Instructional Concurrent Session 1

This interactive instructional session will discuss the surgical differences between skin graft and skin flap surgery following traumatic upper extremity injuries in children. We will review complications that commonly arise following skin graft and skin flap surgery in the pediatric population and consider the role hand therapists play in preventing and addressing post-surgical complications. We hope to consider the physical, psychosocial, and emotional needs of children following skin graft and skin flap surgery. We will shift our focus to explore commonly utilized skin flap surgeries to address complicated traumatic pediatric upper extremity injuries and consider practice guidelines hand therapists can utilize to achieve the best possible functional outcomes. Several case studies involving pediatric patients who underwent complicated skin flap surgery will be presented including use of a free gracilis flap, an anterolateral thigh flap for the elbow, an anterolateral thigh flap for the wrist, and an extended radial forearm free flap. Participants in this session can expect to gain valuable insight into the differences between skin grafts and skin flaps, how to recognize and manage complications, and hand therapy principles that achieve the best functional outcomes for our pediatric patients.

Arthrogryposis Multiplex Congenita (AMC) affects approximately one in 3,000 live births. It is a diagnosis that presents itself in a variety of forms and can be intimidating to both novice and the most experienced hand therapists. Due to the complexity of the diagnosis, it is imperative that this population is cared for by a multidisciplinary team. This presentation will include a brief overview of the diagnosis and types of arthrogryposis, delve into the non-surgical and surgical considerations for children with arthrogryposis, review current research, activities of daily living (ADL) modifications and training approaches, and discuss the benefits of the interdisciplinary care of these patients. Surgical intervention of the upper extremity will be reviewed along with the post-operative protocols to provide the best care for these patients. Presenters will share non-operative splinting, serial casting, and other conservative treatment techniques that are most effective with this population.

Attendees will leave this presentation with an increased understanding and confidence to evaluate and treat children with arthrogryposis. In addition, a list of resources will be provided with AMC resources for therapists and families.

This interactive session will provide a close look at how therapists recognized a gap in programming and collaborated to build a constraint induced movement therapy (CIMT) and bi-manual integration training (BIT) group in a busy outpatient environment. The presenters will also share evidence-based protocols for individual CIMT/BIT intervention and how to use outcome measures and goal setting to determine the optimal treatment plan for the child/family. The presenters will share the evolution of these programs, highlighting how outcome measures and family feedback shaped improvements and guided best practices. Data collected from their programs will be reviewed to illustrate trends, successes, and areas for growth.
The session will conclude with an open forum, led by the presenters, designed to foster collaborative discussion around practical questions, common barriers, and success stories–creating an opportunity for peer learning and networking. Attendees are encouraged to contribute by sharing their own strategies, challenges, and lessons learned in implementing CIMT programs and interventions.