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My 6-month-old has Erb's Palsy. Surgery has been recommended. If the surgery is successful, will my child have a completely normal extremity?

Answer: It is highly unlikely that surgical reconstruction of an obstetrical brachial plexus injury will allow a child to ultimately have an absolutely normal extremity, symmetrical with the uninjured side. In many cases, however, an initially successful repair of the nerves, coupled with appropriate secondary-reconstructive procedures on the shoulder, results in extremity that, while not perfect, has an extremely high level of function and active range of motion. At rest, the extremity appears to be completely normal with no significant limb length discrepancy.

At what age is treatment for Brachial Plexus/Erbs Palsy considered too late?

 Answer: By the age of two to three a child will make no further spontaneuos improvement or
recovery with regard to Brachial Plexus Palsy.
There is still the possibiltiy for secondary reconstructive surgery.


What is the result of taking nerve grafts from my child's legs to reconstruct the
brachial plexus injury?

 Answer:  There is no real deleterious effect from removing the sural nerve grafts, except for minor scarring on the posterior aspect of the leg. Occasionally, there is a small area of numbness on the foot; however, it is extremely unusual for a patient to even notice.

How does the doctor determine whether my child has a brachial plexus palsy?
Answer:
The doctors use a variety of examinations and test to evaluate the functional disability of the infant/child's injury. In general, during the physical examination doctors look at all voluntary movement that occurs at the shoulder and elbow to access the recovery of the upper part of the brachial plexus.

What is Shoulder Dystocia?
Answer: It is a birthing emergency and a direct result of a difficult delivery. During labor and birth, a baby's shoulder can get stuck on the mother's pelvic bone. Doctors may use many different procedures to dislodge the baby's shoulder so that the baby can safely pass through the birthing canal.

I am an expectant mother about to give birth, what are the risk factors of
Brachial Plexus/Erbs Palsy?
Answer:
Some risk factors include fetal macrosomia (a condition in which the pre-birth weight of the baby is over 8 lbs. 14 oz.), maternal weight gain of 35 lbs. or more, maternal diabetes, maternal obesity, gestation that lasts beyond 40 weeks, short maternal stature, platypelliod (a contracted or flat pelvis). a breech birth or other abnormal presentation of a fetus can increase the occurrence for shoulder dystocia, resulting in a brachial plexus injury. The use of labor-inducing drugs suggests an increased risk for shoulder dystocia.

When using an Epidural, a mother loses the pushing sensation, which can result in the baby descending in an awkward position. The use of tools, including forceps or a vacuum, to help the baby descend, may also increase the risk of shoulder dystocia.

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Will therapy help my child's brachial plexus injury?
Answer: Yes! Therapy will provide your child with a program that focuses on increasing active and passive range of movement and promoting use of the weak arm for functional activities. If necessary, an appropriate splint will be provided. The therapist will be able to assist you in planning care for your child.

How long does my child need therapy?
Answer: Occupational and/or physical therapy are usually indicated when the child is diagnosed. Therapy will depend on the child's recovery of active movements. If a child has spontaneous recovery (full active movements) within 3 to 4 months, parent/caregivers are usually given a home program before discharge. However, if spontaneous recovery does not occur, your child will be seen in therapy. The doctor and the therapist will determine how long your child will require therapy. In most cases, once the child is seen in therapy, she/ he will he given a home program that will be reviewed with the parents/caregivers. It is of utmost importance that these home programs be performed consistently. The therapist's role is to guide the parents/caregivers as they are the ones who will work with the child on a daily basis. It is crucial that follow-up with the doctor be arranged once the child is discharged from therapy.
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Who can help my child adjust to life with brachial plexus?
Answer: It is hard for us to image all the challenges one must face on a daily basis with Brachial Plexus. As your child grows older different task that are common place for us may become difficult for them. Depending upon their range of motion, simple things, like driving a car may seem unattainable. Occupational therapist have the expertise to asses individuals with this injury. They can suggest lifestyle modifications that can make performing everyday activities much easier
.

My child is depressed and is unwilling to help himself. What should I do?
Answer: Sometimes Brachial Plexus children suffer from acute depression due to the stress and trauma of their injury and healing. It is recommended that children with this injury be given positive reinforcement from several sources. The parent plays a key role in the child's behavior and willing ness to overcome his/her disability. As parents, it is extremely important not to become a "enabler". Most behavior can be modified and symptoms of depression can be treated with the aid of an occuptaional therapist and family or physiological counseling.

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