| Therapy Services | Home Exercise Programs | |||
| Positioning/Splinting | ||||
| Postsurgical Therapy | ||||
Occupational therapy
and physical therapy
are essential elements in the multidisciplinary approach to treating brachial plexus palsy.
Therapists perform the following functions:
Some of the assessment tools used in evaluating movement, strength, and function are described under Medical Treatment.
Complications associated
with brachial plexus palsy are shoulder/elbow dislocations, frozen shoulders, and
soft tissue/joint contractures.
Therapists provide parents with passive range of motion home exercise programs (to
be completed 2-3 times per day with10 repetitions each time). These exercises increase
joint flexibility and muscle tone, thus decreasing the risk of the above problems.
Families are instructed
by therapists in how to provide tactile stimulation to the involved
arm to increase sensory awareness in the arm and awareness of its position in relation
to the whole body. Therapists also offer developmentally appropriate activity ideas
to increase strength and coordination in the arm and to involve the use of both arms
at the same time.
Therapists provide
parents with ideas for what positions will be beneficial for the child in playing,
including positions that provide joint compression and weight bearing in the arm
to increase proprioceptive
input and muscle contraction. Parents are also instructed on ways to position the
child's arm during sleep, such as using pillows to provide a sustained stretch. It
is not good for the arm to be restrained in elbow flexion across the chest for long
periods (although this position works well for feeding and resting), and it is important
not to let the child's arm dangle in space.
A variety of splints can be used, depending on a child's specific needs. For example,
there are splints to facilitate weight-bearing positions, functional resting positions,
decreased risk of joint contracture, and others. With any splints, it is always important
to watch for circulatory changes, numbness, redness, or swelling.
After surgery, the
child's arm is immobilized, usually with the arm flexed against the chest, for
3-6 weeks. After the surgeon clears the child for range of motion exercises,
gentle passive range of motion (PROM) exercises are initiated. PROM exercises
should be provided in a neutral plane until the child's sutures are healed completely.
Six to eight weeks after surgery, the child will begin weight-bearing activities
in therapy (resistance with weights is not indicated at this time). Regeneration
of nerves may be noted at 6-12 months after surgery, with only minimal return
before this time. Time frames for activities and expected return of muscle strength
after surgery will vary with every child.