Cerebral palsy is a medical condition resulting in disorders of movement because of an injury to the brain. It is usually (but not always) caused by problems at birth or by a severe infection antenatally or in the neonatal period.

Such an injury can, for example, affect muscle control and coordination, muscle tone, reflex, posture and balance. People who are affected by cerebral palsy may also suffer from visual, hearing, and developmental problems with intellectual impairment.  It is usually a permanent and lifelong disability that requires specialist medical treatment and care.

What are the early common signs and symptoms of cerebral palsy? 

It is often difficult to detect signs and symptoms of cerebral palsy until a child reaches the age of 2 or 3.  We know that doctors look for the following more common signs and symptoms of cerebral palsy:

1. Abnormal muscle tone

A child with cerebral palsy may have low muscle tone and reduced muscle strength, also known as hypotonia. Babies with hypotonia often feel floppy when they are picked up and they may have very little or no control of their neck muscles.

Babies with cerebral palsy can alternatively show signs of high muscle tone, also known as hypertonia.  This can result in arms and legs being stiff, crossed and/or difficult to move.

2. Muscle spasms

Having increased muscle tone can often cause involuntary limb movements such as muscle spasms and contractions. This may involve shaky muscles in the arms and legs and twitching.

3. Unusual posture

Children with cerebral palsy may tend to use one side of their body more than the other when reaching, crawling and moving. For example, they may reach out with only one hand whilst holding the other in a fist.

4. Difficulties with feeding 

A young baby with cerebral palsy may have difficulties swallowing milk, as well as poor lip and tongue control. As babies get older, they may struggle to pick up food and put it into their mouth. They may also find it difficult to chew.

5. Developmental delays

Delays in reaching key growth milestones are often an indication of cerebral palsy. Examples include delay in holding and lifting the head unsupported, rolling over, sitting, crawling, standing and walking.

There are other symptoms of cerebral palsy that your child’s treating NHS doctor will likely consider when diagnosing cerebral palsy, for example: epilepsy (causing seizures) and problems with eyesight and hearing.

It is important to note that symptoms and the severity of symptoms vary significantly from child to child.

Types of Cerebral Palsy

There are various types of cerebral palsy, including:

• Dyskinetic (or athetoid) cerebral palsy
• Spastic cerebral palsy
• Quadriplegic cerebral palsy
• Diplegic cerebral palsy
• Hemiplegic cerebral palsy
• Ataxic cerebral palsy
• Mixed type cerebral palsy

Some of the common (but not all) causes of cerebral palsy are:

Infection

If the mother of a baby is suffering from an infection (Group B Streptococcal or Herpes, for example) this can be passed onto the baby before or during the labour.

If infection is suspected, the mother may be given antibiotics to try and stop the baby acquiring the infection. If, after the delivery, the baby has contracted the infection it is crucial that this is diagnosed and treated as soon as possible.  Without early treatment the infection is likely to worsen and cause serious damage to the baby’s brain.

Oxygen Starvation of the Brain at Birth

This can happen for a number of different reasons; for example, the baby becoming stuck and squeezed in the pelvis just before delivery or the umbilical cord becoming twisted and wrapped around the baby’s neck.

Monitoring of the baby’s heart rate should detect any distress associated with oxygen starvation of the brain. If this is identified, delivery of the baby may be brought forward with an assisted delivery (forceps) or caesarean section.

Kernicterus

This is where a baby suffers from severe jaundice that, if left untreated, leads to a build-up of unsafe levels of bilirubin in the blood that can result in permanent brain damage.

Head Injury

Blunt trauma to a baby’s delicate head can cause permanent brain damage.

Brain Haemorrhage Or Stroke

Appropriate monitoring should identify the risk of a brain haemorrhage or stroke after a baby is born, particularly if the delivery was difficult, given both are high risk factors.

Is cerebral palsy always a birth injury?

Cerebral palsy is not always caused by birth injuries. The condition occurs when a baby experiences abnormal brain development or damage to their brain whilst it is still developing. The cause would be considered a birth injury if it involved damage to the brain immediately before, during or after the delivery.

What can cerebral palsy compensation be used for?

When assessing the level of compensation for cerebral palsy birth injury claims, we usually look at the following needs of the child/family:

• Professional Care (Past and Future)
• Occupational Therapy Needs
• Physiotherapy Needs
• Speech and Language Therapy Needs
• Accommodation (whether the family home needs adaption or a completely new house)
• Transport Needs (adapted vehicle, for example)
• Aids and equipment like wheelchairs and hoisting equipment.
• Assisted Technology Needs (computers for communication, for example)
• Future medical treatment
• The child’s loss of earnings
• Court of Protection Costs
• Case Management Costs

A lifetime of much needed extensive professional input, care and treatment like that described above underlines why cerebral palsy claims result in such high value compensation claims.

Are there any risk factors for cerebral palsy?

Yes, the following factors can sometimes increase the risk of a baby suffering from cerebral palsy:

• Premature birth – particularly if the baby is born before 32 weeks
• Low birth weight – particularly if the baby weighs less than 5.5 lbs at birth
• When twins or multiple babies are delivered
• Maternal age – particularly if the mother is over the age of 35 years of age
• Maternal health – particularly if the mother has very high or low blood pressure
• A complicated birth such as when the baby is in the breech position

Treatment for Cerebral Palsy

For people living with cerebral palsy, the right treatment and support can make a huge difference to their wellbeing and quality of life. Understanding what options are available can help to ensure you know what treatment you or your child may benefit from.

