What is cerebral palsy?
The name “cerebral palsy” (CP) is actually an umbrella term that covers a group of disorders that primarily affect the ability of movement, muscle tone, and coordination. The condition is typically caused by damage to the brain, usually in the developmental stage and most often before birth.
Most persons who have CP are born with the condition, which means they have “congenital CP.” However, as we’ll discuss later, CP can begin after the birth process, leading to “acquired CP.”
How many people have cerebral palsy?
The Centers for Disease Control and Prevention (CDC) confirm that about 10,000 babies born in the U.S. will develop CP each year.
It’s also estimated by the CDC that more than 760,000 children and adults in the U.S. will develop one or more symptoms of CP. (See the symptoms section below.)
Globally, just over 17 million people have CP.
What causes cerebral palsy?
CP is triggered by a disruption in the development of the brain, usually before the child is born or during the birthing process itself.
Conditions that can lead to the development of CP include, but are not limited to:
- Severe lack of oxygen to the brain
- Fetal stroke while still in the womb, sometimes caused by weak blood vessels in the fetus’s brain or blood clotting – either in the placenta or in the fetus’s body
- Infections or fevers experienced by the mother during the pregnancy
- Genetic abnormalities
- Abnormal development of the brain
- Incompatible blood type between mother and fetus
- Jaundice (if left untreated, can damage brain cells)
- Complicated labor and birth
- Mother’s exposure to toxic substances
Lack of oxygen to the fetal brain can be caused by a number of issues, including:
- Mismanagement of the vital signs of the mother and infant
- Delayed delivery or failure to perform a cesarean section delivery
- Complications with the umbilical cord or the infant’s size or position
How is cerebral palsy diagnosed?
Because we’re all individuals, signs or symptoms of CP will vary from person to person.
The most obvious tip-off that a child may have a form of CP is a delay is reaching certain milestones related to movement, including rolling over, sitting, standing or walking.
Generally speaking, these milestones include being able to:
- Roll over at about the 6-month mark
- Sit without support after 9 months
- Walk when he/she is 12 months
For a child younger than 6 months, potential signs of CP include:
- Feeling stiff
- When cradled, the child overextends the back and neck as of pushing away
- When picked up, the child’s legs become stiff and cross
For a child older than 6 months, signs include:
- Not being able to roll in either direction
- An inability to bring hands together
- Difficulty in bringing things to his/her mouth
- Reaching out with one hand while the other remains in a fist
For a child older than 10 months, CP indicators include:
- Crawling in a lopsided way
- Scooting around on buttocks or even hopping on knees but not crawling on all fours
In addition to recognizing these signs, tests that can confirm a CP diagnosis include magnetic resonance imaging (MRI), a cranial ultrasound, which can be performed during infancy, and an electroencephalogram (EEG).
What are the specific types of cerebral palsy?
The most common form – affecting about 80% of cerebral palsy patients – reveals itself through increased muscle tone and reflexes or movements that may appear to be awkward or stiff.
The spastic cerebral palsy type is further broken down into these subtypes:
- Spastic hemiplegia
The muscles on one side of the body are in a continuous state of contraction
- Spastic diplegia
Restricts movement in the lower extremities of the body
- Spastic quadriplegia
Affects the entire body, including both arms and legs, and causes uncontrollable shaking and fluid buildup
Unlike persons with spastic CP, those with non-spastic CP actually have muscle tone that is weakened and unstable. Hallmarks of this form of CP include slow movements that can look as if the person is writhing. Speech, facial and tongue movements can be especially difficult.
The non-spastic form of CP is also divided into subtypes:
- Dyskinetic (includes athetosis, dystonia, and chorea)
Usually affecting hands, arms, legs and feet, the movement appears to be jerky and slow.
The least common form of CP, ataxia affects the person’s coordination. Their gait will be wider than normal and their walk may appear unsteady.
It’s not unusual for some persons to have a combination of the various types of CP. Common symptoms include:
- Stiff muscles combined with involuntary movements
- Facial grimaces
- Difficulty speaking and swallowing
- Vision problems
How is the severity of cerebral palsy measured?
Beyond the specific types of CP listed above, the Gross Motor Function Classification System (GMFCS) measures the severity of the condition with a five-level scale.
With an overall look at areas including sitting, walking and ability to use mobility devices, the GMFCS provides family members and physicians with a clear understanding of the affected person’s motor function ability and a general idea of what the person may require in the future (crutches, wheelchair, etc.).
The GMFCS measures function levels for children between the ages of 6 – 12.
- Level 1
While the child can walk, run and jump without limitations, speed and coordination are slightly affected.
- Level 2
Walking is fine but with some assistance required, such as needing to hold a railing while climbing stairs. Uneven surfaces, inclines and crowded settings can be difficult. Ability to run and jump will be limited.
- Level 3
Walking requires the use of adaptive equipment; for indoors, a hand-held mobility device, such as a cane or walker, is required; for outdoor settings, a wheeled device is required.
- Level 4
While they may walk for short distances at home with some assistance, children with Level 4 will require powered mobility or physical assistance in most other settings.
- Level 5
A manual wheelchair is required for all settings, including home. The ability to control leg and arm movements, as well as head position and torso posture, is limited.
Can cerebral palsy be prevented?
