Cerebral Palsy (CP) is a neurological disorder caused by a non-progressive brain, which affects one in every 400 babies born in the UK. The Office for National Statistics indicated that with a birth rate in England and Wales of around 650,000 per year, there may be as many as 1,600 new cases of cerebral palsy in children each year.
How Cerebral Palsy occurs
There isn’t always a clear cause for Cerebral Palsy, but when there is, it will be the result of the brain either being damaged or not developing normally before, during or within five years of birth.
Cerebral Palsy can happen in several ways, the first being developed either before or during the birth, which is known as congenital cerebral palsy. Congenital cerebral palsy can develop from many reasons and remains the most common type of the disorder.
- Maternal infections like rubella, chickenpox and other infections can lead to brain damage and a high risk of Cerebral Palsy if they are not properly detected and treated
- Carrying twins or multiples also increases the chances of Cerebral Palsy with multi-fetal pregnancies more likely to result in a premature delivery
- Placenta problem
- Uterine rupture
- Incompatible blood types (can lead to Rhesus isoimmunization / Rh factor disease)
- Chorioamnionitis (an infection of the placenta) – an inflammation of the fetal membranes due to a bacterial infection
- Medical negligence and mistakes
- Prematurity or low birth weight
- Infertility treatments
- Jaundice (yellowing of the skin and eyes) caused by bilirubin build-up in the blood would need treatment, failure to do so would cause a form of brain damage called kernicterus to occur.
However, there can also be a chance that cerebral palsy has been developed after the child’s birth, this is known as acquired cerebral palsy. Causes for this include:
- Issues with the brain’s blood flow, leading to blood clotting and a stroke
- Serious head injuries
- Neonatal infections
- Sickle cell disease
Types of Cerebral Palsy
Cerebral palsy is a very complex disorder that is classified into four types, with each one affecting the parts of the brain, body and movement differently.
Spastic Cerebral Palsy
Spastic Cerebral Palsy accounts for 75% of all cases and is the most common out of the four. Children with this type of cerebral palsy experience hypertonia (exaggerated or jerky movements), which occurs when the brain’s motor cortex and pyramidal tracts have been damaged. The motor cortex is found on both sides of the brain, and the pyramidal tracts connect the two, meaning when one side of the motor cortex is damaged, then the opposing side of the body gains movement problems.
Spastic Cerebral Palsy, therefore, generates increased muscle tone known as spasticity as well as causing:
- Abnormal movement
- Awkward reflexes
- Stiff and spastic muscles
- Difficulties controlling muscle movement
- Difficulties moving from one position to another
However, Spastic Cerebral Palsy is further classified depending on the location of where the child or person is receiving movement issues:
Spastic quadriplegia affects the whole body and causes a severe restriction in the child’s mobility.
Spastic diplegia, affects the lower half of the body, though in most cases the child is still able to walk, and only receives some impairment, they also may sometimes need assistive devices.
Spastic hemiplegia, affects one side of the body only, generally, in these cases, it is the arm that is more affected than the leg.
Ataxic Cerebral Palsy
Ataxic Cerebral Palsy is the least common type of the disorder. Generally, Ataxic CP will cause problems with voluntary muscle movement, that appear disorganised or jerky as well as affecting a person’s balance and coordination and occurs when there has been damage to the cerebellum (controls balance and coordination). The damage to the cerebellum will specifically cause difficulty with walking, speaking and depth perception as well as shakiness and tremors. The person will also have trouble with performing fine motor functions such as grasping objects and writing.
Athetoid Cerebral Palsy
Athetoid Cerebral Palsy causes a person to have difficulty with their body movement in their face, torso and limbs and occurs from damage to the brain’s basal ganglia (responsible for regulating voluntary motor function and eye movements) and/or cerebellum. Common symptoms include:
- Poor posture
- Floppiness of the limbs
- Stiff or rigid body
- Issues feeding
Mixed Cerebral Palsy
Sometimes the symptoms don’t relate specifically to one type of cerebral palsy, and therefore, the child can develop a combination of them from the other three types, this is known as Mixed Cerebral Palsy. Though it is very uncommon and makes up of less than 10% of the cerebral palsy cases, with the most common diagnosis being a combination of symptoms from Spastic and Athetoid CP.
