Cerebral Palsy Attorneys | Birth Injury Lawyers

Cerebral palsy (CP) is a disorder that causes physical disabilities (and cognitive impairments and epilepsy in some cases). Cerebral palsy is caused by damage to the part of the brain that controls movement. CP often causes musculoskeletal issues as well (the impairments associated with CP result from muscles persistently being too contracted [in a majority of cases] or not contracted enough). This results in issues with fine motor coordination, tremors, joint and bone deformities, balance, and issues with walking.

Each year, nearly 10,000youth are diagnosed with cerebral palsy, making it the most widespread disabling condition among children. While a large number of diagnoses are rooted in medical malpractice, few of the affected families will reach out for any legal advice or action.

Cerebral palsy (CP) is a group of non-progressive motor conditions that cause physical disability. It is caused by damage to the motor control centers of the developing brain, whichcan occur during pregnancy, childbirth, or after birth up to about age three. Cerebral refers to the cerebrum, which is the affected area of the brain (although the disorder may involve other parts of the brain, such as the cerebellum), and palsy refers to a disorder of movement.

Limitations in movement and posture and disturbances of sensation and depth perception are common in children who have cerebral palsy. Cognitive impairments and epilepsy occur in about one-third of childrenwith CP. In addition, cerebral palsy is often accompanied by secondary musculoskeletal problems that arise as a result of the underlying disorder.

Currently, cerebral palsy has no cure. Usually, medical intervention is limited to the treatment and prevention of complications arising from cerebral palsys effects.

Cerebral palsy is characterized by:

The effects of cerebral palsy fall on a continuum of motor dysfunction, which may range from slight impairments to impairments so severe that they render coordinated movement virtually impossible.

Cerebral palsy is divided into four major classifications to describe different movement impairments. These classifications also reflect the areas of the brain that are damaged. The four major classifications are:

Spastic cerebral palsy is by far the most common type of cerebral palsy (70- 80% of all cases). Children with spastic cerebral palsy have lesions in the central nervous system. This damage affects neurotransmitter levels in the brain, leading tohypertonia(extreme muscle tension) in the muscles that receive signals from damaged portions of the brain. Hypertonia can cause involuntary muscle contractions, secondary pain and/or stress, and muscle spasms. Spasticity can and usually does lead to very early onset muscle-stress symptoms (such as arthritis and tendinitis) in individuals as young as their mid-20s. Side effects of spastic cerebral palsy include contractures, pain, joint deformities, scoliosis, hip dislocation, and more.

Ataxic cerebral palsyis characterized by hypotonia (decreased muscle tone) and tremors, affecting controlled movements and fine motor skills. This includes posture and balance (particularly while walking) and movements such as writing, typing, or using scissors. Ataxic cerebral palsy occurs in roughly 5-10% of all cases of CP and is the result of damage to the cerebellum, the part of the brain responsible for regulating balance. It is common for children with ataxic cerebral palsy to have difficulty with visual processing (depth perception and eye movement control) and/or auditory processing. Ataxic cerebral palsy derives its name from ataxia, a neurological disorder caused by dysfunction of the nervous system that affects the coordination of muscle movements.

Athetoid/dyskinetic cerebral palsy occurs in roughly 15% of CP cases. This is the result of damage to the basal ganglia, the part of the brain responsible for regulating voluntary movements. In many cases, ADCP can be caused by kernicterus (a condition where high bilirubin levels in a newborn go untreated, causing damage to the basal ganglia).

Athetoid/dyskinetic cerebral palsy causes a combination of hypertonia, hypotonia, and involuntary motions. Children with ADCP have trouble holding themselves in an upright, steady position for sitting or walking. For some children with ADCP, it takes a lot of work and concentration to get their hands to a certain spot (like scratching their nose or reaching for a cup). Mixed muscle tone and difficulty with maintaining posture can make holding onto objects difficult, especially small ones requiring fine motor control (such as a toothbrush or pencil).

Athetoid/dyskinetic cerebral palsy is further characterized into three subgroups based on the nature of the movements:

Mixed cerebral palsy is characterized by both hypertonia (abnormally high muscle tone) and hypotonia (abnormally low muscle tone). When an individual case of cerebral palsy includes impairments and features of both spastic and non-spastic cerebral palsy, it is considered mixed cerebral palsy. People with mixed cerebral palsy experience different motor disturbances in different limbs.