Surgical treatment for cerebral palsy

With the input of a range of professionals, it may be that the child undergoes surgery to try and alleviate and improve their condition, for example, to lessen muscle tightness or correct bone abnormalities (scoliosis of the spine, for instance). Two types of operations are often considered:

• Surgery to bones or muscle groups, particularly for children with severe deformities that cause pain and hinder movement. Bones, joints, muscles, and tendons can be shortened or lengthened with the aim of minimising pain and distress and promoting mobility.
• Surgery to nerves such as a selective dorsal rhizotomy. This procedure is used when other treatments have not worked so the nerves are cut to relax the muscle groups and to reduce pain. There are risks of numbness associated with these types of procedures, so they are usually only considered in older children (3-12 years old) on a strict criteria basis.
• Botox treatment to lesson strictures and other muscle tightening

Medication and therapy

Some children may benefit from taking medication to reduce pain and help alleviate tight muscle groups affecting their movement. Paediatricians and medical teams will consider this.

Therapy is particularly important in children with cerebral palsy and often results in significant progress, both in terms of physical development and mobility, but also psychological well-being.

There are a number of different therapies. Examples include:

• Physiotherapy to strengthen and stretch muscle groups to help with and improve balance, coordination, flexibility, and mobility. With a very young child, the focus will be on head and trunk control and rolling and collecting objects.  As the child gets older, physiotherapy will then likely focus on strength and conditioning for walking and/or wheelchair control.
• Occupational therapy to use technological aids and equipment to help promote independence and work towards full participation at home, school and in the community.
• Speech and language therapy to help a child with limited muscle group control improve their ability to communicate with their family and peers. If spoken speech is not possible, focus will instead be directed at utilising computers and /or voice synthesisers.
• Recreational therapy such as horse-riding or music therapy to help a child’s motor skills (fine and gross), speech and language and crucially their emotional wellbeing.

Cerebral Palsy Claims

How do you make a cerebral palsy claim?

If you, your child or a child you know is diagnosed with cerebral palsy and there are concerns about the standard of care during their birth then you should seek legal advice from specialists who are experienced in dealing with birth injury claims.

The birth injury solicitors will investigate your concerns about poor medical care and assess whether any failings caused or led to the child developing cerebral palsy.  If it is possible to prove a claim for negligence at birth then the solicitors will liaise with the hospital Trust and seek an admission of fault and compensation but it may also be necessary to seek redress from the courts.

Funding your cerebral palsy claim

Cerebral palsy claims can be funded on a no win, no fee basis, also known as a ‘Conditional Fee Agreement’. This means there is no upfront cost to start a claim, with fees only being payable if the claim is successful.

Gathering evidence

Various types of evidence will be needed to help support a cerebral palsy claim. This typically includes medical records, witness statements and opinions from independent medical experts. This information is needed to help establish that medical negligence occurred and that this caused or materially contributed to the cerebral palsy/brain injury.

Working out how much compensation may be owed

The need of every child is different and with input and the assistance of independent experts, it will be possible to look at assessing the amount of compensation which should be paid.

Settlement negotiations

Most cerebral palsy claims can be settled through negotiation. This can mean families are able to secure compensation for cerebral palsy faster, without the need for a Court trial, with less stress and conflict, as well as keeping legal costs to a minimum.

Court proceedings

In some cases, it may not be possible to secure a suitable out-of-court settlement for cerebral palsy negligence through negotiation and it may be necessary to take a cerebral palsy claim to court.

Is cerebral palsy caused by medical negligence?

Not every instance of cerebral palsy is caused by medical negligence, but negligent mistakes before, during or immediately after a birth can result in cerebral palsy or make the condition more severe than may have been the case with appropriate care.

Establishing whether medical negligence caused or worsened a case of cerebral palsy is a critical part of making a compensation claim.

What is the time limit for a cerebral palsy claim?

A child with cerebral palsy can make a claim for compensation up until the age of 21 years old.  If a person with cerebral palsy does not have the mental capacity to bring a claim, then there is no time limit for someone else to do so on their behalf.

What medical mistakes cause cerebral palsy?

Cerebral palsy can be caused by a problem in the antenatal period, during the labour and delivery or after the birth in the neonatal phase. There are two broad categories of medical mistakes that can occur during these stages that may cause cerebral palsy:

• where brain damage is directly caused by medical errors e.g. delay in delivery
• where brain damage occurs due to clinical staff failing to effectively identify and/or manage risk factors for brain damage before, during or immediately after birth.

Bringing legal action can be daunting, but Fletchers Solicitors experienced cerebral palsy lawyers can guide parents through the process with empathy and understanding.

Fletchers lawyers work with the leading medical experts to:

• identify the mistakes and oversights that led to a child’s condition
• assess the child’s lifelong needs so they have the care they need and the opportunity to live the fullest life
• secure the right amount of compensation so that the family can meet the costs of long-term care and face the future with confidence.

If you would like to discuss any aspect of this article in more detail or would like legal advice, please contact Sahida Patel directly at [email protected] or visit her profile here: www.mintonmorrill.co.uk/site/people/profile/sahida.patel

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