PT Intervention and Family Edu for OBPI

Question 1

Active Mvmt

Answer 1

Facilitation of normal mvmt patterns while inhibiting substitutions during reaching and wb

Scapular Mvmt: possible paralysis of rhomboids and contractures of mm attaching scap and humerus interfere with 6:1 scapulohumeral rhythm in 1st 30d of shoulder movement—want to manually stabilize as shoulder is assisted into active flexion when reaching for toy

Complete active movements in gravity eliminated positions when mm are very weak, prevent substitutions, and manually guiding the extremity to complete task. (hand to mouth , weight shift in prone).

Sidelying on their uninvolved arm to avoid stress on involved side

Gravity and toys can be used for resistance

Constraint of uninvolved side may be needed to encourage use of involved side

Facilitation, tactile stim, or joint compression in WB

Practice transitional movements to both sides

Provide child with opportunities for two-handed activities

Question 2

ROM

Answer 2

PROM through use of developmental activities or positioning
–should not cause pain, gentle movements, avoid over stretching due to joint instability

Discourage picking children up under axilla or pulling by arms–can cause damage to joint

Prevention of scapulohumeral adhesions: educate parents on proper stabilization of scap

Botox: shown to improve AROM, not as successful as neurosurgery

Question 3

Sensory Awareness

Answer 3

Sensory loss can lead to: neglect or self-mutilation

Parent Edu: risk of injury d/t decreased sensation, look for biting in insensate areas, encourage use of neglected extremity, use of different temperatures and textures on the neglected limb on in the hand, encourage parents to provide tactile input and guiding movements of ue

Question 4

Positioning and Splinting

Answer 4

Splints used to stretch soft tissue restrictions

Night splints- place arm in abduction, ER, elbow flex, and supination

Wrist splints- neutral alignment for preservation of tendons while awaiting return of motor function
–wrist cock-up splint- neutral alignment while allowing fingers to be free for play

Constraint therapy of uninvolved side- used for brief periods of time throughout day

Question 5

E-Stim

Answer 5

May be used following neurosurgery

E-stim and PT showed improved shoulder ROM

Need more research, few reports of efficacy