Blazing a New Trail, Beyond Traditional Practice Symposium

Co-contraction of agonist and antagonist muscles is vital for controlled joint movement. In children with brachial plexus birth injury (BPBI), maladaptive muscle firing patterns often develop, particularly with permanent BPBI, affecting motor control during nerve recovery. Co-contractive patterns include overactive triceps preventing elbow flexion as biceps/brachialis recover, and simultaneous activation of shoulder adductors and abductors during reaching. Non-invasive motor retraining is challenging, especially with weak or paralyzed muscles, and children tend to adopt the easiest movement patterns, making it difficult to block maladaptive behavior. Botox can temporarily denervate overactive antagonists, but it also weakens the injected muscles and is not without risk. The TAME approach proposes a non-invasive alternative to Botox or surgery by leveraging gravity and eccentric control of antagonist muscles to hopefully prevent and treat co-contraction in BPBI. Some patient may ultimately require injections or surgery, but should have access to a non-operative approach first.

Have you ever stopped to think about what life is like for children with brachial plexus birth injuries (BPBI) once they graduate from pediatric care? Pediatric hand therapists play a critical role in shaping their future; are we doing enough to prepare them for the journey ahead? This presentation will provide an overview of participation, pain, and health-related quality of life of young adults with BPBI. Evidence from the literature on lifelong participation in this population will be examined. Informed by a group of BPBI young adult patient partners, transitional care considerations for adolescents with BPBI will be presented. The importance of health literacy, self-advocacy, and the resilience to learn, relearn, and reintegrate BPBI during major life transitions will be discussed. In attending this presentation, pediatric hand therapists will be better equipped to support adolescents and their families for the lifelong journey ahead with BPBI.

Twenty-four years ago, an American pediatric hand surgeon partnered with a Bolivian orthopedic surgeon to provide free complex hand surgery for underserved children in Bolivia with congenital hand differences, tendon injuries, and burns. These "hand campaigns," as they are known, occur yearly throughout Bolivia.

One of the key components to the success of each hand campaign is training local physiotherapists on how to provide these children with skilled hand therapy services. Local physiotherapists are eager to learn and committed to supporting the hand campaign's vision and mission but lack the skills and resources to treat complex congenital upper extremity conditions and hand surgeries. This symposium is geared toward pediatric CHT's interested in working in developing countries to enhance the hand therapy skills of local physiotherapists. The methods we will discuss include one-on-one mentoring, didactic lectures, observing pediatric hand surgeries, utilizing a multidisciplinary team, and using technology to collaborate.