What to Know About Spastic Quadriplegia
Learning that your child has cerebral palsy can be emotionally devastating. This condition is the most common type of motor disability diagnosed in children, according to the U.S. Centers for Disease Control and Prevention (CDC). Cerebral palsy is a condition caused by brain damage that disrupts the ability of the muscles to function normally. Cerebral palsy is an umbrella term encompassing multiple forms of the condition. The three major categories of cerebral palsy include spastic CP, ataxic CP, and dyskinetic CP, and these categories can be subdivided into additional forms.
Out of all types of cerebral palsy, spastic cerebral palsy occurs most frequently and accounts for 80% of all those who are diagnosed with the condition. The three forms of spastic CP include the following;
- Spastic diplegia
- Spastic hemiplegia
- Spastic quadriplegia
Out of these types of spastic CP, the most severe and disabling form is spastic quadriplegia. Spastic quadriplegic CP impacts the child’s whole body and is a lifelong condition. Unfortunately, this serious condition sometimes results because of medical malpractice during pregnancy, labor, delivery, or shortly after birth. Here is some information about this condition from the birth trauma attorneys at Raynes & Lawn.
What Is Spastic Quadriplegic Cerebral Palsy?
Children with spastic CP have increased tone in their muscles, making them stiff and their movements awkward and jerky. The three subtypes of spastic CP, including diplegia, hemiplegia, and spastic quadriplegia, describe which areas of the body are affected. In children with spastic diplegia, either the legs or the arms are affected. Those with spastic hemiplegia are affected on one side of the body. Finally, children with spastic quadriplegia are affected in both their legs and arms. They also are affected in the face and torso.
Spastic quadriplegia is the most severe type of cerebral palsy because it impacts the entire body. Most children with this form of CP can’t walk and are likelier to have multiple co-occurring problems, including difficulty speaking, seizure disorder, intellectual disabilities, and others. Children who have spastic quadriplegia might benefit from early treatment and intervention, but they will require lifelong care and ongoing support.
Spastic Quadriplegic Cerebral Palsy Symptoms
The majority of people who have spastic quadriplegic cerebral palsy are unable to work and might have profound difficulties with speech. Their arms and legs have extremely stiff muscles, but they might have floppiness in the neck and cannot voluntarily control their neck muscles. Many children with spastic quadriplegia also suffer seizures.
The following are some common symptoms of spastic quadriplegia:
- Rapid contractions in the muscles followed by sudden releases
- Immobile, stiff joints
- Muscular spasticity and tightness
- Involuntary muscle tremors
- Limb scissoring and difficulty walking
- Intellectual disabilities
- Speech difficulties
The intelligence of children with spastic quadriplegic CP is frequently significantly impacted and might range from moderate to severe intellectual disabilities. Since the child might also have significant speech impairments, it can be difficult to assess their intellectual functioning.
Causes of Spastic Quadriplegia
Spastic quadriplegia and its associated muscle stiffness are caused by damage to the brain and spinal cord. This results in improper nerve signals originating from the damaged areas being sent to the individual’s muscles. The damaged areas of the brain and spinal cord include the corticobulbar and corticospinal tracts, which are responsible for controlling the person’s motor function. Many children with this disorder suffered brain damage caused by birth trauma and injuries before, during, or shortly following birth.
Many children who are diagnosed with spastic quadriplegia suffered from hypoxic-ischemic encephalopathy (HIE) near the time of birth. This is a birth injury that causes brain damage resulting from oxygen deprivation and birth asphyxia. Some children who were born prematurely can also develop spastic quadriplegia after suffering from periventricular leukomalacia (PVL). This involves damage to the white matter of the brain due to HIE. Spastic quadriplegia can also be caused by hydrocephalus, diffuse cortical atrophy, and other complications that can cause widespread damage to the brain. Many of these types of birth injuries that lead to the development of spastic quadriplegia might result from the medical malpractice of doctors, nurses, and other medical providers. Because of this, parents whose children are diagnosed with spastic quadriplegic cerebral palsy should consult a cerebral palsy lawyer to determine the legal merits of a potential claim.
Between 26 to 34 weeks of pregnancy, the fetus’s brain white matter is highly susceptible to brain damage. The white matter transmits signals from the brain to other areas of the body. If it is damaged, the child’s entire body can be affected. Holes and lesions in the brain’s white matter can also result in spastic quadriplegic cerebral palsy.
In some cases, spastic quadriplegia will develop after a child’s birth when they suffered fetal strokes during gestation. A fetus might suffer a stroke because of placenta previa or blood clots in the mother’s placenta. Other causes of fetal strokes resulting in spastic quadriplegia include weak blood vessels in the fetal brain and the mother’s high blood pressure.
To avoid fetal strokes and the potential to develop spastic quadriplegia, it’s imperative for obstetricians to carefully monitor mothers throughout pregnancy. Through careful monitoring, doctors can diagnose and properly treat problems before they grow worse.
