Case 1: Brachial Plexus Flashcards
ATNR (Asymmetric Tonic Neck Reflex)
Developmental reflexes: as the baby’s head turn to one side, the UE on that side extends and the UE on the opposite side flexes
Developmental Reflex
Involuntary responses that are also called primitive reflexes; in typically developing infants, these disappear or are inhibited during development
Moro Reflex
Developmental reflex that is observed in typically developing infants in response to a sudden loss of support at the head, in response to this loss of support, the typically developing infant symmetrically abducts both upper extremities and then symmetrically adducts both upper extremities
Integrates: 3-5 months
Palmar Grasp Reflex
Developmental reflex observed in typically developing infants; when an object os placed in the infant palm, the infant grasp the object
Torticollis
Unilateral shortening of the SCM that causes the infant’s head to be turned to one side and laterally flexed to the opposite side; may be congenital (the infant is born with it ) or may develop as a result of habitual positioning
General Physical therapy plan of care/ goals
Maintain or improve active and passive ROM
encourage functional use of involved UE
improve sensory awareness
support motor and sensory recovery
maximize functional outcomes and avoid further injury
PT interventions
- ROM ( AROM, AAROM, PROM) and strengthening exercises
- Functional UE activities ( especially bi-manual takes: use both hands)
- parent/child education related to joint alignment and extremity protection
- neuromuscular electrical stimulation
5 Biofeedback - Splinting
Precautions during PT
- Awareness of surgeon and physicaian-specific protocols for activity restrictions
- avoidance of overstretching
Complications interfering with PT
Development of Torticollis
Decreased sensation
unstable joints
contracture
flaccidity
neglect of involved UE
Which of the following nerve segments is most frequently inquired in obstetric brachial plexus palsy?
C5-C6
Which of the following conditions is a risk factor for obstetric brachial plexus palsy
Shoulder Dystocia
The Assisting Hand Assessment is intended for use with children in which of the following age ranges?
18 months to 12 years
The tool with the most robust psychometric properties for quantifying UE function in children with OBPP are the assisting hand assessment(AHA), the self care domain of the pediatric evaluation of disability inventory (PEDI) and the pediatric outcomes data collection instrument (PODCI)
Grade A: consistent, good quality patient-oriented evidence
Serial casting, Splinting, and injection of botulinum toxin A improve contracture and function in the affected UE of children with OBPP
Grade B: inconsistent or limited quality patient-oriented evidence
what is shoulder dystocia?
difficult delivery of the shoulder; may result in pulling on the nerve within the brachial plexus and is, therefore, a risk factor or obstetrics brachial plexus palsy
Children with obstetric brachial plexus palsy may experience the impact on the condition well into adulthood
Grade A: Consistent, good quality patient-oriented evidence
