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Georgia BPI Specialists/Clinics
Ann Schwentker, MD
When was your Brachial Plexus Injury Clinic established? 2004. Identify what specialties related to brachial plexus injuries are represented by practitioners working in your clinic including physical/occupational therapists, if any. Plastic surgery, Neurosurgery, Orthopedic surgery, Radiology, Neurology, Physical Therapy, Occupational Therapy, Social Work, Nursing What do you/your clinic specialize in treating?
Indicate the total number of brachial plexus patients you/your clinic has evaluated since your establishment: Number of children (Obstetrical brachial plexus injuries): 150, and we have performed primary (nerve grafting) surgery on more than 40 State your philosophy regarding evaluation, referral and treatment of obstetrical brachial plexus injuries in children. We prefer to evaluate infants as early as possible. I work with a neurosurgeon, Dr. William Boydston and we evaluate all children together with our occupational and physical therapists. Most children with obstetrical brachial plexus injuries recover with appropriate therapy, and we work with the family and pediatrician to arrange physical and occupational therapy. Stretching exercises are very important, even for those children who recover completely. We follow all our babies closely to ensure they are progressing the way we would like. For those children with severe injuries, surgery to reconstruct the plexus with nerve grafts is usually recommended at 3 months of age. For those children with poor recovery of the shoulder and biceps, surgery is usually recommended at 9 months of age. Before surgery, we get an MRI of the plexus and an ultrasound of the diaphragm. We have not found that EMGs help our decision-making, and since they are painful, we prefer not to order them. After surgery, the baby's arm is in a sling for three weeks, and then they get right back to therapy. Whether or not a child has had nerve reconstruction, some benefit from additional surgery to improve the functioning of the shoulder or other joints later on. We refer these children to an orthopedic colleague, Dr. Allan Peljovich at 18 months of age or older. We follow all our children until 18 years of age, to help them adjust to new tasks and situations as they grow. State your philosophy regarding pain management and brachial plexus injuries. In obstetrical brachial plexus injuries, pain is rarely a significant component. In those cases where pain is an issue, there is an anesthesia pain clinic available at Children's Healthcare of Atlanta to evaluate and treat those patients. Indicate research efforts (include dates please) conducted by you specific to brachial plexus injuries. I am publishing a paper based on a review of over 100 children at the University of Toronto Hospital for Sick Children that showed a better result with excision and grafting of neuromas-in-continuity than neurolysis alone. We are involved in a multi-center study with The Children's Hospital in Boston looking at the best time to perform nerve reconstruction surgery in obstetrical brachial plexus injuries. The study is carefully designed so that each center follows its preexisting standard of care -- we don't change the way we treat any child for the purpose of the study. Indicate any other facts that you feel would help families and individuals understand your practice. The Center for Facial Nerve and Brachial Plexus Reconstruction is a new multidisciplinary center the Southeastern United States. The neurosurgeons and orthopedic surgeons involved in the center have been treating brachial plexus injuries in the Atlanta area for many years. Our medical director, Ann Schwentker, MD, is new to the Atlanta area. The multidisciplinary nature of the clinic allows us to provide individualized, comprehensive care for the patient. Do you accept any national/governmental payment for services or are you enrolled in any state medicaid plans? Please provide information on these plans and include which states you are enrolled in for medicaid services. We are enrolled in Georgia Medicaid. |
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