Cerebral Palsy: A Comprehensive Guide

Cerebral palsy is a general term used for a number of neurological conditions affecting movement and co-ordination. It is caused by damage to the brain before, during or after birth usually because of infection, congenital abnormalities, genetic conditions, trauma and cerebral bleeding, low birth weight or premature birth. About 1 in 400 children in the UK is affected by the condition.

What are the four main types of cerebral palsy?

There are four main types of cerebral palsy.

Spastic cerebral palsy

Spastic cerebral palsy involves increased muscle tone (hypertonia) making the muscles tight, stiff (spastic) and weak. It can be hemiplegic (affecting one half of the body, either left or right), diplegic (primarily affecting the legs) or, most severely, quadriplegic (affecting all four limbs).

Ataxic cerebral palsy

Ataxic cerebral palsy causes abnormal unwanted jerking and shaking movements, which disrupt movement control and affect balance.

Athetoid (dyskinetic or dystonic) cerebral palsy

Athetoid (dyskinetic or dystonic) cerebral palsy causes involuntary writhing movements, which also affect movement control, with increased or decreased muscle tone.

Mixed cerebral palsy

Mixed cerebral palsy is a combination of two or more of the above conditions.

What are the features of cerebral palsy?

The features of cerebral palsy vary hugely between individuals depending on the type, the underlying cause and the severity. As well as movement and co-ordination problems those with the condition can suffer from global intellectual impairment, learning difficulties, epilepsy, visual and hearing impairment, difficulty speaking and communicating, scoliosis (a curved spine, common with a hemiplegia) and drooling.

While it is often present in medical negligence claims involving cerebral palsy, hypoxia (a lack of oxygen) during the delivery (intrapartum asphyxia) only accounts for a small number (about five per cent) of the overall causes of the condition.

The type of cerebral palsy can help in explaining the underlying cause. For example, a very severe but relatively short period (as little as 10 to 20 minutes) of hypoxia tends to cause the athetoid form of the condition (due to damage to the most metabolically active part of the brain, the basal ganglia, that are involved in involuntary movement control).

A less severe but prolonged period (possibly over a number of hours) of hypoxia tends to cause the spastic quadriplegic form of the condition (due to damage to the cerebral hemispheres involved in voluntary motor control and cognitive ability).

Investigating a cerebral palsy claim

When we investigate a cerebral palsy claim, we look at the events surrounding the birth to see if there were failures in the care the mother and/or baby received. If we can establish these and prove they caused the condition, we can help you claim compensation for your child.

We will check whether the baby’s heart monitor, the cardiotocograph trace (CTG), was properly monitored and interpreted and whether prompt action was taken if the baby was suffering any distress.

We will look into whether delivery was quick enough, especially if there was a long, poorly progressing labour or a lengthy delivery, or if there was any delay in performing an emergency caesarean section.

It is also important to establish if and when any obstetricians attended or whether a complicated delivery was left to midwives, or even if midwives failed to call for the doctors. A failure properly to resuscitate a baby after delivery could also cause cerebral palsy.

Any clinical negligence claim will involve seeking to identify the origin of the brain injury causing cerebral palsy. This includes blood tests, cranial ultrasounds and CT and, especially important, MRI brain scans.

Role of medical experts in a cerebral palsy claim

A number of medical experts are likely to be involved in helping to determine the cause. A midwife and obstetrician will comment on the standard of care of the midwifery and obstetric staff involved in the labour and delivery.

A neuroradiologist will be needed to interpret the MRI scan and a neonatologist will comment on the likely cause of the cerebral palsy and whether an early delivery would have made any difference to the outcome.

Although cerebral palsy is a non-progressive condition, meaning it does not worsen with age, there is sadly no cure. There are various ways in which health professionals can help those with the condition and many of them will be involved in working out the support required and thus the compensation needed following a successful clinical negligence claim.

A paediatric neurologist or developmental paediatrician will analyse the type of cerebral palsy, comment on the prognosis (including estimated life expectancy) and on any possible medical interventions, such as baclofen (to reduce stiffness), botulinum injections (to reduce contractures and drooling), melatonin (to aid sleep) and diazepam (as a muscle relaxant).

An orthopaedic surgeon will advise on any procedures to help with any skeletal consequences, such as hip subluxation, scoliosis or contractures and a gastroenterologist will advise where feeding by tube is needed (percutaneous gastrostomy feeding, or PEG).

A care expert will advise on the required care and case management package, an occupational therapist will assist with daily living, including washing and dressing, a physiotherapist will help to improve a patient’s movement and co-ordination, and a speech and language therapist (SALT) will help their ability to communicate.

An educational psychologist can help sufferers who have learning difficulties and can assist with any psychological problems, such as anxiety and depression, which may also require medication or cognitive behavioural therapy.

An accommodation expert can advise on any specialist housing requirements and an assistive technology expert will be able to recommend aids and appliances to help patients, for example eye-gaze technology, wheelchairs, computers and environmental controls.

Because of all these requirements, cerebral palsy claims are usually high in value, often totalling many millions of pounds, usually given in a combination of annual payments and a capital lump sum. We are particularly experienced in cerebral palsy cases and have settled many large claims.

We understand that every case is different and will spend time talking with you to understand what happened. Most importantly, we will work with you and your family and support you through every step of the process.

If you think that you or your child may have a potential claim, please feel free to get in touch with us. You can mail us your query at mail@anthonygold.co.uk or give us a call on 020 7940 4060 and ask for a member of the Clinical Negligence team.