What is the treatment for brachial plexus palsy?
Most infants with brachial plexus palsy recover complete function spontaneously during the first few months of life. Unfortunately, some children do not and are left with arm weakness. Treatment of brachial plexus palsy begins with diagnosis, usually by an obstetrician or pediatrician. At Children's Memorial Hospital, evaluation is performed by a pediatric rehabilitation physician, an orthopaedic surgeon, a neurosurgeon and an occupational therapist.
In most cases, we recommend immediately beginning stretching therapy under the supervision of a physical therapist or an occupational therapist. We prefer evaluating the child within the first month of life because early therapy allows the best chance for the best result. Parents play the central role in every aspect of decision making and providing care to their children.
At return visits, infants with brachial plexus palsy are evaluated for the need for further non-surgical intervention or surgical intervention, such as nerve repair tendon surgery, muscle surgery, joint or bone surgery.
Pediatric rehabilitation
Babies grow and develop new skills very rapidly. Even with a temporary nerve injury, without proper attention a child's arm movements may be significantly compromised.
Our therapists focus on a developmental approach, starting with holding techniques and ways to protect and to properly stretch the affected arm. The development of a child's muscles and their movements may be affected if she begins to move her arm and trunk with a weak arm.
A rehabilitation physician monitors your child with the help of an occupational therapist, who helps to determine and assess progress and goals. Together they determine if further testing is required or if the child is expected to have a good recovery. The therapist teaches parents/caregivers the stretching exercises that are needed; the stretching needs to be done several times a day.
The rehabilitation physician monitors the child's progress and suggests methods of adding to the rehab program. Interventions can include botulinum toxin injection to rebalance overactive muscles. Botulinum toxin A is used in small amounts in conjunction with therapy to permit stretching and to allow weak muscles to activate. This requires a quick injection, which can be done in an office visit.
The use of splints may also be suggested as well as electrical stimulation to build up small muscles.