Cerebral Palsy

What Is Cerebral Palsy?

Cerebral palsy is a neurological disorder that affects the body’s movement and muscle coordination. According to the Centers for Disease Control and Prevention, cerebral palsy is the most common motor disability in childhood. In addition, data reveals that cerebral palsy is more common in boys than it is in girls, with many children, boys and girls, suffering from spastic cerebral palsy (stiff feeling and jerky movements).

Cerebral palsy is caused by damage to the area(s) of the brain which control motor related functions. In the word cerebral palsy, cerebral deals with the cerebrum part of the brain, (note the cerebellum can be affected with cerebral palsy too), and palsy refers to a type of paralysis or weakness. Therefore, it is common for children who have been diagnosed with cerebral palsy to have trouble with movement and posture, in addition to having trouble with depth perception. Swallowing and feeding are also other areas of challenge.

What Are The Signs & Symptoms Of Cerebral Palsy In Babies?

For many parents, the one thing that generates concern regarding their baby is when the child fails to meet certain neonatal milestones. This can be in the form of the baby not crawling, or not making sounds, or not eating (aversion to anything placed in the mouth), among other things. Because cerebral palsy is a brain injury, the condition does not get “worse” over time. When certain areas of the brain are injured, the injury can be permanent and there is nothing that can be done to “reverse” the damage. Below are some of the signs of symptoms of a baby who may be dealing with cerebral palsy:

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Not Able To Hold Up The Head: Parents can see this when the baby is laying either on their stomach or the baby is being held in a sitting/support type posture.

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Low Or Poor Muscle Tone: The baby may feel “floppy” when picked up or moved around.

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Muscle Spasms: For parents, the baby may feel extremely stiff. In other words, the child has problems bending limbs and other parts of the body.

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Feeding Difficulties: These types of difficulties can be displayed by the baby not wanting to eat at all. In addition, the baby may display an aversion to anything placed in their mouth.

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Swallowing Difficulties

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Delayed Development: Many babies are performing certain tasks by six months of age. For example, by six months, the baby should be sitting up on their other own or rolling over on their own.

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Favoring One Side Of The Body Over The Other

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Cerebral Palsy Signs & Symptoms In Toddlers

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12-18 Months Have Passed And Child Still Not Walking

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Not Speaking Or Saying Simple Sentences By 24 Months

If your baby is exhibiting the above, you may need to speak with your child’s pediatrician or other medical professional. Remember, cerebral palsy is a condition which can range from mild to severe. Motor deficiencies can range from minor all the way to virtually complete paralysis.

How And When Do Doctors Diagnose Cerebral Palsy?

Cerebral Palsy is diagnosed through physical examination and a review of the child’s medical records. Although the use of MRI and other imaging tests can determine whether a child has suffered a brain injury, these tests cannot by themselves determine the severity of a possible cerebral palsy diagnosis. When conditions such as hypoxic ischemic encephalopathy are present during delivery, certain imaging tests can be ordered to help time the injury.

Many doctors will not diagnose a child with cerebral palsy until around 20-24 months. As a result, a child can move through the early part of their life with their cerebral palsy condition missed. It is not until some of the early milestones (between ages 1-5) are not met that parents begin to suspect the need for medical intervention. The use of many specialists is usually needed when a cerebral palsy diagnosis is suspected. However, note the type of cerebral palsy suspected will determine the timeframe of diagnosis:

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Spastic Cerebral Palsy: Can be diagnosed around 6-9 month of age

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Dyskinetic Cerebral Palsy: Can be diagnosed around 18-20 months of age

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Ataxic Cerebral Palsy: Can be diagnosed around 18-20 months of age

What Types Of Tests Do Doctors Use To Test For Cerebral Palsy?

Because cerebral palsy is a type of neurological disorder, imaging and scan tests are frequently used. Not only can imaging tests assist with a cerebral palsy diagnosis, the tests can help pinpoint the causes of seizures. Below is a list of some of the tests which can be used to help test for cerebral palsy.

MRI: MRI stands for magnetic response imaging. An MRI can take a 3D image of the brain to help determine abnormalities in the brain which deal with motor function. An MRI can take around an hour to perform. MRI’s can help doctors determine the cause of the child’s cerebral palsy.

Cranial Ultra Sound: A cranial ultrasound is a test that allows doctors to examine the brain tissue. Cranial ultrasounds are quick tests. However, they are not as detailed as MRIs or CT scans. Cranial ultrasounds can be helpful because they can capture changes in the white matter of the brain. White matter is typically damaged in a child who has cerebral palsy.

