Cerebral Palsy is a term for a group of chronic conditions that impair the brain's ability to control body movement and muscle coordination due to brain-related damage which occurs before, during or after childbirth. When a part of the brain is damaged during pre-natal development, childbirth, or the first few years of an infant's life, Cerebral Palsy may result. There are an estimated 10,000 cases of Cerebral Palsy diagnosed in the United States (US) every year. There is no known cure for Cerebral Palsy.
There are three major types or classifications of Cerebral Palsy: Spastic, Athetoid and Ataxic.
Spastic Cerebral Palsy is further classified by the affected region of the body as follows:
Spastic Diplegia is the most common of the spastic forms of CP and is marked by spasticity of the lower extremities with little to no upper body spasticity. Intelligence is not impacted. Most of those affected are ambulatory, but tight adductors cause a "scissors gait." Other typical features include flexion at the knee, plantar flexion of the ankle, adduction and internal rotation at the hip, crossed eyes, nearsightedness, movements of the upper extremities to assist walking, and tip toe walking.
Spastic Hemiplegia is a condition not exclusive to Cerebral Palsy that affects one side of the body. Injured muscle nerves controlled by the brain's right side will cause a left body deficit, and vice versa. Those with Spastic Hemiplegia are usually the most ambulatory, although they suffer from equinus, a condition in which the upward bending motion of the ankle is limited and causes a lack of flexibility to bring the top of the foot toward the front of the leg. There is no cure for Hemiplegia but its effects can be minimized through therapy.
Spastic Quadriplegia CP is characterized by the lack of the ability to move, control or feel both arms and both legs as a result of an injury to the spinal cord. It is the most severe type of Cerebral Palsy, and patients usually suffer other disabilities such as mental retardation, difficulty speaking, and uncontrollable shaking (hemiparetic tremors). Respiratory problems are common and a respirator is often necessary for breathing.
Athetoid Cerebral Palsy involves mixed muscle tone (sometimes hypertonia and sometimes hypotonia - loss of or diminished muscle tone). Athetoid CP results in uncontrolled or involuntary movements, difficulty holding oneself in an upright position, difficulty holding onto objects, facial movements, drooling, and difficulty controlling the tongue, breathing and vocal cords. These problems are caused by the muscles alternating between floppy and tense, and uncontrolled movements may be small or big, rapid, irregularly repetitive, random, or jerky.
Ataxic Cerebral Palsy, the least common form of CP, is caused by damage to the brain's cerebellum and its symptoms include visual loss of depth perception, auditory processing, balance difficulties, and walking with a wide-based gait. Ataxic individuals suffer from tremors and hypotonia. Intention tremors are the most significant symptom of the Ataxic CP patient.
About 750,000 Americans are currently living with some form of CP, and in the United States (US) approximately 10,000 infants develop Cerebral Palsy annually. Many CP patients develop their condition during the childbirth process. An estimated thirty percent of all CP patients develop the condition during fetal development.
Cerebral Palsy can have devastating financial consequences for the CP patient and his or her family, and the average cost of expenses related to a CP patient is about $925,000. Those with severe Cerebral Palsy can expend millions of dollars. Some medical and non-medical expenses can include, but are not limited to, the following: hospitalizations and doctor visits, work and home space modifications, speech, phyiscal and occupational therapists, life care planners, neurologists and neurosurgeons, car modifications, orthotic devices, surgeons, medications, rehabilitation equipment, respirators or respiratory therapists, psychological or psychiatric counseling, and special education programs.
There are numerous maternal and fetal factors that can lead to Cerebral Palsy in a new born if a failure to diagnose occurs. Certain maternal infections during pregnancy can cause CP, such as toxoplasmosis, rubella, cytomegallovirus (CMV), herpes simplex, and untreated group B strep. A mother's use or abuse of alcohol, prescription or non-prescription drugs, malnutrition, or exposure to toxic chemicals or poisons can cause CP. Certain medical conditions, including high blood pressure, preeclampsia, eclampsia, toxemia, diabetes, thyroid problems, blood Rh incompatibility between mother and fetus, fetal anoxia, fetal stroke, placental insufficiency or premature aging of the placenta, premature or sudden separation of the placenta from the wall of the uterus (placental abruption), intrauterine growth retardation (IUGR) of the fetus, and other complications have been found to cause Cerebral Palsy. Cerebral Palsy can be caused by birth trauma resulting from the improper dating of the pregnancy which can lead to premature delivery or over-gestation. Other than genetic defects or syndromes which can cause CP, the foregoing risk factors can be recognized and addressed by a medical professional during pregnancy. CP acquired during fetal development is often preventable when a physician timely and appropriately responds to maternal and fetal risks.
