Cerebral palsy (“CP”) is a major physical disability resulting from damage to the fetus’ developing brain during childbirth or late pregnancy. Cerebral palsy is a permanent, non-progressive disorder that is diagnosed in thousands of young children every year. Frustratingly, cerebral palsy remains one of the most common childhood disabilities. The condition affects between 2 to 2.5 children per 1000 births in our country.
Cerebral palsy is a static neurological condition that is a consequence of a brain injury that happens before the brain is fully developed. While damage to the brain is static, the clinical manifestation of the condition can change over time and lead to the development of many associated medical conditions such as muscular contractures, bony deformity, and pain.
Sadly, there is not a cure — at least not yet — for this neurological condition. But while the changes in the brain caused by CP are not amenable to correction, there is a great expenditure of resources from parents and health care providers to provide therapeutic and adaptive support. Why? Because treatment makes a meaningful difference in these kids being able to achieve their optimal functional potential. There is no question that early diagnosis and intervention treatment is critical to improving a child’s long-term prognosis. If you understand the unique indicators and physical symptoms of CP is a critical element of diagnosing the condition early and getting the child the treatment they need to have the best possible outcome.
You can get CP both before childbirth, during childbirth, or shortly after. Which of these is the most common? There is a debate in the medical literature and among experts as to whether cerebral palsy is typically acquired prenatally or during childbirth. In birth injury malpractice cases, there is always a slew of experts hired by defense lawyers who are convinced that the lion’s share of cerebral palsy cases is acquired prior to birth. Does the impartial medical literature support this interpretation of the literature? It really does not.
What kind of signs do you expect to see? Early signs include trouble with coordination, reflexes, stiff or tight muscles, floppy muscle tone and walking on tiptoes.
Cerebral Palsy Motor Deficits
Motor deficits that occur as a result of cerebral palsy impair gross and fine motor skills required for balance, coordination, and general muscle control necessary for ambulation and most independent living skills. The persistence of some primitive reflexes that is commonly seen in young children further delays acquisition of basic motor skills. The influence of abnormal tone, sensory deficits and function, abnormal reflex behavior, and motor deficits negatively impact the attainment of developmental milestones in the child with spastic cerebral palsy.
The severity of cerebral palsy is denoted utilizing the gross motor function classification system (for children between 6 and 12 years)
. Level I – Walks without restrictions; limitations in more advanced gross motor skills
. Level II – Walks without devices; limitations in walking outdoors and in the community
. Level III – Walks with mobility devices; limitations in walking outdoors and in the community
. Level IV – Self mobility with limitations; children are transported or use power mobility outdoors and in the community
. Level V – Self mobility is severely limited even with the use of supporting technology
Cerebral Palsy Intellecutal Impairment
Many assume that there is intellectual impairment with cerebral palsy and this is true in approximately two-thirds of people with CP. One-half of children with CP patients have seizures which are just brutal on the child and the family. Visual defects occur in approximately 25% to 39% of the adult population and it is reported that 18% of adults have hearing problems. Other associated conditions seen in this children with CP include neurological abnormalities, such as impaired or loss of vision and hearing as well as abnormal touch and pain perceptions.
Cerebral Palsy Diagnosis
The complications of cerebral palsy vary by the type of cerebral palsy, which we break down for you below. Children with cerebral palsy manifest abnormalities of their muscle tone, coordination, reflexes, and motor development. When do parents know that their child has CP? What our lawyer see is that most parents know almost from the beginning. But you really cannot know if your child has cerebral palsy usually the child is six to nine months old. If you are seeing a notable lack of selective control of muscle activity or anticipatory regulation there is some cause for concern. Gastrointestinal issues such as vomiting, constipation, or bowel obstruction are also potential symptoms in conjunction with other symptoms.
Cerebral palsy comes in different shapes and sizes and impacts each child differently. There are 4 different recognized types of CP: (1) spastic; (2) dyskinetic; (3) ataxic; and (2) mixed, each with its own unique symptoms.
