Cerebral Palsy*

Cerebral Palsy is caused by abnormal developments or damage in parts of the brain that control muscle tone and motor activity movement. Parents normally notice its effects in infancy or early childhood when the child shows difficulty in rolling over, sitting, crawling, walking, speech, swallowing and other functions.

The damage can occur early in pregnancy when the brain is just starting to form, during the birth process as the child passes through the birth canal, or after birth in the first few years of life.

In many cases the exact cause of brain damage is never known and it takes approximately 18 months to 2 years for doctors to make a positive diagnosis or otherwise.

When a child is diagnosed as having Cerebral Palsy, it does not automatically mean that Medical Negligence occurred either at the prenatal period or during the birth process.

In the vast majority of instances, attending Hospitals, Doctors, Mid-wives and other Medical Professionals act with the utmost care and responsibility in meeting the highest of standards on behalf of patients in their care.

However when that standard of care falls short of the legal standard required, Medical Negligence may have occurred  and outcomes can go wrong.

Cerebral Palsy which involves Medical Negligence is a complicated area of Law, and requires specialist knowledge by your Legal Practitioner. Our Solicitors at Medical Law have that expertise.

Medical Explanations

What Is Cerebral Palsy?

Cerebral palsy (CP) is a group of non-progressive motor conditions that cause physical disability. It is caused by damage to the motor control centers of the developing brain and can occur during pregnancy, during childbirth or after birth up to about age three. ‘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.

Limitations in movement and posture and disturbances of sensation and depth perception are common in children who have CP. Cognitive impairments and epilepsy occur in about one-third of children who have cerebral palsy. In addition, cerebral palsy is often accompanied by secondary musculoskeletal problems that arise as a result of the underlying disorder.

Currently, cerebral palsy has no cure. Usually, medical intervention is limited to the treatment and prevention of complications arising from cerebral palsy’s effects.Cerebral Palsy: Damage to the Cerebellum and Cerebrum

Cerebral palsy is characterized by:

  • Abnormal muscle tone (e.g. slouching over while sitting), reflexes, motor development and coordination;
  • Joint and bone deformities and contractures (permanently fixed, tight muscles and joints);
  • Spasticities, spasms and other involuntary movements (e.g. facial gestures);
  • Unsteady gait;
  • Problems with balance;
  • Soft tissue problems such as decreased muscle mass;
  • Scissor walking (where the knees come in and cross) and toe walking (which can contribute to a gait reminiscent of a marionette).

The effects of cerebral palsy fall on a continuum of motor dysfunction, which may range from slight impairments to impairments so severe that they render coordinated movement virtually impossible.

Types of Cerebral Palsy

Cerebral palsy is divided into four major classifications to describe different movement impairments. These classifications also reflect the areas of the brain that are damaged. The four major classifications are:

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

Spastic Cerebral Palsy

Spastic cerebral palsy is by far the most common type of cerebral palsy (70- 80% of all cases).  Children with spastic cerebral palsy have lesions in the central nervous system. This damage affects neurotransmitter levels in the brain, leading to hypertonia (extreme muscle tension) in the muscles that receive signals from damaged portions of the brain. Hypertonia can cause involuntary muscle contractions, secondary pain and/or stress, and muscle spasms. Spasticity can and usually does lead to very early onset muscle-stress symptoms (such as arthritis and tendinitis) in individuals as young as their mid-20s. Side effects of spastic cerebral palsy include contractures, pain, joint deformities, scoliosis, hip dislocation, and more.

Ataxic Cerebral Palsy

Ataxic cerebral palsy is characterized by hypotonia (decreased muscle tone) and tremors, affecting controlled movements and fine motor skills. This includes posture and balance (particularly while walking) and movements such as writing, typing or using scissors. Ataxic cerebral palsy occurs in roughly 10% of all cases of CP and is the result of damage to the cerebellum, the part of the brain responsible for regulating balance. It is common for children with ataxic cerebral palsy to have difficulty with visual processing (depth perception and eye movement control) and/or auditory processing. Ataxic cerebral palsy derives its name from ataxia, a neurological disorder caused by dysfunction of the nervous system that affects the coordination of muscle movements.

