Cerebral palsy is one of the most common motor disabilities in childhood — but families rarely receive clear medical explanations about how it develops and what the different types actually mean. In Part 1 of this two-part series, Dr. Greg Vigna explains the medical causes of cerebral palsy, how early brain injury occurs, and the differences between spastic, athetoid, and hemiplegic CP. Joined by attorney Ben C. Martin, this episode helps families understand how brain injury affects movement, development, and long-term care needs.
What We Cover in This Episode:
-How cerebral palsy develops in the brain
-Spastic, athetoid, and hemiplegic CP explained
-How CP impacts muscle tone, balance, and daily function
-What families may notice during early childhood
-Why brain cooling, temperature control, and expert evaluation matter (Coming In Part 2)
If you believe your child or someone you know has CP from troubles at birth, feel free to reach out. We try to answer all questions, not just the legal ones.
www.vignalawgroup.com 817-809-9023
TRANSCRIPT:
B: I'm Ben C!
V: I'm Doctor V.
The Medical Legal Guys!
V: Today we're going to be talking about cerebral palsy and how we work up these serious injury cases. And first of all, it's important to understand why does cerebral palsy occur. And that is because of hypoxia. And Ben, do you want to describe what hypoxia is.
B: Hypoxia. He's talking about. That is a lack of oxygen that is flowing to the brain. Generally it's called H.I.E.
V: Hypoxic ischemic encephalopathy. And encephalopathy simply means that the brain is not functioning properly. And there's various forms of encephalopathy that comes to mind then. Let's talk about babies. Hypoxic is a encephalopathy is a form of neonatal encephalopathy. Neonatal is newborn. So when babies are born and they have a lack of oxygen during the birthing process, they could suffer a brain injury. And sometimes those brain injuries are reversible because the baby is delivered and they're resuscitated and the baby is fine. Other times, they have suffered hypoxic brain damage.
B: When a baby suffers from a lower oxygen level in the brain than is normal, or that they should have. Right. It can cause harm if it's for a lengthy period of time or even a shorter period of time. If it's a major crop and in the level of oxygen. Hypoxia. Hypoxia meaning lower oxygen levels. Okay. So that's one of the causes of cerebral palsy. Doctor V to help tell everybody what cerebral palsy is?
V: Well, I first want to talk about how a baby presents at birth. And these babies when they are born they're they're blue. They're electrolytes or their oxygen level are is way off primarily the pH. And the oxygen level is what is important. And are they the notic. That means that the body is not getting rid of its waste.
So these babies are born limp. They they require intensive care, treatment. And they're often taken to the ICU for management. If a baby has hypoxic ischemia, encephalopathy, and it's severe or moderate, they are then treated with therapeutic cooling where they bring the body temperature down. And that is the only way to protect the brain. And then they're in the NICU for quite, quite some time after all.
B: Right. That sounds pretty basic and pretty simple. Is that the way it happens in every case, the let's talk about, cerebral palsy. But what is cerebral?
V: Well, cerebral palsy is, basically a brain injury. Okay. And it's a hypoxic brain injury related to the birthing process. And there are mainly four types of cerebral palsy. They're spasticbyplegia. These kids generally have problems with walk in coordination and it's more of a motor problem then you have hemiplegia, cerebral palsy where they they look like they've had a stroke and they basically did have a stroke.
Generally the MRI will show a problem in the side opposite of their weakness. Then there is kind of a afa Toid cerebral palsy where these kids have in coordination and they're they're kind of always moving. But those are those are really the main types of cerebral palsy. And six cerebral palsy means that that the muscles just don't relax.
Okay. And other kids, they can't get out of a wheelchair because of the cerebral palsy. It affects all four extremities. And these kids are often, you know, very, very tight. And they need treatment to loosen them up so they could sit comfortably so they could be placed in a wheelchair. And and they need baclofen pumps, Botox, riseotomies and really lifelong care. You know. So these are serious injuries. And and what is interesting about cerebral palsy is that when you do MRI's on these these kids brain, 85% of the time they show problems in certain locations of the brain. But 15% of kids with cerebral palsy have normal MRI and the damage just doesn't show up. So they tend to be less severe, but they still meet the clinical diagnosis of cerebral palsy. The most important thing about this is that there are children who have hypoxic brain injuries. They have complicated deliveries. They're born hypoxic. They develop the developmental delay. They have problems in school. They might have problems with coordination, but they're not getting diagnosed as cerebral palsy.
So we know that these kids are injured. But it's hard. It was hard to prove it okay. And now children with, complicated deliveries with developmental delay than autism. Now when you get MRI DPI's it lights up in the same area of the brain as the kids with cerebral palsy. So it's kind of a a different presentation for a hypoxic brain damage.You understand what I'm saying? Yeah. So there are children that had no recourse. The families had no recourse because it was difficult to prove that this brain damage caused their developmental delay or made their autism worse.
