Cerebral palsy is a neurological condition which affects muscle coordination and movement. It is sometimes described as a motor disorder.
Cerebral palsy is caused by damage to the brain which occurs around the time of birth, such as during pregnancy, labour and delivery, or to the newborn baby.
Cerebral palsy brain injury is non-progressive, but as the child grows and develops, their disability and its effect on their muscles and ways of moving may become more apparent or change over time. A formal diagnosis of cerebral palsy may not be made for several months or even years following birth, depending on the severity of the symptoms.
Each child with cerebral palsy has their own individual ‘presentation’ or unique set of cerebral palsy disabilities, which reflect the timing, duration, location and level of injury to their brain. The severity of their movement disability from cerebral palsy is classified according to the Gross Motor Function Classification System (GMFCS). GMFCS is an age-adjusted system for describing the individual’s level of mobility and ability to use wheelchairs and other mobility aids, on a scale from Level 1 (most able) to Level 5 (most severely disabled). Other scales and systems may also be used to assess their ability to participate in activities at home, at school or in the community.
In addition to their movement disability, children with cerebral palsy from brain injury sometimes have additional health concerns and disabilities, such as epilepsy, visual or hearing impairment, language and communication and learning disabilities.
What are the types of cerebral palsy?
Cerebral palsy is often described as dyskinetic, dystonic, spastic or ataxic, depending on the type of movement difficulty experienced by the child and the part of their brain that has been injured. Children can also have a mixture of these types of cerebral palsy or have cerebral palsy disability which mostly falls under one pattern of injury with additional features of another type.
Spastic cerebral palsy
Spastic cerebral palsy is the most common type of cerebral palsy. ‘Spastic’ muscles are stiff and tight, with too much muscle tone (hypertonia). This makes it difficult to move and reduces the child’s range of movement.
Children with spastic cerebral palsy have difficulty with movement, such as:
- contractures (permanent shortening of muscles or tightening of joints), restricting extension of their joints;
- abnormal reflexes;
- altered gait (way of walking);
- exaggerated movements;
- walking on tip-toes.
Cerebral palsy disability from muscle spasticity is caused by an injury to the motor cortex of the brain. Children with spastic cerebral palsy can also have other types of disability arising from their brain injury, such as learning disability.
Examples of birth injury or neonatal injury claims for spastic cerebral palsy brain injury include:
- delayed delivery of a baby with chronic partial hypoxia (HIE) (a long period of reduced oxygen) during labour;
- delayed delivery of a baby at risk of brain injury from intrauterine infection, chorioamnionitis, or premature and/or preterm rupture of the membranes (PROM/PPROM);
- traumatic brain injury during delivery;
- kernicterus brain injury from failure to treat neonatal jaundice.
Dyskinetic cerebral palsy
Dyskinetic cerebral palsy is the second most common type of cerebral palsy. It is also known as athetoid cerebral palsy.
Dyskinesia refers to involuntary muscle movements but other words are also used to describe features of a child’s dyskinetic cerebral palsy, such as:
- athetosis or athetoid, meaning slow writhing movements;
- chorea, meaning movements which are dance-like, fast or repetitive;
- choreoathetosis or choreoathetoid, a combination of sudden spasms, fast twitching movements (chorea) and slow (athetoid) movements;
- dystonia or dystonic, meaning slow, twisting movements of the limbs or torso;
- rigidity, or restricted ability to move.
Children with dyskinetic cerebral palsy have involuntary, random movements or spasms, which they are unable to control, as their muscle tone fluctuates between stiffness and floppiness. These involuntary movements affect their ability to carry out simple, everyday activities, such as getting dressed. Their difficulties with coordination also impair their ability to communicate, affecting their ability to interact with the world around them, which can lead to learning difficulties even for those who have retained intellect and cognition (thinking).
Dyskinetic cerebral palsy is caused by injury to the basal ganglia, thalamus and cerebellum areas of the brain.
Examples of birth injury and neonatal injury claims involving dyskinetic cerebral palsy include:
- HIE birth injury, (fetal heart rate monitoring (CTG or IA) mistakes, delayed delivery);
- delayed neonatal resuscitation;
- Syntocinon, VBAC and hyperstimulation errors;
- kernicterus brain injury from failure to treat neonatal jaundice.
