Sometimes children can be convinced that therapeutic activities are delightful, but it is more difficult for adults to think of therapy as "fun." It is essential, however, for both children and adults with brachial plexus injuries to maintain a regular schedule of stretching, range of motion exercises and therapeutic activities. Adults may find benefit in scheduling regular professional massages. Swimming and most water activities can be beneficial as well. Aqua therapy, lap swimming, or aqua aerobics might add a little fun to your day. Position Therabands around your home or office. Use them as often as possible. Keep a "stress ball" near the phone at work and at your house. Every time you make a call do some squeezes with your affected hand.

While adults may recognize the importance of engaging in routine therapeutic activities, children have no such understanding. Most children are wary of therapy in general, and of course go through various stages in their acceptance of professional therapists and activities. It is very important to find a therapist that has a good rapport with your child. Your child must trust the therapist, respect their authority, and respond well to their encouragement to get the most out of each session.

As the parent or caregiver, it is also important for you to have a good working relationship with the therapist, as ideally the work done in therapy sessions is carried out at home and away from the therapist. This is an important relationship, and you may need to visit with and interview several therapists before you find a good match for everyone. As your child grows and changes you may see the need to switch therapists to one with a personality and style that better suits your child. As a parent, the responsibility for your child's therapy falls heavily upon your shoulders. Your therapist should be one of your partners in the ongoing care of your child, but the majority of the therapy they receive will actually take place at home and during regular activities if possible!

Sometimes it is difficult to find the time to set aside a specific time for required exercises. Shoba Shekar, a busy mom living in the St. Louis area, found herself faced with this situation. So she set about trying to find ways of incorporating therapy into daily activities. She put together a list of therapy ideas that she calls “All Throughout the Day.” She says, "I showed this to my son's therapists and they just loved it because they, as therapists, don't see the child at other times of the day. As parents we are with them for meal times, bed times, bath times, etc. that therapists don't get to see." Many of Shoba's ideas are incorporated into the activities suggested below, the goal of which is to give parents ideas of ways to incorporate therapy into everyday tasks and activities.

FUN IDEAS FOR CHILDREN:

Dropper Designs: Fill three plastic cups with water tinted with food coloring. Using a medicine dropper, have child drop "colors" onto coffee filters. Squeeze middle of coffee filter together when dry and have child hold it together with a clothes pin. Add a pipe cleaner for antennae and a magnet on the back and you have a butterfly magnet.

Tweezer Teaser: Fill a dishpan with colored cotton balls. Give large tweezers to child. Call out a color (you can also use a dye with colors on it) and have child pick that color out. This can also be made into a game using numbered dice. For example, the child's color is blue and the parent's color is green. The child roles a 2. He then tweezes out 2 blue cotton balls. Whoever empties the dishpan of their color first, wins.

Painting: Paint with fingers, Q-tips, vegetables cut in half, rollers, Koosh balls, brushes, gadgets such as combs, corks, spools, etc. Shaving cream is also suitable.

In The Pool / Aqua Therapy Ideas: Play animal games: act like a fish, a dolphin, a sea serpent etc. Write with finger in the water. Use a kickboard with arms outstretched. Throw a beach ball to each other. Treasure Dive: Drop small objects into the pool and have child try to catch it.

Yummy Sprinkles: Spread cream cheese/peanut butter/frosting on graham crackers/ toast / bagels / pumpkin bread. Child should use injured hand to pinch sprinkles and put on bread. Make sure you have a variety of sprinkles available.

Pumpkin Snack: Spread creamy peanut butter on English muffin with plastic knife. Use Cheese Triangles (I know it sounds yucky, but it's yummy!) for eyes, and nose. Use raisins for the mouth, and use small piece of cucumber (if it's age appropriate) for the stem. You can use any toppings you like. Cute for October.

Homemade Lemonade: Roll the lemons till they are mushy. Squeeze the juice. Add sugar and water to taste.

Edible Play Dough: Knead together an 18 oz. jar of peanut butter, 1/8 cup of honey, and enough powdered milk (about 1/3 cup) to work the other ingredients into dough. After admiring their work for a minute or two...they can dig in! Activities to do with play dough: Form a ball in your hand, make a pickle in your hand, make a worm on the table, pull the putty back into a ball, flatten it on the table, push it with fingers to make it wider.

Play “Keep Away” using a Nerf ball

Bicycle Parade: Decorate the bike and have neighborhood children join your child in a parade.

Make a big pile of leaves and jump in them

Raking or sweeping leaves, grass, etc.

Take a walk and encourage your child to collect leaves, acorns, sticks, etc.

Visit a farm stand and talk about the autumn fruits and vegetables. Let your child handle the vegetables. Talk about smell, shape, and texture.

Pillow Fights: with both hands on the pillow

Clipping Clothespins

Screwing on Jar Lids

Screwing Nuts and Bolts Together

Tear and Cut: Tear and cut paper and make an art project

Spooning: Fill shoebox with sand, salt, or cornmeal and have child practice spooning into a measuring cup

Cheerio Transfer: Challenge your child to transfer pieces of cheerios from one bowl to the next with tweezers

Stringing dry noodles: (or straw cut-up straw pieces for older children) on string

Lacing Cards: Use the front of old greeting cards to make lacing cards. Punch holes around the edges of the cards with a hole punch. On each card tie one end of a long piece of yarn through one of the holes. Wrap the other end with tape to make a needle. (You can also use postcards)

Writing with shaving cream: Spray puffs of shaving cream on cookie sheets. Let the children spread out the shaving cream with their hands and enjoy finger-painting with it. Show them how to use their pointer finger to draw letters in the shaving cream.

Make cards using fingerprints: Press finger into washable stamp pad. Press on paper. Using a pen, draw details to turn fingerprint into cute animal or whatever. Bumble bee, etc.

Bathtime:  Encourage your child to bathe him/herself using a sponge or washcloth. This helps with all movements of the shoulder and elbow.

Shampoo Time: Let your child shampoo their own hair. This helps with external rotation of the shoulder. Try to make a game of it by making silly hairdo's and horns.

Self Massage: Let your child put lotion on their body. While doing this ask your child to supinate his/her hand in order for you to give them the lotion and then they can bend their arm in all directions to spread over their body. Lotion and the shampoo are good for sensory stimulation and encourage bilateral use of the hands while rubbing them together.

Reading: Ask your child to be the "page turner" when you are reading books so that he/she can get good elbow and shoulder movements. This works especially well with big board books.

Dressing: Dressing is good therapy as well. Pulling pants up helps the grip, rotates the arm internally and requires some shoulder extension, while pulling a shirt over the head helps with shoulder flexion and external rotation.

Eating: Eating with spoons helps with wrist extension and elbow flexion. In addition to this eating with fingers helps with the pincer grip. Using cups (especially without lids) helps with elbow flexion and supination.

Laundry: Moving small amounts of wet laundry into the dryer—with a ‘toss.’

Dishwasher: Unload the dishwasher by holding plates flat with two arms.

Polish a Door: reach up high

Vacuum: with a light broom vacuum cleaner

Mop Floor: with one of those lightweight dust-attracting throw-away cloth mops.

Ball Games: Golf, Hockey, Baseball, Basketball, etc.

Finger Play Songs: “Itsy,Bitsy Spider”, “Where is Thumbkin”, “Two Little Blackbirds”

Hiding Places: Hide things (especially candy) in your child's pockets and make him/her reach for it as a reward. Just unwrapping hard candies or starbursts is great bilateral hand usage.

Sticker Play: using the entire body, put stickers on and pull them off

Wheel Barrel & Crab Walk: excellent weight bearing