Limitations after 2nd 8 weeks for Caps

[Jodi]

I emailed Dr. Nath a couple weeks ago to ask him what limitations there are after the second 8 weeks. Bailey is very active and I was wondering about things like hanging and sommersaults and playing outside.
He emailed me back yesterday. Here is his response "I would avoid activities that will stess the shoulder for some time now." I have emailed him again to see exactly what he means and how careful we need to be. I am wondering what others have been told?
I am a little worried because Bailey has been out of the splint for over a week and she already been hanging at therapy (in the pool on a bar) and playing on the swingset and stuff. She thinks she is a monkey and I thought it was ok to let her do things on her own. What are others experiences. I am feeling so stressed out!!!!!
Thanks Jodi

[francine]

Maia had stiffness and still has pain in her shoulder/elbow and hand. So she has very closely guarded her arm and hasn't been able to put any pressure on it during this 2nd 8 weeks period. But now that we have one week left- I can see that she's loosening up more. I have to try and figure out what is fear / protecion and what is truly real pain. But I can see now at the end now that she needed the extra 8 weeks to have her arm settle in.

About Bailey - unless she has a really low tolerance to pain- will she do anything that's going to hurt her arm? Is she one of those "A" types that will keep on going and going no matter what? If she is then I'd just explain to her that her arm still needs time to heal and give her a list of things she has to be careful with for now until her arm gets a bit stronger.

Good luck!
-francine

[Jodi]

I just got a new email from Dr. Nath. I asked him if he could be more specific about her limitations. I wanted to know if she can wear waterwings and how careful we need to be on the playground. His response was "She should not do any weight-bearing activities with the soulder?"
So now I am even more confused. So what is water wings. Is that stressing the shoulder, Weight-bearing, or resistive? I thought we were supposed to start resistive things? Do resistive things stress the shoulder?
HELP My therapist is out of town until Friday. I have decided Bailey is Not doing anything until I get this all figured out. I am calling Lisa first thing in the morning.

Francine-
I have explained to her that she has to be careful and she understands that she can't and shouldn't try somethings. She does not complain of any pain. She did the first week when she was out of the splint during the day if she fell on it or put too much pressure on it. Now she complains of nothing. She will tell us when we are doing roms "thats enough" or "no further." I try not to push her. She had much more pain with the Mod Quad.

[francine]

well the way it was explained to us is that Maia was not to do weight bearing...like crawling, etc..... and also not to use weights during her therapy - like the one pound sticks she used to raise overhead....and not do anything resistive like using a Theraband or something that puts pressure into the arm.

I look at it this way....we've played it really safe...I wouldn't want anything to harm the healing that's going on inside. I've told her therapists about this and they've all respected this concept and are waiting patiently for next week to arrive! (april 1st is splinty in the trash day!)

good luck,
francine

[francine]

so one more thing...about the water wings...

well if she were to just go into the pool with a floatie on her back her arms would automatically be at 90 degrees from the floating.... I wouldn't use the water wings at all until the splint goes away....
There's so much more you can do in the water - just the reaching for things, etc.

I heard from a group of therapists last week at the TES course - I asked them a number of questions about aquatic therapy one of them being - why do so many therapists shy away from doing aquatic therapy for upper extremity issues? and they replied - because you can so easily dislocate a child in the water. Surprise! So with that information we've just stuck to arom and prom in the water and just allowing Maia 'to be' - the therapy (rehab) won't start until next week when she's done and then it will still be done with great care until Maia has no more pain - she still has pain in her shoulder.

hope this helps, too,
francine

it's all very complicated and confusing and there's no book that says do this, don't to that, this is good, and this is bad...it's all hunt and peck...very distressing actually.... but that's the nature of it - especially when each child is SO different!

[TNT1999]

I'm sooo confused!! Francine, I think Jodi is talking about after the splint is off totally -- not just on at night only. The instructions I have say "AFTER 16 WEEKS: Strengthening and resistive exercises begin. Continue scar massage. Discontinue wearing splint." Similarly, the instructions Troy got from you (which are pretty much the same, but in a different format and with slightly different wording) say: "Splint wear will be discontinued. Continue therapy with no restrictions. Resistive exercises are now included to begin muscle strengthening. Perform range of motion and resistive exercises at home as instructed by patient's therapist."

I've copied the post-op protocol for all of Nicole's therapists. The plan has been to resume full therapy next week including weight-bearing and other types of resistence. I'm soo confused and will be emailing Dr. Nath too. Sorry Jodi that I can't be of any help here. All I can tell you as far as any longterm restrictions is that Dr. Nath said that the monkey bars will be something Nicole shouldn't do and that we should prevent her from doing them to whatever extent is possible (while he also acknowledged that we won't be there all the time and that there will be times that she will probably be on them). So far, the monkey bars are something Nicole has not tried although she has shown some interest a few times.

BTW, what are water wings?

-Tina

[CW1992]

Hi Tina - Water wings are those little blow-up pillow looking things that go around each arm (between underarm and elbow) - you slip the arm through them and them blow them up so that they help the child float.

[francine]

sorry jodi - Tina's right- I was thinking about the 2nd set of 8 weeks.....didn't realize you are at the end, too.

oh well
-francine

[Jodi]

Yes Bailey is 17 weeks and 2 days past surgery. I also have the protocol that you guys listed. I also copied and gave them to our therapists. Bailey loves the waterwings. She doesn't complain of any pain. She actually gets mad when it is time to take them off. We were under the impression that she could wear them now that we were working on strenthening and with resistive activities. They even let her hang on a bar in the water. She did this on last Wed, and yesterday? We were all thinking that this is OK now. I don't see where there are any procausions in the Protocol or in the therapy prescriptions. I am now so worried and confused.
Thanks Jodi
Please do let me know what you find out from Texas. I do plan on calling Lisa in the Morning.

[francine]

jodi - post splint she is ok to do anything as tina said... but if Dr. Nath said to be careful with certain things .... we only he knows what's inside. Follow your instinct.

sorry I confused you... I really thought you were talking about the 2nd half...

-francine