Ataxic cerebral palsy
Ataxic cerebral palsy is less common than spastic, dyskinetic or athetoid cerebral palsy. Ataxic cerebral palsy or ataxia affects balance and coordination, causing shaky or clumsy movements and tremors.
Children with ataxic cerebral palsy have difficulty coordinating fine muscle movements which can affect their posture, balance, walking and communication. They may have:
- difficulty with walking and balance;
- problems with accurately perceiving depth;
- impaired speech;
- tremors;
- difficulties with grasping and holding objects.
Ataxic cerebral palsy is caused by damage to the cerebellum, the part of the brain that regulates movement and coordination.
Examples of birth injury and neonatal injury claims involving ataxic cerebral palsy include:
- injury to the brain from infection;
- traumatic brain injury;
- stroke, from brain bleeding or ischaemia.
Quadriplegic, diplegic and hemiplegic cerebral palsy
Cerebral palsy can also be described in a way that identifies not only the type of cerebral palsy, but also which parts of the body are affected. For example, a child whose whole body is affected by spastic cerebral palsy might be described as having ‘spastic quadriplegia’, or ‘whole body spastic cerebral palsy’.
The most commonly-used terms to describe which parts of the body are affected by cerebral palsy disability are:
- ‘four-limb’, ‘whole body’ or ‘quadriplegic/ quadriplegia’ – affecting the whole body, and control of the head, torso, facial muscles (and mouth);
- ‘bilateral’ – affecting both sides of the body;
- ‘hemiplegic/hemiplegia’ – affecting one side of the body;
- ‘diplegic/ diplegia’ – mainly affecting the legs.
Understanding the type or features of your child’s cerebral palsy disability can provide some insight into its possible causes, but it takes specialist expertise to establish how the child’s brain was injured and whether their disability was caused by maternity or neonatal negligence. Our highly experienced cerebral palsy solicitors work with a multidisciplinary team of medical experts, including obstetricians, midwives, neonatologists, paediatricians, neurologists and neuroradiologists, who help us identify the cause of the child’s cerebral palsy and advise on how the condition will affect them in future.
What disability is caused by cerebral palsy?
A child who has cerebral palsy may experience one or more of a range of physical effects from their brain injury. The type and combination of these effects will determine their disability and its impact on the different areas of their life.
Cerebral palsy is non-progressive. This means that the severity of the child’s condition stays constant but the full extent and impact of their disability may only become apparent at later stages of their growth and development.
Children with cerebral palsy often experience physical disability, such as:
- delay in reaching developmental milestones, such as sitting or walking;
- muscle tone which is too weak or too tight/stiff;
- weakness in limbs (arms, legs, hands);
- movements which are uncontrolled, clumsy or jerky;
- walking on tip-toes;
- swallowing difficulties;
- problems with speech.
These difficulties with muscle control and coordination, muscle tone, reflexes, posture and balance may affect the child’s mobility, dexterity, feeding, communication and independence.
Cerebral palsy is primarily a motor (muscle movement) disorder, and many children with cerebral palsy retain their cognitive (thinking) and intellectual abilities. With support, they are able to study at school, college or university and then go on to work. In some cases, however, the severe brain injury which caused the child’s cerebral palsy can also result in cortical blindness, epilepsy, severe learning disability and/or a total inability to communicate.
Can medical negligence cause cerebral palsy?
Medical negligence in the care that the mother and baby receive before, during and after birth can cause cerebral palsy brain injury to the baby. Negligent medical care can also significantly worsen or contribute to a baby’s unavoidable brain injury, resulting in additional or more severe disability.
If your child has cerebral palsy or needed neonatal intensive care for brain injury after a difficult or complicated birth, our legal and medical experts can help you understand the cause of their condition. If their cerebral palsy disability was caused by negligent maternity or neonatal medical care, we can help you ensure that their lifelong needs arising from their disability will be met by claiming the compensation they deserve for their injury.
What are the most common cerebral palsy compensation claims?
There are many ways in which negligent maternity or neonatal care can cause a cerebral palsy birth injury, but the following types of birth or neonatal injury commonly feature in successful cerebral palsy claims.
