Brachial Plexus Injury Treatment

brachial plexus injury treatment

Brachial Plexus Injury Treatment is the cornerstone in the management of the symptoms of a child with Brachial Plexus Injury.

A comprehensive Brachial Plexus Injury program that has been designed and implemented by a Pediatric Physical and/or Occupational Therapist is essential for children whose case is being managed conservatively, as well as for children who require surgical intervention.

A Pediatric Therapist’s role is two-fold:

  1. The first responsibility of the therapist is to provide ongoing therapeutic treatment and parental instruction.
  2. The therapist’s second function is to provide precise and ongoing assessment of the child’s functional status and recovery, and to modify the treatment strategies accordingly.
Brachial Plexus Injury Treatment Focus:
  • Promoting nerve recovery
  • Preventing joint contractures
  • Maintaining range of motion is the upper extremities and neck
  • Improving strength
  • Addressing alignment and postural control
  • Facilitating development of efficient and functional motor patterns

Components of Brachial Plexus Injury Treatment

1. Range of Motion Exercises and Stretching:

  • Passive and Active Range of Motion(ROM) in gravity eliminated positions to promote more range of motion as well as anti-gravity positions to increase the muscle strength.
  • Moving the child through their typical developmental sequence allows the child to develop shoulder strength and stability as well as to improve overall symmetry.
  • It is important to stretch the child multiple time throughout the day, during diaper changes, play and even when they are napping (if possible!).  When a child is relaxed, you can gain more range of motion and keep muscles loose so that when they gain active motion, the opposing muscles are not pulling them back.

Range of Motion Exercises

brachial plexus injury treatment
Shoulder Flexion (bringing the arm forward and up)
brachial plexus injury treatment
Shoulder Abduction (bringing arm out to the side)
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Shoulder External Rotation (with the arm close to the body, bringing the forearm away into L shape)
Shoulder Internal Rotation (touching palm of hand to belly)
brachial plexus injury treatment
Elbow Flexion (bending the elbow to bring the palm of hand to touch shoulder)
Elbow Extension (straightening the elbow)
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Forearm Pronation (with the elbow bent and arm to the side, palm faces down)
Forearm Supination (with the elbow in the same position, but palm face up)
brachial plexus injury treatment
Wrist Extension (bringing the palm up in a ‘high five’ position)
Wrist Flexion (pointing the wrist down)
brachial plexus injury treatment
Finger Extension (including the thumb to open up the hand)

2. Splinting

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  • Static and dynamic splinting of the arm can be useful to reduce contractors, prevent further deformity, and assist movement.
  • Commonly prescribed splints include resting hand and wrist splits, elbow extension splints, dynamic elbow flexion and supinator splints.
  • Careful selection and timing of splint use is essential to optimization of the desired effect.
  • Taping techniques may be used by the therapist to control for scapular instability and to promote improved shoulder mobility.

3. Joint Compression and Weight Bearingbrachial plexus injury treatment

  • To facilitate muscle contraction.
  • Weight bearing activities with the affected arm not only provide necessary proprioceptive input, but also can contribute to skeletal growth.

4. Bilateral Motor Planning Activities

brachial plexus injury treatment

      5.  Sensory Awareness Activities

brachial plexus injury treatment
      Use of infant massage and drawing visual attention to the affected arm can be incorporated easily into play and daily activities.

      Active mobility and strengthening early on in the diagnosis of BPI can be facilitated through age-appropriate developmental activities. As the child gets older, standard strengthening exercises can be initiated and specific functional skills introduced. Specific muscle groups can be targeted for strengthening through functional movement.

      Compensatory and substitute movements should be avoided as they may perpetuate weak muscles and deformity. Instructing caregivers and family members in a home exercise program is instrumental in effective management for children with Brachial Plexus injuries. In older children with persistent disability, the focus on home instruction shifts to independence with attention to specific activities of daily living, efficiency and fluidity of movement patterns.

   Thank you to Stacy Kirsch, Pediatric Occupational Therapist extraordinaire for these helpful Brachial Plexus Injury Treatment Ideas! 

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