Medical Malpractice Leading to Spastic Quadriplegia
In some cases, the medical negligence of a nurse, doctor, or another healthcare professional will cause damage to the infant’s brain which leads to spastic quadriplegic CP. Some examples of medical negligence that can result in birth injuries that later cause the child to develop this condition include the following:
- Improper use of forceps or vacuum extractors to deliver a baby
- Failing to monitor the mother for high blood pressure, infections, and other conditions
- Failing to properly treat maternal conditions
- Failing to monitor the fetus’s development
- Failing to monitor the fetus for signs of fetal distress during labor and delivery
- Failint to appropriately intervene when the baby shows signs of fetal distress
- Using excessive force to deliver a baby
- Failing to perform an emergency c-section when necessary
A cerebral palsy lawyer can consult a medical expert to determine whether your child’s condition might have been caused by medical malpractice.
Early Signs of Spastic Quadriplegic CP
Since spastic quadriplegia is the most severe form of cerebral palsy, infants typically show early and obvious signs of the condition, including muscular stiffness, scissored legs or arms, rigidity, spasticity, tremors, and tense muscles.
Babies with this condition typically miss multiple developmental milestones, including an inability to lift and hold up their head, sit, roll over, crawl, and others. Because of the obvious signs that something is wrong, children with spastic quadriplegia are often diagnosed with the condition much earlier than children with other forms of cerebral palsy.
Complications Associated With Spastic Quadriplegia
Many children diagnosed with spastic quadriplegia develop other associated complications. Since this condition affects the whole body, children with spastic quadriplegia have an increased risk of deformities of the limbs. Over time, the constant pulling on the joints and bones of the child’s spastic muscles can cause other problems. Some of the complications that are frequently seen in children with this condition include the following:
- Scoliosis or curvature of the spine affecting up to 25% of children with spastic quadriplegia
- Contractures of the joints or shortened muscles surrounding the joints caused by muscle spasticity
- Deformities of the ankles that limit the ability of the ankles to flex
- Seizures caused by the widespread damage to the brain
- Intellectual disabilities
- Malnutrition caused by trouble swallowing
- Speech and language impairments caused by poor coordination of the tongue and facial muscles
- Bowel and bladder dysfunction resulting in incontinence or constipation
How Spastic Quadriplegia Is Diagnosed
In many cases, parents will notice the signs that something is wrong when their children are still infants and bring them to their doctors. When spastic quadriplegia is suspected, doctors will perform several tests to diagnose the condition.
Some of the tests that might be performed include the following:
- Magnetic resonance imaging (MRI) tests
- Hammersmith Infant Neurological Examination
- Prechtl General Movement Assessment
- Developmental Assessment of Young Children
When a doctor can’t confirm a diagnosis with these tests but multiple factors indicate the child might have spastic quadriplegic CP, they might state the child has a high risk of developing the condition and should be monitored closely during early childhood.
How Spastic Quadriplegia Is Treated
There is no cure for spastic quadriplegia, and the treatment will vary based on the child’s symptoms and the severity of the condition. The common types of treatment and therapy are described below.
Physical therapy is the most common type of treatment used for children with spastic quadriplegia. The goal of physical therapy for children with this condition is to help them become more independent. Physical therapists will help the children perform stretches, exercises to increase flexibility, and activities to improve their range of motion. Physical therapists use age-appropriate games and toys to make the therapy sessions as enjoyable as they can.
Speech therapy is used to help children with spastic quadriplegia improve the coordination of their facial muscles and tongue. This type of therapy might improve the child’s ability to swallow and their language and speech patterns. Children undergoing speech therapy might improve their ability to safely eat. Speech therapists might also help children learn how to use assistive communication devices so they can communicate their needs and wants when their speech is unintelligible or when they can’t speak.
Occupational therapy focuses on helping children build skills so that they can perform the daily activities of life with as much independence as possible. This type of therapy might help children in the community, at school, and home. Since spastic quadriplegia impacts the ability of children to use their legs and arms, occupational therapists might focus on improving the children’s ability to coordinate and use the muscles of the fingers and hands.
Children with spastic quadriplegia might be prescribed several different medications, including muscle relaxers that might be administered by injection or taken orally. They might also be prescribed medications to address co-occurring conditions, including anti-seizure medications and drugs to treat constipation or gastric reflux.
Surgery is only used to treat spastic quadriplegia as a last resort and can be important for children with this condition. Surgeries might be used to correct issues caused by spinal deformities, dislocated joints, shortened muscles, and other problems that cause children to suffer impairment and pain.
One type of surgery that might be recommended is called selective dorsal rhizotomy (SDR). This procedure helps muscles to relax and improves the child’s mobility in different bodily areas.
Prognosis for Children with Spastic Quadriplegia
Children with spastic quadriplegia have a poorer prognosis as compared to those with other types of cerebral palsy. Because of the severity of the condition and the widespread damage, children with this form of CP typically have additional complications and co-occurring conditions that can interfere with their ability to live independently and might shorten their lives.
While spastic quadriplegia can’t be cured, therapies and other types of treatment can help children with the condition have a better quality of life.