- Hypoxic ischaemic encephalopathy or HIE birth injury can be caused by an acute profound episode of oxygen deprivation (hypoxia) in the minutes immediately before, during or after birth, or a longer period of chronic partial hypoxia during pregnancy and labour, or a combination of both. HIE cerebral palsy claims commonly involve fetal heart rate monitoring mistakes, uterine hyperstimulation or delayed delivery of a compromised or ‘distressed’ baby, or errors involving meconium, resuscitation and cooling immediately after the baby is born.
- Obstructed labour and traumatic injury are common causes of cerebral palsy brain injury, with claims arising from excessive force, poor delivery technique or negligent response to an obstructed labour. Cerebral palsy claims from traumatic birth injury or obstructed labour often involve negligent management of pregnancy and delivery where there is shoulder dystocia or a large baby, impacted fetal head (IFH), breech birth or delivery of twins, and forceps injuries.
- Infection can cause birth injury, neonatal brain injury and cerebral palsy, with claims arising from negligent management of maternal GBS infection, premature or prolonged rupture of membranes (PROM/PPROM) and chorioamnionitis, or delayed diagnosis and treatment of neonatal infection such as meningitis.
- Twin pregnancy can have complications which must be managed correctly to avoid severe birth injury, including cerebral palsy, from twin-to-twin transfusion syndrome (TTTS), vaginal breech delivery of twins and delayed delivery of one or both babies.
- Neonatal brain injury can be caused by negligent neonatal care of a newborn baby. Common cerebral palsy claims involving neonatal brain injury include claims arising from kernicterus brain injury, neonatal hypoglycaemia, neonatal infection, hypocarbia (over-ventilation) or vitamin K deficiency bleeding (VKDB).
- Valproate injury from negligent prescription of the anti-epileptic drug, sodium valproate, to a pregnant mother, can cause cerebral palsy and other forms of severe disability to the unborn child.
What is the treatment for cerebral palsy?
Cerebral palsy cannot be cured, but where a baby is born with HIE brain injury, their expected gross motor disability (physical disability affecting their movement) may be significantly reduced or prevented by specialist neonatal intensive care treatment with cooling. It is important to understand that this is not a treatment for cerebral palsy, but a preventative measure known to limit further damage to the brain of a newborn baby who is known to have suffered a hypoxic brain injury.
If your child has a diagnosis of cerebral palsy, their health and development will be overseen by their paediatrician with input from a multi-disciplinary team of other medical specialists, as needed.
Your child’s disability should also be managed with regular therapies which help them maximise their mobility, independence and ability to interact with the people, technologies and opportunities that surround them.
Based on our experience of working with medical experts, therapists and the families of children with cerebral palsy disability, we usually recommend that the child will benefit from regular support from the following types of therapy:
- physiotherapy – using exercises, stretching and positioning, as well as supportive equipment, to maximise your child’s physical movement, posture and function;
- occupational therapy (OT) – using strategies, equipment and adaptations to increase your child’s independence at home, school and in other environments;
- speech and language therapy (SALT) – to support safe feeding and maximise your child’s ability to communicate;
- hydrotherapy – to reduce muscle stiffness and improve muscle control and movement;
- neuropsychology – to provide behavioural, emotional support and strategies to support learning .
In addition, our experts usually recommend that the family is supported in meeting their child’s additional needs, such as for:
- help or support with care;
- home adaptations or a move to a more suitable home;
- adapted vehicles, wheelchairs and specialist equipment;
- assistive technology and IT;
- support with special educational needs (SEN).
Our cerebral palsy specialist solicitors carry out a full assessment of your child’s needs, based on the advice from our trusted team of medical experts and therapists, to ensure that the costs of meeting your child’s lifelong needs arising from their disability are included in their cerebral palsy claim. In most cases, as soon as we have secured an admission of liability (responsibility) for their injury, we are able to secure substantial interim payments to begin meeting these needs, long before we reach final settlement of their claim.
If your child has cerebral palsy or neurodevelopmental disability as a result of medical negligence, or if you have been contacted by MNSI or NHS Resolution, contact us to talk, free and confidentially, to one of our experienced cerebral palsy birth injury claims solicitors.
Written by
Susan Brown
Susan leads the medical negligence team and is recognised as a leading lawyer in the UK, specialising in high value brain injury and cerebral palsy cases.
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