Athetoid Cerebral Palsy

Athetoid cerebral palsy/dyskinetic cerebral palsy occurs in roughly 15% of CP cases. This is the result of damage to the basal ganglia, the part of the brain responsible for regulating voluntary movements. In many cases, athetoid cerebral palsy can be caused by kernicterus (a condition where high bilirubin levels in a newborn go untreated, causing damage to the basal ganglia).

Athetoid cerebral palsy causes a combination of hypertonia, hypotonia and involuntary motions. Children with athetoid cerebral palsy have trouble holding themselves in an upright, steady position for sitting or walking.  For some children with athetoid cerebral palsy, it takes a lot of work and concentration to get their hands to a certain spot (like scratching their nose or reaching for a cup).  Mixed muscle tone and difficulty with maintaining posture can make holding onto objects difficult, especially small ones requiring fine motor control (such as a toothbrush or pencil).

Dyskinetic cerebral palsy is further characterized into three subgroups based on the nature of the dyskinetic movements:

  • Dystonia (dystonic cerebral palsy): Involuntary muscular contractions that cause repetitive twisting motions, postural abnormalities and painful movement.
  • Athetosis: Abnormal muscle contractions that cause slow, involuntary slow writhing movements.
  • Chorea: Irregular, unpredictable jerking movements. When chorea occurs in conjunction with athetosis, it is known as choreoathetosis.

Mixed Cerebral Palsy

Mixed cerebral palsy is characterized by both hypertonia (abnormally high muscle tone) and hypotonia (abnormally low muscle tone). When an individual case of cerebral palsy includes impairments and features of both spastic and non-spastic cerebral palsy, it is considered mixed cerebral palsy. People with mixed cerebral palsy experience different motor disturbances in different limbs.

How Is Cerebral Palsy Classified?

Cerebral palsy is categorized into types and subtypes based on the extent and distribution of impairments such as spasticity and muscle tone abnormalities. The classification systems used to describe and organize cerebral palsy include:

  1. Muscle Tone Classification System
  2. Motor Disturbance Classification System
  3. Limb Involvement Classification System
  4. Severity of Cerebral Palsy
  5. Gross Motor Function Classification System (GMFCS)
  6. Manual Ability Classification System (MACS)
  7. Communication Function Classification System (CFCS)

Many of the classification systems for cerebral palsy overlap. Because these systems range from specific to general, encompass various areas of the body and explain different aspects of functional ability, they are often used together. For example, the motor function and limb involvement classification systems are commonly used together to create the classification of ‘spastic quadriplegic’ cerebral palsy. ‘Spastic’ relates to the motor function classification system and ‘quadriplegic’ relates to the limb involvement classification system.

1. Muscle Tone Classification System

In the muscle tone classification system, cerebral palsy is described based on how muscle tone is impaired. The two muscle tone classifications are as follows:

  • Hypertonia: A physiological term used to describe abnormally high muscle tone. Individuals with hypertonia and hypertonic cerebral palsy have increased muscle tone, which creates muscular stiffness and rigidity. Spastic cerebral palsy is characterized by hypertonia.
  • Hypotonia: A physiological term used to describe abnormally low muscle tone. Side effects of hypotonia include floppiness and weakness. Forms of non-spastic cerebral palsy (ataxic, dyskinetic and athetoid cerebral palsy) are characterized by hypotonia.
  • Mixed cerebral palsy is characterized by both hypotonia and hypertonia,

2. Motor Disturbance Classification System

The motor disturbance classification system organizes cerebral palsy into four main types based on the location of the brain injury and the brain injury’s corresponding movement impairments. The four types include:

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

Other important terms to know relating to the Motor Disturbance Classification System include:

  • Rigidity: Abnormal muscular stiffness.
  • Tremor: An involuntary, shaking muscle movement that is often a sign of a neurological disorder. Coordination and movement in the hands, arms, head, face, voice and legs are most often affected.

3. Limb Involvement Classification System

This classification system categorizes cerebral palsy in terms of limb impairment. In the Limb Involvement Classification System, each type of cerebral palsy describes information about the number and location of affected limbs.