Computed Tomography: CT scans take cross sectional images of the brain. A CT scan can be performed in around 20 minutes. A CT scan can detect things such as brain bleeding and other brain conditions. In a cerebral palsy diagnosis, a CT scan can help confirm the diagnosis and assist with the timing of a brain injury. The film from a CT scan will look like an X-Ray.

Electroencephalogram: An EEG determines the electronic activity of the brain. Seizures have distinct patterns and EEGs can detect these patterns.

Umbilical Cord Gas Test: In certain instances, doctors during labor and delivery will order an umbilical cord gas test. This test can be triggered if there is meconium staining when a mother’s water is broken, and other factors present, like a non-reassuring fetal heart strip. The cord gas test looks to measure how much oxygen and carbon dioxide is in the baby’s blood. Oxygen and carbon dioxide impact the blood’s acidity, or pH. Acidity in the blood means that the blood cells are beginning a change which suggests that the baby has suffered a lack of oxygen. A lack of oxygen can trigger fetal hypoxia, or hypoxic ischemic encephalopathy, thus leading to cerebral palsy.

Developmental Testing: Developmental testing can be used to see if the child is meeting certain milestones. Because some children go through the early months with symptoms undetected, parents are alerted to potential problems due to the failure of their child to meet certain milestones (ex. Crawling).

Reflex Testing: Just as the name suggests. These tests look to the child’s reflexes. Remember, cerebral palsy affects the motor system, so a test of the reflexes is a good indicator.

Hearing Impairment Testing

Visual Impairment Testing

Speech Impairment Testing

How To Understand The 4 Types Of Cerebral Palsy

Cerebral palsy can be broken down into four major types, with the most common being Spastic. In the world of cerebral palsy, there are two terms to understand regarding how CP affects the muscle tone. They are the following:

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Hypotonia: Hypotonia means low muscle tone. This low muscle tone leads to a loss of firmness and strength.

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Hypertonia: Hypertonia means high muscle tone. Hypertonia leads to rigid and erratic type of movement.

Below is a breakdown and discussion regarding the types of cerebral palsy children face:

Spastic Cerebral Palsy

As mentioned above, spastic cerebral palsy is the most common type of cerebral palsy diagnosed. Around 80% of cerebral palsy cases will be of the spastic type. Spastic cerebral palsy includes hypertonia because the muscle movements are ridged and jerky.

Because cerebral palsy is due to injury to the motor functions in the brain, voluntary movement is impaired. These injured areas prevent the brain from sending out signals regarding the flexibility of the muscles, hence hypertonia.

Athetoid Cerebral Palsy

Athetoid, or dyskinetic cerebral palsy, is another type of cerebral palsy in which injury to the motor functions of the brain have occurred. Usually, the area(s) of the brain damaged will be the basal ganglia and/or cerebellum. Hypoxic ischemic encephalopathy can also lead to this type of cerebral palsy.

Children suffering from athetoid cerebral palsy will experience both hypotonia and hypertonia. Due to this combination, low muscle tone and rigid/erratic movements will be present. Since injury to the basal ganglia and or cerebellum occurs with this type of cerebral palsy, children can have trouble with things such as eye movement, motor functions, and balance and coordination. When athetoid, or dyskinetic cerebral palsy is present, parents may see their child experience some of the following:

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Trouble Feeding/Swallowing

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Floppiness With Limbs

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Rigid Body/Trunk Area

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Balance & Posture Issues

Mixed Cerebral Palsy

Children who suffer from mixed cerebral palsy generally have a brain injury that is not concentrated in one area of the brain. As a result, a child suffering from mixed cerebral palsy might display spastic cerebral palsy (rigid legs) and athetoid cerebral palsy (poor facial control). Mixed type cerebral palsy is present in about 10% of cerebral palsy diagnoses.

