Elbow Flexion Contractures in Children With Obstetrical Brachial Plexus Palsy
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2. To encourage hand therapists all over the world to market the profession among quilters and other crafters, as we can enable them to continue prac- ticing their craft. ELBOW FLEXION CONTRACTURES IN CHILDREN WITH OBSTETRICAL BRACHIAL PLEXUS PALSY Emily Ho, The Hospital for Sick Children, University of Toronto, Trisha Roy, Howard Clarke, Canada Purpose: Elbow flexion contrac- tures are a common sequela in ob- stetrical brachial plexus palsy (OBPP). The etiology of these con- tractures is unclear. Non-operative treatment involving serial casting and splinting is indicated in the literature. The purpose of this study is to evaluate the effectiveness of non-operative treatment of elbow flexion contractures in children with OBPP. Methods: A retrospective review of children with OBPP who partici- pated in serial casting and splinting for an elbow flexion contracture was conducted. Elbow extension range of motion (ROM) measurements at ini- tial, best-achieved, and final outcome were compared. Results: Nineteen (n 5 19) pa- tients, aged 2 to 16 years, were stud- ied. Elbow ROM improved from initial to best-achieved and final out- come measurements. Conclusions: Serial casting and splinting of elbow contractures in children with obstetrical brachial plexus palsy is effective. Successful maintenance of treatment effects is dependent on age and compliance. Relevance: Serial casting and splinting is an effective intervention in improving elbow flexion contrac- tures in children with obstetrical brachial plexus palsy. Therapists should spend time educating patients and families regarding the commit- ment required to participate in this treatment to ensure compliance and successful outcome. OBJECTIVES 1. To demonstrate the effective- ness of serial casting and splinting as an intervention to improve elbow flexion con- tractures in obstetrical brachial plexus palsy. 2. Present a clinical decision tree and treatment protocol for serial casting and splinting of elbow flexion contractures in obstetri- cal brachial plexus palsy. STRATEGIC CHOICE AND TIMING OF UPPER EXTREMITY SPLINTS AND ADL AIDES IN THE TREATMENT OF ARTHROGRYPOSIS MULTIPLEX CONGENITA Tracy C. Fairplay, Policlinico di Modena, Silvana Sartini, Italy Purpose: This brief paper de- scribes the appropriate timing of physical therapy and occupational therapy upper extremity treatment in the global care of the arthrogry- potic child. Methods: The key to treating the arthrogrypotic deformity is to imme- diately address the child’s articular or peri-articular rigidity during the first weeks of life. The physical ther- apy regimen emphasizes early pas- sive stretching and serial splinting to improve joint motion during limb growth, and to prevent contracture progress or re-occurrence. The growth years must therefore be dom- inated by physical management, which consists of stretching, casting, and bracing interspersed by staged soft-tissue procedures and the use of adaptive equipment to render the patient more autonomous in their activities of daily living. At comple- tion of limb growth, final surgical corrections should be attained by os- teotomies. Adolescence should be a time to follow social and prevoca- tional pursuits in preparation for a place in society. Results: Clinicians attempt to overcome these limitations through interventions that focus on remedia- tion, adaptation and/or compensa- tion. Remediation techniques target the problem at the level of impair- ment in an effort to promote normal functioning. Adaptation involves modifications to the environment to allow access for the child with a functional impairment, while com- pensation involves the use of assis- tive devices to circumvent the functional impairment. Conclusions: Children afflicted with Arthrogryposis require ongoing care with a skillfully and timely delivery of medical services. Close collaboration is needed between medical professionals, educators and the child’s family members in order to enhance both quality and autonomous function throughout the child’s growing years. Relevance: Functional splinting and assistive devices are provided to arthrogrypotic children with func- tional impairments to increase inde- pendence and age appropriate function. The physical and occupa- tional therapist play a vital role in helping the child to achieve and maintain their maximal functional autominomy throughout the growing years and in association with surgical functional interventions. OBJECTIVES 1. To present a timely guideline in regards to splinting the AMC infant and child throughout their growing years. 2. To present a timely guideline in regards to the use of func- tional adaptive equipment in the AMC patient. RADIAL DYSPLASIA: A PROPOSAL FOR EVALUATION AND REHABILITATION PROGRAM IN THE SURGICAL TREATMENT OF INDEX POLLICISATION Silvana Sartini, Policlinico di Modena, Tracy Fairplay, Annalisa Nesti, Italy Purpose: This brief paper would like to propose an evaluation and pre and post operative sequential October–December 2010 e19
Transcript of Elbow Flexion Contractures in Children With Obstetrical Brachial Plexus Palsy
2. To encourage hand therapistsall over the world to marketthe profession among quiltersand other crafters, as we canenable them to continue prac-ticing their craft.
