Cerebral Palsy Lawyer

A child with cerebral palsy may require unique care, including therapies, mobility equipment, and extra time from a caretaker. Taking care of a child with cerebral palsy can become financially demanding.

Contacting a cerebral palsy lawyer can help determine if your child’s cerebral palsy was caused due to a preventable birth injury, such as hypoxic-ischemic encephalopathy (HIE). When medical malpractice leads to cerebral palsy, families can receive compensation through filing a lawsuit. A successful verdict or settlement can help to pay for a child’s treatments, mobility equipment, and other needs for the rest of their life.

When considering a legal action, consider this guide for finding the best birth injury attorney to ensure the best results for your child.

• What is cerebral palsy?
• Birth injuries and causes of cerebral palsy
• Preventing cerebral palsy
• Types of cerebral palsy
• Classification methods
• Signs and symptoms of cerebral palsy
• Diagnosis
• Treatments and therapies

Cerebral palsy (CP) is caused by damage or abnormalities in the part of the brain that controls movement. It is a motor disorder, meaning that it’s characterized by unusual or involuntary movements. Cerebral palsy also often causes conditions that manifest in joint and bone deformities. Additionally, many people with cerebral palsy have issues such as epilepsy, cognitive impairments, and problems with vision or hearing.

Cerebral palsy is the most common motor disability in childhood, affecting one in 323 children. A large number of diagnoses are caused by preventable birth injuries and medical malpractice.

The effects of cerebral palsy can vary dramatically from one individual to the next. Some have only minor impairments and are totally independent; others struggle greatly with the tasks of daily life and require extensive assistance and 24-hour care.

Currently, cerebral palsy has no cure, but there are a variety of treatments and therapies that can alleviate certain symptoms and improve function.

Cerebral palsy (CP) is a group of non-progressive motor conditions that cause physical disability. CP is caused by damage to the motor control centers of the developing brain, which can occur before a baby is born, during childbirth, or after birth up to age five. ‘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.

In most cases, cerebral palsy is attributable to a birth injury — something that goes wrong during pregnancy, birth, or the neonatal period. Unfortunately, birth injuries that result in cerebral palsy are often linked to medical malpractice.

The following are some examples of birth injuries and risk factors that can cause or increase the risk of cerebral palsy:

• 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

These issues do not guarantee that a child will necessarily develop 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 conditions above, cerebral palsy is much more likely to result.

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 effects of cerebral palsy can be severe, it is tragic that many cerebral palsy diagnoses may be the result of preventable medical errors and birth injuries.

Medical professionals (including doctors, nurses, and midwives, among others) are required to meet a certain standard of care in order to prevent injury or harm to an expectant mother and her baby.

Medical personnel are responsible for:

• Providing proper prenatal care and recognizing risk factors for birth injury/cerebral palsy
• Taking actions to prevent birth injury or cerebral palsy (special caution must be taken if risk factors are present)

In particular, doctors should consider prescribing magnesium sulfate or betamethasone for babies who are likely to be born prematurely, because premature birth increases the likelihood of neonatal brain damage. When given in utero, these drugs can help to prevent cerebral palsy..

Additionally, medical professionals must be aware of pregnancy and delivery complications and recommend a C-section if the safety of a mother or baby is in jeopardy. Many cases of cerebral palsy stem from the failure to perform a C-section when one is necessary.

Finally, research shows that birth-injured babies who are given therapeutic hypothermia (brain cooling or whole-body cooling) within the first hours of life have a decreased chance of having cerebral palsy, or may have a less severe form of the disorder.

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

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

Although there are many different ways of describing or categorizing the way cerebral palsy affects an individual (this will be discussed more in the next section), people often divide it into the following four subtypes:

• Spastic cerebral palsy
• Ataxic cerebral palsy
• Athetoid/dyskinetic cerebral palsy
• Mixed cerebral palsy

Spastic cerebral palsy is by far the most common type of cerebral palsy, comprising roughly 80% of all cases. Children with spastic cerebral palsy have lesions in the upper motor neurons of the central nervous system. This damage leads to hypertonia (extreme muscle tension) in the muscles that receive signals from damaged portions of the brain. Hypertonia can cause involuntary muscle contractions, spasms, and secondary pain and/or stress. Additional side effects of spastic cerebral palsy include joint deformities, scoliosis, hip dislocation, and more.

