Historically, the term "Cerebral Palsy" has been used to describe a loosely connected group of neurological problems resulting from prenatal (before birth) and perinatal (typically considered to be the time frame of 20-28 weeks gestation, before birth, and 7-28 days after birth) brain damage.
Cerebral Palsy typically appears before the age of 3 years due to non-progressive damage to the brain. It is sometimes referred to as "Little's Disease." It can develop before, during, or shortly following birth. In this context, "cerebral" refers to the brain and "palsy" refers to lack of appropriate control over the muscle structures and muscle weakness.
The primary categories of Cerebral Palsy include:
In summary, the general signs of Cerebral Palsy include:
The causes of Cerebral Palsy are often misunderstood even by lawyers professing expertise in the area.
The most common cause of brain damage resulting in Cerebral Palsy is from intrauterine infections. An additional cause is rhesus incompatibility where, for example, maternal antibodies cause hemolytic anemia (a breakdown of the oxygen carrying hemoglobin) and the excess bilirubin (formed from the breakdown of hemoglobin) damages the brain cells. This problem is now less common since the Rh factor incompatibility can be identified early on and preventative measures can be taken. For example, when there is present an Rh negative mother and an Rh positive father, the mother can be prescribed an anti-rhesus gammaglobulin immediately following delivery of the baby. Other preventative measures can also be taken throughout the course of the pregnancy.
Trauma is also a cause of Cerebral Palsy. The trauma usually involves the cerebrum (the primary portion of the brain), the cerebellum (the "little" brain, dealing with equilibrium, and corresponding to the description as "Little's Disease"), the basal ganglia, or the pyramidal tracts (which are nerve transmitters, resembling cables, which transmit impulses corresponding to movement of muscles).
Birth trauma associated with a long and hard delivery process can certainly cause Cerebral Palsy, but it actually occurs far less often than previously thought. Similarly, neonatal asphyxia (the baby is blue when delivered, appears not to be breathing, and is difficult to resuscitate) can cause Cerebral Palsy, but again occurs less frequently than previously thought. The fetus, as well as the newborn, are very resistant to hypoxic (lack of oxygen) damage and, thus, it is thought in many cases that the brain damage was already present before the labor began. Ultrasound studies performed in the first week of life will demonstrate damage to the white fiber bundles in the region of the cerebral ventricles (known as periventricular leukomalacia). Typically, over a period of 2-3 weeks, these damaged white fiber bundles are replaced by small fluid-containing cysts. If these periventricular cysts, which take approximately 3 weeks to develop subsequent to the insult to the brain, are present soon after birth, it is more likely than not the original damage occurred, at least, 2-3 weeks earlier.
Though the fetus and newborn are very resistant to hypoxic (lack of oxygen) damage, such a lack of oxygen may certainly cause Cerebral Palsy. Oxygen supply to the fetus can be disrupted and thus result in brain damage for a number of reasons including, but not limited to: compression of the umbilical cord during the birth process; separation of the placenta prematurely from the wall of the uterus; mechanical trauma (inappropriate or excessive use of vacuum extraction); unusual birth position of the baby (breech or butt first rather than head first); placenta previa (the placenta is implanted in the lower portion of the uterus); trauma related to the disproportionate size of the fetal head when compared to the pelvis of the mother (thus increasing the likelihood of the fetus becoming stuck in the birth canal); prolapse of the umbilical cord (the umbilical cord is delivered prior to the fetus); a build-up of acid in the blood level of the fetus related to lack of oxygen measured by a decrease in the blood pH, also called acidosis, and frequently linked to babies with brain damage; and, very importantly, fetal distress including, but not limited to, meconium (fecal) staining (which represents the first intestinal discharge of the fetus and which does occur during times of distress when, for example, the fetus is stuck in the birth canal), bradycardia (the heartbeat is too slow), tachycardia (the heartbeat is too fast), cardiac arrhythmia (the heartbeat is irregular and thus abnormal). All of the foregoing possible complications are reasons for a Cesarean Section (C-Section) to be performed. It is often the failure of the physician to perform the Cesarean Section when indicated which results in otherwise preventable brain damage.
In summary, the issues we typically examine closely include:
Recognizing the signs and symptoms mentioned earlier can lead to earlier intervention. Commencing physical therapy within the first year, if possible, will make the adjustment in dealing with Cerebral Palsy easier for you and your child. However, the typical features of Cerebral Palsy may not become obvious until your child's second year of life. This is the typical time frame in which the brain assumes more control physically over the body. Prior to this time, you may simply think your child's muscle tone to be more flaccid than expected. If your child has difficulty crawling, walking, or holding his or her head upright, this may be an indicator. Abnormalities become more visible and noticeable when your child reaches the second year.
As noted, ultrasound studies in the neonatal time frame where suspicion is present can reveal periventricular leukomalacia and thus identify those children who are likely to develop Cerebral Palsy. Where periventricular leukomalacia is identified, it can also provide an indicator as to the severity of Cerebral Palsy. Physical therapy should be commenced as soon as practicable to reduce long-term deficits. Similarly, as soon as practicable, speech therapy and other modes, such as specific play therapy, should be initiated.
Normal development by 3 months:
Abnormal development by 3 months (which may indicate CP):
In general terms, your baby may experience problems indicated by:
Normal development by 6 months:
In general terms, your baby should be able to:
Abnormal development by 6 months (which may indicate CP):
In general terms, your baby may experience problems indicated by:
Normal development by 9 months:
Abnormal development by 9 months (which may indicate CP):
In general terms, your baby may experience problems indicated by:
Normal development by 12 months:
In general terms, your baby should be able to:
Abnormal development by 12 months (which may indicate CP):
In general terms, your baby may experience problems indicated by:
Normal development by 15 months:
In general terms, your baby should be able to:
Abnormal development by 15 months (which may indicate CP):
In general terms, your baby may experience problems indicated by:
**If any of the above-identified abnormal symptoms persist, you should have your baby evaluated by a pediatric neurologist.
If you have questions, please call us toll free at 1-800-393-8686. You may also e-mail us at info@FloridaTrialLawyer.com or use our "Contact Us" form. We will be pleased to answer your questions and to provide you with immediate feedback concerning your potential birth-related injury claim.