Type of Cerebral Palsy # Limbs Affected Location of Affected Limbs
Monoplegic cerebral palsy (monoplegia; monoparesis) 1 Usually an arm, but can be any limb.
Hemiplegic cerebral palsy 2 Limbs affected on the same side of the body (ex: left arm and left leg).
Double hemiplegic cerebral palsy 4 Both arms and both legs affected; one side of the body is more involved.
Diplegic cerebral palsy 4 CP that affects symmetrical parts of the body (for example, both arms and/or both legs); most commonly impacts both legs.
Paraplegic cerebral palsy 2 Impairs the lower body, affecting both legs.
Triplegic cerebral palsy 3 Impacts three limbs; usually both arms and one leg.
Quadriplegic cerebral palsy 4 Involves all four limbs; commonly associated with spastic CP.
Pentaplegic cerebral palsy 5 Impacts both legs, both arms, and the head and neck.

4. Severity of Cerebral Palsy

Classifying cerebral palsy based on severity is the simplest way to describe the extent of an individual’s impairment.

  • Mild Cerebral Palsy: Those with mild cerebral palsy may be independent and fully mobile depending on level of cognitive function. Some can complete daily tasks without or with very little assistance.
  • Moderate Cerebral Palsy: Those with moderate cerebral palsy require assistance from assistive technology, adaptive equipment and other people to perform daily tasks.
  • Severe Cerebral Palsy: Those with severe cerebral palsy require extensive help from assistive technology, adaptive equipment and other people in order to complete daily tasks.

5. Gross Motor Classification System (GMFCS)

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 following categories:

  • Extent of movement impairment: The GMFCS measures a child’s ability to perform gross motor functions independently. It takes into consideration limb control, movement transition, dependence on equipment and related factors.
  • Age: The GMFCS measures individuals by age group including 0-2, 2-4, 4-6, 6-12 and 12-18.
  • Performance in a variety of settings: The GMFCS measures a child’s functional ability in settings such as the home, school and community.

The GMFCS is measured in levels (GMFCS Level 1-5) with the highest level signifying the most severe forms of cerebral palsy. By classifying a child with cerebral palsy based on the GMFCS, parents, medical professionals and caregivers can determine appropriate therapy regimens, plan lifestyle adjustments and estimate rehabilitation potential. The GMFCS works in conjunction with other classification systems including the Manual Ability Classification System of cerebral palsy (MACS), the Motor Disturbance Classification System, severity, and the Communication Function Classification System of cerebral palsy (CFCS).

  • GMFCS Level I
    • Mobility: Children walk, climb, jump, run and move largely without limitations, but experience compromised speed, coordination and balance.
    • Self-care: Independent.
    • Adaptive Equipment: No adaptive equipment needed.
  • GMFCS Level II
    • Mobility: Children can walk with limitations and may require assistance balancing and moving on inclined or uneven surfaces. Many have difficulty running or jumping.
    • Self-care: Independent.
    • Adaptive Equipment: May require equipment to move on uneven or complicated surfaces.
  • GMFCS Level III
    • Mobility: Children can walk with hand-held adaptive equipment and may require a wheelchair for long distances and inclines.
    • Self-care: Semi-dependent on adaptive equipment and personal assistance.
    • Adaptive Equipment: Children often require handheld walking devices for level surfaces and manual wheelchairs for uneven or abnormal surfaces and long distance travel.
  • GMFCS Level IV
    • Mobility: Children are self-mobile only with significant limitations. Many use powered wheelchairs and require help with transfers.
    • Self-care: Dependent on others and adaptive equipment.
    • Adaptive Equipment: Powered wheelchairs and other assistive devices.
  • GMFCS Level V
    • Mobility: Children have physical limitations that impair voluntary movement and posture in all areas of motor function and are very dependent on assistive technology, adaptive equipment and people for mobility.
    • Self-care: Very dependent on other people or assistive devices to stand, walk and move.
    • Adaptive Equipment: Requires powered mobility, adaptive equipment and assistive technologies.

