Brachial Plexus Birth Injury: Late Childhood Through Adolescence
Presented by Tymar Fields
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A brachial plexus birth injury (BPBI) can dramatically impact the physical development of the upper quarter in a child’s younger years. By the time they enter late childhood and adolescence, these individuals have often gone through surgical procedures and countless hours of therapy. Despite these interventions, there are still challenges and limitations with functional use of the affected arm. Clinicians must understand the unique needs of older children and teens to optimize upper extremity function and facilitate participation in meaningful activities. Brachial plexus birth injuries are relatively uncommon, and most pediatric clinicians will infrequently provide care for this population. Many pediatric clinicians need additional resources to provide optimal interventions. After completing this course, clinicians will be confident in evaluation, therapeutic interventions, and home programming for older children and teens with a BPBI. Clinicians will understand critical timelines and common surgical interventions to optimize development and upper extremity function. This is an introductory course for occupational and physical therapists.
Meet your instructor
Tymar Fields
Tymar is a pediatric occupational therapist and certified hand therapist. Professionally, she is inspired by new ideas and creative problem-solving and has a passion for learning. She began her occupational therapy career in 2008 at a nonprofit level 1 trauma hospital. In this role, she worked with children and adults in the…
Chapters & learning objectives
1. Brachial Plexus Birth Injury (BPBI)
Chapter 1 introduces anatomy of the brachial plexus and shoulder muscles and includes descriptions of typical clinical presentations. Special attention is paid to the impact of weakness patterns on the development of the glenohumeral joint and resultant loss of function. This chapter includes a review of critical timelines that require a referral to a BPBI specialty clinic and/or provider.
2. Evaluating an Older Child or Adolescent With a BPBI
Chapter 2 describes a comprehensive evaluation of an older child or teen with a BPBI. The chapter includes instruction on obtaining pertinent history and performing occupational, pain, range of motion, strength, and sensory assessments. Also discussed is the use of the modified Mallet scale, Brachial Plexus Outcome Measure, Assisting Hand Assessment, and goal attainment scaling.
3. Interventions for Older Children and Adolescents With a BPBI
Chapter 3 is an instructional review of interventions to optimize functional arm use in children and teens with a BPBI. Special attention is placed on the concept of shared decision-making and its value for this age group. Interventions include pain management, range of motion, strengthening through exercise and play, therapeutic taping, and adaptations for participation in occupations. The chapter focuses on therapeutic use of self-coaching and home program design.
4. Surgery, Orthoses, and Care of the Family
Chapter 4 reviews the most common surgical interventions for older children and teens with a BPBI. Discussion includes postoperative care after Botox injections and rotational osteotomy of the humerus. A comprehensive review of common orthoses is provided, including indications for use and basic design principles. The chapter concludes with special considerations and care for the family.