Ataxic Cerebral Palsy

Ataxic cerebral palsy is one of the rarest forms of cerebral palsy. It is usually accompanied by poor muscle tone, or hypotonia, causing the child impaired fine motor skills and other movements. Ataxic cerebral palsy affects the entire body and leads to abnormal body movements. A child’s arms, hands, body/trunk, and feet will be affected due to injury to the cerebellum. Parents may notice the following with their child if ataxic cerebral palsy is suspected:

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Balance Problems

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Coordination Problems: A child may not be able to keep their feet close together while walking

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Issues With Movements Which Require Precision: Tasks such as grabbing an object may be a challenge for a child

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Hand Movement: Tasks such as buttoning a shirt or using a fork or pencil may be a challenge, usually do to hand tremors/shakes

Understanding The Classification Of Cerebral Palsy

There are multiple factors involved when classifying cerebral palsy. Because of the number of specialists involved, the classification system encompasses numerous factors. A doctor looking at the child’s limbs, such as an orthopedic specialist will need to focus on the challenges regarding this area of the body and possible treatment options. The same can be said for neurologists and other specialists. As a result, parents must remember to think about their child’s cerebral palsy classification from a global standpoint. In addition, medial professionals are moving to a universal classification to help with treatments for children who have been diagnosed with cerebral palsy. Below are some of the ways in which cerebral palsy can be classified:

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Motor Function Classification

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Gross Motor Function Classification

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Severity Level Classification

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Topographical Distribution Classification

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Communication Classification System

Motor Function Classification

The motor function classification system for cerebral palsy examines the area of the brain which controls the baby’s motor functions. These functions involve your child using their muscles. When a child has a cerebral palsy diagnosis, muscle use becomes impaired, leading to hypotonia and or hypertonia (Mixed Cerebral Palsy if both are present). Under the motor function classification system, four types of cerebral palsy exist. They are the following:

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Spastic Cerebral Palsy

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Athetoid Cerebral Palsy

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Mixed Cerebral Palsy

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Ataxic Cerebral Palsy

Gross Motor Function Classification

Gross motor function is defined as your baby’s ability to use their arms, hands, legs, feet, or the entire body. Gross motor function is important because it is with gross motor functions a person can make large movements. When a child walks, crawls, runs, jumps, etc.…gross motor functions are on display. Injury to areas of the brain which control these functions can lead to impairment.

The Gross Motor Function Classification System has been developed to assess the gross level function of a child with cerebral palsy. The system pays close attention to actions such as walking, sitting, and wheeled mobility and grades out on a 5-level classification system, with the highest level denoting the most severe case of cerebral palsy. With this system, doctors and other medical professionals can better develop treatments and assisting devices to help children gain independence. Most practitioners use The Gross Motor Function Classification System in conjunction with other systems to find the best treatment options for children with cerebral palsy.

Gross Motor Function Classification System Level 1

Under the Level 1 classification system children can walk at home and in other places in the community. They can also use stairs without a railing. The child can mostly move without limitations, but speed, balance, and coordination may suffer a bit.

Gross Motor Function Classification System Level 2

Under the Level 2 classification system the child can walk in most settings and when using stairs, the assistance of the rail is needed. Walking over long distances may be problematic, especially when coupled with having to use balance on uneven surfaces or in crowded spaces. Physical devices or wheelchairs can help with long distance mobility. The ability to run and jump is impaired.

Gross Motor Function Classification System Level 3

Under the Level 3 classification system a handheld mobility device is used in many indoor settings. Climbing stairs can be done with the help of holding on to railings with assistance, or supervision. Wheeled mobility is needed for long distances and self-propelled devices are used for short distances.

Gross Motor Function Classification System Level 4

Under the Level 4 classification system methods of mobility require physical or motored assistance in most environments. When in settlings like school, and other parts of the community, children need wheelchairs or powered mobility. Regarding home life, the child might be able to walk around some, with the assistance of wheel chairs, powered mobility, or body support devices.

Gross Motor Function Classification System Level 5

Under the Level 5 classification system the child needs a manual wheel chair in all settings. In addition, head and limb movements are impaired (holding the head up and/or the limbs).

Severity Level Classification

Cerebral palsy is classified on a severity scale of mild, moderate, or severe. The severity classification is a way to generally classify the challenges a child might face with cerebral palsy, but the classification is not as specific as say the Gross Motor Function Classification System. Below is the severity level classification for cerebral palsy:

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Mild: A child with a mild form of cerebral palsy can move for the most part without assistance. Little to no limitations exist when performing daily tasks.

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Moderate: A child with moderate cerebral palsy will need wheel chairs and other devices to assist with daily activities.

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Severe: A child with severe cerebral palsy will not only need wheel chairs and other devices for mobility, they will also struggle to accomplish daily tasks.