Ataxic cerebral palsy is the least common type, occurring in roughly 5-10% of all CP cases. It is caused by damage to the cerebellum, and affects controlled movements and fine motor skills. This includes balance and coordination (particularly while walking) and precise movements such as writing.

In young children, hypotonia is a common manifestation of ataxic CP. Unlike the rare form of degenerative neurological disease ataxia, ataxic cerebral palsy is a non-progressive condition. It is common for children with ataxic cerebral palsy to have difficulty with visual processing (depth perception and eye movement control) and/or speech.

Athetoid/dyskinetic cerebral palsy (ADCP) occurs in roughly 0.27 per 1,000 live births, and comprises 15-20% of CP cases. This subtype is the result of damage to the basal ganglia, the part of the brain responsible for regulating voluntary movements. In many cases, ADCP is caused by hypoxic-ischemic encephalopathy/HIE (brain damage due to a lack of oxygenated blood) or kernicterus (brain damage due to severe or improperly-managed jaundice).

ADCP causes a combination of hypertonia, hypotonia, and involuntary motions. Children with ADCP may have trouble sitting upright, walking, grasping objects, performing fine motor tasks, sucking, swallowing, and talking.

Mixed cerebral palsy involves a combination of symptoms that don’t all fit within a single subtype of CP. For example, a child may have both hypertonia and hypotonia. In other words, some of their muscles are too tight, while others are too loose.

In addition to being divided into the main types discussed above (spastic, ataxic, athetoid/dyskinetic, and mixed), cerebral palsy can also be classified by using a variety of organizational/diagnostic systems. These include the following:

1. Classification based on muscle tone
2. Classification based on limb involvement
3. Gross Motor Function Classification System (GMFCS)
4. Manual Ability Classification System (MACS)
5. Communication Function Classification System (CFCS)

It is important to know that the cerebral palsy classification systems can be used in conjunction to reveal various aspects of a patient’s condition. In other words, they’re not conflicting or mutually exclusive, and a child may receive a diagnosis using terms from various classification systems.

Cerebral palsy may be described based on how muscle tone is impaired. The following terms are often used:

• Hypertonic cerebral palsy: Hypertonic or hypertonia refers to abnormally high muscle tone, which creates muscular stiffness and rigidity. Spastic cerebral palsy is characterized by hypertonia.
• Hypotonic cerebral palsy: Hypotonic or hypotonia refers to abnormally low muscle tone. Symptoms of hypotonia include floppiness and weakness.

Mixed cerebral palsy is characterized by both hypotonia and hypertonia.

This classification system categorizes cerebral palsy by which limbs are affected (17, 18, 19):

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 extent of movement impairment, age, and functional performance. Our knowledgeable Cerebral Palsy law firm may use this system to explain how your child is affected if your claim goes to a jury for a final decision. 

The Manual Ability Classification System (MACS) categorizes cerebral palsy based on an individual’s ability to manipulate objects with their hands, which is closely tied to one’s ability to complete tasks independently. The MACS is applicable to children ages 4-18.

The Communication Function Classification System (CFCS) categorizes individuals with cerebral palsy and other disabilities based on everyday communication performance. As with the GMFCS and the MACS, the CFCS has five levels that represent increasing severity.

• CFCS Level I: The person can effectively send and receive communicative information with unfamiliar and familiar partners.
• CFCS Level II: The person effectively, but slowly, sends and receives communicative information with both unfamiliar and familiar partners.
• CFCS Level III: The person is usually able to effectively send and receive communication information with familiar partners, but may struggle to communicate with unfamiliar partners.
• CFCS Level IV: The person inconsistently sends and receives communication information with familiar partners, and rarely can communicate with unfamiliar partners.
• CFCS Level V: The person rarely communicates effectively, even with familiar people.

Because cerebral palsy affects different people in different ways, there is no one sign or symptom used individually to diagnose it. Most people with cerebral palsy are diagnosed as infants or toddlers, but others do not show clear signs or express symptoms until they are a bit older and developmental delays (missed milestones) become more obvious. 

Learn more about early signs of cerebral palsy.

