Climbing New Heights, Advanced Clinical Skills Symposium

Infants with brachial plexus birth injury (BPBI) are at risk for abnormal glenohumeral joint positions and dysplastic changes in joint surfaces. While early therapeutic strategies to mitigate glenohumeral dysplasia have been proposed, little evidence is available to support their effectiveness. Through this session, participants will be introduced to ultrasound imaging as a modality to examine glenohumeral joint morphology in infants with BPBI. The effects of the Sup-ER orthosis on joint alignment will be presented and discussed using ultrasound data to assist therapists with clinical decision-making.

Nerve transfer surgery techniques in young infants and toddlers with brachial plexus injuries are progressing. It can be challenging as a therapist to develop post-operative protocols and treatment plans. Not all children have a perfect result after nerve transfer surgery. Not all children regain all motions on their own. We have developed a program for young children based on the DAFRA nerve transfer rehabilitation for adults. We will explore case studies for different nerve transfers and play activities encouraging functional movements that target the donor and recipient nerves for these very young kids who cannot follow a set, strict exercise protocol. Participants will leave with ideas to take back and implement immediately with this population of children.

This presentation will briefly review the basic structures of the elbow and common elbow fractures in the pediatric population. It will differentiate healing and progression of a pediatric versus the adult population.  It will highlight pediatric-centered interventions and progression of plan of care/protocol for patients who have sustained an elbow fracture and/or dislocation based on evidence from the literature.