Spastic Cerebral Palsy – Symptoms
Spastic CP is the commonly diagnosed form of CP. Spastic accounts for approximately 77% of all CP cases worldwide. Spastic CP has characteristic physical symptoms, most notably excessive muscle stiffness (hypertonia) with sudden freezing during movements.
In a normal person, movements of the body are coordinated by electrical impulse signals sent out by the cerebral cortex in the brain. To achieve certain movements, the brain signals contraction in certain muscles while opposing muscles relax. In effect, the brain acts like a traffic signal giving a red light to some muscles while others get a green light. In children with spastic CP, these movement signals from the brain are distorted. Instead of giving a red light to some muscles and a green light to others, the spastic CP brain gives green light signals to both groups of opposing muscles at the same time. The result is like a “muscle jam” much like the traffic jam that would result if all lanes of traffic got green signals.
The activation of opposing muscle groups simultaneously causes the muscles to contract and stiffen. Spastic cerebral palsy is classified into subtypes based the area of the body affected by muscle spasticity. Spastic CP is often diagnosed early on because it has physical symptoms that are more apparent in babies.
Dyskinetic Cerebral Palsy – Symptoms
Non-spastic forms of cerebral palsy include dyskinetic cerebral palsy (athetoid and dystonic subtypes) and ataxic-hypotonic cerebral palsy. Dyskinetic CP is the second most common type of CP. People with dyskinetic CP often exhibit abnormal movements and postures as a result of fluctuations of muscle tone (hypotonia) that affect muscles in a more widespread pattern. You may also see atypical facial expressions and speech.
Dyskinetic features may co-exist with spasticity in some children with cerebral palsy. This situation further compromises movement and complicates rehabilitation. In contrast, ataxic-hypotonic cerebral palsy is associated with loose muscle tone, incoordination, and severe balance problems.
Dyskinetic CP also causes very abnormal posture and sometimes awkward facial expressions. The symptoms associated with dy
skinetic CP are often triggered when the child attempts certain movements. The most common descriptions of symptoms associated with dyskinetic CP include:
- Repetitive torsion or twisting motions (dystonia)
- Sloe writhing or convulsive movements (athetosis)
- Fast, jerking movements usually in the shoulders and arms (chorea)
Ataxic Cerebral Palsy – Symptoms
Ataxic CP is the least common form of cerebral palsy, accounting for less than 5% of cases. This rare form of cerebral palsy causes children to suffer from a noticeable lack of depth perception, balance and muscle coordination. Ataxic cerebral palsy is marked by hypotonic muscles, poor coordination, and balance. Patients with this form of CP often ambulate with a wide-based gait and have intentional tremors that complicate the performance of daily activities that require fine motor function. So when you see children with ataxic CP, you will usually see tremors and shakes in the arms and hands along with a general lack of coordination. Fine motor activities such as writing or hand clapping can be a particular challenged for someone with ataxic cerebral palsy.
How does this wide-based gait present? Kids with ataxic CP typically have a very wobbly and unsteady walk with their feet spaced abnormally far apart. Fine motor movements like writing or buttoning a shirt will often be particularly difficult with ataxic CP. Many children with ataxic cerebral palsy are plagued by what are known as “intention tremors” which trigger shaking or tremors in the hands and arms just when the brain signals the body to perform a particular movement like reaching for an object.
Mixed Cerebral Palsy – Symptoms
Many CP cases do not fit neatly into one of these tailor-made boxes. Instead, the children exhibit a combination of 2 or more different types are classified as mixed-type cerebral palsy. Combinations of spastic and dyskinetic symptoms are the most frequent type of mixed CP.
CP Symptoms by Age
Instead of a uniform condition, cerebral palsy is more like a cluster of related disorders resulting from the brain’s ability to control the movements of the body normally. The physical symptoms and characteristics vary for of the different types of CP and even within the same type, individual symptoms will differ significantly based on severity and other environmental factors. This makes it exceedingly difficult to accurately list global symptoms of CP, but there are telltale signs at certain stages of early childhood development.
