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Plastic and Reconstructive Surgery

Occupational Therapy

The Occupational Therapist on the Brachial Plexus Palsy Team has an important role in evaluating how a child with a brachial plexus injury functions in daily activities. This helps the team to provide appropriate recommendations for rehabilitation and surgical planning if any secondary reconstructive procedures are necessary.

Occupational Therapy Assessment Areas

The Occupational Therapist works with the child and family to evaluate their functional concerns by observing the child while performing a task. The areas assessed by the Occupational Therapist are:

  • Shoulder, Elbow and Hand Functional Range of Motion
  • Fine Motor Skills
  • Activities of Daily Living (e.g., Dressing, Grooming, Feeding)
  • School Work (e.g., Handwriting, typing)
  • Leisure (e.g., Sports, musical instruments)

 

colourful shirt occupational therapy

 

Fine Grasp
Fine Grasp (Use of precision pinch)
Gross Grasp
Gross Grasp (Power grips and/or carrying large loads)

Occupational Therapy Treatment Areas

When a child with a brachial plexus palsy presents with difficulties in function in any of the above areas the therapist will work with the team to provide proper treatment. Some treatment recommendations involve therapy to directly improve the child’s use of their hand. These types of recommendations include stretching, hand orthotics and exercises or activities to improve hand skills.

Stretches

stretch blue box occupational therapy

Stretches may be recommended to best improve the child’s passive range of motion in their joint(s) in preparation for future surgery. An example of this type of recommendation is for a child who has a stiff wrist joint and cannot lift up their wrist on their own. Achieving the maximum passive range of motion in wrist extension (i.e. lifting wrist up) is needed for the best surgical result.

Orthotics

pink cast blue box occupational therapy

Hand orthotics may be recommended to either stretch stiff joints or to position the child’s hand in the best position for function. This is often done for a trial period to assess whether reconstructive surgery is appropriate for the child.

The picture on the right shows how a wrist cock-up splint can be used to help a child with cannot lift their wrist up on their own. This is a good example of the type of splint that is used before a child is considered for wrist extension surgery.

Fine Motor Activities

child red bar occupational therapy

Fine motor activities that aim to improve specific hand skills are also an important part of occupational therapy for children with a brachial plexus palsy. Some children need encouragement to use their affected arm in daily activities. Parents are often given suggestions for activities using both hands to encourage their child to develop their hand skills.

Adaptations for Activities of Daily Living

Other treatment recommendations involve teaching techniques and using adaptive equipment to improve the child’s day to day function. These include therapy such as teaching the child the steps to dress and groom independently and sharing tips on the best suited garments and fasteners. Adaptive equipment such as Dycem® anti-slip mats, built-up handles are helpful in helping the affected arm to participate more effectively in day to day tasks. The challenges encountered by each child and family are unique. The Occupational Therapist works together with the child and family to problem solve and find ways to make day to day activities easier.

Connecting with the Child, Family and Their Community

The Occupational Therapist on the Brachial Plexus Team plays an important role as a facilitator between the clinic and professionals in the community. At times, a child with a brachial plexus palsy may need therapy in the community at a pediatric rehabilitation facility or at school. The Occupational Therapist can help with this referral process and will speak with community professionals to provide the best care for the child.