Birth injuries like cerebral palsy and hypoxic-ischemic encephalopathy (HIE) will severely impact how a child will go through their life. Often from the moment they’re born, these children must undergo extensive specialized treatment to manage and prevent the long-term effects of a brain injury or paralysis at birth.
Our Birth Injury Lawyers are available to meet you in your home or the hospital.
The cost of these specialized treatments and services can place a significant financial strain on families. But when a child’s injuries can be traced back to preventable medical mistakes, such as delaying therapy treatments or making mistakes during treatment, some of that financial burden can be alleviated through filing a medical malpractice claim.
We are prepared to meticulously investigate the circumstances of your case, gather crucial medical records, consult with top medical experts, and fight tirelessly to secure the compensation you deserve for your child's injury.
We represent families and their birth-injured children throughout the United States. You can contact us today to schedule your free legal consultation by calling our toll-free line at 888-987-0005 or by filling out our online request form. We work on a contingency fee basis, meaning you won't pay any legal fees unless we win your case. We only receive payment once you do.
Recent Birth Injury Settlement:
Birth Injury settlement against a hospital in which nurses and physicians failed to properly monitor the mother's blood pressure during delivery causing an HIE event resulting in neonatal seizures and cerebral palsy at birth. Our team of experienced birth injury lawyers recovered $13,750,000 for the family to help with future medical expenses and developmental therapy.
What is Birth Injury Therapy?
Birth injury therapy is a term that encompasses the wide range of treatments that healthcare professionals use to manage or mitigate the injury’s effect on the child’s wellbeing.
When a child’s birth injury limits their physical and cognitive functioning, doctors will often take a multifaceted approach toward treatment and recommend multiple types of therapy. A child will sometimes be enrolled in multiple types of therapy at once, depending on their needs.
Timing can be crucial when administering therapeutic treatment; when healthcare professionals needlessly delay treatment, they run the risk of the therapy becoming less effective or even not working at all. When this happens, it can constitute medical malpractice.
What Birth Injury Therapies are Used During Infancy?
When a baby is born with a severe brain injury like HIE, they will often show symptoms before and after birth such as an irregular heartbeat, signs of fetal distress, weak cries, low muscle tone, and low APGAR scores.
When a baby meets the criteria for a hypoxic brain injury, doctors may prescribe one of the following therapeutic treatment options to reduce the chances of permanent disability:
When this happens, healthcare teams will typically need to administer some form of respiratory therapy to assist the baby’s breathing. In extreme cases where the baby isn’t breathing at all, neonatal resuscitation is required.
Respiratory therapy is a blanket term that includes all breathing management care and techniques. Neonatal resuscitation, on the other hand, is an emergency form of respiratory therapy that is used when a child’s oxygen levels at birth are dangerously low.
Upon birth, the medical team must observe the newborn’s breathing and lung capacity by answering the following questions:
Is the newborn visibly not breathing nor crying?
Is the newborn’s heart rate less than 100 beats per minute?
Was the infant born prematurely and at risk for an underdeveloped respiratory system?
Does the infant’s amniotic fluid have traces of meconium and evidence of infection?
Is the newborn showing discoloration around their lips and face?
Does the newborn have weak muscle tone?
If the answer to any of these questions is “Yes,” the newborn is likely suffering from respiratory distress syndrome (RDS) and will require at least some level of respiratory therapy.
The most common cause for respiratory distress in infants is underdeveloped lungs due to prematurity. This is because premature lungs usually are deficient in surfactant, a slippery liquid present that increases airflow and prevents the alveoli (air sacs in the lungs) from collapsing with deflation.
Surfactant is produced in the baby’s lungs at about 26 weeks of gestation. As the fetal growth progresses, the lungs produce higher volumes of surfactant.
The alveoli in the baby’s lungs are coated with surfactant to prevent them from collapsing. As the air sacs open, the oxygen enters the bloodstream from the lungs, while carbon dioxide from the bloodstream goes into the lungs. In preterm babies, the lack of surfactant can cause the air sacs to deflate.
Another way an infant can go into respiratory distress is when a foreign object or substance blocks their airways. The most common complication that causes airway obstruction is meconium aspiration syndrome.
Meconium is a sterile form of fecal stool, dark green in color, which is produced in the intestines prior to birth. In normal conditions, meconium is passed when the newborn begins to feed after birth.
But in some cases, the fecal material may be released into the amniotic fluid close to the time of birth. The baby can then ingest the amniotic fluid and meconium, allowing it to travel through their mouth and into their lungs. This can cause fetal distress, respiratory distress syndrome, and pulmonary hypertension that occurs due to restricted lung vessels and oxygen deprivation.
What Respiratory Equipment and Techniques are Used to Help Newborns?