Source for this section: Sanger, T. D., Chen, D., Fehlings, D. L., Hallett, M., Lang, A. E., Mink, J. W., Valero-Cuevas, F. (2010). Definition and classification of hyperkinetic movements in childhood. Movement Disorders, 25(11), 1538-1549. doi: 10.1002/mds.23088

Cerebral palsy is categorized into types and subtypes based on the extent and distribution of impairments such as spasticity and muscle tone abnormalities. The classification systems used to describe and organize cerebral palsy include:

Many of the classification systems for cerebral palsy overlap. Because these systems range from specific to general, encompass various areas of the body, and explain different aspects of functional ability, they are often used together. For example, the motor function and limb involvement classification systems are commonly used together to create the classification of spastic quadriplegic cerebral palsy. Spastic relates to the motor function classification system and quadriplegic relates to the limb involvement classification system.

In the muscle tone classification system, cerebral palsy is described based on how muscle tone is impaired. The two muscle tone classifications are as follows:

The motor disturbance classification system organizes cerebral palsy into four main types based on the location of the brain injury and the brain injurys corresponding movement impairments. The four types include:

Other important terms to know relating to the Motor Disturbance Classification System include:

This classification system categorizes cerebral palsy in terms of limb impairment. In the Limb Involvement Classification System, each type of cerebral palsy describes information about the number and location of affected limbs.

Classifying cerebral palsy based on severity is the simplest way to describe the extent of an individuals impairment.

The Gross Motor Function Classification System (GMFCS) is a system that is used to classify infants, children, and adolescents with cerebral palsy into five groups based on the following categories:

The GMFCS is measured in levels (GMFCS Level 1-5), with the highest level signifying the most severe forms of cerebral palsy. By classifying a child with cerebral palsy based on the GMFCS, parents, medical professionals, and caregivers can determine appropriate therapy regimens, plan lifestyle adjustments, and estimate rehabilitation potential. The GMFCS works in conjunction with other classification systems including the Manual Ability Classification System of cerebral palsy (MACS), the Motor Disturbance Classification System, severity, and the Communication Function Classification System of cerebral palsy (CFCS).

Source for this section: Palisano, R., Rosenbaum, P., Walter, S., Russell, D., Wood, E., & Galuppi, B. (1997). Development and reliability of a system to classify gross motor function in children with cerebral palsy. Developmental Medicine and Child Neurology, 39(4), 214-223.

The Manual Ability Classification System (MACS) categorizes cerebral palsy based on an individuals ability to manipulate objects with their hands, which is closely tied to an individuals ability to complete tasks independently. The MACS works in conjunction with the Gross Motor Function Classification System (GMFCS) and the Communication Function Classification System (CFCS).

The Communication Function Classification System (CFCS) categorizes individuals with cerebral palsy into five levels based on everyday communication performance. The CFCS works in conjunction with the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS).

Section source: //cfcs.us/

Although signs and symptoms are often used interchangeably, they have their own specific definitions:

Because the types, impairments, levels of severity, and side effects of cerebral palsy vary so greatly, there is no one sign or symptom used individually to diagnose CP. While some children will be diagnosed with cerebral palsy immediately after delivery, others will not show signs or express symptoms until later in early childhood when the brain finishes developing. Often, medical professionals, family members, caretakers, friends, or other people close to the child pick up on one of an array of signs and prompt the diagnostic process. Symptoms may appear or change as a child gets older. Classically, cerebral palsy becomes evident when the babyis about6 9 months old and is becoming mobile, where the preferential use of limbs, asymmetry, or gross motor developmental delays are seen.

Secondary conditions can include seizures, epilepsy, apraxia, dysarthria or other communication disorders, eating problems, sensory impairments, developmental disabilities, learning disabilities, urinary incontinence, fecal incontinence, and/or behavioral disorders. Speech delaysand language disorders are common in children with cerebral palsy. Speech problems are associated with poor respiratory and oral-facial muscle control.

