IT'S NOT JUST AN ARM

A brachial plexus injury that occurs during birth is not something that affects only the arm. Although no scientific studies have been conducted to survey these secondary issues, parents have found the following symptoms to be commonly associated with BPI (this information has also been confirmed by adults who have suffered an obstetric BPI). Whether or not these items below are directly related to the brachial plexus injury or whether they are due to the traumatic birth itself leaves room for argument. We don't know why these issues may occur but just know that the following are common among the parents who discuss their children's issues online.

Horner's Syndrome: Characterized by droopy eyelid and a difference in pupil size. Children with BPI should consult with a pediatric eye doctor to confirm whether or not they have Horner's Syndrome and address any other eye problems that may be related to BPI.

Lung/Diaphragm Issues: Many children with BPI have asthma and other lung issues that need to be treated by a pulmonary specialist. If you notice periods in which the function in your child's arm is drastically reduced, this may be due to a change in lung function.

Changes in the Hair & Face: Many adults with OBPI state that the hair on their face is different on the affected side. Other comments indicate changes in perspiration on the affected side, inconsistencies in how hair dye colors the hair, and differences in aging.

Nails: Nail growth appears to be affected on the injured side. Mothers also report a higher incidence of hang nail.

Smelly Skin Rash: Yeast rashes are common on the affected limbs due to differences in motion and use. Rashes should be appropriately treated and kept as clean and dry.

Hypotonia: Nerve damage that is associated with birth trauma can often result in hypotonia or "low tone". Children with hypotonia will require physical therapy at different times of their lives. Physical therapy also addresses secondary issues that are related to the long-term effects of low muscular tone. A healthy posture can be maintained if physical activity is started early and continued throughout the child's life.

Balance & Gait Issues: Problems with balance are commonly observed in children with BPI. Changes in a child’s normal walking gait can actually be directly correlated to OBPI due to spinal cord involvement at the level of the injury. Parents report that their children often walk and run differently. Some physical therapists are successful in using orthotics to treat gait and balance issues.

Sunburn: Extreme caution should be taken when a child is in the sun because the affected side is often more prone to serious sunburn. Sunblock and other appropriate measures should be to avoid sun damage.

Sensory Integration: In the spectrum of BPI secondary issues, sensory integration issues (SI) seem to be very common. Many OT's specialize in treating the various levels of sensory integration .Many parents suggest reading the book "The Out of Sync Child" by Carol Kranowitz.

Biting Hand and Fingers: At certain levels of recovery, parents have reported that their children may bite the fingers/hand of the affected side. Children who don't have sensation in their fingers may do a great deal of damage (biting off nails, biting through the skin without realizing it) to themselves and may require wound care by a physician and possibly neoprene gloves, as a protective measure.

Temperature Sensitivity: Decreased circulation in the affected arm may result in heightened sensitivity to temperature (both hot and cold).

Weakened Affected Arm When Sick or Tired: Parents of children with BPI relate that their children’s arms do not function as well or even at all when they are ill. Actually, many parents see this decrease in function and pain in the arm as a barometer to a child's current level of health.

Excessive Drooling & Eating Issues: This can be evaluated and treated by an OT. This can possibly be related to the nerve damage.

Ear Infections: We have learned that the ear and all associated tubes, etc. on the affected side, grow differently. In some the ear canal is much smaller and the ear drum itself is smaller. This may lead to increased ear infections on that side. One parent has informed us that she does what she coins as "Crunch Therapy" with her child. Every day her child gets a carrot to crunch on or an apple to bite into as a snack. This jaw movement has helped her child move fluids out of the ear canal - which in her child was defined by two ear specialists as being literally half the size of her other ear!

Scoliosis Risk: Because of the compensation that the children do on a day-to-day basis to account for their muscle imbalances, children with BPI are at risk for scoliosis. This is something that your pediatrician can assess at each visit. X-rays are now used as a diagnostic tool in children with severe injuries to monitor the health of the spine and the possible progression of scoliosis. Scoliosis can be treated with bracing and possibly surgery for the most severe cases.

Edema: Decreased circulation in the arm may show up as "edema" – also known as puffiness or swelling of the arm. Your OT can help assess this and teach you how to massage and/or wrap the arm to enhance circulation. One parent whose child has severe edema has observed that doing nightime electrical stimulation therapy - TES - has helped to reduce the swelling in her daughter's arm.

Speech Delays and Developmental Delays: Specialists have told us that whenever a child has surgery before the age of 3, in most cases the child will have some developmental delays and possibly speech delays. This is because the child is spending much of their time doing tasks related to their post surgical health rather than being active and working on "normal" development. PT and OT and speech therapy can help a child catch up developmentally.

Delayed Self Help Skills: Children with BPI may have trouble with dressing and hygiene issues. An OT would be able to show you how to teach your child to dress, potty and bathe. Have no fear because there are ways to do all of this one-handed.

Torticollis: This is a tightening of the neck muscles early on after the birth. Often a chlid with an injury doesn't want to move their head on that side - so the neck muscles tighten. An OT or PT can show you exercises to do to relieve the torticollis. At home you can do things like put a light show toy on that side of the crib so that the baby is more likely to use that side and thus stretch those muscles. A good therapist will teach you how to be inventive and develop new techniques to help your child be active and healthy.

Lightning Strikes / Fascilculations / Nerve Pain / Never Ending Itchies: As the nerve grows in and as the child develops - he or she may experience a myriad of sensations. Some say that it feels like lightening going down their arm. Others say that it's like a movement "tick" (fasciculation). There can be nerve pain, buzzing sensations or itching that may never go away. Unfortunately, this is all part of the injury.

Apraxia: A child with apraxia is often unaware that they are carrying or using their affected limb for a particular task. Some children with BPI are slower at doing tasks because they have to "motor plan" – or figure out how to direct their body appropriately. Dr. Karen Pape (www.tascnetwork.net) can give you good information about apraxia. Dyspraxia might also be an issue with some children.

Issues Concerning Changing Handedness
http://www.linkshaender-beratung.de/english/Problem.htm

For those affected with Horner's Syndrome: Issues with overhead lighting.