When a baby shows signs of respiratory distress syndrome, obstetricians and labor and delivery medical teams must act quickly for the best chance at preventing long-term effects and injuries. The two most common methods of providing oxygen to infants are positive pressure ventilation (PPV) and supplemental oxygen.
PPV supports a baby’s breathing by delivering pressurized air into their lungs either through an oxygen mask (noninvasive PPV) or a tube inserted into the throat (invasive PPV).
Supplemental oxygen is used to help increase oxygenation in the baby’s body and bloodstream. Put simply, PPV helps to deliver oxygen-rich air to the lungs and alveoli, whereas supplemental oxygen helps the lungs to deliver oxygen from the alveoli to the tissues in the body to maintain cellular respiration.
There are many methods that healthcare professionals can use to improve respiration and oxygenation, including:
CPAP Machines: Continuous Positive Airway Pressure (CPAP) is a form of PPV used to support breathing for neonates in severe respiratory distress. In this case, a breathing tube will be inserted in the newborn’s windpipe after birth, and they will be placed on a CPAP machine.
The CPAP machine helps the baby breathe on their own through prongs placed within the nostrils, while the machine delivers pressurized air, with or without supplemental oxygen. CPAP machines can be used to perform neonatal resuscitation.
Positive Pressure Ventilation (PPV): Whenever the baby's heart rate is less than 100 bpm, is gasping, or apneic, positive pressure is recommended. It is designed to improve the exchange of air between the lungs and the outside world via a mask, inflating bag, or T-piece Resuscitator.
Ventilation consists of delivering a controlled amount of air or oxygen into the baby's lungs. This helps to provide adequate oxygenation and support the baby's respiratory function.
Some of the risks associated with PPV include barotrauma, which is lung damage caused by excessive pressure during ventilation. Other risks of PPV include pneumothorax, a condition where air or gas accumulates in the space between the lungs and the chest wall.
Endotracheal Intubation: Endotracheal intubation may be necessary for babies with heart rates below 60 bpm or if PPV is not successful. Endotracheal intubation is the process of inserting a tube through the nose or through the mouth into the trachea.
A Nasogastric tube may be required for premature infants. This provides a secure airway for ventilation and allows for the delivery of oxygen and other respiratory support directly into the lungs.
Airway obstructions and secretions can be relieved with intubation. There are risks and complications associated with intubation, such as hypoxia (if the process takes too long), placement injuries, contamination risks, and the possibility of inhaling vomit.
While ventilating the lungs, a resuscitation specialist will monitor the infant’s heart rate, C02 output, and oxygen levels to protect their delicate lung tissue and assess breathing.
High Frequency Ventilation: High frequency ventilation (HFV) is a relatively new ventilation technique that involves the use of high respiratory rates compared to normal breathing. HFV enables successful gas exchange (air exchange at low volumes) and is known to be a useful breathing treatment. The advantages of HFV include reduced barotraumas, faster generation of airway secretions, and fewer changes in the lung tissue.
Surfactant Therapy: This treatment involves the delivery of intermittent, repetitive high doses of surfactant to premature babies who are deficient. It’s known to improve oxygenation, reduce the air leaks, resolve pulmonary hypertension, and lower the duration of ventilation. Surfactant therapy is a significant advance in respiratory therapy care and can reduce infant mortality and morbidity in severe cases.
Inhaled Nitric Oxide: Inhaled nitric oxide (INO) is an important management modality for pulmonary hypertension, which is often associated with meconium aspiration syndrome. It can lower the resistance of blood vessels in the lungs and reduce lung edema.
Effective INO use in the recommended dosage – usually 20 PPM (parts per million) – requires sufficient lung expansion so that the dosage delivery in the lungs can be optimized. Therefore, the use of mechanical ventilation is necessary to achieve the maximum benefits of inhaled nitric oxide therapy.
Extra Corporeal Membrane Oxygenation: Extra corporeal membrane oxygenation (ECMO) is an effective tool to reduce disability and death in babies in respiratory distress. Research shows that the incidence of breathing complications is lower when ECMO is used.
The ECMO device involves the use of a pump that functions like an artificial lung. Like a biological lung, it adds oxygen to the pumped blood and takes out carbon dioxide. Thereafter, it delivers the oxygenated blood back to the baby.
What are the Steps for Neonatal Resuscitation?
Equipment used for neonatal resuscitation should be available in the delivery room before the baby is born. In addition to standard supplies and equipment, the following items should be available for resuscitation efforts:
Suction bulbs and mechanical suction devices
PPV face masks
Endotracheal tubes
Laryngoscopes
Laryngeal mask airways
Supplemental oxygen
Epinephrine
Medications for volume expansion
Pulse oximeter
Pressure transducer and monitor
Cardiotachometer with electrocardiogram oscilloscope
Radiant warming units
Failing to provide the necessary equipment and supplies could cause irreparable harm to the baby. Once it has been decided to resuscitate the infant, the team should begin the following procedures done in sequence:
Stabilization: They should provide warmth, position the baby to make breathing easier, clear the baby’s airway, stimulate the baby, and reposition them if necessary.