Source for this section: Palisano, R., Rosenbaum, P., Walter, S., Russell, D., Wood, E., & Galuppi, B. (1997). Development and reliability of a system to classify gross motor function in children with cerebral palsy. Developmental Medicine and Child Neurology, 39(4), 214-223.

6. Manual Ability Classification System (MACS)

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 an individual’s ability to complete tasks independently. The MACS works in conjunction with the Gross Motor Function Classification System (GMFCS) and the Communication Function Classification System (CFCS).

  • MACS Level I: Children handle objects with ease.
  • MACS Level II: Children largely handle objects successfully, but with compromised speed or ease.
  • MACS Level III: Children experience difficulty handling objects and require help.
  • MACS Level IV: Children always require help handling objects.
  • MACS Level V: Children have no ability to perform manual activities.

7. Communication Function Classification System (CFCS)

The Communication Function Classification System (CFCS) categorizes individuals with cerebral palsy into five levels based on everyday communication performance. The CFCS works in conjunction with the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS).

  • 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 communication information with both unfamiliar and familiar partners. Communication ability may vary by environment.
  • CFCS Level III: The person effectively sends and receives communication information with familiar partners, but not 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 with familiar people and cannot communicate effectively with unfamiliar people

Signs and Symptoms of Cerebral Palsy

Although signs and symptoms are often used interchangeably, they have their own specific definitions:

  • Signs can be detected, measured and confirmed in a clinical setting by medical practitioners. Examples include seizures and tremors.
  • Symptoms are solely based on a patient’s personal experience of his or her medical conditions. Examples include pain and irritability.

Because the types, impairments, levels of severity and side effects of cerebral palsy vary so greatly, there is no one sign or symptom used individually to diagnose CP. While some children will be diagnosed with cerebral palsy immediately after delivery, others will not show signs or express symptoms until later in early childhood when the brain finishes developing. Often, medical professionals, family members, caretakers, friends or other people close to the child pick up on one of an array of signs and prompt the diagnostic process. Symptoms may appear or change as a child gets older.  Classically, cerebral palsy becomes evident when the baby reaches the developmental stage at 6 ½ – 9 months and is becoming mobile, where the preferential use of limbs, asymmetry, or gross motor developmental delays are seen.

Secondary conditions can include seizures, epilepsy, apraxia, dysarthria or other communication disorders, eating problems, sensory impairments, intellectual and developmental disabilities, learning disabilities, urinary incontinence, fecal incontinence and/or behavioral disorders. Speech and language disorders are common in children with cerebral palsy. Speech problems are associated with poor respiratory and oral-facial muscle control.

Babies born with severe cerebral palsy also may have an irregular posture; their bodies may be either very floppy or very stiff.  Birth defects (such as spinal curvature, a small jawbone, or a small head) sometimes occur as a part of CP.

Neonatal Signs of Cerebral Palsy

  • The baby does not cry after delivery
  • The baby does not breathe right after delivery
  • The baby requires resuscitation after delivery
  • Neonatal seizure activity
  • Weakness or floppiness (hypotonia)
  • Joint and bone deformities
  • Neurological signs such as excessive irritability or docility
  • Poor head position

Signs of Cerebral Palsy: Joint, Bone and Muscle Abnormalities

  • Low muscle tone (hypotonia)
  • High muscle tone (hypertonia)
  • Athetosis (writhing movements)
  • Tremors; involuntary movements
  • Spasms and muscular stiffness
  • Malpositioned limbs
  • Poor muscle control
  • Scoliosis
  • Pelvic bone tilting
  • Joint stiffness
  • Increased tendon reflexes
  • Clonus (involuntary, rhythmic muscular contractions) of the ankles, feet, or wrists

Signs of Cerebral Palsy: Impaired Coordination, Control and Balance

  • Spasticity
  • Athetosis
  • Dyskinetic movement
  • Ataxia
  • Inability to prop one’s self up on hands
  • Inability to sit up without supports
  • Balance impairments
  • Swaying, slow movements

Signs of Cerebral Palsy: Gait Abnormalities

  • Abnormal toe placement
    • Walking on toes, angling toes inwards, angling toes outwards
  • Uneven weight distribution
  • Abnormal bodily alignment while walking
  • Scissor gait
  • Dragging feet or legs

