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Occupational therapy (OT) provides services to patients who are at high risk for developmental delays due to marked prematurity or delays in fine motor skills, upper extremity dysfunction, visual perceptual difficulties, oral motor skills or activities related to daily living skills (i.e., bathing, dressing or feeding). Those patients with diagnoses including (but not limited to) head trauma, stroke, failure to thrive, brachial plexus injury and feeding and swallowing disorders are appropriate referrals for services provided by occupational therapy.
Physical therapy (PT) provides services to patients who are at high risk for developmental delays due to marked prematurity or delays in gross motor skills. Additional indications include limitations in bed or wheelchair mobility, transfers, gait, coordination/balance, or lower extremity losses in function. Patients in preparation for or following organ transplant, those with limited pulmonary or cardiac function, compromised skin integrity/open wounds/burns and/or pain are also appropriate for PT services.
Hand therapy is the art and science of evaluating and treating injuries and conditions of the upper extremity (shoulder, arm, elbow, forearm, wrist and hand). Hand therapy uses a number of therapeutic interventions including: orthosis fabrication, Kinesiotape application, neuromuscular electrical stimulation (NMES), passive stretching, and other therapeutic exercise/activity to help return a child or adult to their highest level of function. It evolved from the need for a specialist with the knowledge and experience required to manage the challenging recovery of complex hand and upper extremity injuries. Both physical and occupational therapists can pursue this specialty.
Botox injections can be useful in relaxing tight or overactive muscles to allow for easier stretching of a muscle group and to restore proper balance of a joint (both issues that can result after a brachial plexus birth injury).
In some cases when the nerves of the arm are unable to heal on their own, primary nerve surgery is recommended to repair, graft, and/or transfer nerves to restore function. Care is taken by the team to evaluate and discuss these infants frequently to determine if primary nerve surgery is needed.
In some cases, when conservative efforts are unsuccessful in improving a child’s arm range of motion and/or strength (e.g. therapy, Botox injections, and orthoses), orthopedic surgery is recommended. Our orthopedic surgeons specialize in surgery of the bones and soft tissue (muscle and tendon) to restore function of the arm. As with nerve surgery, care is taken by the team to evaluate and discuss patients frequently to determine if orthopedic surgery is needed.