Ventilation: If the baby’s breathing has not improved, the team then provides additional ventilation. For example, they may give supplemental oxygen or positive pressure ventilation.
Chest compressions: The team may move on to chest compressions if their previous efforts have not worked.
Medication: Hormone medications like Epinephrine can stimulate breathing and heart rate. Other medications help with respiratory volume expansion.
Healthcare providers must carefully follow these steps, along with all other procedures and techniques they employ when resuscitating a baby or while administering any form of respiratory therapy.
When neonatal breathing is mismanaged, it greatly increases an infant’s chances for hypoxia and death.
Therapeutic Hypothermia
Therapeutic hypothermia, also known as "brain cooling treatment", is a form of therapy that’s done shortly after birth to reduce the long-term effects of brain injuries like hypoxic-ischemic encephalopathy in infants.
The treatment has also been proven to treat spinal cord injuries at birth. It is recommended to start treatment no more than six hours after birth for the best chance at reducing brain inflammation and tissue damage.
Therapeutic hypothermia involves cooling the baby’s core temperature to around 92.3 degrees Fahrenheit. This is done by placing the newborn in a thermal regulating machine, which are present in many neonatal intensive care units (NICUs).
Passive cooling may also be done with ice packs and fans. After 72 hours, medical staff begin to gradually rewarm the baby while simultaneously monitoring their vital signs. Cooling or rewarming too quickly can harm the baby’s brain and other organs.
A number of complex processes occur or are suppressed during therapeutic hypothermia treatment, particularly in the baby’s brain. The procedure, when conducted properly, aims to have the following effect on the infant:
Reduction of the cerebral metabolism that slows cell depolarization.
Reduction of the accumulation of excito-toxic neurotransmitters.
Suppression of oxygen-free radical release.
Suppression of expected cell death (apoptosis).
Failing to provide therapeutic hypothermia treatment could worsen the baby’s condition, causing lifelong disabilities or death. It’s crucial that doctors and other healthcare providers carefully assess the events that caused the child’s potential brain damage in connection with current test results to make the right call on when to proceed with brain cooling.
Craniosacral Therapy
Craniosacral therapy is a gentle spine and scalp massaging technique used on infants to release tension and relieve pain. It is a non-invasive, gentle treatment that can bring quick relief to newborns with head and neck pain.
While it may seem simple, craniosacral therapy requires special training and certification and should only be performed by licensed physical therapists, chiropractors, osteopaths, and massage therapists.
The idea behind craniosacral therapy is that it helps to regulate the flow of cerebrospinal fluid in the body and get rid of blockages and obstructions. The technique also aims to relive tension in the body’s fascia, which is a kind of connective tissue that surrounds and holds the muscles, bones, blood vessels, and internal organs into place.
The fascia in a baby’s head or neck may tighten up at birth in response to trauma, causing headaches and sharp pains.
The craniosacral therapy massage takes between 30 minutes and an hour, and it can be performed on people of all ages, not just newborns. While anyone can experience relief from craniosacral therapy, it is typically recommended for newborns because it is relatively painless and not intrusive.
What Are the Risks Associated with Craniosacral Therapy?
Craniosacral therapy can relieve tension and prevent muscle spasms in the neck and back, but it isn’t recommended for all injuries.
For example, newborns who have experienced severe head trauma are not recommended to receive craniosacral therapy. Examples of head trauma injuries that would preclude an infant from receiving the therapy are cephalohematoma, hydrocephalus, caput succedaneum, or concussions.
However, there are numerous neonatal conditions that craniosacral therapy has been proven to alleviate. The most notable example is torticollis, a condition where the infant’s neck muscles become injured and cause their head to turn and rotate to one side.
Craniosacral therapy has been proven to relax the infant’s neck muscles and provide relief from soreness.
For more serious injuries, a doctor may recommend craniosacral treatment in addition to other types of physical therapy to address a newborn’s mobility complications on a larger scale.
Several other types of muscle release surgeries are available to those with spastic cp that can correct joint dislocation, relax muscles, and improve mobility in various areas.
The severity of spastic cerebral palsy symptoms cause many parents to seek medical attention during early infancy. A doctor may diagnose the condition through the detection of significant developmental delays.
The treatment options that your doctor may choose to include in your child's spastic cerebral palsy treatment plan will depend on the severity of your child's symptoms and the extent of damage to the brain.
What Birth Injury Therapies are Used During Early Childhood?
