Cerebral Palsy

The Hixson & Brown Law Firm has represented babies that suffer from cerebral palsy as a result of medical negligence occurring during the process of labor and delivery. The claims occur for a number of reasons, but the primary result is usually the same: an anoxic (lack of oxygen) injury to the baby.

Sometimes the medical malpractice involves the failure of the nursing staff or obstetrician to diagnose a problem with the labor. Other times, the medical negligence involves the failure to diagnose a poor fetal response to labor. In our experience, if a baby is born with a low APGAR score, a low blood pH or a low Base Excess with a resultant brain injury to the baby, the parents should have the complete medical record reviewed by a lawyer who handles medical malpractice claims involving birth injuries.

Types of Cerebral Palsy

  1. Spastic Cerebral Palsy: Increased muscle tone is the defining characteristic of this type. The muscles are stiff (spastic), and movements are jerky or awkward. This type is classified by which part of the body is affected: diplegia (both legs), hemiplegia (one side of the body), or quadriplegia (the entire body). This is the most common type of cerebral palsy, accounting for about 70-80% of cases. See http://www.emedicinehealth.com/cerebral_palsy/article_em.htm.
  2. Dyskinetic (extrapyramidal): This includes types that affect coordination of movements. There are 2 subtypes.
  3. Athetoid: The person has uncontrolled movements that are slow and writhing. The movements can affect any part of the body, including the face, mouth, and tongue. About 10-20% of cerebral palsy cases are of this type.
  4. Ataxic: This type affects balance and coordination. Depth perception is usually affected. If the person can walk, the gait is probably unsteady. He or she has difficulty with movements that are quick or require a great deal of control, such as writing. About 5-10% of cases of cerebral palsy are of this type.
  5. Mixed: This is a mixture of different types of cerebral palsy. A common combination is spastic and athetoid.

Most children with cerebral palsy require significant medical and physical care, including physical, occupational, and speech/swallowing therapy.

Causes of Cerebral Palsy

Cerebral palsy results from damage to certain parts of the developing brain. This damage can occur early in pregnancy when the brain is just starting to develop, during the birth process as the child passes through the birth canal, or after birth in the first few days of life. However, in some cases, the exact cause of the brain damage is never known.

From a legal perspective, problems during birth, usually inadequate oxygen, have been blamed for cerebral palsy. Inadequate oxygen delivery to the baby can be caused by a number of factors including compression on the umbilical cord, a nuchal cord (cord wrapped around baby's neck), hyperstimulation of the uterus (too many contractions) and hypertonicity of the uterus (contractions too strong). Hyperstimulation and hypertonicity of the uterus can be caused during induction or augmentation of labor with medications such as Pitocin.

In some cases the oxygen deprivation and corresponding brain injury can occur after birth. In cases that we see, this is often cause by inadequate resuscitative measure by medical personnel.

Risk Factors for Cerebral Palsy

There are a number of risk factors linked with cerebral palsy, many of which are not associated with medical negligence or medical malpractice. Risk factors for Cerebral Palsy include the following:

  1. Infection, seizure disorder, thyroid disorder, and/or other medical problems in the mother.
  2. Birth defects, especially those affecting the brain, spinal cord, head, face, lungs, or metabolism.
  3. Certain hereditary conditions.
  4. Complications during labor and delivery.
  5. Premature birth.
  6. Low birth weight (especially if less than 2 pounds at birth).
  7. Multiple births (twins, triplets).
  8. Lack of oxygen (hypoxia) reaching the brain before, during, or after birth.
  9. Brain damage early in life, due to infection, head injury, lack of oxygen, or bleeding.

The risk factors that are underlined and in bold reflect risk factors that are potentially avoidable and represent areas of potential medical negligence.

When to Seek Legal Counsel and Guidance

If your baby is transferred to the Pediatric Intensive Care Unit (PICU), the Intensive Care Unit (ICU) or the Critical Care Unit (CCU) after birth then you should be asking physicians and medical care providers why. Key things to listen for that may give rise to medical / legal issues include the following:

  1. Hypoxic injury.
  2. Hypoxic Ischemic Encephalopathy (HIE).
  3. Periventricular Leukomalacia (PVL).
  4. Intraventricular Hemorrhage (IVH).
  5. Brain injury (hemorrhage, bleeding) being reflected on MRI, Brain CT or Ultrasound of the brain.
  6. Respiratory Distress Syndrome.
  7. Seizures

If any of the above is diagnosed or suspected, then the brain injury may be the result of negligent care provided by nursing staff, midwives, obstetricians or other physicians during the labor and delivery process.

Treatment for Cerebral Palsy

There is no cure for cerebral palsy. With early and ongoing treatment, however, the disabilities associated with cerebral palsy can be lessened or reduced. Many different therapies are available, most under the supervision of a medical specialist or other allied professional. The therapy regimen for a specific individual with cerebral palsy should be tailored to meet the needs of that individual. A treatment may work for one child but not for another. The parents and the child's care team work together to choose only those treatments that offer some benefit to the child.