and adequate cognitive skills.
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.
If the child with has seizures, the treatment is based on the type and frequency of the seizures. Complete seizure control can often be achieved using a single medication, but some children with cerebral palsy and other motor problems have particularly difficult-to-control seizures. Medication can have side effects affecting the brain, ranging from sedation to hyperactivity. 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. It is of no benefit to the child to be seizure-free but significantly impaired by medication side effects.
Spasticity treatment should involve multiple health professionals. Treatments include the use of medications and surgical procedures to decrease spasticity, facilitate movement, and prevent contractions. Among the most common medications are dantrolene sodium and diazepam. Diazepam is both a muscle relaxant and a sedative. Baclofen, a muscle relaxant, can be taken by mouth or infused continuously with an implanted pump directly in the cerebrospinal fluid. This treatment might be specifically useful for children with spasticity in the lower legs. Botox can be injected into tight muscles to relax them.
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 that cause high muscle tone are cut. The goal of SDR is to relax the muscles by identifying and cutting only those nerve fibers that contribute to spasticity. This provides long-term improvement in muscle tone because the abnormal nervers – the ones that were cut – do not grow back together. When it is followed by months of rehabilitation, SDR can improve the child’s ability to move and control her muscles.
In this procedure, physicians place a pump about the size of a hockey puck in the child’s abdomen. The pump continuously delivers baclofen into the fluid surrounding the spine. Baclofen is a muscle relaxant that reduces spasticity throughout the child’s body. Since the medicine goes directly into the nervous system, the dose of baclofen the child gets through the pump can be much lower than doses delivered through the mouth. This helps avoid the side effects of higher doses, which include sleepiness and sedation.
During surgery, the pump is placed under the skin of the child’s abdomen. Once the pump is in place, the physician attaches a catheter to it. Then the physician threads the catheter under the skin at waist level to the child’s spine. The catheter is inserted into the spinal canal.
Next, the physician fills the pump with baclofen and sets it to deliver the exact amount of medicine the child needs. The pump begins slowly releasing the medicine through the tube and into the spinal canal.
Tendon Release Procedures
In some cases, tendon release surgery allows improved range of motion. 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, allow relaxation of joints, and decrease irritation caused by friction. Sometimes the tendon is re-routed to maintain muscle function.
Birth Injury and Motor Disorder Attorneys Helping Children for Almost Three Decades
Jesse Reiter, award-winning partner at ABC Law Centers, is the only attorney in Michigan who has spent his entire year career (beginning in 1987) focusing on birth injury cases (especially hypoxic ischemic encephalopathy and cerebral palsy). When the ABC Law Centers 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 one of the best medical malpractice law firms in the countr, according to U.S. News and World Report 2014.
Birth injury cases are difficult to pursue due to the complex nature of the medical records. The award winning lawyers at ABC Law Centers have decades of experience with these complex cases. Our firm is unique in its use of in-house medical staff. We handle cases in Michigan, Ohio, Washington, D.C. and throughout the nation. 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 attorneys are available to speak with you 24 / 7.\
Video: Motor Disorder Attorneys Discuss Birth Asphyxia
Watch a video of birth injury attorneys Jesse Reiter & Rebecca Walsh discussing how birth asphyxia can cause brain damage and motor disorders in a child.
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