Babies born with severe cerebral palsy also may have an irregular posture; their bodies may be either very floppy or very stiff. Birth defects (such as spinal curvature, a small jawbone, or a small head) sometimes occur as a part of CP.

Signs and symptoms often differ and evolve depending on a childs age. Learn more about the signs of cerebral palsy based on age here.

In certain cases, there is no identifiable cause of cerebral palsy, but typical causes include problems with intrauterine development (e.g. exposure to infection), asphyxia before birth, a lack of oxygen to the brain during labor and delivery, birth trauma during labor and delivery, and complications during the perinatal period. Cerebral palsy is also more common in multiple and premature births.

40-50% of children who develop cerebral palsy are born prematurely. Premature infants are vulnerable because their organs are not fully developed, increasing the risk of hypoxicbrain injury, which can cause cerebral palsy. Low birth weight is a risk factor for cerebral palsy, and premature infants usually have low birth weights. In addition, multiple-birth infants are more likely than single-birth infants to be born early or with a low birth weight. Infections in the mother can also cause premature birth and predispose a child towards cerebral palsy.

Causes and risk factors for cerebral palsy include:

For a full list of conditions that could cause cerebral palsy, please visit our Practice Areas page.

It is worth noting, however, that these conditions are risk factors and do not guarantee that a child will necessarily have cerebral palsy. In many cases, cerebral palsy is a preventable condition. This means that medical practitioners can avoid cerebral palsy by following the standards of care for a given pregnancy, labor, or birth. If they mismanage the above conditions, birth injuries can result.

No two cases of cerebral palsy are quite alike. Depending on the location and severity of the initial brain injury, the conditions and side effects associated with cerebral palsy will vary. Factors such as treatment, therapy, environment, and age may also affect a persons functional potential. Common conditions associated with CP include:

The diagnosis of cerebral palsy is typically based on a physical examination and the childs medical history. Neuroimaging with CT or MRI is warranted when the cause of a childs cerebral palsy has not been established. When abnormal, neuroimaging studies can suggest the timing of the initial damage. An abnormal neuroimaging study indicates a high likelihood of associated conditions such as epilepsy and developmental disabilities.

A diagnosis of cerebral palsy can be made as early as one month of age, but most cases are not diagnosed until a baby is around 18-24 months old. Sometimes, cerebral palsy goes undetected until children miss major developmental milestones, typically between the ages of 1 and 5. Because clinical signs of cerebral palsy evolve as the babys nervous system matures, the diagnostic process usually involves multiple trips to the childs primary physician, as well asseveral other specialists.

Furthermore, the time at which a cerebral palsy diagnosis is made often depends on the type of cerebral palsy the child has. For instance:

Medical professionals must thoroughly examine children to determine the severity of brain injury, location of brain damage, and the form of cerebral palsy. Repeated examinations over time are generally required to ensure the condition is static. Below are the common tests and procedures used to diagnose a baby at risk for cerebral palsy:

Diagnosing cerebral palsy as early as possible is a critical componentof maximizing a childs independence, function, and potential. The sooner children are diagnosed with cerebral palsy, the sooner they can begin the treatment and therapy regimens designed to preserve brain function, lessen impairments, and improve functional ability.

The best way to treat cerebral palsy is to minimize risk in the first place. There is promising researchindicating that magnesium sulfate has a neuroprotective effect and can help protect the brain from cerebral palsy when the baby is exposed to it while in the mothers womb. In addition, research shows thatbirth-injured babies who are given hypothermia treatment (brain cooling or body cooling therapy) within the first hours of life have a decreased chance of having cerebral palsy, or may have a less severe form of the disorder.

Once a child has been identified as having cerebral palsy, treatment is mostly supportive and focuses on helping the child develop as many motor skills as possible or to learn how to compensate for a lack of them.

Various forms of therapy are available to children living with cerebral palsy. The earlier treatment begins, the better chance children have of overcoming developmental disabilities. The earliest proven intervention (hypothermia therapy) occurs during the infants recovery in the neonatal intensive care unit (NICU).

While no single cure for cerebral palsy exists, patients are encouraged to participate in a comprehensive and diverse range of therapies and procedures to alleviate its associated social, physical, emotional, and cognitive difficulties.

