brachial plexus avulsion

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Hello, I have a 5mo old Aussie who jumped out of the car window (while in motion) on 4/16. Was sent to a neuro center for assessment, she has good strength, muscle tone and symmetry on 3 limbs. Owner is doing limb stretching, bicycling movements and will start massage and PROM. Sassy is NWB on affected limb. This is my first brachial plexus avulsion and I would appreciate any thoughts, ideas you all may have. I know of other exercises for her, but only when she is WB. Thanks, Joyce Matott Sendaishi Canine Rehab Manchester, NH

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I can't stress enoug the importance of early weight bearing in a functional position for strengthening as well as maintaining ROM. Too often when I see these guys a little later they already have carpal contractures. I would recommend a standing brace to support elbow and wrist while weigth bearing and weigth shifting. I work with an orthotist that also makes a nice brace for walking that will allow at least placing the pads on the ground. Standing brace can also be used as a resting splint.

Feel free to e-mail me off list too if you have specific questions. These guys really need the early intervention and I can't stress enough maintaining the ROM and weigth bearing. Patti Pinski -- any peds related experience you can offer?

Jeanine Freeberg, PT, DPT

Subject: brachial plexus avulsionTo: VetRehab Date: Friday, May 2, 2008, 6:22 PM

Hello,

I have a 5mo old Aussie who jumped out of the car window (while in motion) on 4/16.

Was sent to a neuro center for assessment, she has good strength, muscle tone and symmetry on 3 limbs. Owner is doing limb stretching, bicycling movements and will start massage and PROM. Sassy is NWB on affected limb. This is my first brachial plexus avulsion and I would appreciate any thoughts, ideas you all may have. I know of other exercises for her, but only when she is WB.

Thanks,

Joyce Matott

Sendaishi Canine Rehab

Manchester, NH

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Hi- re peds related experiences- In a Brachial Plexus Injury- return of sensory innervation seems to preceed motor innervation-as demonstrated by behavioral responses to touch and position before muscle activity is visible or palpable. A flex-withdrawl response to pain (or fear of pain) is not possible as the motor component is not intact. Kids show pain by facial grimacing, avoiding eye contact, or becoming fussy, or crying when you come close to the affected limb. Older kids (ie had developed movement, and had language skills-and then had a trauma vs birth trauma) have described the sensation as burning, tingleing, or "like it is asleep". They are hypersensitive a few days to few weeks before muscle movement function is palpable or visible. Older kids not treated as toddlers (ie some neonatal treatment-which was D/C ed) seem to have visual perceptual and

body awareness issues. These seem to me to resemble Brown-Sequard Spinal Cord Injuries- in that the motor intact side that lacks proprioception sense actually looks "worse" because the client doesn't feel their hand caught in the wheel of the wheelcair unless they visually look at it. I agree weightbearing in a functional position is really important. I think it is related to being able to experience "good sensations" and "stability" as the sensory nerves recover and they can perceive pain or instability before they initiate a muscle contraction for a protective response. Hope this is helpful. Patti Pinski, PT, PCS Jeanine Freeberg wrote: I can't stress enoug the importance of early weight bearing in a functional position for strengthening as well as maintaining ROM. Too often when I see these guys a little later they already have carpal contractures. I would recommend a standing brace to support elbow and wrist while weigth bearing and weigth shifting. I work with an orthotist that also makes a nice brace for walking that will allow at least placing the pads on the ground. Standing brace can also be used as a resting splint. Feel free to e-mail me off list too if you have specific questions. These guys really need the early intervention and I can't

stress enough maintaining the ROM and weigth bearing. Patti Pinski -- any peds related experience you can offer? Jeanine Freeberg, PT, DPT From: Joyce Matott <matottjoyce>Subject: brachial plexus avulsionTo: VetRehab Date: Friday, May 2, 2008, 6:22 PM Hello, I have a 5mo old Aussie who jumped out of the car window (while in motion) on 4/16. Was sent to a neuro center for assessment, she has good strength, muscle tone and symmetry on 3 limbs. Owner is doing limb stretching, bicycling movements and will start massage and PROM. Sassy is NWB on affected limb. This is my first brachial plexus avulsion and I would appreciate any

thoughts, ideas you all may have. I know of other exercises for her, but only when she is WB. Thanks, Joyce Matott Sendaishi Canine Rehab Manchester, NH Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now.