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World Cerebral Palsy Day - what is cerebral palsy and how can we help?

Today is World Cerebral Palsy Day, a global occasion to raise awareness of cerebral palsy, gather support for those with cerebral palsy and promote an understanding of their needs. Clinical negligence solicitors Sanja Strkljevic and Kriya Amin explain what cerebral palsy is and how the clinical negligence team can help.

Posted on 06 October 2017

What is cerebral palsy?

Cerebral Palsy is a condition that affects muscle control and movement. It is caused by abnormal development or damage to the brain, before, during or after birth. Children with a diagnosis of cerebral palsy may have difficulties in controlling muscle movements as they grow and develop, with the range of difficulties usually classified by the type of cerebral palsy they have. 

There are three main types of cerebral palsy: spastic cerebral palsy, ataxic cerebral palsy and athetoid cerebral palsy. As its name may suggest ‘mixed cerebral palsy’ s a mixture of the different types of cerebral palsy.

Spastic Cerebral Palsy is the most common form of cerebral palsy, where the part of the brain that controls muscle tone does not function properly leading to very tight muscles and stiff, jerky movements. It can affect the arm and leg on one side of the body (Hemiplegia), both legs (Diplegia) or both arms and legs (Quadriplegia).

Ataxic Cerebral Palsy is caused by damage to the part of the brain that is responsible for balance and coordination. People with ataxic cerebral palsy will often have difficulties with fine motor skills such as balance, co-ordination and tremors. 

Athetoid Cerebral Palsy is divided into two groups, choreoathetoid dyskinetic cerebral palsy, which is characterised by involuntary movements, and dyskinetic cerebral palsy, which is characterised by repetitive muscle contractions (which can cause a lot of pain as a result of muscular cramps/spasms). Athetoid cerebral palsy can cause eye contact problems, difficulties with speech and eating problems.

The current UK incidence rate of cerebral palsy is around 1 in 400 births.  In many children brain damage which causes cerebral palsy occurs prenatally, and the causes are unknown. However, other causes of brain damage that cause cerebral palsy can be linked to birth trauma; for example, lack of oxygen to the brain, or infection during labour or birth.  Other causes may include very low blood sugar levels (hypoglycaemia) and also brain damage caused by sepsis or infection such as meningitis.  Whilst some of these causes can be a result of clinical negligence, not all brain injuries leading to cerebral palsy will be actionable in respect of a clinical negligence claim. 

How can we help?

We act on behalf of children (and adults) who have sadly developed cerebral palsy as a result of mismanagement of their birth/mother’s labour.   We also act for individuals who are affected by the condition as a consequence of other causes, such as for example infection. 

To prove a claim in clinical negligence, a two-stage legal test needs to be satisfied. Firstly, we need to be able to show that the medical professionals providing the care (i.e. midwives, doctors, nurses) breached their duty of care to the patient; in other words they were negligent. For example, in our cases we often see failures in respect of the management of labour/appropriate monitoring of the CTG trace which monitors the heartbeat of the baby. In these instances, the distress of the baby is sadly missed, leading to the development of hypoxia and brain injury. 

Secondly it must be proved that the negligent failure(s) of the medical professionals involved probably caused the injury and the resultant disabilities. 

To prove both legal tests, a thorough investigation of the events surrounding the mother’s labour and the birth of the child.  Expert evidence is required to prove whether the quality of care fell below a reasonable standard, and if the brain injury and subsequent disabilities would have been avoided with appropriate care.  

In cases where it is successfully established that the brain injury was caused by negligent care provided to the mother or the baby, we will investigate the needs that the child has now and the needs for the future.  One of the most important steps of that investigation is an assessment of the nature of the brain injury and the child’s condition and prognosis.  We will identify and instruct an experienced expert paediatric neurologist who will carry out this assessment.  It informs the other experts of the child’s needs.  

Earlier, we summarised different types of cerebral palsy.  The condition that the child suffers from will dictate the type of aids and equipment that they will need.  However, some common themes prevail across the spectrum and they are:

  1. Care: in all cases we will instruct experienced care experts to advise on the care needs and the cost associated with putting in place appropriate care with suitably experienced carers.  
  2. Case Management: in most cases, a specialist case manager is required to assist and support the family of the child with their day-to-day treatment, rehabilitation and other needs and ensure that appropriate provisions are in place.  This can include liaising with local authorities regarding care and education, helping with the recruitment of carers and sourcing appropriate therapies amongst other aspects of the role that will be specific to the needs of the child with cerebral palsy. 
  3. Accommodation: it is inevitable that the family home may not be suitable.  We will instruct expert architects who specialise in disability accommodation needs to advise on the adaptations that will be required and their cost, or whether a new property needs to be purchased or rented, taking into account the family circumstances. 
  4. Therapies: in many cases the therapies provided by the National Health Service may not be sufficient and private input is required.  We instruct experts specialising in cerebral palsy to advise on speech and language, physiotherapy and occupational therapy needs so as to maximise the therapeutic intervention that the child needs, assist in the relief of their symptoms and aid their development.   
  5. Assistive technology, aids and equipment: with some types of cerebral palsy, the child will have communication issues or they may require specialist equipment.  We appreciate that this is expensive and that the state funded aids may not maximise the child’s potential.  We will instruct experts who will advise on the child’s needs and the cost of specialist assistive technology, aids and equipment that is required now and in the future.  
  6. Special educational needs:  in most cases, a child will have a statement of special educational needs.  We will instruct experts specialising in this regard to assess the needs now and in the future including any challenges to the Special Educational Needs Tribunal.  We may be able to refer you to appropriate solicitors specialising in these challenges and claim the reasonable costs from the Defendant.  

This list is not exhaustive, but in our experience, it identifies some of the immediate issues that children with cerebral palsy will require.  In cases where liability has been admitted or we have been able to achieve an agreement as to the extent of the Defendant’s responsibility for the injures, we can apply for an interim payment of damages to meet the costs of immediate needs, such as, care, case management, accommodation, therapies and education.  We can help you identify and appoint a case manager. 

In cases where an interim payment has been obtained, we can direct you to practitioners specialising in Personal Injury Trusts of Deputyships so that the award of interim damages (and ultimately damages) can be properly managed.