Signs of CP in Babies Under 6 Months:
- Crying with arched back without an apparent reason for discomfort
- Neck appears limp and the child is unable to lift her head independently
- Has “rag doll” feel from lack of muscle tone
- Extreme stiffness and rigidity in muscles
- Stiffness in muscles resulting in crossed or scissor legs
- Disabling muscle contractions during movements (spastic paralysis)
Signs of CP in Babies Over 6 Months:
- Cannot roll over independently and appears limp
- Not able to bring her hands together
- Not able to independently bring hands to face or touch mouth
- Noticeable limpness on one side of the body.
- Non-voluntary movements
- Consistently fails to reach developmental milestones
- Abnormal postures
- Vision, hearing or speech problems
Signs of CP in Babies Over 10 Months:
- Crawls awkwardly with abnormal movements or limpness on one side
- Hops on knees or drags butt instead of crawling on all fours
- Trouble with fine motor movements
- Range of motion appears limited
- Slow development and maturation
What is Cerebral Palsy and How is it Caused?
Cerebral palsy is a disorder in which the brain is not able to control and manage ordinary movement and coordination of the muscles in the body. Cerebral palsy caused by injury to the developing brain of a fetus or newborn baby resulting from oxygen deprivation. Oxygen deprivation during labor and delivery is the most common cause of CP and can result from a number of events or complications during childbirth. When CP is the result of something that happens during delivery, medical error is frequently involved. Oxygen deprivation resulting in cerebral palsy can also occur during pregnancy from things such as chorioamnionitis and prenatal asphyxiation or from complications involving the placenta or umbilical cord.
What are the Earliest Symptoms of Cerebral Palsy?
Early signs of cerebral palsy include trouble with coordination, reflexes, stiff or tight muscles, floppy muscle tone and walking on tiptoes. Most parents know there is something wrong almost from the beginning. But you really cannot know for sure if your child has cerebral palsy until around six to nine months old. If you are seeing a notable lack of selective control of muscle activity or anticipatory regulation there is some cause for concern. Gastrointestinal issues such as vomiting, constipation, or bowel obstruction are also potential symptoms in conjunction with other symptoms.
When is Cerebral Palsy Diagnosed?
Most cases of cerebral palsy are diagnosed within the first 18 months after birth. However, mild cases of cerebral palsy may take significantly longer to diagnose because the physical symptoms are more subtle. Milder cases of cerebral palsy often do not get diagnosed until the child is 3-4 or even older. Diagnosis is usually made by the child’s pediatrician based on clinical symptoms and failure to meet certain developmental milestones (e.g., sitting up by 6 months, walking by 18 months, etc.). Once cerebral palsy is suspected based on clinical symptoms, the assumptive diagnosis is usually confirmed with diagnostic imaging tests like a CT scan.
What are the Different Types of Cerebral Palsy?
There are 4 recognized types of cerebral palsy and each type of CP has its own unique set of symptoms:
- Spastic CP: excessive muscle stiffness (hypertonia) with sudden freezing during movements.
- Dyskinetic CP:
abnormal movements and postures as a result of fluctuations of muscle tone (hypotonia) that affect muscles in a more widespread pattern.
- Ataxic CP: hypotonic muscles, poor coordination, and balance; ambulate with wide gait and sometimes have tremors.
- Mixed CP: combination of 2 or more different types, with mix of symptoms.
Call Miller & Zois About Cerebral Palsy Malpractice
Cerebral palsy is a birth injury that is often the direct result of medical negligence or bad judgment on the part of doctors or nurses during labor and delivery. The birth injury attorneys at Miller & Zois have helped hundreds of parents get financial compensation for cerebral palsy caused by medical malpractice. We can help you figure out whether your child has cerebral palsy because someone made a mistake. Call us today at 800-553-8082 or get a free online consultation.