Cerebral Palsy Attorney in Maryland

When Is Medical Malpractice Responsible for a Child's Cerebral Palsy Diagnosis?

Some common examples include instances in which medical professionals:

• Fail to recognize or diagnose a high-risk pregnancy
• Fail to monitor or respond to signs of fetal distress
• Do not detect or treat maternal infections
• Allow labor to continue for a prolonged amount of time
• Do not order a timely C-section
• Misuse of assistive birth devices, such as forceps or vacuum extractors
• Extend labor or delivery unnecessarily

In short, any time a medical professional does not uphold the standard duty of care—both to the mother and the baby—that doctor may be liable for any injuries either the mother or child suffers.

Understanding the nuances of medical malpractice in cerebral palsy cases is critical. This involves dissecting the timeline of pregnancy and delivery for potential negligence points. Legal teams typically consult extensively with medical experts to validate claims of malpractice. By thoroughly analyzing events leading up to the birth injury, families can better understand their legal options and the potential avenues for seeking compensation.

There are some known risk factors for cerebral palsy.

These include:

• Birth weight less than 2,500 grams at birth, with additional risk if birth weight is less than 1,500 grams
• Prematurity, especially if born prior to 32 weeks gestation
• Twins, triplets, or multiple births
• Infections—viral infections such as chickenpox, rubella, cytomegalovirus, as well as bacterial infections of the placenta, uterus, or other maternal organs
• Medical conditions of the mother that are undiagnosed or not treated, affecting the blood and oxygen flow to the baby

Each of these risk factors presents unique challenges and considerations. For example, birth weight and prematurity are associated with underdevelopment in infants, making them more susceptible to conditions like cerebral palsy. Twins or multiple births can increase complications due to limited space and nourishment in the womb, necessitating different prenatal monitoring approaches. Understanding these variables is essential in assessing and managing the likelihood of cerebral palsy.

Is Cerebral Palsy Preventable?

Cerebral palsy that is due to genetics is not preventable. However, during the process of birthing, the lack of oxygen may cause cerebral palsy. This can often be prevented by the labor and delivery staff at the hospital.

Preventative measures during pregnancy and childbirth are key to minimizing the risk of cerebral palsy. Expectant mothers are encouraged to maintain regular prenatal check-ups, follow healthcare advice on nutrition and exercise, and report any signs of distress immediately. Hospitals employing attuned, highly-trained staff can effectively monitor fetal well-being, make timely decisions regarding labor management, and implement interventions as needed.

Congenital CP vs. Acquired CP

• Congenital CP makes up the vast majority of CP cases (85%-90%). This kind of CP is associated with brain damage that occurred prior to or during childbirth. Oftentimes, the exact source is unknown.
• Acquired CP makes up a very low percentage of CP cases. It is attributed to brain damage occurring over 28 days after the baby is born, widely attributed to infection (like meningitis) or head injury.

Educating parents about these types of CP helps them understand potential lifelong care requirements. Awareness can foster early intervention, enhancing a child's quality of life by targeting specific needs, whether it's through adaptive equipment, targeted therapies, or special education programs.

Connect with The Law Firm of Michael H. Bereston, Inc. to speak with a skilled birth injury lawyer near you. Contact us at (410) 220-6581 or complete our online form.

Lowering the Risks

In order to lower the risk factors for cerebral palsy, keep yourself healthy before and during your pregnancy.

Before Pregnancy:

• Before becoming pregnant, make sure you are as healthy as possible. Treat any infections before getting pregnant.
• Attain vaccines for diseases that could harm the baby before you become pregnant.
• If assistive reproductive technology (ART) infertility treatments are used to become pregnant, do what is possible to decrease your chance of a multiple pregnancy (twins, triplets, etc.).

Pre-conception counseling can play a vital role in preparing for a healthy pregnancy. By optimizing health prior to conception, potential parents can address high-risk factors and make informed decisions about pregnancy management. This strategic approach reduces risks and promotes the best possible health outcomes for mother and child.

During your pregnancy, have open discussions with your healthcare providers regarding any risk factors you may have, and follow the advice of your healthcare providers to promote a healthy environment for the baby.

As labor and delivery approaches, ensure that healthcare providers and the hospital you select for labor and delivery are equipped with staff educated in the signs and symptoms your baby may show if hypoxia occurs, to prevent injury from hypoxia or ischemia. If you have questions, before, during, or after labor and delivery, ask questions of the staff and your healthcare provider.

When Is Cerebral Palsy Diagnosed?