Signs of Cerebral Palsy: Motor Function Impairments

  • Gross motor function abnormalities
  • Impairments or delays, including any of the following:
    • Sitting up
    • Standing
    • Crawling
    • Walking
    • Balancing
    • Rolling
  • Fine motor function abnormalities
    • Difficulty handling small objects or performing tasks such as using utensils and scissors
    • Difficulty holding objects with thumb and pointer finger
  • Oral motor function abnormalities
    • Speaking problems
    • Swallowing difficulties
    • Eating, chewing and feeding problems
    • Saliva control problems
    • Breathing problems
    • Communication problems
    • Problems opening and closing the mouth
    • Abnormal tongue patterns, such as retracting and thrusting tongue
    • Abnormal mouth patterns, such as tonic bite (biting hard and not letting go), mouth sensitivity and frequent grimacing

Signs of Cerebral Palsy: Developmental Delays

  • Inability to sit up independently by 6 or 7 months
  • Inability to roll over by 6 months
  • Inability to walk between 12 and 18 months
  • Difficulty speaking by 12 months and failure to speak in simple sentences by 24 months
  • Inability to hold up head while in a sitting or reclined position
  • Failure to blink at loud sounds by one month
  • Favoring one side of the body
  • Delayed postural reactions
    • Righting reactions (maintenance of head and bodily alignment)
    • Protective reactions (Protection against falls)
    • Equilibrium reactions (Returning displaced body to original vertical position)
  • Prolonged incontinence

Signs of Cerebral Palsy: Retention of Primitive Reflexes

  • Crawl reflex
  • Grasp reflex
  • Tonic neck reflex
  • Rooting reflex
  • Step reflex

Other Signs and Symptoms of Cerebral Palsy

  • Visual impairment
  • Hearing impairment
  • Intellectual disabilities
  • Tenseness
  • Irritability
  • Fatigue
  • Behavioral and emotional problems
  • Sensory abnormalities

Signs and symptoms often differ and evolve depending on a child’s age. Learn more about the signs of cerebral palsy based on age here.

Birth Injuries and Other Causes of Cerebral Palsy

In certain cases, there is no identifiable cause of cerebral palsy, but typical causes include problems with intrauterine development (e.g. exposure to infection), asphyxia before birth, a lack of oxygen to the brain during labor and delivery, birth trauma during labor and delivery, and complications during the perinatal period.  Cerebral palsy is also more common in multiple and premature births.Birth Injuries and Other Causes of Cerebral Palsy

40-50% of children who develop cerebral palsy are born prematurely. Premature infants are vulnerable because their organs are not fully developed, increasing the risk of hypoxic  brain injury, which can cause cerebral palsy. Low birth weight is a risk factor for cerebral palsy, and premature infants usually have low birth weights.In addition, multiple-birth infants are more likely than single-birth infants to be born early or with a low birth weight. Infections in the mother can also cause premature birth and predispose a child towards cerebral palsy.

Causes and risk factors for cerebral palsy include:

  • Maternal infection
  • Breech births
  • Severe or untreated jaundice
  • Bacterial meningitis: This is a bacterial infection that causes inflammation in the membranes that surround the baby’s brain and spinal cord.
  • Viral encephalitis: This is a viral infection that causes inflammation of the baby’s brain.
  • Chorioamnionitis: This is an inflammation of the fetal membranes due to a bacterial infection.

It is worth noting, however, that these conditions are risk factors and do not guarantee that a child will necessarily have 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 above conditions, birth injuries can result.

