Cerebral Palsy Compensation
Whilst all births are fraught with potential dangers, these hazards are, in the main navigated successfully by our NHS trained birthing experts.
We are lucky in the UK that traditionally the birthing location is usually within a fully equipped hospital. Having this location as a base, means of course, that obstetrician / gynaecology, midwifes and support staff who are involved in an emergency situation can look toward the full range of hospital services for assistance with diagnostic, medicinal or surgical input.
In spite of this however, mistakes can be made and wrong decisions can lead to life threating conditions, serious injury and disablement. Perhaps the most commonly referred to condition is Cerebral Palsy.
What Causes Cerebral Palsy?
Most Cerebral Palsy is best described as “damage to the baby’s brain”.
This can occur through a natural malformation of the brain. This malformation and the subsequent diagnosis of cerebral palsy may have nothing to do with any negligence. Conversely, cerebral palsy may be caused by negligent treatment or failure to diagnose clinical issues in a timely manner. So trauma to a foetus or new-born either direct or indirect. An example of direct trauma may be inappropriate forceps delivery, or wrongful persistent application of a ventouse delivery. An example of indirect trauma may be; lack of oxygen or the presence of toxicity in the womb through meconium poisoning or incidental infection.
In any event; the condition is permanent brain damage and the result is usually a continuing problem with both the baby’s and the growing child’s physical and psychological development.
What Does Cerebral Palsy Cause?
The most often and most cited effect is a developmental “lag”.
Most parents are aware that there is a pattern of infant development that is predictable to a large degree. This pattern of human development occurs because all new-borns are overcoming the same environmental stimuli at roughly the same time. So for instance; the muscles, ligaments and soft tissues that were cossetted and protected in the safe environment of the mother’s womb are being properly stretched for the first time. The neurological pathways (brain to muscle) are being formed in response to these stimuli and each day, week and month that goes by and improvements in the infant’s strength, grip, balance and poise are certainly more and more notable and provoke parental adoration. The child’s ability to interact with the world, to see, to hold and to manipulate objects is being prompted by their parents every day and so sight, sound, touch and taste are also developing at the same time. A useful guide / developmental calendar put together by Applebys Solicitor Advocate Mr Graham Balmforth to such development can be found here it is based on universal observations by medical professionals. The NHS also publishes an excellent guide for parents which can be found here. The Birth to 5 or 0 – 5 Guide has the advantage of including key steps post birth that should be undertaken by NHS staff.
Of course if the child is suffering from a brain injury then these developmental “targets” are not being hit by the child at the same rate as other children. Care has to be taken here though, some children will hit these stages early and late with no apparent reason and no professional can ever rely solely on developmental lag as proof positive of injury.
Other Symptoms of Cerebral Palsy
As the child develops, the tone and control of movement in children with pronounced cerebral palsy, can be seen more readily. Often the child’s fine motor control and reflexes are effected by the condition and the child may demonstrate spasmodic uncontrolled movements of the limbs. Sometimes there can also be a bladder and bowel control failure as well as issues surrounding the senses.
Types of Cerebral Palsy
There are different types of cerebral palsy which are dependant, to some degree, on the level of damage and area of damage to the brain, however, it is very important to remember that injuries are such that often “typing” of the condition is not possible or is possible only by reference to multiple types. It is also notable that various terminology is bandied about as definitive when actually the condition is subject to a great deal of research and so the state of knowledge and subsequent terminology surrounding “labelling” is in development. Nonetheless, as legal practitioners we find ourselves between clinicians and lay clients and we have found the following system a useful guide;
(a) Spastic (often referred to as pyramidal) cerebral palsy
This is by far the most common type, usually analogous to cerebral cortex damage and is associated with tight muscles in some parts of the body that are unable to fully or appropriately relax. The affected joints are very stiff or “set” and are difficult to mobilize. There are accompanying problems with walking and eating etc. These Spastic types are usually also grouped into 1 of 4 subsets, which are usually classified by reference to the limbs affected so:
- Hemiplegia / Diplegia = one arm and one leg on one side of the body, diplegia = both legs.
- Monoplegia = 1 limb only.
- Quadriplegia= Both arms and both legs
- Triplegia = 3 of 4 limbs.
(b) Non Spastic (often referred to as extra-pyramidal)
This is split into 2 groups; dyskinetic cerebral palsy and ataxic cerebral palsy. Dyskinetic is associated with muscle tone that is in constant flux between the states of relaxation and tension. It is this failure to reach a state of complete control that results in the failure to fine tune movements and the jerky responses that seem spontaneous and are the result of this.
Ataxic cerebral palsy is the rarest type of cerebral palsy and involves the entire body. Abnormal body movements affect the trunk, hands, arms, and legs. Poor coordination in terms of precision of movement and poor hand control (tremors) are regular.
(c) Mixed Cerebral Palsy (often referred to as a combination condition)(
It is not unusual for children to display more than one type of cerebral palsy. For example, bilateral spastic legs, which are the symptoms of spastic diplegic cerebral palsy and problems with facial muscle control or swallowing, which are typically symptomatic responses associated with dyskinetic cerebral palsy.
(d) Total body cerebral palsy (often referred to as athetoid cerebral palsy)
A condition can affect the entire body to various degrees. The condition can include all types of cerebral palsy suffered at differential rates across the entire physiology. This condition is usually indicative of a massive brain injury to what is known as the basal ganglia area.
The Legal Process
The first thing to be understood is that these claims represent the most complex clinical and legal issues that a medical negligence Solicitor can ever encounter. They require a massive amount of work in term of initial investigation and many potential actions are halted by clinical evidence at the introductory stages. Meticulous preparation and scrupulous attention to detail is required in this stage and therefore experience of such issues is essential in the Solicitor with supervision of such a claim and it must be understood from the outset that the claim will take a considerable amount of time to complete.
What is important is that the presentation of the matter is done in such a way that the case has the maximum prospects of success. Many Solicitors indicate an interim payment is usual and certainly Applebys Solicitors achieve this regularly, however, it should be noted that this is possible in cases where there is an early admission, however, it will not be true in every case. These cases are usually subject to very large awards, indeed some of the largest awards made by the UK courts in injury related damages are for Cerebral Palsy claims and as such the Defendants Solicitors will not hesitate to defend any action where they feel success is a possibility.
Once the issue of breach of duty is tackled and the Defendants have accepted fault, we can then undertake the task of gathering expert evidence on the issues of the child’s needs and how best they can be met with assistive devices and technology or even accommodation. Ultimately each case is different and requires very different input from the Solicitors. We at Applebys have an assembled team of both legal and clinical experts who can assist in every case, regardless of complexity.