During the hospitalization at the time of birth, the healthcare providers for the baby will monitor closely for signs of injury if risk factors were present or if there were signs the baby was lacking oxygen or blood supply during labor and birth. The term hypoxic-ischemic encephalopathy or HIE is used when an injury to the brain of the baby from lack of oxygen and blood flow causes brain injury. Other terms describing this include perinatal asphyxia, intrapartum asphyxia, and neonatal encephalopathy.

HIE can cause cerebral palsy, seizures, vision and hearing loss, cognitive, and motor difficulties.

Recognizing early signs of developmental delays can be challenging, but it is crucial for initiating prompt interventions. Parents and healthcare providers must work together, being vigilant about motor functions, reflexes, and feeding patterns in newborns. Early diagnosis and tailored intervention programs enable families to address developmental issues swiftly, incorporating therapeutic strategies that can significantly impact the child's progression and overall quality of life.

As children age from infants to toddlers, they begin to hit certain milestones in their development. One of the most notable is when they are able to smile and push themselves up while laying on their stomachs. Once a child is several months old, they begin to stand, and even walk shortly thereafter. If babies are unable to reach expected developmental milestones, doctors can then investigate to determine why this is happening.

Cerebral palsy affects individuals depending on what area of the brain has been injured. This means doctors can’t simply look at symptoms and automatically diagnose a child with the condition. It’s necessary to closely examine each child and their development or lack thereof. This includes motor skills, speech, autonomy, and independence.

In some cases, a doctor may tell parents they have a concern about cerebral palsy after childbirth due to certain factors. If there are complications during labor or delivery, the baby might be at a higher risk of developing the condition. Babies who are born prematurely are particularly at risk, especially if they develop jaundice that is left untreated. Other problems that can lead to cerebral palsy include infections like meningitis or trauma during delivery.

Cerebral Palsy & Missing Milestones

However, if there are no risk factors involved, the doctor must closely examine the child’s development. It’s common for parents to note certain issues with their children, such as not learning to crawl during the normal age or a lack of muscle tone. Parents who notice anything unusual must report their observations to their pediatrician immediately. These are known as missed milestones in the child's development.

Precise documentation of missed milestones can lead to earlier intervention and better outcomes. By tracking developmental progress and consulting with healthcare providers, parents can advocate for their child's needs more effectively. Intervention plans involving therapies and support can then be tailored to help the child achieve better developmental progress.

[ Click here to open our Missed Milestones infographic in a new tab]

On average, babies should begin to walk between 12 and 18 months and begin to speak in basic sentences or phrases by two years old. In some cases, cerebral palsy may affect only one side of the body, only the arms, or only the legs.

Diagnosis in Children

A definitive cerebral palsy diagnosis generally depends on the child’s age. However, certain factors may determine a diagnosis, including the following:

• Severity: If severe symptoms are present in a child, notably their inability to control their movements, it may be possible for a doctor to diagnose cerebral palsy earlier in the child’s life.
• Parental involvement: In many cases, the doctor will rely on parents to tell them about the symptoms they have witnessed their babies experiencing.
• Type: Certain types of cerebral palsy are easier to diagnose.

Generally speaking, babies with severe cerebral palsy can be diagnosed within only a few months, but some babies are not diagnosed until their first birthday. If the condition is mild, the child may not be diagnosed until around three or four years old.

Understanding the diagnostic process is vital for parents, offering them the clarity needed to make informed decisions about their child's care. Pediatricians may use a combination of developmental screenings, neurological exams, and imaging tests to reach a cerebral palsy diagnosis. Once diagnosed, a comprehensive care team will typically be assembled to support the child's health journey.

Tests for Cerebral Palsy

There are certain tests doctors can use to diagnose cerebral palsy in children. Overall, most of these are imaging tests that allow for a view into the brain. Doctors typically see the area in the brain that has suffered trauma and then make a definitive diagnosis. 

These are a few tests used:

• MRI: An MRI is noninvasive and can produce 3D images of the brain. This is the most common imaging used for this purpose and may be used in combination with an MRA or MRV (spectroscopy) that looks at blood flow in the brain)
• CT scan: A CT scan takes X-rays from many angles and shows images of the brain.

In addition to imaging tests, metabolic and genetic testing may be conducted to rule out other conditions often linked with cerebral palsy. These tests not only aid in diagnosis but also play a role in determining the best course of action for therapeutic interventions. They provide valuable insights that can guide individualized treatment plans, helping maximize the potential for improvement in children with cerebral palsy.

The Law Firm of Michael H. Bereston, Inc. is ready to answer your questions. Get in touch now: dial or submit an online form to set up a consultation.

What Are The Potential Complications & Associated Conditions of Cerebral Palsy?

