palsy and risk factors
In erbs palsy what nerve roots are affected and what would we see
C5-C6, occasionally C7
Adduction, pronation of forearm, flexion of the wrist "tipping the waiter"
Neurotmesis is what type of nerve injury
its an avulsion nerve injury where the nerve completely rips off of the spinal cord
What are the components involved in neuroplasticity?
attention, sensory input, skilled activity/task, increased difficulty, variation
Modified Mallet Classification what is a grade 1 and a grade 5
grade 1= no funciton
grade 5= normal function
for infants how long should we wait to start working on ROM? What should we avoid for the first 4 weeks?
wait 1-2 weeks after birth
avoid ROM greater than 90 degrees for 4 weeks
what nerve roots are damaged in a Klumpkes palsy? What is the presentation
C8-T1
severe limb atrophy and "claw-like" hand
what type of nerve injury is neuropraxia?
It is a stretch injury to the nerve
what are some shoulder impairments?
what is the scapulothoracic rhythm and its impairment?
factors to consider: persistent muscle imbalance, habitual posturing, shoulder subluxation/dislocation, impaired scapulothoracic rhythm
the scapula and humerus move in a 1:2 ratio with the arm abducted to 180 degrees; 60 degrees occur by rotation of the scapula and 120 degrees by rotation of the humerus. an impairment is for use of the scapula to assist with arm elevation
what is the SHEAR scale and what is the grading scale
SHEAR deformity- scapular hypoplasia, elevation, and rotation
grading scale 1-5, 5 being the worst
why might we use botox for children
for muscle imbalance especially for the overactive muscles
what nerve roots are affects in global palsy and what could we see
C5-T1
we may see flaccid arm
what type of nerve injury is Axonotmesis?
This is either a full or partial rupture of the nerve
what are associated injuries with brachial plexus
phrenic nerve injury
facial palsy
SCI
clavicle fracture
horners syndrome
what is the active movement scale?
what is the grading scale for gravity minimized and against gravity?
to look at active movement for a child with brachial plexus injuries
gravity minimized 0-4
against gravity 5,6,7
what are the goals for surgeries
restore alignment: scapula, humerus, Ilizarov
what are some risk factors for a brachial plexus injury?
high birth weight (>4000 grams)
fetal position
breech delivery
maternal diabetes
disparity between maternal pelvic size and fetal size
what type of nerve injury is a neuroma?
inflammation of the nerve causing expansion of a certain area in the nerve
what could be some injuries of brachial plexus without shoulder dystocia
uterine tumors
tumors in the neck of the baby
viral disease
other abnormalities
breech position (feet coming out first)
what is a grade III for the following movements:
abduction
global ER
hand on spine
hand to neck
hand to mouth
IR
abduction: 30-90 degrees
global ER: 0-20 degrees
hand on spine: S1
hand to mouth: partial trumpet sign
IR:can touch with wrist flexion
why might we do muscle transfer surgery
helps to release tight muscles
what are the delivery modes and shoulder dystocia
Babys shoulder gets stuck behind the mother's pubic bone during delivery; a vacuum, force or the medical team (traction injury) can occur
what is the nerve injury recovery?
what is important for the first 2 years and in early physical therapy
it is a SLOW process
first 2 years: protect joint alignment and soft tissue
early physical therapy: develop appropriate motor patterns, decrease developmental apraxia (learned non-use secondary to neurological damage)
what are some medical assessments we can use?
electrophysiological study
MRI
X-RAY/CT scan
ultrasound
what would a grade 3 indicate on the active movement scale
in a gravity minimized position where the patient can through >1/2 available passive range
what are some protocols for muscle transfer surgery
maintaining scapular stability while building ER in both adduction and abduction
PROM followed by the facilitation of active movement of ERs and abductors progress to strengthening
IR and adduction is discouraged
compensations not allowed