Children with brain injuries and other debilitating birth injuries will sometimes need therapy during their early childhood years as a preventative measure against long-term harm.
Examples of different therapies a young child might need include:
Stem Cell Therapy for Cerebral Palsy
Stem cell therapy for cerebral palsy involves injecting stem cells into the brain or spinal cord, which can help repair damaged cells and promote regeneration of neurons.
Stem cells have the remarkable potential to change into different cell types and, in turn, form various tissues. Through a process called differentiation, stem cells can transform from unspecialized cells into specialized types such as heart, lung, or even brain cells.
Stem cell therapy can offer unique benefits to children living with cerebral palsy by replacing the child’s damaged and non-functional brain cells and supporting the remaining cells within the nervous system (neurons and oligodendrocytes cells). While stem cell therapy may not cure cerebral palsy, it can reduce symptoms and increase mobility.
During a stem cell transplant, the doctor injects the stem cells into the space around the spinal cord by a lumbar puncture. Alternatively, the cells can also be transplanted into the child through intravenous infusion into the bloodstream. The treatment uses the patient's own tissue, bone marrow, or fetal stem cells from a donor cord blood bank.
Neural stem cell treatment needs to be administered directly into the brain via neurosurgery for the damaged brain cells to be replaced.
Stem cell therapy is performed in 3 sessions scheduled 45 days apart or in 3 consecutive days. More than one treatment may be required for very advanced cases. The child’s age and weight determine the number of cells that will be administered. Like most types of therapy, earlier treatment is associated with stronger prevention for long-term effects.
For a stem cell treatment in cerebral palsy to work, the injected stem cells must develop into nerve cells (neurons), which can then build connections with other cells. Once the nerve cells build connections with other cells, they will need to be able to deliver messages to the muscles that control movement. To make stem cell therapy treatment more effective, a doctor will often recommend intensive physical therapy alongside it or afterward.
Although stem cell research for cerebral palsy is still in its early stages, it shows great promise in becoming a potentially effective treatment for all affected individuals.
Botox, scientifically known as botulinum toxin, is the name given to an injectable drug made from a highly toxic substance created by the bacterium Clostridium botulinum. This bacteria is found in numerous natural settings, including the intestinal tracts of fish, and can be deadly when ingested.
However, when purified, this toxin can safely be used to effectively reduce muscle spasticity, lessen overly high muscle tone and stiffness, and provide increased mobility to children living with spastic cerebral palsy.
Botox reduces spasticity by weakening or completely paralyzing specific muscles and preventing certain nerves in the body from firing.
A child with cerebral palsy might experience improved range of motion, better position of the joints and limbs, fewer spastic movements, and less gait when treated with Botox injections.
For some cases, the relief from stiffness and muscle and joint pain can be so great that surgery may be delayed or even avoided altogether.
When treating cerebral palsy spasticity, oral and injected medications have both proven to be effective.
However, children who experience significant spasticity from their cerebral palsy may benefit more from injected Botox medication rather than oral medication. This is because oral medication cannot be directed to a specific area of spasticity, whereas Botox injections can. It is also important to note that the paralysis or weakening effect is not permanent and will eventually wear off.
Botox injections for cerebral palsy work by temporarily paralyzing specific muscles, reducing muscle stiffness, and improving range of motion.
Before Botox therapy begins, a multidisciplinary team of specialists should complete a full evaluation of a child's range of motion, strength, motor control, and muscle tone. Once completed, a medical professional will inject the medication directly into the child’s affected muscles.
Since this procedure often involves multiple injections, the areas to be injected must be first sprayed with an analgesic numbing substance to minimize discomfort. After administering the injections, the physician may order a serial casting to help stretch the muscle and improve the position of the child’s extremities.
Physical therapy is also recommended to help meet specific mobility goals. Each case of cerebral palsy is different and presents its own unique challenges for the child. Instructions regarding follow-up treatments will be provided once the injection therapy is completed.
Physical Therapy for Cerebral Palsy
Physical therapy plays an important role in managing the long-term effects of birth injuries. Almost all children diagnosed with cerebral palsy, particularly spastic cerebral palsy, should receive physical therapy to improve motor skills and achieve more physical independence. Like most forms of therapy, starting physical therapy as early as possible increases the chances of a child’s condition improving.
Physical therapists use several therapeutic interventions to enhance the strength, coordination and autonomy of voluntary bodily movements. According to researchers, physical therapy may also have a key role to play in triggering neuroplastic changes (brain rewiring) in the damaged neural networks that could eventually alter the natural history of motor function disorders.
