Therapy Management of Adult Traumatic Brachial Plexus Injury
Presented by Aviva Wolff
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Adult brachial plexus injuries are traumatic and complex and require specialized care and expertise for therapy management. Initial care is routinely provided in specialized centers and then continued at local clinics. The typical therapy practitioner does not treat these injuries frequently and often lacks the knowledge and skill required. This course will assist practitioners in developing appropriate treatment plans by providing an in-depth understanding of the anatomy and mechanics of the brachial plexus, the mechanism of injury, and available surgical repair options, such as tendon transfers, nerve repair, and nerve transfers. The course will provide practitioners with guidelines for assessment, preoperative management, and postoperative management of this patient population. This course is designed for occupational and physical therapists of all levels.
Meet your instructor
Aviva Wolff
Aviva Wolff is an occupational therapist and clinician-scientist with a strong background in motor control and movement analysis and extensive experience working with performing artists and individuals with musculoskeletal injuries. She currently consults for the Juilliard School and runs the upper extremity clinical movement…
Chapters & learning objectives
1. Brachial Plexus Anatomy and Injury
This chapter reviews basic brachial plexus anatomy and common mechanisms of injury to properly assess and treat adult traumatic brachial plexus injuries. The review covers brachial plexus anatomy, including nerve roots, trunks, divisions, cords, and branches. The chapter will review the mechanism of injury, etiology, and pathology, including pathophysiology of pre- and postganglionic lesions and injury classification by site. Injury symptoms and signs will also be discussed.
2. Preoperative and Postoperative Assessment of Traumatic Adult Brachial Plexus Injuries
This chapter covers the components of conducting a comprehensive preoperative and postoperative clinical assessment using specialized tests and available evidence to identify functional limitations and disability level. The chapter reviews tests of muscle function, sensory function, posture, position, function tasks, and patient-reported outcomes measures specific to brachial plexus injury. The chapter will also address common diagnostic tests, such as EMG and imaging, and how to interpret findings.
3. Surgical Treatment Options for Brachial Plexus Injury
This chapter describes the range of surgical options for tendon and nerve transfers based on the level of injury and provides the information necessary to develop an individualized treatment plan. The chapter discusses available surgical options and strategies, indications for nerve transfer surgery and timing, and common tendon transfer surgeries.
4. Preoperative and Postoperative Management of Traumatic Adult Brachial Plexus Injury
This chapter reviews treatment strategies to assist practitioners in developing a patient-specific preoperative and postoperative plan of care for acute traumatic adult brachial plexus injury. The preoperative management section includes proper positioning, maintaining joint motion, adaptive devices, and neuromuscular reeducation. The postoperative management section includes discussion regarding immobilization techniques, use of biofeedback, assistive devices, and neuromuscular reeducation.