Conditions Associated with Cerebral Palsy

No two cases of cerebral palsy are quite alike. 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 may also affect a person’s functional potential. Common conditions associated with CP include:

  • Pain from cerebral palsy (50-75%)
  • Cognitive disabilities from cerebral palsy (50-85%)
    • Intellectual ability ranges widely from person to person. Individuals with spastic quadriplegic cerebral palsy may experience the greatest degree of cognitive disability. Individuals with athetoid or dyskinetic cerebral palsy may have less extreme cognitive disability.
  • Learning disabilities from cerebral palsy
  • Communication disorders from cerebral palsy; speech-language disorders from cerebral palsy (40-60%)
    • Many individuals with cerebral palsy have communication and language disorders including and caused by aphasia, dysarthria, breathing issues, hearing impairments, muscular issues, breathing issues and cognitive impairments. Some are non-verbal.
  • Epilepsy and seizure disorders from cerebral palsy (25-45%) 
    • Seizure disorders are most commonly associated with spastic quadriplegic cerebral palsy and are less common in mild symmetric spastic diplegia. Epilepsy and seizure disorders are more common in individuals with cerebral palsy and intellectual impairments.
  • Visual impairments from cerebral palsy (30%)
    • Low visual acuity
    • Slow eye movement
    • Strabismus:
      • Strabismus is a condition characterized by the misalignment of the eyes. Strabismus is caused by an imbalance of the eye muscles, and it occurs in roughly half of all children with spastic cerebral palsy. Individuals with strabismus often appear cross-eyed.
      • Strabismus can be treated with glasses. Others may choose to treat the condition by patching the strong eye. However, if these means prove unsuccessful, surgery can help ensure that both eyes work together for visual acuity in each eye. In many cases, an individual with strabismus may require multiple surgeries to achieve proper ocular alignment. According to statistics, roughly 25% of children with strabismus may require more than one surgery to solve the problem.
    • Cortical visual impairment
    • Retinopathy of prematurity (ROP)
  • Hearing impairments from cerebral palsy (10-20%)
    • Hearing impairments are most common in individuals with cerebral palsy due to low birth weight or hypoxic ischemic encephalopathy (HIE).
  • Hip displacement from cerebral palsy (30%)
  • Spinal abnormalities from cerebral palsy
    • Scoliosis
  • Behavioral disorders from cerebral palsy (25-40%)
    • Behavioral, emotional or psychiatric disorders may result from dependency on personal assistance and adaptive equipment, low self-esteem, frustration or other limitations. Behavioral and emotional disorders can also result from the initial brain insult.
  • Incontinence from cerebral palsy (30-60%)
  • Sleep disorders from cerebral palsy (20%)
  • Saliva control problems from cerebral palsy (20%)
  • Gastronomy-tube dependence from cerebral palsy (7%); Eating and drinking problems from cerebral palsy
  • Gastrointestinal disorders from cerebral palsy (90%)
    • Chronic constipation
    • Gastroesophageal reflux
    • Vomiting
    • Swallowing disorders
    • Abdominal pain
  • Growth failure from cerebral palsy
  • Pulmonary disease from cerebral palsy
  • Orthopedic disorders from cerebral palsy
  • Urinary disorders from cerebral palsy
  • Arthritis and tendonitis from cerebral palsy

Diagnosing Cerebral Palsy

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.  When abnormal, neuroimaging studies can suggest the timing of the initial damage. An abnormal neuroimaging study indicates a high likelihood of associated conditions such as epilepsy and intellectual/developmental disabilities.

A diagnosis of cerebral palsy can be made as early as one month of age, but most cases are not diagnosed until a baby is around 18-24 months old. In other cases, cerebral palsy goes undetected until children miss major developmental milestones, typically between the ages of 1 and 5. Because clinical signs of cerebral palsy evolve as the baby’s nervous system matures, the diagnostic process usually involved multiple trips to the child’s primary physician, as well as multiple other specialists.

Furthermore, the time at which a cerebral palsy diagnosis is made often depends on the type of cerebral palsy the child has. For instance:

  • Spastic cerebral palsy diagnoses are often made around 6 months of age
  • Dyskinetic cerebral palsy diagnoses are often made around 18 months of age
  • Ataxic cerebral palsy diagnoses are often made even later than 18 months of age

Diagnostic Tests for Cerebral Palsy

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 the common tests and procedures used to diagnose 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 impact the blood’s pH (acidity). If the baby’s blood is acidic, it means the baby’s cells began operating under anaerobic conditions, indicating that the baby suffered an oxygen deprivation injury, which increases the likelihood the baby will have cerebral palsy.
  • Neuroimaging: These techniques allow medical personnel to produce images of the structures and activity of the brain and nervous system:
    • 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 assesses whether infants are meeting specific developmental milestones at the expected time.
  • Screening for associated conditions
    • Hearing/visual impairment
    • Intellectual disability
    • Speech and language problems
    • Problems with the mouth muscles
    • Attention difficulties
  • Scanning for coagulation or other blood disorders

Diagnosing cerebral palsy as early as possible is a critical component in maximizing a child’s independence, function and potential. The sooner children are diagnosed with cerebral palsy, the sooner they can begin the treatment and therapy regimens designed to preserve brain function, lessen impairments and improve functional ability.