Cerebral Palsy can be caused when the flow of blood and oxygen to a child's brain is disrupted during the childbirth process (fetal anoxia), which can occur as a result of a long labor, low amniotic fluid, a twisted umbilical cord resulting in umbilical cord compression, prolapse or occlusion, large fetal head size, newborn lung problems, brain hemorrhaging or inter-cranial bleeding, unrecognized or untreated signs of fetal distress from pressure on the umbilical cord or due to dystocia, a fetus stuck in the birth canal because of the position of its descent down the birth canal, placenta being prematurely sheared by the birth process (placenta previa or placental abruption), too much pitocin, and other conditions. Failure of the obstetrician to recognize the necessity of a Cesarean Section as opposed to a vaginal delivery, or the failure to interpret fetal monitor strips, may be medical malpractice which can cause CP. Head trauma caused by a difficult forceps or vacuum extraction delivery can also cause Cerebral Palsy. Most of the adverse outcomes caused by these childbirth Cerebral Palsy risk factors are preventable if a medical doctor acts within the standard of care to timely and appropriately diagnose and treat these conditions.
About 10% to 20% of children in the United States with CP acquire the disorder after birth. Brain damage after child birth, brain infections such as bacterial meningitis or viral encephalitis, and head injuries represent many of the acquired Cerebral Palsy cases. Brain or head trauma can occur in the first few years of life from accidents such as falls or motor vehicle collisions, or may occur from child abuse or shaken baby syndrome.
The above causes of CP have the potential to interfere with proper development of the nervous system or potential to interfere with the delivery of oxygen and nutrition to the brain of the fetus or the newborn infant. If the oxygen supply and nutrition to the brain is interrupted, impeded or decreased for a period of time, the brain may become injured.
Diagnosis of CP can sometimes be difficult. Some methods which help determine whether or not brain damage has occurred include reflex tests, hand preference checks, diagnostic radiological tests. Reflex test are used because some reflexes disappear in a normal child, while an affected child may retain these reflexes for abnormally long periods of time. Hand preference checks are used because an early tendency to prefer either the right or left hand may indicate CP. It is important to rule out of other movement disorders which can cause the loss of motor skills, including genetic diseases, muscle diseases, metabolism disorders, or tumors in the nervous system. Some of these conditions are progressive or worsen over time. If the child's conditions are not worsening, this may be an indication of a CP diagnosis. Performing diagnostic imaging tests, such as CT scans, MRIs, and/or ultrasounds, can reveal underdeveloped brain areas, abnormal cysts, or other physical problems. It is also important to assess conditions linked to CP such as seizure disorders, mental impairment, and vision or hearing problems.
Medical malpractice litigation involving Cerebral Palsy in South Carolina (SC) requires expert testimony to prove both a breach of the standard of care and that the breach was the proximate or legal cause of the patient's injury. For such cases arising on or after July 1, 2005, S.C. Code § 15-79-125 requires that before a medical malpractice suit can be filed, a plaintiff has to simultaneously file both a notice of intent to file suit and an affidavit of an expert witness subject to the affidavit requirements established in § 15-36-100 in a county in which venue would be proper for filing or initiating the action. The expert affidavit must specify at least one negligent act or omission claimed to exist and the factual basis for each claim based on the available evidence at the time of the filing of the affidavit. Qualified, experienced, board certified obstetricians and registered obstetrical nurses should be used to evaluate claims of medical malpractice and to provide the requisite expert opinion testimony in litigation with respect to Cerebral Palsy cases.
If your child has developed Cerebral Palsy and you believe that medical malpractice or negligence was a possible cause of the brain injury which resulted in CP, you should seek out a competent medical malpractice attorney to evaluate your child's case.
Joseph P. Griffith, Jr., Esquire
Joe Griffith Law Firm, LLC
7 State Street
Charleston, S.C. 29401
843.225.5563 (tel)
843.722.6254 (fax)
http://www.joegriffith.com
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