B: One of the types of cases that we handle and we work and we work, our what I would call the acute birth trauma cases. Those are the cerebral palsy cases. Those are the cases where you've got hypoxic events that lead to lower oxygen, leads to brain damage in these in these kids, and leads to all these things that are offshoot of and form cerebral palsy.
But it almost always comes down to a lack of oxygen and lowering of that oxygen, either in the length of time that there is oxygenation levels that have gone down, or the depths of that lowered oxygen level to complete loss of arch heat, for instance. It may not be for long, but it's long enough to give the brain damage.
People come to us, parents of these babies come to us and children after years of like seeking some help. And well, how did this happen with this new technology in doctors and the lawyers are able to take that new technology in and use it because now, to explain something called causation. Right. So let's say that, there was negligence in the birth labor delivered, loss of oxygen, all that stuff. And then you have a baby with cerebral palsy. One of the things we have to do is that we have to prove that first there was lack of oxygen. Secondly, that that lack of oxygen is what caused the ORS to. Now we can do that. And more cases because the studies are more significant in their detail. Right. Does every case mean that there was lack of oxygen at birth?
Maybe not necessarily, because every cerebral palsy case will lead to the conclusion that the doctors, or the hospitals, or the nurses during the labor and delivery were negligent. No, no. But it is a situation where if a child has cerebral palsy and if there was a complicated delivery, these things can be studied.
V: Pediatricians, historically, when taking care of a child, aren't meeting their goals. You know, in terms of ability to roll, ability to suck on a bottle, the ability to sit up. Pediatricians have always traditionally had a wait and see kind of attitude, you know, well, let's just see how things go, okay. And now with these diagnostic studies, you can find the babies who are at most risk of not meeting their goals. If you have a baby who had a complicated delivery and is not meeting their goals, these children need to diagnose nurses so that it gets them into the treatment they need. And this wait and see attitude that was last decade and the decades before. And the reason why is, you know, I'm seeing this right now.
We had had a case and the birth history was terrible. Okay. The care was bad. And this was in Connecticut. They don't have a statute of limitations that protects babies there. You have to file the case within three years. The wait and see attitude. I got the call for an age four. There's nothing that we can do as lawyers if the law doesn't protect a baby. So you want to talk about statute of limitations for kids.
B: Limitations being a time period after which you can't shoot? Okay, most states, even Texas, has a statute of limitations for minors that go much farther than than just age three. So some states, go to 14, some states go to age 12, some states go all the way to 18. Right. And so, many states two years after age 18.
So that baby, now an adult is 20 years old, then a lawsuit can be brought. Right? All the states are different. So it's important that with respect to the statute of limitations that that be evaluated so that every lawyer wants to make sure that that statute limitations as well.
V: So we're not waiting for diagnosis of cerebral palsy. If a baby is if a child has the global developmental delay, that is a criteria for us to to investigate. And now hypoxic brain damage in children with autism, you can find those children who have hypoxic brain damage in those kids in studies perform much worse than the kids with autism, that there is a subgroup of autistic kids who have been exposed to hypoxic brain damage and they fall off the charts in terms of performance, those are the kids who require a 24 hour care to their life expectancy.
If they have a complicated delivery, you know, you know, those are cases that we are investigating. So I'd like to kind of describe how our law firms, evaluate a case and every, every case that comes into my firm. You know, I take the first call to kind of understand how the baby is functioning. Okay. And and to understand, is this a serious injury?
From there, the mother, and the father will be directed to our staff, ObGyn to be able to take the birth history, the prenatal care history, to understand the events as the parents experienced it, to see if the events suggest negligence and and if the events suggest hypoxic brain damage, and if it meets our criteria on the phone. That's when we are executing contracts and getting the the medical records. And we're getting the fetal straps. And then our ObGyn is reviewing, you know, was there a neglige nt delivery or our clients are talking to Experts from the start
B: Yeah. It's pretty amazing how sometimes talk to folks who have been looking for an answer. Right. This is a very traumatic, obviously traumatic event. And their lives or family's life. Right. And it's really difficult sometimes when folks who are just reaching out trying to find answers, I don't think they necessarily care about litigation, but we get calls from folks who just want answers and sometimes that turns into litigation, sometimes it turns into a lawsuit.
But what, what I have seen is that, kind of almost a sigh of relief when we're able to have folks like that, staff look at the records and then talk to the family and put things together so that so that we can usually, you have the family and it and tell them what we think and what, our, our thoughts are with what has happened and the cause of what has happened.
And sometimes some cases are harder than others to get to those answers. But generally we get an answer in the families. Do give that sigh of relief when they're happy to hear even some bad news, but they're happy to hear that news because it's an age...