Treatment and Therapy for Cerebral Palsy

The best way to ‘treat’ cerebral palsy is to minimize risk in the first place. There is promising research that indicates that magnesium sulfate has a neuroprotective effect and can help protect the brain from cerebral palsy when the baby is exposed to it while in the mother’s womb.  In addition, research shows that babies who are given hypothermia treatment (brain cooling or body cooling therapy) within the first hours of life have a decreased chance of having cerebral palsy, or may have a less severe form of the disorder.

Once a child has been identified as having cerebral palsy, treatment is mostly supportive and focuses on helping the child develop as many motor skills as possible or to learn how to compensate for a lack of them.

Various forms of therapy are available to children living with cerebral palsy.  The earlier treatment begins, the better chance children have of overcoming developmental disabilities. The earliest proven intervention (hypothermia therapy) occurs during the infant’s recovery in the neonatal intensive care unit (NICU).

  • Treatment for Cerebral Palsy
    • Magnesium sulfate treatment (before birth)
    • Therapeutic hypothermia treatment (brain cooling) for hypoxic ischemic encephalopathy (HIE) (within  6 hours of birth)
    • Technology
      • Assistive technology
      • Adaptive equipment
        • Braces and Orthotics
        • Walkers, canes, wheelchairs, etc.
      • Augmentative and alternative communication (AAC)
    • Surgery (to correct anatomical abnormalities or release tight muscles)
    • Medications and drug therapy for long-term spasticity and seizure control
      • Baclofen
      • Botox
    • Stem cell therapy (potential future treatment; still in clinical trials)
  • Therapy for Cerebral Palsy
    • Physical therapy
    • Occupational therapy
    • Speech-language therapy
    • Recreational therapy
      • Play therapy
      • Art therapy
      • Music therapy
      • Animal-assisted therapy
        • Hippotherapy (equine-assisted therapy)/ therapeutic horseback riding
        • Pet therapy: Dogs, cats, fish, reptiles, etc.
    • Behavioral and emotional therapy
    • Sensory integration therapy
    • Electrical stimulation therapy
      •   Threshold Electrical Stimulation (TES)
      •   Functional Electrical Stimulation (FES)
      •   Neuromuscular electrical stimulation
    • Social therapy
    • Sports therapy
      • Aquatic therapy
  •   Complementary and alternative therapy
    • Hyperbaric oxygen therapy (HBOT)
    • Acupuncture
    • Craniosacral therapy (Cranial-sacral therapy; CST)
    • Chiropractic therapy
    • Nutrition therapy
    • Respiratory therapy
    • Yoga
    • Anat Baniel Method
    • Body work
    • Rolfing
    • Massage therapy
    • The Alexander Method
    • Reflexology
    • Intensive suit therapy
      •   Adeli Suit Therapy
      •   NeuroSuit Therapy
    • Conductive education (CE)

While no single cure for cerebral palsy exists, patients are encouraged to participate in a comprehensive and diverse range of therapies and procedures to alleviate its associated social, physical, emotional, and cognitive difficulties.

Preventing Cerebral Palsy

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 injuries, disabilities and limitations associated with cerebral palsy can be severe, it is tragic that many cerebral palsy diagnoses may be the result of preventable medical errors and birth injuries. There are several preventative measures medical professionals are required to take in order to prevent cerebral palsy and birth injury.

Who Is Responsible for Preventing Cerebral Palsy?

According to the standards of care, medical professionals (including doctors, nurse, surgeons, obstetricians, midwives, NICU staff, pharmacists and anesthesiologists, among others) are required to provide medical care in accordance with certain set standards in order to prevent injury or harm to an expectant mother and her baby.

