Tub & Bath Time

My daughter LOVES bath time and it's a perfect opportunity to get those arms moving! I let the faucet run and she reaches up to play with the water using both arms! She loves to scoop and dump which works on grasp and getting the palm to face up (supination). She also reaches to dump water over bath toys. Splashing is always a fun game and I usually let her go crazy! We save old soap containers and work on squeezing the water out or use squirting toys. I also encourage her to lather up her hair. We call it "squishy squish" and she has worked really hard on being able to get that hand behind her head to wash her hair. Lotion afterwards she really enjoys and we work on supination again. I get her to rotate her wrist so that palm faces up before I squirt lotion in it. She does sometimes need help. The one thing I have learned is that repetition is important for BPI kiddos. I've found personally the more we incorporate into everyday routines, the more progress we see. So make 'em work during bath time! They think they're just playing anyways! 

We also do swim lessons at our local community center. 

ALWAYS MAKE SURE TO SUPERVISE YOUR KIDS IN THE TUB! ☺️

Where There is a Will There IS a Way!

So one of my biggest worries with my daughter was that she'd have her arm just hanging there her whole life.... I'm a therapist and I've seen kids adapt even in the most horrible circumstances to over come any "disability." I wasn't necessarily worried about my daughter's health as much as "what would other people think of her?" Especially other kids. I know kids can be mean, I dealt with it in school and I don't want that for her. I also don't want her to ever feel left out or think she can't do the same things as other kids. I have ALWAYS believed, where there is a will there is a way and I want her to believe that too! 

As strong willed, stubborn, and determined as she already is I don't foresee that being a problem but I still worry. 

What have your kids have to overcome? Are they treated differently? How did you handle it? 

Jessica's Story

I want to thank Michelle Svetlitski for sharing her daughter Jessica's story. Everyone's journey is so different. Hope you can relate. I hope some of you can relate and this gives you hope! 

My daughter Jessica was born in 2003 at 8lbs 14 ounces, and as a result of shoulder dystocia, sustained a left obstetrical brachial plexus injury. For the first few months we were paralyzed with fear worrying about her future and whether she would need surgery or have normal use of her arm. Her neurologist did an EEG at 3 weeks old and had told us the results showed she had a "significant" injury which was quite upsetting to hear! Fortunately she was able to get hand to mouth at 3 days past that "magic" 3 month old milestone. As a baby, I know she suffered in pain and would be up many nights crying from 2 to 5am. I finally realized a warm bath would calm her and ease her pain, and she could go back to sleep. She was delayed in crawling, rolling over, and walking. She started OT at 1 week old. She was followed by her neurologist and saw 4 surgeons for consults between the ages of 3 months and 2 years old. When she was 6 months old, one surgeon told us she needed 2 surgeries and that we should schedule them immediately! I, and her therapist, both thought she was following a great pattern of natural recovery. Fortunately, the other 3 surgeons agreed (as well as 3 others I had sent videos to), and I am happy to report that today she is 11 years old and has not had any surgeries. She was released from OT and her neurologist's care at 2 years old. She does everything pretty normally, she supinates (uses a little compensation to get to full), she claps, runs and swings both arms normally, puts her hair in a ponytail, hands behind the back, etc. Although no one can tell she has an injury, she does have some residual deficits. She has limited external rotation, a winging scapula, and tends to elevate her elbow sometimes. Although her injury was a constant focus and worry for the first 2 years, it became much less of a focus from age 2 to 9. Around 9 years old, we noticed she started experiencing some pain, likely due to growing and additional lengthening of the nerve. She always has some sensitivity in the deltoid area and usually will have muscle tightness with any kind of weight bearing or activities that involve the arm, but she is back in OT now and does well as long as she remembers to stretch before and after any activities. The stretching makes all of the difference in the world! Although we are delighted beyond words with her recovery, there are unfortunate consequences of her injury. She desperately wanted to play the violin like her brother, but in therapy we quickly realized this just was not going to be possible; however, she did not let this deter her and we had a custom left-handed violin made where she holds the bridge with the right arm and bows with the left arm (reverse of normal). She desperately wanted to do gymnastics and cheer and tried both, but she was in so much pain from it and still found her left arm to be weaker when trying to bear her own weight, so she dropped these activities and instead is very passionate about dancing and takes tap and jazz. Today, she is a very beautiful, intelligent, determined Straight A 5th grader!

Let me know if you would like to share your story! 

