Not all people with cerebral palsy have the same uniform disability. In fact, cerebral palsy is not one singular medical condition but rather a grouping of multiple movement disorders all of which are caused by abnormal or impaired brain function. All of the conditions within the umbrella of "cerebral palsy" share the same point of origin: damage to the developing brain during pregnancy or childbirth. The brain damage during pregnancy or childbirth which results in cerebral palsy also has the same end result. The brain is not able to properly direct and control normal muscle movements in certain areas of the body. Beyond these similarities, however, individual cases of cerebral palsy present a very wide variation of symptoms, severity, and characteristics. There are actually 4 different recognized types or classifications of cerebral palsy: (1) spastic (2) dyskinetic; (3) ataxic; and (4) mixed. This page will focus specifically on spastic cerebral palsy. For a more general discussion about cerebral palsy including a summary of the 4 subtypes and origins of the disorder, visit our page on What is Cerebral Palsy?What is Spastic CP?
Spastic cerebral palsy (sometimes referred to symptomatically as "spasticity") is the most frequently occurring subtype of cerebral palsy. Approximately 77% of all documented cerebral palsy cases are classified as spastic. The primary physical symptom that is the hallmark of spastic CP is hypertonia. Hypertonia is the medical term for excessive muscle rigidity and stiffness.Symptoms & Characteristics of Spastic CP
People with spastic are disabled by severe hypertonia in specific areas of their body. Hypertonia causes people with spastic CP to suffer from debilitating tightness and contraction in certain muscle groups in the body. This muscle rigidity is particularly noticeable when someone with spastic CP attempts to move the affected parts of their body. This muscle spasticity is caused by abnormal brain functioning.
All movements of the human body (running, walking, writing, or just lifting an arm or leg) are controlled by a series of complex impulse signals transmitted from the brain and communicated to muscles in the body via nerve channels in the spine. To execute these movements correctly the brain signals certain muscles to engage while other opposing muscles simultaneously relax. So when you want to lift your arm up, your brain signals the muscles that lift the arm to engage while directing muscles that lower the arm to disengage or relax. In people with spastic CP, however, the brain does not transmit normal impulse signals for movement to certain muscles. Instead of telling one set of muscles to disengage while an opposing muscle set engages, the brain sends conflicting signals telling both muscle sets to engage or activate at the same time. The result is that the involved muscles essentially freeze up and become locked and rigid. The way the brain directs muscle movements is similar to how a traffic signal functions at an intersection. One direction of traffic gets a green signal to go while traffic in the opposing direction gets stopped with red. If someone has spastic CP, their brain is like a traffic signal that gives a green light to both directions at the same time. Instead of smooth, coordinated movement people with CP exhibit exceedingly stiff, jerky abnormal movements.Subtypes of Spastic CP
Spastic CP tends to affect only specific areas or compartments of the individual's body. So individual cases of spastic cerebral palsy are typically further categorized into 1 of 3 separate spastic CP subtypes. The subtypes of spastic CP are generally defined based on what section of the body is disabled by muscle spasticity.
- Spastic Diplegia: when hypertonia from spastic CP is confined to just the legs and the lower body it is subtyped as spastic diplegia (or diplegic spastic CP). Roughly 20% of all cerebral palsy cases are classified as spastic diplegia. Individuals with this subtype typically have normal muscle movement and control above the waist and the hypertonia affecting their lower body tends to be less severe compared to other subtypes. Many people with spastic diplegia require special crutches or orthotics to walk on their own. The excessive rigidity in their leg muscles often pulls their knees together and results in what is often described as "scissoring" in the legs.
- Spastic Hemiplegia: this subtype of spastic CP occurs when the hypertonia only affects the muscles on one particular side of the body (left or right) and not the other. This subtype is sometimes referred to as "one-sided" cerebral palsy. Spastic hemiplegia is a common subtype and accounts for around 20-30% of all CP cases diagnosed each year. In the majority of spastic hemiplegia cases, the arms and upper body of the affected side are more impaired than the legs and lower body.
- Spastic Quadriplegia: this subtype applies to cases of spastic CP in which the entire body (upper/lower and left/right) is impaired by muscle spasticity and hypertonia. This is the most severe subtype of spastic cerebral palsy and often results in confinement to a wheelchair or other mobility device.
