Last updated on August 29th, 2017 at 10:33 am

What is cerebral palsy?

Cerebral palsy is used to describe a group of conditions characterised by abnormalities of movement and posture caused by non-progressive disorders of the brain. Depending upon the exact nature of the abnormality of movement and posture, it can be classified into different types.

• Spastic cerebral palsy is characterised by an increase in muscle tone. On examination you would also expect to find features such as exaggerated tendon flexes, extensor plantar responses (extension of the big toe and possibly other toes when the sole of the foot is stroked) and ankle clonus (involuntary shaking or jerking of the leg when the toe is placed on the floor with the knee slightly bent)
• Dyskinetic (also called dystonic, extra-pytamidal and athetoid) cerebral palsy is characterised by marked fluctuations in muscle tone according to factors such as position and emotion (dystonia) and also often by the occurrence of abnormal writhing-type movements (athetosis)
• Ataxia cerebral palsy has the principle problem of balance.

Mixed forms of cerebral palsy with, for example, both spasticity and dyskinesia are relatively common. Cerebral palsy can also be classified according to the distribution of affected limbs.

• Quadraplegic cerebral palsy involves all four limbs to s significant degree.
• Diplegic cerebral palsy mainly or exclusively involves the lower limbs.
• Hemiplegic cerebral palsy involves one side of the body, usually with the upper limb being more severely affected than the lower limb.

The functional impact of cerebral palsy can be used to classify it as mild, moderate or severe.

What causes cerebral palsy?

Cerebral palsy can be caused in a number of ways.

It may be due to brain damage caused by a lack of oxygen to the baby’s brain during birth or shortly afterwards in the neonatal period.

Cerebral palsy can also be caused by a number of conditions such as:

• genetic problems
• premature birth
• malformations of the brain and infection

It can also be the case that a baby may have suffered a stroke or a bleed on the brain whilst it is growing in the womb.

How do you know when the brain damage occurred?

There are two main ways of timing the onset of brain damage caused by an acute, near total hypoxic-ischaemic insult (brain injury caused by oxygen deprivation) at the end of labour:  the working forward method and the working backward method.

Working forward method

The working forward method relies on identifying the start of the terminal bradycardia. Bradicardia refers to an abnormally slow heart rate which is usually less than 110 beats per minute for at least 10 minutes. This may be caused by a lack of oxygen. A sudden profound bradycardia is a medical emergency and this is known as a terminal bradycardia.  It is then assumed (often wrongly) that brain damage will start ten minutes after the start of the terminal bradycardia.

The situation in relation to using the working forward method can be complicated by several factors:

1. The time of onset of the terminal bradycardia may not be known – or may be somewhat unclear.
2. Damage can supervene after less than ten minutes.
3. Damage can supervene after considerably more than ten minutes.
4. When there is ongoing bradycardia postnatally there may or may not be ongoing damage depending on how effective the cardiac massage is.

Working backward method

The working backward method relies on two main assumptions:

• The longer the brain damaging hypoxia-ischaemia persists the worse the brain damage will be and the more disabled the baby will be.
• The period of time between the onset of brain damage and the time when the baby becomes un-resuscitatable is about fifteen minutes.  This assumption is in line with the two central principles of the working forwards method – that is that, in relation to the start of an acute near total hypoxic-ischaemic insult, the first damage is seen after about 10 minutes and death is likely after about 25 minutes.

It follows from the second of these assumptions that a baby cannot survive an acute near total hypoxic-ischaemic insult whose brain damaging element lasts for more than about fifteen minutes.

In fact, there may be sufficient variability that, on occasion, a fetus can survive an insult whose brain damaging element lasts as long as 20 minutes.

Therefore, in cases of brain damage due to an acute near total hypoxic-ischaemic insult, the duration of the brain damaging insult ranges from less than a minute to about fifteen to (at the most) twenty minutes.

In the working backward method, the severity of a child’s impairments is used to estimate how long the brain damaging insult lasted for.

Why a solicitor could help you and your child?

In some cases the brain damage may have been caused by a lack of oxygen to a baby’s brain during birth, or shortly afterwards, as a result of a medical mistake made by either the doctor or midwife. If those mistakes were avoidable then your child may have suffered a birth injury and you may be able to pursue a claim for clinical negligence.

With a severe brain injury comes life-changing, debilitating problems. The affected child is likely to suffer cognitive, behavioural, and physical disabilities and may remain dependent upon the care of others for the rest of their lives.

Whist cerebral palsy is permanent and cannot be ‘cured’, in many cases there are a number of treatments and therapies available that can help reduce the effects and increase independence, communication skills and self-esteem, such as physiotherapy, occupational therapy. Medication to relieve muscle stiffness and spasms may all help.

Here at Graysons we understand that caring for a loved one that has suffered a catastrophic injury is both stressful and demanding and can have a severe strain financially, psychologically and physically upon the whole family.  Contact a member of our specialist medical team for a confidential, free, discussion.

Find out more about cerebral palsy.