United Brachial Plexus Network, Inc.

Hi all,

My 14 month old son has a RBPI. We have been doing physical therapy since he was 3 months old along with frequent visits to an orthopedic surgeon (Dr. Gharbaoui in Houston). Recently his physical therapist has been pushing for casting his UNAFFECTED arm so that he is forced to use his affected arm 24/7 for 2-3 weeks. I believe he called it constrictive therapy and will help with the speed and frequency of using his right arm. It will be a short thumb spike cast so he will still be able to bend at the elbo but will not be able to pick things up with his hand, therefore forcing him to use the affected arm.

I wanted to see if anyone has heard of this or has experience with this. We are waiting to hear back from the surgeon but as you can imagine...the therapist and surgeon don't exactly agree on anything beyond the fact that he needs physical therapy.

Thanks for listening!

Personal opinion here.

I think constraint/constrictive therapy (or whatever current term is desired to be used) serves a purpose here by strongly encouraging injured limb function. That being said, to force a child to do this 24/7 sounds to be a bit much. There are some things that just won't be able to be accomplished with the affected limb. What I've always heard suggested by others (MD's, PT's, parents) has been time-frame constraint therapy where you put something on the unaffected limb to prevent it from being the limb of choice but only for a certain number of hours per day. You can do this by putting zippered pj's on your child and velcro the unaffected limb to the pj's, putting a mitten on the unaffected hand so they can't use their fingers, putting a air splint on the unaffected arm (removeable) so the affected arm needs to be used instead. The theme here is short-term utilization of immobilizing the unaffected arm rather than putting a cast on for a few weeks (or whatever timeframe) and not being able to use the unaffected arm at all for that length of time. Let's face it...we all do this to some extent with our children when we purposely place that toy on the ground nearest their affected limb in hopes they will reach out and grab it. Same thought process here...encouraging injured limb usage.

Tanya in NY
Amber's Mom, ROBPI, 7 years old

Thank you Tanya.
We are currently doing the time-frame constraint therapy by wrapping his hand 3x day for 30 minutes. My first reaction to the casting was "absolutely not!" but with every decision we make, I do as much research as i possibly can to make the best educated decision for Ethan. I feel that it is a little extreme as well but just wanted to see if there was anyone who had done the casting and their experiences.

Hi mom2ethan! My daughter also has a robpi. She had surgery when she was 6 months old for this. We do constrant therepy 2 hours a day/every day! She does very well with this! It is so they can use thier injured arm more. I have seen a vast improvement with my baby since we have been doing this, but we also do electrical stimulation twice a day. Hope this was helpful for you!

Hi!

We also have used constraint therapy in the past, but with a removable cast. Cameron is 2 and we did it when he was about 18 months, after a botox injection. Since the purpose was to strengthen his arm during the botox window, we saw great results, but it was not restrained all day. We did it for a max of 2 waking hours during the day while performing different activities. It really encouraged him to use it more and although he got frustrated at times, he didn't mind it much. During constraint therapy, he learned how to self feed with his left (affected) hand. I never did it when he was really hungry, I think that would have been torture! It was much better for us to have a removable cast since we had aqua therapy once a week. We will probably have a cast made for Cameron again soon.

Hi!
I'm 29 with a ROBPI. I think that for what you are planning to do is downright mean. Some constriction therapy is all right, but your child is learning their limitations. You try putting something like that on your dominant arm and see how you like it.

I was told by someone early on (and believed it) that constraint therapy caused serious mental distress and I went along with that mindset until I spent a lot of time talking to this one mom who took her little one to a "constraint camp" where a group did this together for a couple of weeks (I think the parents did it, too) and the kids got through all the hurdles together and had really good results. This mom recently told me that they were planning on doing it again soon and that her daughter was really looking forward to it! And I can't wait to hear how much more result they will get from this second time around. Her little girl is really excited about it!

I'm sure nobody wants the kids to become traumatized by it.
Attitude and intention is everything

Maybe you can find the posts on here about it ? try searching for "constraint camp"

I think that Tanya made a great point. I was forced to use my robpi arm for many things just so that I would use it.
My mother insisted I do certain ordinary tasks right handed and I still do them. But the thought of anyone restricting my arm 24/7 makes me cringe. I once lost the use of my left arm, due to an auto accident ( drunk driver hit my friends car.) I was about 21 years old and it was a HORROR! I didn't realize, until then, how many things I would never be able to do if I lost the use of my left unaffected arm.

I believe it helps to push the use of the affected arm and even train children to use it (within their person limitations) as much as possible. I felt nagged and pushed as a child and constantly reminded to use my arm/hand but my mom was right.
Our doctors told my parents to MAKE/FORCE me to drink my milk with my right hand and it would eventually work. That time is still a bad memory, I spilled my milk every night. I could never get the glass to my mouth and quite frankly will never be able to do that, due to my injury. Thank goodness my Mom stopped that! She did, however, assign tasks to each hand within my limitations. I was only allowed to use the iron with my right hand. She taught me to hang clothing on the line but had to put the clothes pin on with my right hand and pull the line with right hand only. When I was older she was able to teach me to do these things and insist it only be right handed. My hand was barely functional until after 5 but the strength I have in it is due to that push. I probably would never use my right hand if she had not forced me to do these things and assigned tasks to each hand.
The OBPI child is challenged to do the ordinary, they have a high level of frustration just to preform ordinary tasks. Yet, they must be pushed to use and strengthen their arms to the best of THEIR ABILITY TO COPE WITH THE TASKS BEING ASSIGNED TO THAT ARM.

I have very strong negative feeling about a 24/7 constraint of any kind. It would be torture for me. My PT suggested that parents should restrict their dominate hand function to the exact limitations of their child's for a week or two so that they could fully appreciate the frustration level of their children. He also said they would not last a day. I know of only one mother who took this challenge during Awareness week. Just try not being able to fully function, even if it's just for a day and then see how much constraint therapy you want to use.

We had an O.T. who firmly believes in forced casting. I never liked the idea, and she had to work hard to get me to do this with my little girl. I agree with all the above emotions mentioned. There were one or two times that it did have a great outcome. Even her preschool teachers commented they saw a big difference afterwards. I think I removed it once because I thought it was impairing her circulation and another time because it just pissed her off so much, and me as well. We worked so hard, so long, to get her to see both her arms as a team, and then 'split up' the team and just enraged her. I couldn't see ever doing this again, unless she was older and consented to it. We did achieve noticeable physical progress, but it was emotionally difficult for her and myself.

You know your child the best, and your child will keep changing in many ways. If you do try it and you use the same kind of cast we used, it can be unwrapped at any time by yourself... An urge I fought every second it was on her.

My daughter has come a long way, but NOTHING about this whole injury has been easy! It really sucks.
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