Physical therapy is often a gateway for many children with cerebral palsy or other birth injuries to achieve an increased level of self-reliance among other quality-of-life improvements. Some of its key include:
Increased independence
Building of muscle tone and lowered risk of muscle atrophy
Improved ability to overcome physical obstacles
Increased flexibility
Expansion of range of motion
Improved balance, posture, and gait
Increased endurance and reduction in pain & discomfort
Reduced risk of bone deformity and loss of joint function
Greater ability to use adaptive or assistive devices
Physical therapists may also tailor therapeutic interventions based on the location of movement problems. In children diagnosed with Cerebral Palsy or other birth injuries, movement issues may be limited to the legs (diplegia), one side of the body (hemiplegia), or both the arms, legs, and torso (quadriplegia).
Special exercises and physical routines prescribed for these targeted conditions can help your child regain movement in the affected location over time. According to a research study, physical therapy may also be effective in upper extremity training (to improve the movement, coordination and reflexes of the hand, wrist, forearm, elbow and shoulder).
What Physical Therapy Exercises and Techniques are Used to Treat Cerebral Palsy?
Cerebral Palsy usually results in a variety of disorders related to different motor functions. Some children only have their legs affected, while others may have no motor function in one side of the body or even their full body. Therefore, different physical therapy exercises, methods, and techniques will be recommended according to the child’s specific needs. Examples of different techniques and exercises a physical therapist may use include:
Stretching Exercises: According to the CDC, more than 80% of the individuals with Cerebral Palsy experience spasticity or high muscle tone. The damage to the brain causes a disruption in sending and receiving motor signals, which can result in involuntary contraction of the muscles. Over time, the muscle tightening may worsen, leading to abnormal movement patterns, limited range of motion, uneven growth, poor posture, and chronic pain.
To counter this condition, physical therapists can train the child and their caregivers to perform stretching exercises that will effectively relax and stretch the affected muscles. Regular stretching will help stabilize and improve muscle tone, reduce strain on the joints and muscles, and increase the range of motion.
Range of Motion Exercises: For a child with severe cerebral palsy, the physical therapist or a trained caregiver will move the affected parts of the body for them, helping them move the muscles and gain motion in the joints. This stimulates circulation and promotes flexibility, even when the child is not exerting energy on their own. For children with better muscle control, the physical therapist will train them to actively practice range of motion exercises.
The physical therapist will also encourage the child to perform range of motion exercises in multiple positions to modulate the exercise intensity. For instance, range of motion exercises for shoulder flexion (raising the arm) require the child to use greater muscle strength to fight the gravitational force when they are sitting upright or standing compared to when they are lying on their back.
Strengthening Exercises: Strength training or resistance training is now recognized as one of the most well-researched physical therapy interventions for children with cerebral palsy. Studies have shown that strengthening exercises are safe and are unlikely to cause the spasticity to worsen. Muscle strength can be increased in predictable measures to improve gait, posture, balance, flexibility, and other elements of motor function as long as a correctly designed strength training program is implemented.
Constraint-Induced Movement Therapy (CIMT): There is evidence to suggest that children with hemiplegia can improve the functioning of their upper limbs with constraint-induced movement therapy (CIMT). This intensive upper limb training program involves restraining the child’s use of the unaffected arm, which forces them to continuously use only the affected arm for various activities. The continuous use of the affected arm in this manner helps strengthen the brain’s neural pathways for the functioning of this arm and support adaptive changes.
While CIMT is primarily used only for improving the upper limb function, some modified forms of CIMT may also be considered to target improvements in an affected leg.
Gait Training: Research studies have shown that gait training might be the most effective physical therapy approach to improve gait speed in a child with cerebral palsy who can walk. Spasticity in legs causes many children with cerebral palsy to walk with an abnormal gait. Gait training particularly focuses on improving the child’s walking form or walking speed.
Gait training usually involves the use of assistive devices and equipment such as walkers and bodyweight-supporting treadmills. These specialized tools can help the child practice correct gait patterns without losing stability. The physical therapist may also require the child to wear orthotics (like a leg brace) to gently stretch the contracted muscles and help correct the musculoskeletal alignment.
In the child’s early years, their physical therapist will focus on movement development and provide hands-on training to the caregivers for movement, positioning, feeding, and play. They will recommend changes at home to facilitate the child’s movement development and play skills.
The physical therapist will create an individualized plan for fun and play activities tailored to the child’s unique needs. The activities will be designed to improve movement, muscle strength and motor function. At this stage, the physical therapy is usually administered at home, at an outpatient facility, or a day care center.
Occupational Therapy for Cerebral Palsy
Occupational therapy is a type of training for children living with cerebral palsy or other physical and mental disabilities that focuses on improving their capacity to perform everyday tasks. It is conducted by a trained and licensed occupational therapist who works closely with the child to practice daily life activities like holding silverware and brushing their teeth.