Topographical Distribution Classification

Topographical distribution classification focuses on the area of the body affected by the cerebral palsy diagnosis. A topographical distribution classification can be helpful when creating treatment options for a child. The following are the areas of concentration for topographical distribution classification:

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Pentaplegia: All the limbs are affected, with head and neck paralysis. Children can also experience eating and breathing problems

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Monoplegic: Only one limb is involved. Most of the time an arm will be affected, but so can a leg

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Hemiplegic: Two limbs are affected and on the same side of the body (right arm, right leg)

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Double Hemiplegic: Both arms and legs are affected, with a concentration on one side of the body over the other

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Diplegic: The legs are generally affected more so than the arms. Concentrated generally in the lower body

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Paraplegic: affects both legs and the lower body

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Triplegic: 3 limbs are affected, usually both arms and a leg

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Quadriplegic: All 4 limbs are affected

Communication Function Classification System

The goal of the communication function system is to classify the everyday communication of a person diagnosed with cerebral palsy. The system is based on a five-level communication platform. When using the communication function classification system, a person who is familiar with the communication of the person diagnosed with cerebral palsy, helps with the classification. For many with cerebral palsy, the lack of “speech” does not mean that communication is absent. Gestures, facial expression, speech, etc.…are used in the communication function classification system. Below are the levels:

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Level 1: Effective sending/ receiving information with unfamiliar and familiar partners

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Level 2: Effective but slower sending/ receiving information with unfamiliar and familiar partners

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Level 3: Effective sending/ receiving information with familiar partners not so much with unfamiliar partners

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Level 4: Inconsistent sending and/or receiving information with familiar partners

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Level 5: Seldom able to communicate effectively even with familiar people

How Birth Injuries Can Lead To Cerebral Palsy

When parents are given a cerebral palsy diagnosis, for many the thought of “How did this happen?” crosses their minds. Sometimes, the cause cannot be identified. However, in other cases, birth injury (or birth trauma) is the cause. Issues like the lack of oxygen to the baby during labor and delivery, shoulder dystocia problems, and the use of forceps and vacuum instruments can lead to the type of birth trauma responsible for a cerebral palsy diagnosis. Premature babies are also at a higher risk of developing cerebral palsy because their organs are not yet fully developed. When the organs are not yet developed, the risk of a brain injury increases. For a more detailed look on how birth injuries can occur, click HERE.

Although in some cases, cerebral palsy cannot be prevented, in some cases, the diagnosis can be prevented by following the standards of care when caring for mom during pregnancy and labor and delivery. A doctor or nurse, who fails to pay attention to the signs of fetal distress on a fetal heart monitor, for example, increase the risk of a baby suffering a brain injury and developing a subsequent cerebral palsy diagnosis.

How Do You Know Who Caused Your Child’s Cerebral Palsy Diagnosis?

Determining who may be responsible for your child’s birth related injury takes a thorough examination of the facts and circumstances surrounding the case. Remember, Maryland law requires that to be successful in these types of cases, you must have a medical expert(s) give an opinion as to the standard of care owed, and how the treating doctor failed to adhere to the standard of care, causing your damages, or harm/injury. Below are some of the ways in which medical professionals can help prevent a brain injury and subsequent cerebral palsy diagnosis:

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Correctly Interpreting Fetal Heart Monitor Strips

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When Certain Risk Factors Are Present For A Birth Injury Taking The Necessary

Steps For Preventative Action

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Giving All Necessary Treatments

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Not Delaying An Emergency C-Section When Baby Is In Distress

After a review of the facts and medical records, your attorney, with the help of medical experts will be able to explain if there was a departure from the standard of care, who departed from it, and how this departure caused your injury.

Do You Have A Cerebral Palsy Case? Or A Birth Injury Case For That Matter?

More than likely, a Maryland medical malpractice attorney will not be able to immediately tell you whether you have a birth injury claim until they have had an opportunity to review the facts and get the necessary medical records. During the review process, your Maryland medical malpractice attorneys will be reviewing documents like the electronic fetal heart monitor strips. The review will focus on things such as whether there are late decelerations present, or whether minimal variability is reflected on the strips, among other things. In addition, whether meconium was present in the fluid will be reviewed. A look at the umbilical cord gas (if done), will be reviewed. These are but some of the areas of analysis when examining whether medical malpractice caused your child’s cerebral palsy diagnosis.

Boston Law Group, LLC represents victims of birth injury and medical malpractice throughout Maryland. We can help victims in:

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Prince George’s County

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Montgomery County

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Baltimore City

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Baltimore County

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Anne Arundel County

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Howard County

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Charles County

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St. Mary’s County

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Allegany County

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Calvert County

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Caroline County

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Carroll County

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Cecil County

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Dorchester County

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Frederick County

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Garrett County

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Harford County

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Kent County

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Somerset County

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Talbot County

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Washington County

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Wicomico County

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Worcester County

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