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Brachial
Plexus Palsy
If
your newborn's arm is notably weak or completely paralyzed, your child may
have Brachial Plexus Palsy (BPP), also known as Erb's Palsy or Brachial Plexus
Injury (BPI). The cause of this injury is usually the stretching of one (or
both) sides of the neck during a difficult delivery.
The
Brachial Plexus is a network of nerves that go from the spinal column in the
neck down to the fingers. The mildest form of this injury is when the nerves
have been stretched. When the nerves are torn (ruptured) or pulled out of
their spinal "socket" (avulsed), surgical intervention may be the
only hope to regain function of the arm.
The
1st Weeks of Life
During
the first few weeks of life, handle your baby’s neck and arm carefully. Be
aware of the positioning of your baby's arm especially when you lift or carry
him/her. Family, friends and caretakers will need to be taught that pulling or
lifting by the arm can cause further injury and pain.
Doctors
& Therapists
One
of the first steps you may wish to consider is to make an appointment with a
Pediatric Neurologist experienced in brachial plexus injuries to define the
nature of your child's injuries and whether or not there are any other
complications.
See a
Physical (PT) or Occupational (OT) therapist to learn how to do “Range of
Motion” (ROM) exercises that you will do with each diaper change to keep
your child's joints from becoming stiff. A regular schedule of therapy will
also begin at this time. Choose a therapist that understands brachial plexus
injuries and has experience at making splints.
Research
the resources for a Pediatric Brachial Plexus Specialist. These are
doctors who specialize in the treatment and repair of these types of injuries
in babies. Their expert assessment of your child's recovered movements will
define whether or not the injury is temporary or permanent and severe.
Timeframe
For Recovery
The brachial plexus nerves
originate in the neck - in the cervical spine. They
branch down the arm all the way to the fingertips. When the nerve is
severely injured, it has to regrow from the neck, down the
arm. Regeneration of nerves happen at a slow
rate of one inch or three centimeters per month. As they
regenerate, movements of the muscles
associated with that nerve will begin to appear. At first they will be very
weak and the child will use gravity as a helper. As the muscles get fully
innervated (connection from nerve to muscle established), they will gain
strength and move without the assistance of gravity.
A
real turning point in your child's prognosis will be the presence or absence
of biceps function at three months of age. The brachial plexus specialists
worldwide agree that if the child does not have biceps function by that time, surgical repair is discussed.
Time
Is Of The Essence
The
timeframe for surgical repair is a very important factor for recovery.
Within
12 to 18 months of the injury, the muscles that have not already been
innervated (connected to nerves) will have atrophied to the point where
innervation is no longer possible.
It is
most important to contact the Pediatric Brachial Plexus Specialist as early as
possible so that appointments can be scheduled. Wait lists are common in the
larger clinics.
The
neurosurgical techniques most often used to repair a severe injury are:
exploration of the brachial plexus nerves, testing the nerves to see if the
brain is receiving messages from them (EMG), removal of the scar tissue that
has formed around the nerve (neuroma), and if necessary, nerve grafting. This
first surgery - called "primary surgery" is done between the ages of
8 weeks and 12 months of age depending on the protocol of the clinic you
choose and the severity of the injury.
Handling
Medical Costs
Contact
your health insurance company to see if they have a program for children with
special needs. Your state has programs that will give your child access to
free or low cost in-home therapies. In some states it is called Early
Intervention (EI) (ages 0-3). Medicaid programs may give you an option for
free or low cost secondary insurance.
Your
health insurance may cover travel to out-of-state clinics. If not, free or
discounted medical airfare is available from many airlines. (see http://www.injurednewborn.com/maia/travel.html)
Emotional
Support
Emotions
will be strong during the first few years of your child's
life. The best support can come from a counselor who is
experienced at the issues of having a special needs child
and from other families experiencing the same thing. A
local support group can be very helpful for the entire
family. Also, there are some very good Internet sites to
visit and gain support and information from, too. Anger,
sadness and grief are normal and important processes.
Glossary
of Terms
Atrophy:
A wasting away, in the size of a cell, tissue, organ or
part.
Brachial
Plexus: A
network of lower cervical and upper dorsal spinal nerves
supplying the arm, forearm and hand.
Electromyography
(EMG):
A test in which a small needle is inserted, to record
electrical activity of the muscles.
Horner's
Syndrome:
A nerve condition which involves a dropping eyelid (ptosis),
constricted pupil, enophthalmos (sunken eyeball) and lack
of sweating on one side of the face.
Multidisciplinary
Team: a
team of medical professionals that work together to
support the patient; a multidisciplinary team for brachial
plexus specialization would include a pediatric
neurologist, rehabilitation physician, and specialized and
experienced surgeons.
Neurologist:
A physician who diagnoses and treats disorders of the
nervous system.
Occupational
Therapist: A
health care professional who provides services designed to
restore self-care, work, and leisure skills to patients
who have specific performance incapacities or deficits
that reduce their abilities to cope with the tasks of
everyday living.
Physical
Therapist: A
rehabilitation professional who promotes optimal health
and functional independence through the application of
scientific principles to prevent, identify, assess,
correct, or alleviate acute or chronic movement
dysfunction, physical disability, or pain.
Torticollis:
A contracted state of the cervical muscles, producing
twisting of the neck and an unnatural position of the
head.
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