Since cerebral palsy is frequently the result of medical mistakes made during pregnancy, around the time of delivery, or in the neonatal period, it is often preventable. Because the injuries, disabilities, and limitations associated with cerebral palsy can be severe, it is tragic that many cerebral palsy diagnoses may be the result of preventable medical errors and birth injuries. There are several preventative measures medical professionals are required to take in order to prevent cerebral palsy and birth injury.

According to the standards of care, medical professionals (including doctors, nurses, surgeons, obstetricians, midwives, NICU staff, pharmacists, and anesthesiologists, among others) are required to provide medical care in accordance with certain set standards in order to prevent injury or harm to an expectant mother and her baby.

Medical personnel are responsible for:

Although it is solely the responsibility of medical professionals to prevent medical errors that can cause cerebral palsy, there are steps patients and their loved ones can take to prevent birth injury and medical mistakes. Patients and their loved ones are encouraged to speak up with any questions or concerns they may have regarding their care. Many dangerous medical errors result from miscommunication between medical personnel, so prioritizing clear, open communication with your doctors often helps.

Additionally, being aware of dangerous phenomena such as the Weekend Effect and the July Effectcan help prevent medical malpractice, birth injuries, and cerebral palsy.

Beyond the management, prevention, diagnosis, and treatment of the various causes and risk factors for cerebral palsy, there are specific procedures that can prevent birth injury and cerebral palsy. Depending on the specific situation, some of these procedures include the following:

Determining whether a childs cerebral palsy is the result of medical negligence is crucial in determining eligibility for compensation permitted by the law. Unfortunately, a number of families avoid medical malpractice litigation for different reasonssome fear confrontation, some feel they dont have the resources, some simply feel overwhelmed, and others doubt they have a case. The bestand onlyway to find out if you have a cerebral palsy case is to reach out to an attorney for a legal consultation. An experienced birth trauma attorney will do a thorough investigation of the medical records and review the case with expert medical professionals to determine whether negligent care was the cause of a childs cerebral palsy.

Because all cases involve unique injuries, result from varying instances of medical malpractice, and take place in different states, no two cases look alike. Every day, the Reiter & Walsh, P.C. birth injury team helps people determine whether or not they have a case free of charge. Our cerebral palsy attorneys and labor and delivery nurses gather important information about each specific prospective client in order to determine if medical malpractice occurred.

Before filing a medical malpractice case, our cerebral palsyattorneys contact a wide range of experts witness and medical professionals to confirm negligence.These practicing experts and medical professionals often include all obstetrics and gynecology medical professionals, maternal-fetal medicine expert doctors, forensic document examiners, placental pathologists, neonatologists, respiratory therapists, pediatric neurologists, pharmacologists, neuroradiologists, neuropsychologists, neurosurgeons, pediatric surgeons, anesthesiologists, genetics experts, infectious disease experts, economists, physical medicine and rehabilitation doctors, and many others.

In this video,birth injury lawyers Jesse Reiter and Rebecca Walsh discuss cerebral palsy, how birth injuries and negligence can causecerebral palsy, and agroundbreaking treatment that can prevent cerebral palsy. This treatment, known as hypothermia treatment, is the only known treatment forhypoxic-ischemic encephalopathy, a dangerous brain injury that often leads to cerebral palsy.They alsodescribe the symptoms to look for if you think your loved onemay have cerebral palsy. To determine liability in a cerebral palsy case, the cerebral palsy attorneys and nurses at ABC Law Centers review hospital birth records, which include fetal monitoring strips, lab tests, and much more.

Birth injury is a difficult area of law to pursue due to the complex nature of the medical records. The award-winning birth injury attorneys at Reiter & Walsh ABC Law Centers have decades of joint experience with birth injury and cerebral palsy cases. To find out if you have a case, contact our firm to speak with one of our attorneys. 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. We give personal attention to each child and family we help, and our award-winning attorneys are available 24/7 to speak with you.

I would recommend the attorneys at Reiter & Walsh to anyone with a birth trauma case. I am continually impressed with their dedication and compassion for their clients, as well as their knowledge and skills in the area of birth trauma litigation.

-Client review from 2/10/2017

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Cerebral Palsy Attorneys | Birth Injury Lawyers