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My 6-month-old has Erb's Palsy. Surgery has been
recommended. If the surgery is successful, will
my child have a completely normal extremity?
Answer: It
is highly unlikely that surgical reconstruction of
an obstetrical brachial plexus injury will allow a
child to ultimately have an absolutely normal extremity,
symmetrical with the uninjured side. In many cases,
however, an initially successful repair of the nerves,
coupled with appropriate secondary-reconstructive
procedures on the shoulder, results in extremity that,
while not perfect, has an extremely high level of
function and active range of motion. At rest, the
extremity appears to be completely normal with no
significant limb length discrepancy.
At what age is treatment
for Brachial Plexus/Erbs Palsy considered too late?
Answer: By the age of two to three a child
will make no further spontaneuos improvement or
recovery with regard to Brachial Plexus Palsy. There
is still the possibiltiy for secondary reconstructive
surgery.
What is the result of taking
nerve grafts from my child's legs to reconstruct the
brachial plexus injury?
Answer: There is no real deleterious effect from removing
the sural nerve grafts, except for minor scarring
on the posterior aspect of the leg. Occasionally,
there is a small area of numbness on the foot; however,
it is extremely unusual for a patient to even notice.
How does the doctor determine
whether my child has a brachial plexus palsy?
Answer: The doctors use a variety of examinations and test
to evaluate the functional disability of the infant/child's
injury. In general, during the physical examination
doctors look at all voluntary movement that occurs
at the shoulder and elbow to access the recovery
of the upper part of the brachial plexus.
What is Shoulder Dystocia?
Answer: It is a birthing emergency and a
direct result of a difficult delivery. During labor
and birth, a baby's shoulder can get stuck on the mother's
pelvic bone. Doctors may use many different procedures
to dislodge the baby's shoulder so that the baby can
safely pass through the birthing canal.
I am an expectant mother
about to give birth, what are the risk factors of
Brachial Plexus/Erbs Palsy?
Answer:
Some risk factors include fetal macrosomia (a condition
in which the pre-birth weight of the baby is over 8
lbs. 14 oz.), maternal weight gain of 35 lbs. or more,
maternal diabetes, maternal obesity, gestation that
lasts beyond 40 weeks, short maternal stature, platypelliod
(a contracted or flat pelvis). a breech birth or other
abnormal presentation of a fetus can increase the occurrence
for shoulder dystocia, resulting in a brachial plexus
injury. The use of labor-inducing drugs suggests an
increased risk for shoulder dystocia.
When using an Epidural, a mother loses the pushing
sensation, which can result in the baby descending in
an awkward position. The use of tools, including forceps
or a vacuum, to help the baby descend, may also increase
the risk of shoulder dystocia.
Will therapy help my child's brachial plexus
injury?
Answer: Yes! Therapy will provide
your child with a program that focuses on increasing
active and passive range of movement and promoting use
of the weak arm for functional activities. If necessary,
an appropriate splint will be provided. The therapist
will be able to assist you in planning care for your
child.
How long does my child need therapy?
Answer: Occupational
and/or physical therapy are usually indicated when the
child is diagnosed. Therapy will depend on the child's
recovery of active movements. If a child has spontaneous
recovery (full active movements) within 3 to 4 months,
parent/caregivers are usually given a home program before
discharge. However, if spontaneous recovery does not
occur, your child will be seen in therapy. The doctor
and the therapist will determine how long your child
will require therapy. In most cases, once the child
is seen in therapy, she/ he will he given a home program
that will be reviewed with the parents/caregivers. It
is of utmost importance that these home programs be
performed consistently. The therapist's role is to guide
the parents/caregivers as they are the ones who will
work with the child on a daily basis. It is crucial
that follow-up with the doctor be arranged once the
child is discharged from therapy.
Who can help my child adjust to life with brachial
plexus?
Answer: It is hard for us to
image all the challenges one must face on a daily basis
with Brachial Plexus. As your child grows older different
task that are common place for us may become difficult
for them. Depending upon their range of motion, simple
things, like driving a car may seem unattainable. Occupational
therapist have the expertise to asses individuals with
this injury. They can suggest lifestyle modifications
that can make performing everyday activities much easier.
My child is depressed and is unwilling to help
himself. What should I do?
Answer: Sometimes Brachial Plexus
children suffer from acute depression due to the stress
and trauma of their injury and healing. It is recommended
that children with this injury be given positive reinforcement
from several sources. The parent plays a key role in
the child's behavior and willing ness to overcome his/her
disability. As parents, it is extremely important not
to become a "enabler". Most behavior can be modified
and symptoms of depression can be treated with the aid
of an occuptaional therapist and family or physiological
counseling.
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