Cerebral Palsy
What is it?
Cerebral palsy is not a single condition, but a term given to a spectrum of related disorders. While it has often been associated with injuries occurring during labour, the majority of cerebral palsy cases are actually attributable to factors during pregnancy; some are triggered by events after birth.
Very many antenatal factors can lead to cerebral palsy, including prematurity, intrauterine growth restriction, intrauterine infection, foetal coagulation disorders, multiple pregnancy, breech presentation, and chromosomal or congenital anomalies. Just after birth, virulent infections such as meningitis can also trigger cerebral palsy. Sometimes, cerebral palsy can be triggered by events in labour. In such cases, there is usually "hypoxia", or lack of oxygen.
What are the symptoms?
Cerebral palsy is characterised by abnormal or deficient control of movement and posture. Because babies only develop muscle and limb coordination gradually, cerebral palsy is usually not diagnosed until months or even years after the sufferer's birth. The severity of the symptoms can vary quite considerably. Sometimes, one set of limbs (either legs or arms) may be more affected by the condition than the other; sometimes, all the limbs are affected ("spastic quadriplegic" cerebral palsy). There may be a cognitive deficit, although this is by no means always present - we know of one lady with cerebral palsy who passed her MA and started work on a PhD thesis before receiving her seven-figure damages award!
How do we investigate the claim?
In order to win a cerebral palsy claim, we need to prove that contemporaneous clinical guidelines were not followed (breach of duty), and that if they had been, then on the balance of probabilities the condition would not have developed (causation). It follows from this that we need to find out what was most likely to have caused the condition.
It is often extraordinarily difficult to isolate a single underlying factor which has triggered cerebral palsy, and generally, it is necessary to ask several medical experts from different fields (e.g., obstetrician, midwife, paediatrician, neuroradiologist) to comment on the various issues raised. Because the investigations are multidisciplinary, involving many experts, they can take a considerable amount of time to conclude.
Although this is by no means always the case, the majority of cerebral palsy cases that succeed are the result of a catastrophic event or series of events during labour. In order to establish whether there was a period of acute hypoxia during the birth process, all or most of these criteria must be satisfied:
Suggestive Criteria
- Evidence of metabolic acidosis in foetal, umbilical arterial cord or very early neonatal (first month of life) blood samples. Acidosis is a term denoting an imbalance of blood pH levels, in which the blood is too acidic. Acidosis happens after oxygen starvation, so if it's present, you can be reasonably certain that blood oxygen levels were too low.
- Early onset of neonatal encephalopathy (a coverall term denoting any disease or disorder of the structure or function of the brain);
- Cerebral palsy of spastic quadriplegic (i.e., involving all 4 limbs) or dyskinetic (a group of involuntary movements) type.
- A traceable hypoxic event occurring immediately before or during labour - these can sometimes be established by reference to foetal heart monitoring devices.
- Sudden, sustained, and rapid deterioration of the foetal heart rate pattern, usually after the hypoxic event. The more normal the foetal heart rate prior to this point, the clearer the implication that something has gone badly wrong.
- APGAR scores of 0 - 6 for longer than 5 minutes.
- Early evidence of multisystem involvement.
- Early imaging evidence of acute cerebral abnormality.
Timescale
Cerebral palsy cases are incredibly complex, and usually take years to resolve, whether or not they are concluded successfully. It is obviously vital that you choose a suitably experienced and qualified lawyer. It is also extremely important that you choose a solicitor with whom you feel comfortable, and who you get on with: you will almost certainly be in a professional relationship with your lawyer for some considerable while to come.
Contact
Angelina Rigby Head of Medical Accidents
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