Children with cerebral palsy who require occupational therapy are generally referred to a pediatric occupational therapist by their family doctor or a cerebral palsy resource center or support group.
Occupational therapy can be performed in various settings, such as inpatient medical centers, outpatient offices, specialized occupational therapy centers, a nursing center, or in the home with a certified therapist.
Pediatric occupational therapists usually have an expertise in assessing the child’s strengths and weaknesses to develop a plan tailored to the child’s specific needs and goals.
The two most common specialized forms of occupational therapy are sensory integration therapy and constraint induced movement therapy (CIMT):
Sensory Integration Therapy
When a baby suffers from a birth injury to their brain, such as hypoxic-ischemic encephalopathy (HIE) that results in cerebral palsy, it may alter the brain’s ability to process sensory perceptions. Sensory integration therapy can be helpful in rebuilding the physical and mental framework within the child’s nervous system.
This type of occupational therapy can improve a child’s ability to accurately perceive sensory inputs, comprehend the purpose behind a specific sound, movement, texture, or another stimulus, and appropriately regulate their responses. Sensory integration therapy offers both physical and psychological benefits to the child.
For example, as part of the sensory integration occupational therapy, the therapist may ask the child to pick up a ball or another object. Although the child may be able to identify the ball and comprehend what it is used for, they may not be able to describe the ball because of sensory miscues. A child with cerebral palsy may have impairments in perceiving the texture and weight of the ball because of excessively high or low sensitivity to touch.
Occupational therapists may use finger paints, sand, silly putty, colorful liquids, and Play-Doh, among other similar tools to perform sensory therapy to improve on these impairments. Sensory integration occupational therapy should be used early during the child’s development because treating sensory deficits early will give the child the advantage of learning to adjust and compensate for their condition while the senses are still developing.
Constraint Induced Movement Therapy (CIMT)
Children with hemiplegic cerebral palsy (spasticity in one side of the body) will usually start compensating early for motor impairments by using only the active arm on the functioning side of the body. If no intervention is made, the infrequent use of the affected arm will gradually render it completely non-functional. A specialized form of occupational therapy called constraint-induced movement therapy or CIMT can help in countering this condition.
CIMT involves two primary components:
The occupational therapist will restrain the unaffected arm using a sling, cast, splint, mitt, or glove. This will encourage the child to use the affected arm because it’s the only one available for use.
The affected arm becomes the focus of intensive occupational therapy so that the child learns how to move and utilize it correctly.
Not only does CIMT promote the physical function of the affected arm, but it also helps stimulate the brain to reinforce neural pathways for associated movement.
CIMT may sometimes be modified according to the child’s needs, but its primary role is to encourage the use of the affected arm for most of the day with specialized activities under the supervision of the occupational therapist.
CIMT is an effective and feasible treatment for babies in the age group of three months and above when it consists of professional caregiver coaching, age-appropriate activities, and therapy performed in the child’s typical environment.
Parents can also support different forms of occupational therapy by helping their child practice new skills at home according to the therapist’s recommendations.
Speech Therapy for Cerebral Palsy
Speech and language therapy can help children with cerebral palsy strengthen the muscles involved in speech and oral motor skills, improving their ability to communicate, chew, and swallow. Specialized therapy can help children with birth injuries to express themselves more clearly and have more enriching relationships with others.
Speech therapy and speech training helps most children with speech problems articulate themselves more easily and effectively while communicating.
In a few cases, speech improvements may not occur sufficiently despite professional speech therapy. In this situation, the child should continue working with a speech pathologist to learn to use alternative forms of communication and assistive devices.
Most children diagnosed with cerebral palsy and other restrictive birth injuries can achieve some or all of the following benefits with speech therapy:
What Treatment Strategies are Used in Speech Therapy?
Specific speech-language therapy exercises can be designed for toddlers and children to improve their ability to communicate and express themselves independently. Examples of some techniques a licensed speech language pathologist may use include:
Language Intervention Activities: The speech language pathologist will interact with the child with one-on-one therapy, such as talking or playing using pictures, objects, books, or ongoing events with an aim to stimulate speech and language development.
The therapist will use repetition exercises and model correct pronunciation to help develop the child’s speech and linguistic skills. They will focus on developing the child’s language and word association with techniques such as flashcards with multiple sounds and words inscribed on them. They may also put together puzzle pieces with pairs of words, such as “bat and ball,” “shoes and socks,” and “toothpaste and toothbrush.”
Articulation Therapy: Sound production and articulation exercises are an important part of speech therapy. The therapist will model correct syllables and sounds for the child by physically demonstrating how to produce certain sounds, such as the “r” or “s” sound. They may use a mirror or language cards to show the child how to move the tongue to make a particular sound.
