Occupational therapy and physical therapy are essential elements in the multidisciplinary approach to treating brachial plexus palsy. Therapists perform the following functions:
- initially evaluate the child's arm strength, range of motion, active movement, motor development, sensation, functional use, and ADLs
- track progress and improvement
- monitor splinting, positioning needs, and recommend adaptive tools and techniques
- educate parents on precautions, home exercise programs, positioning, splinting and recommendations for community activities
- provide postsurgical therapy
Some of the assessment tools used in evaluating movement, strength, and function are described under Medical Treatment.
Home Exercise Programs
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 make recommendations to patient and family for adaptive tools and techniques for increasing independence in ADLs.
Positioning/Splinting
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. 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.
Postsurgical Therapy
After surgery, the child's arm is immobilized, usually with the arm flexed against the chest, for 2-6 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. Two to six 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.