Cerebral palsy can be associated with various complications and additional conditions that may affect individuals with the condition. 
Some potential complications & associated conditions of cerebral palsy include:

• Motor impairments: Cerebral palsy primarily affects motor function, leading to difficulties with movement, coordination, and muscle control. These impairments can vary in severity and may impact different parts of the body.
• Intellectual disabilities: Some individuals with cerebral palsy may experience cognitive impairments, ranging from mild learning difficulties to more significant intellectual disabilities.
• Speech & language disorders: Communication challenges, including difficulties with speech production, articulation, and language development, are common in individuals with cerebral palsy.
• Epilepsy: Seizures, often categorized as epilepsy, can occur in individuals with cerebral palsy. These seizures can vary in type and frequency.
• Vision impairments: Visual problems, such as poor visual acuity, strabismus (crossed eyes), or nystagmus (involuntary eye movements), can be associated with cerebral palsy.
• Hearing impairments: Some individuals with cerebral palsy may have hearing loss or other auditory disorders, which can impact their ability to hear and understand sounds.
• Musculoskeletal issues: The abnormal muscle tone and posture associated with cerebral palsy can lead to secondary musculoskeletal problems, such as joint contractures, scoliosis, and muscle tightness.
• Breathing difficulties: Severe cases of cerebral palsy may affect respiratory muscles, leading to respiratory problems, difficulty swallowing, and an increased risk of aspiration pneumonia.
• Gastrointestinal issues: Digestive issues, such as gastroesophageal reflux disease (GERD), constipation, or feeding difficulties, can be observed in some individuals with cerebral palsy.
• Mental health concerns: Individuals with cerebral palsy may be at a higher risk of experiencing mental health conditions, including anxiety, depression, and social-emotional difficulties.

Addressing these complications often involves a multidisciplinary approach, incorporating a range of healthcare professionals such as neurologists, nutritionists, therapists, and mental health specialists. Comprehensive care plans are designed to focus on each individual's specific difficulties, promoting well-being and enhancing quality of life. Understanding the relationship between cerebral palsy and these associated conditions helps families navigate the challenges and pursue effective treatments.

What are the Different Types of Cerebral Palsy?

There are different types of cerebral palsy, each having different symptoms due to the part of the brain affected. Each of the different types causes a different movement disorder and shows different symptoms.

The different types of CP are:

Spastic Cerebral Palsy

Spastic cerebral palsy is caused by damage or developmental differences to the Cerebral Cortex. This is also the most common form of cerebral palsy. Stiff muscles and jerky movements (spasticity) may affect the upper part of the body, the lower part of the body, or both upper and lower; one side of the body or both sides.

This can lead to difficulty with:

• Getting dressed
• Walking, crawling, sitting up
• Showering/bathing
• Eating/drinking
• Writing/typing
• Grasping objects
• Sitting/standing upright
• Walking/running

Therapeutic interventions for spastic cerebral palsy focus on improving muscle tone and coordination. Techniques include physical therapy regimes designed to increase flexibility, strengthen muscles, and improve movement precision. Assistive technology may also augment mobility, allowing individuals to perform daily tasks with greater ease and independence.

Dyskinetic Cerebral Palsy

Dyskinetic cerebral palsy is associated with damage to the Basal Ganglia. The Basal Ganglia is essentially the brain’s delivery system between the movement center and the spinal cord and is responsible for regulating voluntary movements.

There are three different types of Dyskinetic cerebral palsy, based on which area of the Basal Ganglia was damaged:

Dystonia

Dystonia is known for resulting in involuntary muscle contractions that result in slowly twisting movement or repetitive movement, triggered by trying to move.

Characteristics:

• Repetitive motions
• Unusually awkward posture
• Rapid or extremely slow movements, which often cause pain
• Involuntary, sporadic movement
• Sensory ticks to suppress unwanted movement - touching of the face or chin with hands, tucking the hand under the chin, sitting on hands

Targeted therapies for dystonia may include botulinum toxin injections and occupational therapy aimed at reducing muscle contractions and enhancing functional skills. Managing dystonia requires regular monitoring and adjusting treatment plans to changes in symptoms over time.

Athetosis

Athetosis displays slow, involuntary movements while at rest and amplified by movement. There is also a vast fluctuation in muscle tone, with some being extremely floppy and some being very tight.

Characteristics:

• Restlessness
• Constant slow movements
• Drooling due to lack of facial muscle control
• Challenging to hold objects
• Unwanted sporadic movements

Management of athetosis focuses on improving voluntary control of movement, possibly through therapies such as constraint-induced movement therapy (CIMT). This approach encourages the use of affected limbs, helping to cultivate better control and reduce involuntary motions over time.