ELBOW FLEXIONCONTRACTURES INCHILDREN WITHOBSTETRICALBRACHIAL PLEXUSPALSY
Emily Ho, The Hospital for SickChildren, University of Toronto,Trisha Roy, Howard Clarke,Canada
Purpose: Elbow flexion contrac-tures are a common sequela in ob-stetrical brachial plexus palsy(OBPP). The etiology of these con-tractures is unclear. Non-operativetreatment involving serial castingand splinting is indicated in theliterature. The purpose of this studyis to evaluate the effectiveness ofnon-operative treatment of elbowflexion contractures in children withOBPP.
Methods: A retrospective reviewof children with OBPP who partici-pated in serial casting and splintingfor an elbow flexion contracture wasconducted. Elbow extension range ofmotion (ROM) measurements at ini-tial, best-achieved, and final outcomewere compared.
Results: Nineteen (n 5 19) pa-tients, aged 2 to 16 years, were stud-ied. Elbow ROM improved frominitial to best-achieved and final out-come measurements.
Conclusions: Serial casting andsplinting of elbow contractures inchildren with obstetrical brachialplexus palsy is effective. Successfulmaintenance of treatment effects isdependent on age and compliance.
Relevance: Serial casting andsplinting is an effective interventionin improving elbow flexion contrac-tures in children with obstetricalbrachial plexus palsy. Therapistsshould spend time educating patientsand families regarding the commit-ment required to participate in thistreatment to ensure compliance andsuccessful outcome.
OBJECTIVES
1. To demonstrate the effective-ness of serial casting andsplinting as an intervention toimprove elbow flexion con-tractures in obstetrical brachialplexus palsy.
2. Present a clinical decision treeand treatmentprotocol for serialcasting and splinting of elbowflexion contractures in obstetri-cal brachial plexus palsy.
STRATEGIC CHOICEAND TIMING OF UPPEREXTREMITY SPLINTSAND ADL AIDES IN THETREATMENT OFARTHROGRYPOSISMULTIPLEXCONGENITA
Tracy C. Fairplay, Policlinico diModena, Silvana Sartini, Italy
Purpose: This brief paper de-scribes the appropriate timing ofphysical therapy and occupationaltherapy upper extremity treatmentin the global care of the arthrogry-potic child.
Methods: The key to treating thearthrogrypotic deformity is to imme-diately address the child’s articularor peri-articular rigidity during thefirst weeks of life. The physical ther-apy regimen emphasizes early pas-sive stretching and serial splinting toimprove joint motion during limbgrowth, and to prevent contractureprogress or re-occurrence. Thegrowth years must therefore be dom-inated by physical management,which consists of stretching, casting,and bracing interspersed by stagedsoft-tissue procedures and the use ofadaptive equipment to render thepatient more autonomous in theiractivities of daily living. At comple-tion of limb growth, final surgicalcorrections should be attained by os-teotomies. Adolescence should be atime to follow social and prevoca-tional pursuits in preparation for aplace in society.
Results: Clinicians attempt toovercome these limitations throughinterventions that focus on remedia-tion, adaptation and/or compensa-tion. Remediation techniques target
the problem at the level of impair-ment in an effort to promote normalfunctioning. Adaptation involvesmodifications to the environment toallow access for the child with afunctional impairment, while com-pensation involves the use of assis-tive devices to circumvent thefunctional impairment.
Conclusions: Children afflictedwith Arthrogryposis require ongoingcare with a skillfully and timelydelivery of medical services. Closecollaboration is needed betweenmedical professionals, educatorsand the child’s family members inorder to enhance both quality andautonomous function throughout thechild’s growing years.
Relevance: Functional splintingand assistive devices are providedto arthrogrypotic children with func-tional impairments to increase inde-pendence and age appropriatefunction. The physical and occupa-tional therapist play a vital role inhelping the child to achieve andmaintain their maximal functionalautominomy throughout the growingyears and in association with surgicalfunctional interventions.
OBJECTIVES
1. To present a timely guidelinein regards to splinting theAMC infant and childthroughout their growingyears.
2. To present a timely guidelinein regards to the use of func-tional adaptive equipment inthe AMC patient.
RADIAL DYSPLASIA: APROPOSAL FOREVALUATION ANDREHABILITATIONPROGRAM IN THESURGICAL TREATMENTOF INDEXPOLLICISATION
Silvana Sartini, Policlinico diModena, Tracy Fairplay,Annalisa Nesti, ItalyPurpose: This brief paper would
like to propose an evaluation andpre and post operative sequential
October–December 2010 e19
