March marks the awareness of Cerebral Palsy month
What is Cerebral Palsy?
Cerebral Palsy is a permanent neurological condition which affects normal movement, muscle tone, balance and co-ordination. In the UK, it is estimated that 1 in 400 children are born with Cerebral Palsy and that there are nearly 300,000 children who have been diagnosed with this condition.
How is Cerebral Palsy caused?
Cerebral Palsy is caused by an injury to the brain either before, during or after birth. An injury to the brain can occur in any one of the following ways:
Cerebral Palsy can be caused whilst the baby is still in the womb and the development of the brain may be affected by:
- Trauma to the baby’s brain such as a serious head injury
- A maternal infection such as rubella, chickenpox, cytomegalovirus or syphilis
- Periventricular leukomalacia (PVL) where damage occurs in the white matter of the brain
During or shortly after birth, a baby’s brain can be damaged by:
- The baby’s brain being deprived of oxygen where the birth may be difficult (asphyxiation)
- Brain infections such as meningitis or encephalitis which can damage the motor functions of the brain
- Trauma to the brain during birth
- A low blood sugar level
Increased risk of Cerebral Palsy
The chances of a baby being born with Cerebral Palsy is increased where:
- There is a premature birth and the baby is born at 32 weeks
- A baby has a low birth-weight
- There are multiple births such as twins or triplets
- A mother has been smoking, drinking or consumed drugs during the course of her pregnancy
Symptoms of Cerebral Palsy
Cerebral Palsy is a motor related disorder which can cause a multitude of problems. Whilst Cerebral Palsy usually occurs at birth or shortly before birth, Cerebral Palsy can be difficult to diagnose in some cases and where there is a suspicion of Cerebral Palsy after birth, doctors will usually carry out investigations such as an Ultrasound, MRI or CT scan to confirm the diagnosis.
Early signs and symptoms of Cerebral Palsy ordinarily begin to show when the condition begins to impede on a child’s ability to reach certain developmental milestones such as:
- The inability to sit up alone, crawl or roll over
- Difficulty in being able to walk because of weakness in the arms and legs
- Issues with feeding and swallowing
Other common symptoms of Cerebral Palsy Include:
- Spasticity and stiffness of the muscles
- Problems with communication and speech
- Inability to fall asleep
- Urinary incontinence
- Learning disabilities
- Reduced vision and hearing loss
However, the degree and severity of symptoms is dependent on the type of Cerebral Palsy a child will have.
Types of Cerebral Palsy
The NHS categorises Cerebral Palsy into 4 different subtypes:
- Spastic Cerebral Palsy – This is the most common type of Cerebral Palsy which affects the movement, control and co-ordination of muscles, especially in the upper and lower limbs. Spastic Cerebral Palsy tends to reduce the range of movement in the body as the muscles are stiff and compressed. Symptoms include involuntary movement of the limbs and spasms.
- Dyskinetic Cerebral Palsy – This is the second common type of Cerebral Palsy and occurs as a result of damage to the cerebellum or basal ganglia (central) parts of the brain which is responsible for control and co-ordination movements. Involuntary and abnormal movements are Indicators of this type of Cerebral Palsy.
- Ataxic Cerebral Palsy – This is an uncommon type of Cerebral Palsy caused by damage to the cerebellum (located at the back of the brain), which regulates the movement and co-ordination functions of the brain. Damage to this area can cause poor balance and causing symptoms such as tremors, shakiness and an unsteady gait.
- Mixed Cerebral Palsy – Mixed Cerebral Palsy is a broad term and is used where an individual demonstrates symptoms of more than one type of Cerebral Palsy.
Cerebral Palsy classification
Many people with a cerebral palsy diagnosis can grow up and live independent and productive lives, attend mainstream school, have careers and raise families without any assistance. Others will need lifelong care and a good deal of therapeutic input from an early age and for the rest of their lives.
The Gross Motor Function Classification System (GMFCS) is a tool that classifies the problems that children will experience in their lives in terms mobility. There is also a significant correlation between the GMFCS classification and overall mental abilities.