Chorea

Chorea stems from a Greek word meaning “dance.” Fittingly, Chorea shows symptoms of restlessness, causing brief movement that is often unpredictable.

In cases of chorea, treatment may involve a combination of medications to suppress erratic movements and therapies that encourage controlled movement and strength enhancement. Gaining control over these movements can empower individuals in daily activities, increasing confidence and independence.

Ataxic Cerebral Palsy

Ataxic cerebral palsy is caused by damage to the Cerebellum, which is the balance center for our brain. It’s the Cerebellum’s job to fine-tune motor commands to maintain proper posture.

Characteristics:

• Tremors/shakiness - caused by the brain trying to under/overcorrect movements
• Difficult to perform precise hand movements
• Walking with a “wide-base gait” to try to fix poor balance
• Breezy sound during speech
• Difficulty tracking movement visually

Interventions for ataxic cerebral palsy often include exercises to improve muscular coordination, occupational therapy to enhance goal-directed movements, and speech therapy to address articulation challenges. Approaches are continuously fine-tuned to respond to the brain’s evolving adaptive process and the individual's developmental progress.

Mixed Cerebral Palsy

When multiple regions of the brain are damaged, it’s possible for multiple types of CP to be present. Addressing mixed cerebral palsy challenges may involve a combination of approaches that focus on the predominant symptoms exhibited by the individual. Tailored therapy plans are essential to accommodate the complex needs stemming from various movement disorders experienced together.

How Is Cerebral Palsy Classified?

Cerebral palsy is classified according to the Gross Motor Function Classification System (GMFCS), which is broken down into 5 levels. The GMFCS categorizes the level of CP based on movements and the use of mobility devices.

This tool is helpful because it allows families to have a clear understanding of their child’s current motor function skills, as well as gives them an idea as to which mobility devices would assist their child.

The five levels of the GMFCS increase as the mobility decreases, as follows:

• Level 1: The child can walk without any limitations. They can climb stairs without using rails, as well as perform gross motor skills (running, jumping, etc.) although their speed and coordination may be limited.
• Level 2: The child can walk in most situations and climb stairs with the use of a rail. In certain situations, like uneven terrain, long distances, or crowded places, the child may have trouble walking. They may also use some form of a handheld mobility device to traverse long distances. Children have a very limited ability to perform gross motor skills.
• Level 3: Whether it’s a short distance indoors stroll or a long walk outside, some form of mobility device is necessary for the child to walk. They can still make their way upstairs, as long as they are holding onto a rail along with supervision. Wheeled mobility is necessary when the child is going to travel long distances.
• Level 4: In most cases, the child requires manual assistance or powered mobility. At home or in the comfort of their own time, the child may walk short distances with the assistance of a walker with body support or a powered mobility tool. While the child is in public, they will be in a wheelchair or use powered mobility to get around.
• Level 5: The most severe level of CP, the child must be taken in a wheelchair anywhere they go, and their head and neck must remain supported, due to the lack of ability they have to control them on their own. They also must have a support system in place for their trunk and their arms and legs.

The GMFCS is a vital tool in assessing the needs of individuals with cerebral palsy, establishing concrete objectives for enhancing mobility and independence. It aids healthcare teams in devising practical frameworks for therapy and equipment use, ensuring the most beneficial support and interventions for the child's development.

Recovering Fair Compensation After a Cerebral Palsy Diagnosis

A cerebral palsy diagnosis means that your child will lead a far different life than the one you had envisioned. This does not mean, however, that all of his or her opportunities should be limited. With the right care, therapy, and assistance, your child can lead a more fulfilling and stable life. The financial compensation awarded in a birth injury lawsuit can help ensure you can provide for all of your child’s needs.

As an experienced cerebral palsy lawyer, Michael Bereston understands what it takes to seek justice in birth injury cases involving this serious condition. For more than 30 years, Mr. Bereston has been practicing law and using his trial experience to help disabled children and families recover the complete compensation they need and deserve.

Find out more about recovering fair financial compensation to help your child face a brighter future.

Understanding the full scope of your child's future needs is critical in calculating the compensation required. This may encompass anticipated medical treatments, therapies, special education, adaptive equipment, and any necessary home modifications. Engaging professionals who specialize in life-care planning can aid in projecting costs and ensuring adequacy in the compensation sought, thus facilitating better preparedness for enhancing your child's quality of life.

Related Articles

• Spastic Diplegic Cerebral Palsy: What Does the Condition Mean?
• Different Forms of Assistive Technology
• FAQs about C-Sections & Birth Injuries
• CP & Vision Problems

Call (410) 220-6581 for your free case evaluation. Our cerebral palsy attorney practices in Maryland and across the U.S.