Families Play Important Role in Rehab of Children with Brachial Plexus Injury

CLEARWATER, Fla. — Family compliance is integral to the
rehabilitation success for children with brachial plexus injuries, according to
a presentation here at the Association of Children’s Prosthetic-Orthotic
Clinics (ACPOC) Annual Meeting.

From the time this condition is identified — usually within the
first week or so after birth —
brachial plexus injuries, which are most often caused by
birth-related trauma and other trauma injuries, require immediate intervention.
Joshua Ratner, MD, pediatric orthopedic hand surgeon at Children’s
Healthcare of Atlanta, said he tries to impress this on families.

“Right off the bat, it’s important for the children’s
benefit, but also important for the families’ understanding, to establish
the [need for] early passive range of motion therapy,” Ratner said.
“The family will become an important member of the care team.”

When third-party payer coverage falls short for the amount of treatment
necessary, parents must become extra vigilant in their home care, he said.

“Greater than other diseases and syndromes and pathologic diagnoses
that I treat, the families are imperative, especially because out in the
communities of rural Georgia, there just are not therapists who are
particularly experienced with this,” Ratner said.

He found that the longer it takes to begin this treatment, the slighter
the degree of recovery in patients; the children who regain bicep function
early on in their rehabilitation, however, will return to close-to normal
function. Since it may take up to 2 and a half years to determine the results
of any surgical intervention, it is imperative to start the process as soon as

Surgical intervention is one option available to Ratner and his team,
depending on patients’ degree of dysfunction. Some of these children never
completely develop fine motor coordination.

“It’s a pronation world, a keyboard world,” he said.

For patients who are over-supinated, he works to put them in a more
normal or slightly pronated position, which improves their ability to complete
everyday tasks.


In this country, we live in a pronated world. We tend to use keyboards.
We write. And when we eat, we eat with implements. But in a vast part of the
world, they don’t eat with implements. They use their hand supinated.

It’s particularly a problem in the Muslim world, where you eat with
your right hand and you wipe your back end with your left hand, and you
can’t do the opposite at all. If you eat with your right hand, and you eat
without implements, you have to scoop the rice up and put it in your mouth and
you can’t do that pronated. If your hand has some supination, you can
always pronate by abducting your shoulder, but you can’t do it the other
way. By contrast, your left hand, if you’re in a Muslim world where you
have to wipe yourself after you defecate, you can’t do that with a
pronated hand.

It’s important to keep in mind that other cultures have other
demands. We in this culture tend to be the ones doing the research, doing all
of the teaching, and unfortunately, then that’s conveyed to the rest of
the world as if that’s the right way to go. We need to be very careful
when doing that.

— Hugh Godfrey Watts, MD
Adjunct associate
professor, Division of Biokinesiology and Physical Therapy, University of
Southern California

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