Headbands and Hats

If your the mother of a daughter with a BPI and you never want your daughter to wear headbands again than ignore this post... Lol. Once my daughter started moving her arm more, (I want to say around 6-9 months) headbands were our friend. We had this big obnioxus flower head band with a thick band that I would put on her head and encourage her to reach up and get to pull down. I would sometimes have to hold down non-affected arm and give her as minimal help as possible or switch between both arms (one grab with affected one with non-affected). I tried to do 6-10 reps of the headband exercise daily or at least every other day. Once she grabbed the headband, we celebrated and she laughed and laughed. 

I feel like laughter was an important part of my daughters recovery. Finding things that were fun for her to do and seeing her laugh made me forget, even for a split second, the reason we were doing all these crazy exercises to begin with. 

I would encourage, even boys, to complete the headband exercises. After we mastered the headband we tried hats and scarfs and pretty much anything my daughter would put on her head (just please, please supervise your child when they are putting anything at all on their heads!). I think she even played peek a boo with a toy bucket/basket. 

My daughter, to this day, isn't a huge fan of headbands or bows and I think it's because I encouraged her to pull them off. However, the exercise was well worth the sacrifice! :) 

Side note on the scarfs: we saved an old baby wipe container and encouraged her to pull out the scarfs. She loved this exercise. Also encouraging them to throw them up in the air. And if you don't have scarfs and an old wipes container, a cheap box of tissues will do the trick! :) 

Can We Possibly Buy Anymore Toys??

Gosh WE bought everything! Anything I thought may help her move we purchased! Some of my favorites were the activity mats that had hanging toys. One of the ones we had, had rings at the end of it. Since infants have a primitive grasping reflex, and Ardyn (our daughter) had functional movement in her hand, I would hook her hand in the loops so she had to hold it off the floor. 

We also did lots and lots of tummy time. Weight bearing through shoulders is a great way to send input to the joints. Like most babies, my daughter wasn't a huge fan. We had to do short spurts (maybe 5 minutes) at first and build up to longer times as she began to tolerate more. Make a schedule or set a goal to do this a few times a day! I feel that weight bearing really helped us!!! We also set up the changing table in her room like this:

Each time I changed her, besides doing exercises, I made her touch the toy (blue, pink, and green hippo here). I think we had one with rings too that was a little bigger that made crinkle noises. When she started gaining more movement in her arm, she would reach for it herself which helped promote extension and external rotation. 

The Waiting Game

Since nerves regenerate about 1mm a month waiting to see progress is the most frustrating part about the whole process. Everyday we continued to do our exercises at every diaper change. I did it for my daughter, but I HATED it. I shouldn't have to be doing this.... Is what I thought to myself every time! I knew they were important so even if she screamed we were pretty religious about doing them! 

Here is a link to what we did 

https://m.youtube.com/watch?v=U4aOr1CXAGQ

I tried to mix it up by singing songs and moving her arms together to itsy bitsy spider, twinkle twinkle, old McDonald, etc. it seemed to break up the manaughtny of our plain old exercises. 

Like I said, waiting was the hard part.....

I would swear she moved or twitched when I'm sure nothing was happening. I figured it couldn't hurt to be optimistic! 

After each appointment it was like "Each child is so different. We just have to wait and see." Gosh I HATED that statement! Hated! Hated! Hated! Especially since I was soooo impatient!!!! I just wanted her to be better. Seeing her arm hang there broke my heart! 

It wasn't until right before Christmas 2013 that I saw some functional movement. I even recorded it to show my husband and specialists to prove I wasn't crazy and losing my mind just in case she didn't do it again. Even the littlest improvements we celebrated!!!! And we waited ..... Hoping for more.... 

Fun with Your Fridge

We like to use the fridge for my daughter to work on her reaching skills! We did this a lot when she was old enough to pull herself to standing. Not only does it encourage her to reach to get desired objects (we like magnets and post it notes) but gives her the support to slide her arm further up than she would have if she was just reaching for an overhead object. She does require encouragement to use her affect arm at times. However, I feel it's important for them to use both. I sometimes have to hold down lefty. I realize this may be a struggle for some parents as my daughter can sometimes be a booger when I try and hold down lefty. You may have to find something HIGHLY motivating to reach for or ease into how frequently they use their affected arm. For example, let them start with their unaffected arm. Then, encourage 1 or 2 turns with effected arm. Then, back to unaffected arm. It may take some time to build up to getting them to use just their affected arm. Also, as they start growing and/or reach higher and higher switch the height of the magnets or post it notes for more of a challenge. You can even make a game out of it.... Have them pull colored post it's off the fridge and put them in a desired location matching by colors.