Pediatric Physical Therapy:
Abstracts: Abstracts of Platform and Poster Presentations for the 2006 Combined Sections Meeting: Poster Presentations
1Physical Therapy, The University of Findlay, Findlay, OH, USA (Walsh)
2Neurology, Rocky Mountain University of Health Professions, Provo, UT, USA
Background & Purpose:
Brachial plexus injuries are frequently seen in the physical therapy department with treatment most often beginning soon after birth. Many treatments such as surgery, bracing, and E-stim meet with very poor compliance. The purpose of this case study will be to describe the treatment and subsequent progress of a 2 year old child whose brachial plexus injury was treated successfully with kineseotape and exercise.
The subject was a 2 year old female with a diagnosis of brachial plexus injury. She had been treated by a previous therapist until 1 1/2 years of age and was discontinued from therapy when she plateaued. A followup at a large urban center was successful until x-rays demonstrated severe inferior subluxation of the humeral head and severe winging of the scapula. The subject was fitted with a night time brace to stretch shoulder internal rotators. E-stim was recommended. Reconstructive surgery was also scheduled in six months. At the initial physical therapy examination she was observed to hold the involved shoulder in approximately 80 degrees of abduction, displayed significant asymmetry between sides, used the arm only as an assist, and always transferred objects to the noninvolved hand for manipulation. Treatment at the outpatient clinic consisted of discontinuing use of the night resting brace as it was impossible for the child to sleep, discontinuing E-stim as not feasible for a child of her young age, beginning patient education, and initiating kinesotape to facilitate rotator cuff and scapular stabilizer function. The parent typically left the tape on for 2–3 days before reapplying, with the average weekly wear time of 4–5 days/week.
After only 2 weeks of taping (4 visits), there was significant progress. The deltoid muscle definition was prominent. The subject typically held her shoulder in approximately 20 degrees of abduction. Her shoulders were level and her scapula was displaying less winging. Tape was then added for scapular stabilizers. At the end of 4 weeks of taping (6 visits), her involved arm was held to her side similar to her uninvolved arm. She used the involved arm to initiate activities, no longer transferred objects to the uninvolved arm, and displayed increased fine motor use with the involved hand. The subject's involved arm also displayed a very stable scapula on the thoracic spine with negligible asymmetry. Treatment continued for 3 months. X-rays of the involved shoulder displayed an intact shoulder with good position of the humeral head in the socket.
Treatment of shoulder dislocation began quite late for this child, almost 2 years after her diagnosis. Many of the treatments suggested were inappropriate for a child of her age. With the use of simple kinesotape and parent education for follow through, weekly therapy visits made a significant difference in the functional use of the involved upper extremity. Research needs to follow in this area so that unnecessary surgery and expensive treatments for children of this age do not occur.