The GMCFCS is often used as a predictor of the lifelong care needs that a child might need.
Managing Cerebral Palsy
Cerebral Palsy cannot be cured but it can be managed through various treatment options to mitigate the effect of the condition and enhance an individual’s quality of life.
Certain medicines can be used to minimise the symptoms of Cerebral Palsy including:
- Diazepam to treat muscle stiffness
- Melatonin to help with sleeping difficulties
- Botulinum toxin injections which relaxes the muscles and reduces spasticity
- Painkillers to relieve pain and discomfort
Operative management is another option to relieve the symptoms associated with Cerebral Palsy and surgery can be performed to:
- Improve the range of movement in parts of the body with compressed muscles
- Correct spinal curvature (scoliosis)
- Repair a dislocated hip joint
- Treat urinary incontinence
- Optimise mobility by reducing stiffness in the legs. This is carried out by a surgical procedure known as selective dorsal rhizotomy.
Therapies are holistic and play a pivotal role in helping an individual with Cerebral Palsy overcome their difficulties by encouraging independence.
- Physiotherapy – Physiotherapy aims to restore functions of mobility by increasing strength and improving the range of movement in the muscles. A physiotherapist will usually devise a tailored care plan, provide advice and encourage mobility through the use of mobility aids. The overall aim of physiotherapy is to promote independence.
- Speech and Language Therapy – Cerebral Palsy can affect the muscles in the mouth, face, tongue and jaw resulting in speech defects and the inability to understand language. A speech and language therapist can help an individual strengthen their facial muscles, make sounds and control their breathing. Speech and Language therapists will help individuals practice their speech in order to improve their communicating skills so that they can become more confident.
- Occupational Therapy – Occupational therapy focuses on functionality and aims to improve an individual’s day to day living as well as the confidence to become more self-sufficient. An occupational therapist will usually devise strategies so that an individual can overcome these difficulties. Occupational therapy interventions can include tools, mobility aids and assistive technology.
- Hydrotherapy – Hydrotherapy is an aquatic therapy and rehabilitates individuals with cerebral palsy. It is a water-based therapy which takes place in a heated pool and aims to facilitate physical functionality by reducing pain, improving mobility and flexibility. For some children and adults with severe CP this is the only form of exercise that they can undertake. The temperature of the water should be around the level of 34-36%. This enables a longer session of exercise, stretching and relaxation. When the water up to your neck, the percentage of weight-bearing is only 8%, at chest-level only 30% and at hip-level it is only 50%.
Legal claims arising from cerebral palsy
Approximately 1,800 children are diagnosed with Cerebral Palsy every year. With increasing life expectancy this means that there are now an estimated 30,000 children with cerebral palsy in the UK. Of course a diagnosis of cerebral palsy does not mean that the treatment of the mother and/or baby has been negligent. As the table below shows, the number of claims against the NHS relating to Cerebral Palsy has remained at the same level for many years – around 200 new claims are made each year.
Table: A comparison of the number and total value of claims for maternity cerebral palsy/brain damage claims over time across all clinical negligence schemes (Source: NHS Resolution Annual Report 2018/2019)
The table also show how the costs of dealing with these claims has increased in recent years, primarily due to better medical treatment overall, improvements in managing percutaneous endoscopic gastrostomy (PEG) feeding, the increasing life expectancy of Claimants and the increasing costs of care. The table below also factors in the change to the discount rate in February 2017.
Where to get further help and support
Cerebral Palsy can be diagnosed at any age. Parents of a young child will find the diagnosis of Cerebral Palsy very distressing and it can be difficult to digest as it will affect the lives of families. There are various online platforms which provide information and advice on Cerebral Palsy including:
How Hodge Jones & Allen can help you
Our experts are very experienced in handling high value Cerebral Palsy cases. We understand the difficulties faced by parents in accessing support for their child. We have a long track record of successfully assisting families to resolve their claims and achieving the best possible outcomes for our clients. Our highly skilled team of medical negligence solicitors will advise you comprehensively about the merits of your claim, funding and ensure that you and your family get the best possible results.