Proving Malpractice in a Spastic Quadriplegia Case
In Pennsylvania, plaintiffs must file a medical certification from an expert that the doctors or other medical providers in their lawsuits delivered care that fell below the expected standard of care and that the negligent treatment caused the injuries and resulting harm. To prove malpractice, the plaintiffs must present evidence showing the following elements:
- Existence of a provider-patient relationship
- The provider’s treatment deviated from the standard of care expected of a reasonably competent provider in the same field and geographic region
- The breach of the standard of care caused the victim’s injuries
- The plaintiff suffered actual damages as a result
Experienced cerebral palsy attorneys pore over medical records, doctor’s notes, nurses’ notes, and other evidence and work with medical experts to determine the relevant standard of care and whether the doctor’s treatment deviated from it and caused the injuries.
Damages in Spastic Quadriplegia Cases
In a medical malpractice lawsuit, damages are meant to compensate plaintiffs for the losses they have suffered because of their injuries. In the case of someone with spastic quadriplegia, the losses can be substantial.
In a 2003 study, the CDC found that the lifetime cost for someone with cerebral palsy was around $921,000. In today’s current dollars, that would approximately equal $1.5 million.
Compensation in a spastic quadriplegic CP lawsuit includes both economic and non-economic damages. Economic damages are monetary amounts designed to compensate plaintiffs for their current and future out-of-pocket expenses, including the following types:
- Past and future medical expenses
- Past and future therapy costs
- Cost of mobility and adaptive equipment
- Cost of communication assistive devices
- Home modification costs
- Lost wages
Non-economic damages are designed to compensate plaintiffs for their intangible losses and might include the following types:
- Physical pain and suffering
- Loss of the enjoyment of life
If the defendant’s actions were especially egregious, punitive damages might also be available. Punitive damages are additional monetary amounts that might be ordered on top of the compensatory damages, but they are only awarded in the most outrageous cases.
Pennsylvania does not cap compensatory damages in medical malpractice lawsuits. However, the Commonwealth does cap punitive damages as no more than twice the compensatory damages recovered by the plaintiff.
Statute of Limitations for Spastic Quadriplegia Lawsuits
Pennsylvania has a statute of limitations in place for all medical malpractice and personal injury cases, including those involving spastic quadriplegia. A statute of limitations is a law that limits the amount of time people have to file lawsuits. Under 42 Pa.C.S. § 5524, people generally have two years to file a lawsuit from the date of the injury. However, the limitations period is tolled until the date you discover or reasonably should discover that your child’s injury was caused by medical negligence.
If you don’t file a lawsuit, your child will have until they reach age 20 to file a lawsuit because the statute of limitations is tolled for minors. The state has a statute of repose, which used to limit the ability of plaintiffs to file medical malpractice claims after seven years regardless of whether they could have reasonably discovered their injuries were caused by medical malpractice. However, the Supreme Court of Pennsylvania found that the statute of repose was unconstitutional, meaning there is no outside limit on when a cerebral palsy lawsuit can be filed in cases in which the medical negligence that caused it is not discovered until much later.
If you plan to sue the hospital for its negligence, the limitations period is much shorter if the hospital is a government-owned medical facility. In that case, you must file a notice of your intention to sue the government within six months. Like the other statutes of limitations, the rules around this are complex. An experienced cerebral palsy attorney can help you understand the applicable statutes of limitations and when you should file your lawsuit.
When Should I Contact a Lawyer?
You might think that you have plenty of time to speak with a lawyer. However, the best time to consult an attorney is as soon as possible after you learn about your child’s diagnosis. Cerebral palsy claims require significant investigative work and vast amounts of medical documentation and evidence. If you wait too long to contact an attorney, some of the important evidence needed to support your claim could be lost. Similarly, witnesses might forget what they saw as time passes, or they might move away. Getting immediate legal help can prevent these and other problems from occurring.
Do I Need to Hire a Lawyer?
It is extremely difficult to prove a cerebral palsy case without the help of an attorney. Pennsylvania requires the help of a medical expert to review and certify that your case is legally merited before you can file a lawsuit. Experienced lawyers regularly work with medical experts and can find professionals who can review medical records and provide expert opinions. To prove your case, you will have to prove that a medical professional failed to meet the standard of care and caused your child’s condition. This can be difficult without legal help since the causes of cerebral palsy are still largely unknown. You will need the help of medical experts to establish causation in your lawsuit.
Medical professionals are also represented by their malpractice insurers’ defense lawyers. Malpractice insurance companies have teams of aggressive defense lawyers prepared to fight malpractice lawsuits. They are especially aggressive in cases involving spastic quadriplegia because of the substantial amounts of money at issue and the damages that are typically awarded.
With the help of a competent and experienced cerebral palsy lawyer, you can even the playing field when you go up against the insurance companies. A good lawyer can determine liability in your case and help you understand its value. In many cases, attorneys can negotiate fair settlements. However, when that is not possible, a lawyer can build a strong case for you and fight for your and your family’s rights at trial before a jury.
Talk to Raynes & Lawn
If your child has been diagnosed with spastic quadriplegic cerebral palsy, you should schedule a consultation with an experienced birth trauma attorney as soon as possible. The lawyers at Raynes & Lawn have more than five decades of experience fighting for the rights of people who have been harmed by medical malpractice. Call us today to schedule a free consultation at 1-800-535-1797.
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