United Brachial Plexus Network, Inc.

We have had Nicole achieving a protective extensor reflex on the left (injured) side as an objective with the school. They just sent me a progress report on her goals and objectives indicating that she has mastered that skill (which I am questioning). Anyway, I was thinking, is that ever really mastered? If the PT stops working on that, will it cause regression and will her ability to use it go away or decrease? Is that something that we will always have to work on or is there ever a time when it automatically just kicks in? Although Nicole has the physical ability of using a protective reflex on the left side and will probably do it during therapy (b/c she knows that she's supposed to do that), it doesn't mean that she will do it automatically when she falls (which I've seen and she doesn't). I was thinking that this is an objective that might have to always be considered "ongoing" and not really ever "mastered." I'd appreciate any feedback esp. from older children or adults. Thanks. ~Tina

Tina
I don't know if the instinct to protect can be taught in therapy. I still forget I have an arm unless I remind myself. I have to make myself use my arm except in the cases where I have assigned tasks for my robpi arm, hand. My mother forced me to do certain tasks with my right hand (one's I could accomplish) or I would never have used my arm. I wonder if the protective reflex would work the same as assigned tasks worked for me... that would be great if it would.

It was called to my attention recently I give one handed hugs. I can hug with both arms but just don't. I did not realize it until my niece (40 something) was giving me a hug and said " come on Aunt give me one of those great one handed hugs of your". I was totally unaware and she meant it kindly not mocking... but I was shocked and began to notice.
But my instinct to hug with both arms is not there now that I am paying attention.
I hope it can be taught. I don't have it and do not reach out to protect myself.

Kath

Hi Tina!
I do not think that Brittney has ever gotten the 'protective reflex' back, but that doesn't mean that Nicole won't! Brittney plays soccer and when she gets slide tackled, or trips - SPLAT! same as outside with friends and she falls. She has always fallen, fallen hard - and it has become a family funny because we hear her say "I'm OK!" and we all know that she must have fallen again or ran in to something. I believe it has so much to do with balance and instinct. I know that Brittney lacks balance, and her instinct maybe is also in there telling her to protect her left side - and that is where she falls the hardest because without the balance... That's our experience - Hopefully Nicole will have better balance.

I agree with you that it is an ongoing thing - never completely mastered. I do not know how you feel about trampolines - but I think that has helped Brittney gain better balance because she has to focus on her balance - strengthens up all sorts of muscles...
I will email you!
Christy

Can you explain more how a protective reflex would work for an obpi? I know that I avoid falling on my affected side, is this it? Of course what that means is that I usually hurt the unaffected arm, and even broke that hand once when I fell a few years ago. I'm not sure this is the best protection and I wonder how it would be best for us to fall, to be honest!

Now that snow and ice season is upon us, it is probably something to consider, esp. for us older bpi'ers.

Nancy

Nancy:
The protective response that the therapists look for is what happens to a baby when you roll them on their tummy on a ball. When you roll them towards the floor, they should put their hands out.

For moderate to slightly injured bpi's this makes sense to teach. I never quite understood why we worked on it for Juliana, who really doesn't have the strength to help herself out even if she could put that hand out in time.

Non injured people have this response, it is why we break our wrists in the snow and ice!!! The injury takes away not only the ability to do this, but also the automatic response to danger--that is, to protect the head.

Juliana, being the trained seal that she is, can do this if you roll her on a ball. If she falls down, she will just go down!

So, Tina, perhaps that is your argument. Just because a child who has had therapy her whole life can do what a therapist wants her to do, doesn't mean she has "mastered" that skill in the real world. Could Nicole, if she even got that arm out, really protect herself with it???

There are a few "therapy goals" that I never really understood for our kids. It is like they are on a list of some sort and we are all supposed to just check them off.

As for the snow and ice...we just salt and salt and salt!!!!

claudia

If Nicole were to fall forward and use both arms to break her fall, then I think there would be enough strength to break her fall (b/c it would be a combination of the strength of both arms). If she were to fall to the left side and use just her left arm to break her fall, then I don't think she would have the strength to support herself. Actually, if she broke a fall with just her left arm, she might end up injuring her left arm more than whatever else would've hit the ground instead (now that I think about it). I don't think we have to worry about that though b/c the chances of her breaking a real fall with just the left hand is pretty small.

I guess I was just trying to figure out a few things: does it help to work on this in therapy (meaning if it's worked on enough in therapy, will it actually help in a real life situation)? if it does help, then is it something that you "use or lose" meaning that if you stop working on it in therapy, are you back to where you were before you worked on it?

Another thing is, although therapists can work on this during therapy and can determine the success rate (% of trials that they appropriately use the protective reflex), how can we ever check the success rate spontaneously? The only way I can think is to intentionally try to knock your child down when they're working on something else and not expecting it and sitting in a safe place where they either won't get hurt if they fall or where you can catch them before they do fall. I don't know, this is an odd one to me.

~Tina

Nancy, that is interesting to hear. I never would've thought that Nicole might try to avoid falling on her injured side and instead try to fall on the other side. That would be a problem too b/c what if she were to break her right (non-BPI) arm / hand?? I would have one very frustrated child on my hands!

~Tina

Some things that I remember Brittney doing in therapy really made no sense! She jumped in sponges - never understood that one.... I feel a reflex is a reflex and no matter how much you try to work on it - when the time comes - you either have it or you don't from birth - things happen fast and your brain takes over no matter how much you practice falling.

Please don't knock Nicole down to test her!:) (teasing - I know you wouldn't) - but I do understand exactly what you are saying - and even after 'mastering' a skill for a while - I would think that your normal reflexes along with your abilities (what side could catch your fall - and your brain quickly telling you this) would kick back in - which would be the uninjured side because it is a split second - no time to think about how you want to fall - just how to protect yourself the most - and the uninjured side would be stronger.

I think that time in therapy working on balance though makes sense - so that the fall is less likely to happen.
Christy

Hi Nancy & all,
I am an expert in falling, tho lucky not to break anything...yet! I'm LOBPI and that right(good)arm goes out front to break the fall every time. My knees legs & shins have a patch-work of multiple scars but if I had known about that medoderm ? lotion earlier I know the scars wouldn't have been so permemant. It's funny but before UBPN Boards I always attributed falling to the shoes I was wearing!!
How are you enjoying the South,Nancy?
Carolyn J(adult LOBPI)

We also worked on this with Hannah in therapy when she was little. She is now 3. We don't work on this anymore. When we were working on it she was definetly slower on her injured side to get that arm out in front of her. Now when she falls both arms go out at the same time. Sometimes, though the injured side does collapse under her. I hope this helps a little bit.

Lisa