Medical personnel are responsible for:

  • Detecting and diagnosing causes and risk factors for birth injury and cerebral palsy
  • Taking preventive action in the presence of risk factors for birth injury or cerebral palsy
  • Promptly diagnosing brain injury and cerebral palsy
  • Properly managing all causes and risk factors for cerebral palsy
  • Providing all necessary treatments for cerebral palsy

Although it is solely the responsibility of medical professionals to prevent medical errors that can cause cerebral palsy, there are steps patients and their loved ones can take to prevent birth injury and medical mistakes. Patients and their loved ones are encouraged to speak up with any questions or concerns they may have regarding their care. Many dangerous medical errors result from miscommunication between medical personnel, 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.

Preventative Procedures for Cerebral Palsy

Beyond the management, prevention, diagnosis and treatment of the various causes and risk factors for cerebral palsy, there are specific procedures that can prevent birth injury and cerebral palsy. Depending on the specific situation, some of these procedures include the following:

  • Choosing an obstetrician for your pregnancy
  • Prenatal care and testing
  • Prenatal care for high-risk pregnancies
    • Betamethasone (in-uterine steroids)
    • Management of maternal obesity
  • C-section deliveries
  • Magnesium sulfate
  • Progesterone ( used to prevent premature birth)

Your Legal Options

Determining If You Have a Cerebral Palsy Case

Determining whether a child’s cerebral palsy is the result of medical negligence is crucial in determining eligibility for compensation permitted by the law. Unfortunately, a number of families avoid medical malpractice litigation for different reasons—some fear confrontation, some feel they don’t have the resources, some simply feel overwhelmed, and others doubt they have a case. The best—and only—way to find out if you have a cerebral palsy case is to reach out to a solicitor for a legal consultation.  An experienced birth trauma solicitor will do a thorough investigation of the medical records and review the case with expert medical professionals to determine whether negligent care was the cause of a child’s cerebral palsy.

Because all cases involve unique injuries, result from varying instances of medical negligence, no two cases look alike. Every day, the Medical Law birth injury team helps people determine whether or not they have a case. Our cerebral palsy solicitors and consultant labour and delivery nurses gather important information about each specific prospective client in order to determine if medical negligence occurred.

Before filing a medical negligence case, we engage on your behalf a wide range of medical experts and consultants to confirm as to whether or not medical negligence has occurred. These practicing experts and medical professionals encompass a wide range of medical disciplines, and our panel includes a diverse range of consultants such as maternal-foetal medicine expert doctors, forensic document examiners, placental pathologists, neonatologists, respiratory therapists, pediatric neurologists, pharmacologists, neuroradiologists, neuropsychologists, neurosurgeons, pediatric surgeons, anesthesiologists, genetics experts, infectious disease experts, economists, physical medicine and rehabilitation doctors, and many others.

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Medical Law:   Our Priorities
As experienced solicitors, we know how to pursue these kinds of Cerebral Palsy claims.  We understand the needs of our clients.   We can employ the resources to be effective in complex medical negligence litigation.
Medical Law:  Our Promise to You
We are dedicated to the service of our clients from our initial consultation and case review until we reach a settlement or judgment on your behalf.   Your best interests are our priority.  If you or a loved one have suffered due to medical negligence, we want to help you by finding out, what happened, who was responsible and holding that responsible party or parties to account.

*In contentious business a solicitor may not calculate fees or other charges as a percentage or proportion of any award or settlement. This statement is made in compliance with Regulation 8 of S.I. 518 of 2002.

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About Us

Medicallaw.ie is a team of experienced solicitors and medical consultants who specialise in taking on medical negligence claims.

The team is headed up by Siobhan Fahy, Solicitor.

We are all well qualified in our respective fields and have years of experience in the area of medical negligence. We seek justice and financial compensation for patients who feel that they have been the victim of medical neglect.

We recognise the dedication of those who serve in our hospitals and health service, but the reality is that our health system is so inadequate that many people find they have become victims of a particular consultant or the Health Service Executive itself. We are here to help.

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