Oral Exercises: To help strengthen a child’s jaw muscles when tone and strength are limiting factors, the speech language pathologist may encourage the child and their caregivers to focus more on serving foods that demand extra chewing (such as carrots, celery, and apples). The child may also practice opening and closing the mouth while the therapist holds their chin (so that only the jaw muscles are used).
Tongue strengthening exercises to improve enunciation may involve sticking out the tongue and pushing it gently against a spoon or tongue depressor for a few seconds at one time. The therapist may also train the child and their caregivers in performing lip exercises to help form words. These may involve squeezing the lips around a candy or lollipop to improve muscle strength or pursing the lips to enhance lip extension.
Swallowing Exercises: In addition to using oral exercises for eating, the speech therapist will also work with various food temperatures and textures to help develop the child’s oral awareness while they eat, chew, and swallow.
Swallowing therapy may include performing an “effortful swallow.” This involves collecting the saliva or another liquid in the mouth and swallowing it down the throat in a single gulp. This ensures that fluids and food fragments do not fall into the airway.
Another swallowing exercise is called the “Masako Maneuver,” which will help strengthen the muscles located at the back of the throat. In this exercise, the therapist will ask the child to stick out their tongue and put mild pressure on it with their teeth so that it stays in place – and then attempt swallowing.
Depending on factors such as the child’s age, health condition, and accessibility of services in the local area, speech and language therapy may be received one-on-one or in a group setting. In many cases, the speech language pathologist and their assistant may provide treatment at the child’s home.
In any case, for children with cerebral palsy who have communication difficulties, the ideal scenario would be to provide professional therapy to the child and train the parents or caregivers in exercises and activities so the child can build their skills at home.
What Birth Injury Therapies are Used Later in Childhood?
Children who have severe injuries at birth often require extended therapy throughout their lives, even sometimes extending into their later childhood years. Examples of beneficial therapies to help children and teenagers with disabilities include:
Recreational Therapy
Recreational therapy involves participation in entertainment activities such as skiing, soccer, rock climbing, therapeutic horseback riding, music, dancing, or art.
Recreational therapy can help children improve their emotional wellbeing and motor skills in addition to the usual health benefits associated with physical activity and exercise.
Recreational therapy can encompass many types of specialized therapeutic methods, such as aquatic therapy or hippotherapy.
Aquatic therapy takes place in a swimming pool. When the child is submerged in water, it gives them a feeling of weightlessness, enabling them to focus on form development without straining their joints.
Simply resisting the water pressure can gradually help strengthen the muscles.
Hippotherapy involves placing the child on a horse’s back or applying equine movements aimed at controlling the horse. Horseback riding or hippotherapy can be effective in improving posture, coordination, gait, and balance.
Studies have shown that hippotherapy may reduce asymmetrical activity of the child’s hip muscles, resulting in better postural control.
A therapist will often attempt to find forms of recreational therapy that align with the child’s interests. When done in the right setting, it can allow the child to practice similar strategies used in physical, speech, and occupational therapies.
Continued Speech, Physical, and Occupational Therapies
In the child’s school years, a therapist will provide training to the caregivers to enable the child with cerebral palsy to accomplish functional goals relative to their age.
Cerebral palsy treatments such as physical therapy, speech therapy, or occupational therapy may be provided to the child at the school, in the family’s community, or a combination of the two. School-based therapy is designed to promote changes that provide the best possible learning environment to the child.
Physical therapy for adolescents with cerebral palsy focuses on combating joint mobility limitations and prevention of posture problems. Speech therapy for older children may incorporate more complex vocabulary and more rigorous word and pronunciation exercises.
Developing and maintaining a personal fitness and exercise program at this stage can help improve the health and function of the child with cerebral palsy and other limiting conditions for a lifetime. In addition, a therapist may recommend the child’s participation in sports activities, such as swimming, bowling, cycling, tennis, basketball, or volleyball to promote physical fitness.
Many children with cerebral palsy and other conditions require assisted care and therapies well into adulthood. But transitioning a child from pediatric to adult care can be complex and emotionally taxing for families. It can be challenging for parents to accept that their child must adapt to the independence of adulthood after caring so closely for them since birth.
When poorly managed, it can lead to missing necessary treatment, higher insurance costs, and an overall reduced quality of life.
Parents and specialized healthcare providers must work together to help transition the child-turned-adult to medical teams that treat adults and fit the patient’s unique needs.
As they become adults, children with birth injuries must learn to take on a greater responsibility for their own care needs. Parents can assist their child in the years leading up to adulthood by involving them in conversations and decisions related to their care. They can also encourage their child to ask questions about their care and health.
A child is considered a legal adult at age 18 in the U.S., but exceptions are made depending on the extent of the child’s mental competency. If deemed competent, parents may no longer be able to access their child’s medical and legal documents without their consent.