While most cases of CP can’t be prevented, there are some preventative measures that can be taken, including the mother:
- Having early and continuous prenatal care, so that issues like low birth weight and infections can be identified and treated appropriately
- Keeping up to date with vaccinations to prevent infections from causing brain damage to the fetus
For newborns who have experienced a lack of oxygen, neonatal therapeutic hypothermia – or cooling therapy – is a treatment that is often times successful in preventing brain injury. The treatment is based upon medical observations of people who are injured when they’re cold and often experience fewer negative outcomes and even healed easier.
Cooling therapy is used to treat infants who experience hypoxic ischemic encephalopathy (HIE), a lack of oxygen to the brain that can lead to CP. The lack of oxygen can be the result of blood loss or a host of other complications.
Findings reported by the National Institute of Child Health and Human Development confirmed that reducing the body temperature of infants to about 92 degrees in the first six (6) hours since delivery can reduce the likelihood of developing brain injury or even dying.
What other conditions do people with cerebral palsy face?
While CP will typically reveal itself by the way it affects motor functions, muscle tone and coordination, there are a host of associated conditions that many people with CP face.
Examples of associated conditions include, but are not limited to:
- Learning impairment
- Hearing loss
- Vision problems
- Bowel and bladder control
- Stiff joints
- Acid reflux
- Delayed growth and development
- Difficulty with breathing due to posture problems
- Skin disorders due to pressure sores
What’s the life expectancy for someone with cerebral palsy?
Most people with milder forms of CP can look forward to living long and relatively normal lives. While their life may be one with more doctor’s office visits and therapy sessions than most others, their overall life expectancy should not be lessened with a mild form of CP.
However, severe forms of CP coupled with mismanagement of the condition and other conditions stemming from CP can shorten life expectancy.
Some conditions that can contribute to shortening the lifespan for someone with CP include:
- Seizure activity
- Mental problems that hinder decision making and comprehension
- Severity of feeding complications
How is cerebral palsy treated?
Keep in mind that there is no cure for CP. However, treatment can go a long way in improving the lifestyle of those with the condition. Essentially, the overall goal is for the treatment to focus on ways to either maintain or improve their quality of life as much as possible and to maximize their level of daily life independence.
Once a diagnosis has been made, the patient and his/her family should be provided by health professionals with a plan of action for not only living with the condition but for reaching his/her full potential.
Beyond the treatment for physical needs, social and emotional aspects of life should also be taken into consideration when putting together a plan of action.
The level of care and treatment is often vast and requires a team working together to provide long-term care. The team may be comprised of:
- Physical therapist – improve overall strength of muscles and walking skills
- Mental health specialist – either a psychologist or psychiatrist who can help patient and family cope with CP
- Occupational therapist – helps patient develop skills for daily life and learn how to incorporate and use adaptive products (electric wheelchair, quadrupedal cane, etc.) that can help with daily activities
- Special education teacher – can help with addressing learning disabilities and identifying available educational resources
- Speech therapist – assists with improving patient’s ability to communicate clearly, either through speech, sign language, computerized voice synthesizer or other methods
- Developmental therapist – assist with development of social and interpersonal skills
In some cases, severe contractions or distortions may lead to surgical procedures to place limbs (arms, legs, hips) into their correct positions. Surgery may also be needed to help lengthen muscles and tendons.
What are the costs of providing care for someone with cerebral palsy?
Even though cerebral palsy was identified well over a century ago, there’s been little information shared about the economic impact on the nation and the average lifetime costs for a family when their child is born with cerebral palsy.
In addition to providing ongoing medical care, families often have to also deal with special education services, assisted living and developmental assistance.
In their Morbidity and Mortality Weekly Report publication, the Centers for Disease Control and Prevention said that the average lifetime costs for persons with cerebral palsy is $921,000.
The numbers break down this way:
- Indirect costs: $742,326 (80.6%) – automobile modifications, special medical equipment, special clothing, day care, etc.
- Direct medical costs: $93,942 (10.2%) – regular doctor appointments, therapy, medication, lab & imaging tests, surgery, medications, etc.
- Direct non-medical costs: $84,732 (9.2%) – loss of earning potential
Of course, these expenses do not include emergency room visits, out-of-pocket expenditures and lost wages by family members who are required to stay at home to provide care.
How can a lawyer help with cerebral palsy?
By reading the section above, it’s clear why providing care for someone with CP is an expensive venture. In cases when the CP was the result of a birth injury caused by medical malpractice, a lawsuit can be the most fruitful way to get help with the costs of treatment and comfort.
Because initiating a medical malpractice lawsuit and prevailing in court with a settlement or jury decision is a daunting task, it’s crucial that the family leverage the strengths and expertise of a lawyer skilled in the area of medical best practices and knows how to find and collect evidence.
Because lawsuits involving cerebral palsy are bound by a statute of limitations, time is of the essence in deciding upon a lawyer. When deciding, be sure to select a lawyer who will:
- Undertake an intense investigation of the medical history of your child, including all medical records that could prove cerebral palsy malpractice
- Consult with pediatric neurologists about your child’s CP
- Attempt to identify the cause and time of the birth injury that lead to your child’s CP
- Aggressively seek to recover compensation from the hospital and other parties responsible for your child’s CP
For more information about CP, visit these sites:
Genetic and Rare Diseases (GARD) Information Center
Christopher & Dana Reeve Foundation
NIH/National Institute of Child Health and Human Development