When the time comes that your doctor or GP suspects your child has cerebral palsy, they will need to evaluate their signs and symptoms, monitor growth and development, review their medical history, and conduct a physical exam, allowing them to identify the type of cerebral palsy. This also means that no two people will receive the same treatment and can be seen by a variety of specialists. The specialists your child may require include:
- Developmental paediatrician
- Physical therapist
- Occupational therapist
- Behavioural therapist
- Speech and language therapist
- Ophthalmologist (eye specialist)
- Otolaryngologists (ear, nose and throat specialist)
Physiotherapy is one of the most important treatments for cerebral palsy, based on the idea that their issues can worsen over time. Specialists have recommended that patients should start as early as possible, to avoid complications like contractures (a shortening or tightening of the tissues in the muscles and tendons) in the future. During the physiotherapy, your child will undergo muscle training and exercises in a bid to improve their strength, flexibility, balance, motor development and mobility, using equipment such as weights, resistance bands, balance balls and machines to enhance muscle tone.
Speech and language therapy
The brain injury that is suffered, as a result of the birth affects more than just physical attributes, it can also affect the parts of the brain that control speech and the muscles that allow us to speak. Speech therapy is designed to teach children how to pronounce certain words and communicate more effectively, they may also help improve other skills such as breathing and eating.
There is a wealth of technology to assist in communication, including specially adapted laptops or tablets which will be covered with symbols of everyday objects and activities. To communicate, the child will then press a combination of symbols if communication is difficult. There is also eye gaze technology to enable more severely disabled children to communicate using a mouse controlled by a person’s eyes.
Occupational therapists work to aid your child with improving their fine motor skills and independence in carrying out everyday tasks. They sometimes may work cooperatively with speech and physical therapists to build a complete therapy plan, for example, in the first one to two years after birth both your physical and occupational therapists provide support with issues such as head and trunk control, rolling, and grasping. Throughout, the therapy, your child will be recommended adaptive equipment including walkers, quadrupedal canes, seating systems and electric wheelchairs.
Several of the symptoms of cerebral palsy can be relieved and managed with medication, such as issues with movement and secondary conditions that are developed due to cerebral palsy can be treated.
The type of medication will, however, depend on the symptom and can include:
- Medicines for muscle stiffness such as diazepam or baclofen
- Antidepressants for epilepsy
- Nerve blocks for spasticity
- Laxatives for constipation
- Botulinum toxin injections (relaxes certain muscles or groups of muscles for a few months at a time)
There are many options when considering surgery that will help correct movement issues. However, it is worth pointing out that surgery is usually prescribed to those with spastic cerebral palsy to reduce increased muscle tone so their restricted movement can be relieved.
Surgeries that can improve mobility in children include:
- Orthopaedic surgery
- Muscle tightening
- Tendon tightening
- Tendon transfer
- Selective dorsal rhizotomy
The benefits of surgery may not be immediately fulfilled and may take months or even years to feel the full effects, with the likely outcome being for your child to have additional physiotherapy to aid with the recovery.
How Cerebral Palsy can occur
Cerebral Palsy can sometimes occur because of mistakes made by medical professionals during birth. If there is a delay in delivery, it could mean that the baby is deprived of oxygen and will cause permanent damage to the brain. However, there is the possibility that a breach in the duty of care owed, can occur when a medical professional fails to identify and treat diseases such as perinatal infections, jaundice, meningitis and low blood sugar.
Pryers Solicitors have helped many clients who have suffered from Cerebral Palsy because of medical negligence. If you believe, you or a family member have also suffered as a result of medical negligence, speak to our expert team of lawyers and receive the information you need to see if you can make a claim.