Cerebral palsy: causes, common features and making a claim

Posted: 26/04/2022

This is the third article in our new series covering topics relating to birth injuries and natal care. The first two articles discussed APGAR scores and post-partum bleeding. This article explores the group of lifelong conditions known as ‘cerebral palsy’.

What is cerebral palsy?

Cerebral palsy is the name given to a group of conditions which typically affect muscle control and movement, although they often involve a range of additional complications. Approximately 1 in every 400 children are affected[1]. Cerebral palsy is usually caused by injury to a baby’s brain before, during or after birth. During pregnancy, it can be a result of damage to the white matter of a baby’s brain, which can be caused by reduced blood or oxygen supply to the brain.

Other causes include maternal infection, for example rubella, chickenpox, or toxoplasmosis, injury to the baby’s head, or a stroke. Events leading to cerebral palsy either during or after birth include a lack of oxygen to the baby’s brain (hypoxia) during delivery, neonatal infection, for example meningitis, severe head injury, very low blood sugar (hypoglycaemia), or stroke.

Sometimes cerebral palsy can arise for no obvious reason, although it can be more common in cases where there is a difficult birth involving fetal distress, premature birth, multiple births (ie twins), with parents aged under 20, or a mother aged over 40.

What are the common features of cerebral palsy?

The most common features or symptoms of cerebral palsy include[2]:

• Delay in reaching developmental milestones – for example not sitting up by eight months or walking by 18 months.
• Muscles being too stiff or too floppy, known as hypotonia.
• Weak limbs.
• Muscle spasms.
• Jerky, uncoordinated, or uncontrolled movements.
• Walking on tip toes.
• Tremors (shaking) in the hands.

Either one (hemiplegia) or both (diplegia) sides of the body can be affected.

Associated problems can include:

• Feeding and swallowing difficulties.
• Speech and communication difficulties.
• Sleeping problems.
• Abnormal curving of the spine (scoliosis).
• Hip disorders, causing risk of dislocation.
• Eye problems.
• Hearing loss.
• Learning difficulties.

How is it diagnosed?

It is not always possible to make a definitive diagnosis of cerebral palsy for several months or even years, as not all symptoms are immediately obvious. If concerns are raised, an examination may include history taking regarding the child’s medical issues and development, as well as an assessment of movement, muscle tone and learning abilities.

Brain scans, including cranial ultrasound, MRI or CT scans, can be used to detect signs of brain damage which may indicate cerebral palsy; electroencephalogram (EEG) can be used to check for epilepsy; electromyogram (EMG) can determine how well the nerves are working; and blood tests can rule out other conditions.

Treatment

There is currently no cure for cerebral palsy, but there are a range of treatments which can improve symptoms and maximise independence. A care plan will be put in place by healthcare professionals which will be adapted as the child gets older and into adulthood, as their needs will evolve.

Treatments include physiotherapy to maintain and improve movement, speech and language therapy to help with feeding or swallowing difficulties as well as to practice and improve speech, and occupational therapy to advise on ways to improve independence with performing daily activities. Orthotics can be worn to improve a child’s gait, or walking patterns, where this is an issue, and lycra garments covering some or all of the body can improve postural stability, balance and function.

Medication and treatments can also be offered: botulinum toxin injections into muscles to relax them; anti-seizure medication for epilepsy; laxatives for constipation; or muscle relaxants such as diazepam or baclofen. In some cases, surgery may be offered – for example, scoliosis surgery to correct curvature of the spine, and selective dorsal rhizotomy (SDR) to reduce muscle stiffness making walking easier.

Making a claim

Cerebral palsy can arise despite the best medical care. However, in some circumstances it arises as a result of medical negligence. For example, a negligent delay in delivery following indications of fetal distress can lead to hypoxia, or a negligent misdiagnosis or delay in diagnosis of infection to mum or baby can lead to brain damage – both of which may lead to the baby suffering cerebral palsy.

In order to bring a claim for clinical negligence, it is necessary to prove that there was negligent treatment which no responsible body of clinicians would have provided, and that this treatment caused the injury. If successful, compensation for the injury is awarded, which will also fund the cost of support, such as care and treatments required due to the child’s additional needs.

Though it is of course impossible to truly compensate for the effects of cerebral palsy, the broad aim of compensation is to place the individual in the position they would have been in had the negligence not occurred. Compensation can be awarded for the following:

• Suitably adapted accommodation.
• Cost of care and specialist aids and equipment.
• Loss of earnings where ability to work is compromised.
• Additional cost of leisure pursuits/hobbies.
• Treatments such as physiotherapy, occupational therapy, speech and language therapy.
• Mobility aids and additional transportation costs.
• Costs of deputyship where the individual lacks mental capacity to manage compensation.

If you have a child with cerebral palsy and have concerns about the circumstances of their birth, we have a specialist birth injury team with a wealth of experience who can assist. Please call us on 0800 328 9545, email clinnegspecialist@penningtonslaw.com or complete our online assessment form.

[1] https://www.scope.org.uk/advice-and-support/cerebral-palsy-introduction/

[2] https://www.nhs.uk/conditions/cerebral-palsy/

Previous articles in this series:

• APGAR scores - what do they say about your baby's health?
• Bleeding after giving birth - what does it mean and when can it cause problems?

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