Families can best prepare for this transition by starting the planning process early: getting recommendations for adult healthcare teams, identifying specific needs, determining legal competency, and preparing for changes in healthcare insurance.
Families must adequately plan for their child’s transition to adult care to avoid difficulties and unforeseen complications. A registered nurse attorney at Miller Weisbrod Olesky can provide more information for how to make the transition as smooth as possible.
What Mistakes Can Healthcare Providers Make During Therapy?
Mistakes when administering therapeutic care can range in severity. But when preventable medical errors during therapy causes an injury or causes the child’s conditions to worsen, it may be considered medical malpractice. Examples of these preventable mistakes include:
Pushing a child too far during physical therapy, resulting in an injury.
It’s important to note that it requires a detailed review of the specific facts of a child’s history in therapeutic treatment before making a definitive judgement as to whether medical malpractice played a factor in their condition worsening or any newly sustained injuries.
Was My Child’s Birth Injury Therapy Mishandled?
Therapy is intended to provide support for children with limitations after suffering from injuries and health conditions. It is not intended to cause further harm. When doctors, physical therapists, osteopaths, speech language pathologists, and all other licensed medical professionals make preventable errors during therapy, it can become more harmful than helpful and decrease a child’s odds for recovery.
If a family believes medical negligence during therapy contributed to their child’s injuries, legal support may be an option. An attorney specializing in birth injuries can review the medical records and circumstances to assess whether a viable claim for medical malpractice exists.
Parents whose children suffer from the long-term effects of birth complications like HIE that develops into cerebral palsy deserve to know if therapy made their conditions worse. Our dedicated birth injury lawyers want to help you find those answers and obtain the funds necessary to improve the quality of life for your child.
If your child has been diagnosed with a birth injury and you suspect they were further harmed after a medical error during therapy, Miller Weisbrod Olesky will thoroughly investigate the facts and hold the responsible medical providers accountable by pursuing medical malpractice claims against them.
Sometimes families are hesitant to reach out to a medical malpractice attorney or law firm. They may feel overwhelmed by their circumstances or are worried that a law firm will not be able to help them. But the only way to find out if you have a case is to talk to an attorney who understands how birth injuries can lead to developmental delays and other complications that require long-lasting medical support.
What is the Statute of Limitations in a Birth Injury Case?
A statute of limitations (SOL) is a law that sets a time limit on how long an injured person has to file a lawsuit after an accident. It is essential to understand that statutes of limitations vary based on the type of case and the state where it is filed. For instance, the deadline for birth injury claims is typically different from other claims, such as injury to personal property, fraud, contract disputes, and collection of debts.
Generally, the clock starts ticking on the date the injury occurred. However, there are exceptions to this rule, and in some cases, the statute of limitations starts when a person discovers or reasonably should have discovered an injury. When dealing with government agencies, SOLs can become even more complex.
For example, if the party that injured you was:
A federal employee
Employed by a military hospital, Veterans Administration facility, or a federally funded medical entity
You may need to file a birth injury claim under the Federal Tort Claims Act (FTCA). In FTCA cases, claimants must go through certain administrative procedures before filing a lawsuit. In some states, if the negligent party was a local or state government hospital or the doctors and medical providers are employees of a governmental entity, the time period in which you must give "notice" may be shorter.
If your case is filed outside of the statute of limitations, it will typically be dismissed, and you will not be eligible to recover compensation for your injuries. Determining when a statute of limitations begins on your case can be tricky. If you're considering pursuing compensation for a birth injury, contacting an attorney as soon as possible is in your best interest.
How The Birth Injury Attorneys at Miller Weisbrod Olesky Can Help?
It takes a detailed expert review of the facts and circumstances of your child's birth and the therapies they have underwent to determine whether their injuries came as the result of medical malpractice.
At Miller Weisbrod Olesky, a team of committed attorneys, nurses and paraprofessionals uses our detailed medical negligence case review process to assess your potential birth injury case. We start by learning more about you and your child and the status of meeting/missing developmental milestones. Then we gather medical records to determine what happened before, during, and after your delivery.
We call in skilled medical experts who review your records and let us know if they think medical errors could have caused your child's injuries.
If we feel medical negligence caused or contributed to your child's death, we meet with you to discuss how you can receive compensation from the medical professionals who made the errors.
At no point in our legal intake process will we ask you to pay anything. The medical review of your case and the consultation are free. We only receive payment when you do. The sooner you reach out to us, the sooner we can begin investigating your case and gathering the evidence needed to support your claim.
We work on a contingency fee basis, meaning you won't pay any legal fees unless we win your case. Contact us today to schedule your free legal consultation by calling our toll-free line at 888-987-0005or by filling out our online request form.