• Seizures
• Low birth weight
• Unusually small or large head circumference
• Low Apgar scores
• Low activity
• Diminished cry
• Problems with temperature regulation
• Feeding problems
• Breathing problems (e.g. apnea) or need for resuscitation
• Hypotonia (baby appears floppy)
• Hypertonia (baby appears stiff)
• Low red blood cell count (anemia)
• Metabolic acidosis

• Involuntary movements (spasms, writhing, etc.)
• Poor coordination (ataxia) or balance
• Unusual posture or limb positioning
• Difficulty bringing hands together or manipulating objects
• Favoring one side of the body over another (i.e. a strong preference for reaching out with one hand)
• Failure to reach (or delay in reaching) developmental milestones such as sitting up, crawling, or walking
• Speech-language problems
• Difficulty swallowing or excessive drooling
• Cognitive impairments
• Vision or hearing problems
• Behavioral and emotional problems
• Incontinence
• Retention of primitive reflexes (e.g. Moro reflex)

No two cases of cerebral palsy are identical. 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 also affect a person’s functional potential. However, common conditions associated with CP – aside from mobility impairments – include the following. Please note that incidence estimates have been rounded to the nearest five and that some come from studies with small sample sizes:

• Chronic pain (50-75%) 
• Cognitive disabilities (50%) 
• Speech-language problems (40-50%; approximately 25% are nonverbal)
• Epilepsy (25-45%) 
• Visual impairments (30-50%) 
• Hearing impairments (5-20%) 
• Hip displacements (35%) 
• Scoliosis (20-65%) 
• Behavioral disorders from cerebral palsy (25%) 
• Bladder control problems (25%) 
• Sleep disorders from cerebral palsy (20-45%) 
• Saliva control problems (20%) 
• Eating problems (5% use a feeding tube)

The diagnosis of cerebral palsy is typically based on a physical examination and the child’s medical history.  Neuroimaging with CT or MRI is warranted when the cause of a child’s cerebral palsy has not been established. These tests can also help to determine the timing of the initial damage and the likelihood of associated conditions such as epilepsy and developmental disabilities.

Some people with cerebral palsy are diagnosed in early infancy, and most receive their diagnosis by age two. However, cerebral palsy may go undetected until children miss major developmental milestones; sometimes, a diagnosis is not made until age four or five. Because clinical signs of cerebral palsy evolve as the nervous system matures, the diagnostic process usually involves multiple trips to the child’s primary physician, as well as several other specialists.

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 some common tests and procedures used to evaluate a baby at risk for cerebral palsy:

• Apgar Scoring: Apgar tests determine a newborn’s overall health within the first few minutes of life.
• Umbilical Cord Blood Gas Tests: Blood gas tests measure how much oxygen and carbon dioxide are in the baby’s blood, which impacts the blood’s pH (acidity). If the baby’s blood is acidic, this means the baby may have suffered oxygen deprivation, which could lead to cerebral palsy and other types of brain damage.
• Neuroimaging: These techniques allow medical personnel to produce images of brain structures and activity:
  • MRI
  • CT Scan
  • EEG
  • Ultrasound
  • Evoked Potential Tests
• Reflex Tests: Reflex tests help diagnose cerebral palsy and developmental delays, and monitor abnormal reflex development in babies.
• Muscle tone, posture, and coordination tests
• Developmental testing: Developmental tests assess whether infants are meeting specific developmental milestones at the expected time.
  • Screening for associated conditions (see “Conditions associated with cerebral palsy,” above)
• Scanning for coagulation or other blood disorders

It is very important that medical professionals diagnose cerebral palsy as early as possible. The sooner children are diagnosed, the sooner they can begin the treatment and therapy regimens designed to preserve brain function, lessen impairments, and improve functional abilities.

Various forms of treatment and therapy are available to children with cerebral palsy. Treatments and therapies for cerebral palsy are mostly supportive and focus on helping the child develop as many motor skills as possible and/or to learn how to compensate for a lack of them. Typically, the earlier medical interventions begin, the better outcomes children have.

In addition to medical treatments and therapies, children with cerebral palsy may benefit greatly from assistive technology (AT). According to the Assistive Technology Industry Association, this is “any item, piece of equipment, software program, or product system used to increase, maintain, or improve the functional capabilities of persons with disabilities.” AT includes everything from low-tech items like weighted pens to more high-tech equipment, such as mouth-controlled wheelchairs.

These treatments can be very expensive. Frequent therapy can help a child with cerebral palsy, but can also be prohibitively costly. With the help of the cerebral palsy attorneys at ABC Law Centers, you may be able to recover the compensation you need to pay for the care and the life your child deserves.