Spastic cerebral palsy is not a genetic disorder that parents pass on to their baby. When a child is diagnosed with spastic cerebral palsy is means that something went wrong during pregnancy or in the labor&delivery room. At some point during pregnancy or childbirth, the child's brain was damaged by oxygen deprivation, external head trauma or some other event. In many cases, the event that ultimately damaged the baby's brain and caused their cerebral palsy was the result of preventable medical error or negligence. Below are summaries of reported settlements and verdicts in cases where spastic cerebral palsy was caused by medical negligence.
- Rojas v. United States (Florida 2017) $3 million: labor was induced 3 days after due date at a federally funded hospital. Things were progressing slowly when fetal monitoring strips indicated prolonged decelerations that were concerning. Doctors used a vacuum extractor to facilitate a vaginal delivery. The baby was not breathing correctly and there was a 10 min delay before NICU team arrived to intubate him. It was eventually discovered that the baby suffered hypoxic ischemic encephalopathy (HIE) injury to the brain resulting in spastic cerebral palsy. The malpractice suit alleged that doctors and hospital were negligent in failing to timely deliver the baby and failing to have a NICU team immediately ready after delivery. About halfway through discovery, the parties agreed to settle for $3,075,000.
- Welker v. Carnevale (Pennsylvania 2017) $14.4 million: the child had a very severe case of spastic cerebral palsy (quadriplegia) which left him unable to walk, talk, or even sit up on his own. The parents sued the doctor and hospital alleging that their son's spastic CP was the result of a catastrophic birth injury caused by negligent mismanagement of the delivery. Specifically, the parents claimed that the doctor negligently administered Pitocin to induce labor when the mother was already dilated (a violation of hospital policy). Then when there were clear indications that the baby was under duress, the defendants allegedly failed to promptly respond and perform an emergency C-section. The defendants denied any wrongdoing. The case was tried in Johnstown, PA, a small town 60 miles west of Pittsburg. The jury found that the defendants were at fault and awarded damages totaling over $14 million.
- Lee v. Kaiser Foundation (California 2015) $4 million: defendants obstetrician and hospital were allegedly negligent in failing to perform a timely emergency Cesarean section when it became apparent that the fetus was in distress and suffering deprivation of oxygen. The baby was diagnosed with spastic cerebral palsy (diplegic) and epilepsy leaving him unable to walk or communicate and requiring full-time care. Plaintiff's initial settlement demand of $5.6 million was rejected but the case eventually settled for $4 million.
- Doe v. Overlake Hosp. (Washington 2013) $20 million: Plaintiff, a first-time mother, was admitted to labor and delivery on an extremely busy night. Five babies were being delivered at the hospital with Defendant OB/GYN being the only doctor. After fetal monitoring strips showed signs of stress the doctor decided to perform an emergency C-section. There was a delay of almost an hour before the emergency C-section was actually performed, due mainly to the fact that the hospital was busy and understaffed. By the time the baby was delivered she was not breathing and was essentially dead. Despite another delay in the arrival of the neonatal specialist, the baby was successfully resuscitated but only after prolonged oxygen deprivation. The baby was diagnosed with spastic quadriplegic cerebral palsy. Plaintiff's experts were prepared to testify that the baby would have been normal and health had the C-section be performed on time. The case settled before trial for $20 million.
We post there because we think they are illustrative in better understanding the settlement ranges of these cases. But to really understand the settlement value of your claim, you need to talk to a birth injury lawyer who has experience handling spasticContact Miller & Zois about Spastic Cerebral Palsy
The attorneys at Miller & Zois can help investigate your case and determine whether your child's spastic cerebral palsy may have been the result of medical negligence. Call our Maryland birth injury malpractice lawyers at 800-553-8082 today or get a free online consultation.Medical Literature on Spastic Cerebral Palsy
- Albright AL. Spasticity and movement disorders in cerebral palsy. J Child Neurol. 1996;11 Supp 1: S1-S4.
- Katz RT. Management of Spasticity. In Braddom R (ed): Physical Medicine and Rehabilitation. Philadelphia, WB Saunders, 1996.
- Massagli T. Spasticity and its management in children. Physical Medicine and Rehabilitation Clinics of North America. Vol2, No4, 1991.
- Molnar GE. Long-term treatment of spasticity in children with crebral palsy. International Disability Studies. 1987;9(4): 170-172.