Restraint Therapy

[Julie]

Has anyone used restraint therapy with their OBPI child? Our PT just recommended it and I have heard of it before but I wasn't sure if it is useful with this type of injury. It involves "restraining" the unaffected arm to force the child to use the affected arm. It seems extremely cruel to me but if it works I would try it. If anyone has any experience with it could you tell me how you "restrained" the unaffected arm, how much use of the affected arm your child had when you tried it, and for how long of a period of time did you do it. I did a little research on this type of therapy and I saw it mentioned in use with stroke victims. I'm just not sure if it would benefit OBPI children since they have nerve damage. My daughter is sometimes trying to do things with her affected arm first but then the other arm does take over. I'm just not sure if she can use her arm enough for it not to frustrate her too much to restrain the unaffected arm. Any input would be greatly appreciated.

[Kristie]

We have used this in several ways. Sometimes we hold his unaffected arm down or position him so he can't use it. The best way we found was to place his unaffected arm inside his shirt. I either pin down the sleeve or knot it if it is long enough. Ian does get frustrated but I only do it for short period of time when I can stay and play with him. This is also helpful because then I can show him how to use his arm. I think it is effective since it encourages use... but I think that you need to see your child using it some before trying this. Like you mentioned your daugther does use her arm but the other takes over. So any way I would say to give it a try a few times a day and see what she does. How old is your daughter? Ian is almost 1 and we have done this off and on since he was a few months old.
Kristie

[Julie]

Kristie,

My daughter just turned one on January 12. She had a severe right brachial plexus injury (2 avulsions, a rupture, and a stretch) so she has not had much use of her arm until recently. she is scheduled for the mod quad on 2/26 because TCH was pleased with her progress from the primary surgery.

[francine]

Julie - we did look in to serial casting as it was recommended by Maia's therapist - but we discussed it further and found that many doctors believe that it causes emotional issues- they get angry and frustrated and it can backfire. There was one parent a while back whose child broke the unaffected arm and they had no choice and it worked well for the child.

We try passive restraining.... I might hold Maia's unaffected hand while I get her to do something with her other hand - hold it in a nice way though - have her play with my fingers or something.

OR she will bring an animal (stuffed) friend with her to therapy and she holds him with her unaffected arm so that her bpi arm can do therapy...

OR we just find a task that will occupy the unaffected arm while the other one is asked to do something else.

good luck,

-francine

[Kathleen]

OHHHH my.... MY>>>>>MY>>>>>>

I can't even imagine this!!! I have never posted this before and swore I never would....

But I always had issues with anyone holding my hands or preventing me from using my unaffected arm.....

I think we have enough frustration to start with.... wanting to use our arms and they don't take direction from the brain.... Now someone holding down or restraining the unaffected arm...... YIKES>>>>YIKES>>>

OK... I just had to express my true feeling on this one.... right or wrong.... unless you have felt the frustrations of someone unable to use both arms it might be hard to understand how frightening and frustrating not being able to use the healthy arm would be..... ugh....
just my humble opinion.... and I am 62 right obpi....

I think obpi children have enough frustration between PT/OT.... ROM.... now the healthy arm restricted....
ok my stomach is upset that a doctor would suggest it..... Encourageing the use of the bpi arm is one thing.... preventing the use of the unaffected sounds like tourture.... just my honest... from the gut opinion... and I could be wrong... but glad my Mom did not do it....it was bad enough being nagged to death to use my arm....

Ok jumping off the high soap box... sorry but this one shocked me.
Kath

[admin]

Hi Julie,
I know that this type of restraint therapy is most commonly found in stroke and cerebral palsy patients. I am not sure if it is known to be used for BPI children or adults. Since stroke and cerebral palsy are much much different than a BPI I would ask for several different opinions on this therapy and not jump into it too quickly. Hope everything works out for you.
Krista

[blakesmom]

My husband used to hold Blake's unaffected arm down by using his primary splint upside down, thus holding the arm down, but letting the hand free. He wiggled until he could use his hand for anything and I don't think it made him use bpi arm more, just frustrated him and me both. I can't tell you how mad I was at my husband for doing that to my baby...I know he was just trying to help, but it scared Blake.

[TNT1999]

I have heard of using restraint therapy / serial casting. I have tried it for very brief intervals by using a Pedi-Wrap (a splint type device that wraps around the arm and is secured with velcro and has a bar inside it to keep the arm straight) on Nicole's right (non-BP) arm. It doesn't totally restrict use of her arm, but greatly reduces the function in it. However, we never kept it on for too long as Nicole would get frustrated. I suppose in cases where the uninjured arm gets broken, then you would have no choice. I'm sure that you would see some benefits out of it. It's still early to tell, but I wonder if your daughter's injured arm is her dominant arm and that's why she tries to use it initially. I would think that if she's already initiating trying to use her BP arm before using her other arm that this wouldn't be the ideal type of therapy for her (but would be more ideal for children who "forget" to use the injured arm unless they're "reminded"). I personally couldn't do this for Nicole (but I'm not judging those who have done it). My heart just couldn't take that (as some parents' hearts can't take doing surgery). I think that the present level of function also plays a big role in the decision of whether or not to try restraint therapy. If the nerves are working and the function is there, but the child just needs to re-think how to do things, then it might be effective w/o being too frustrating. However, if the function is just not there, I couldn't see frustrating my child like that. JMHO. Hope this helps. -Tina

[CW1992]

Hi. I agree with Kathleen completely and who better to get an opinion from than an older OBPI who knows! Therapists suggested we try restraining too but I didn't try it because I didn't think my child would understand why I would do that to her - seemed mean and I know it would have scared her and frustrated her because she already tried so hard on her own. I tried to get her to use her injured arm by having her hands take turns constantly. Eating cheerios, building blocks, holding objects, playing with anything - her left arm got equal time even though it might not be able to get the food to the mouth or whatever her left hand got a chance to try. Then her right - then her left. Of course everything we did took twice as long but she learned to share at a very early age:) It was so much of habit for me to say "give your left arm a turn now" and "don't forget to give your left arm a try" Gees I got some weird looks from strangers when they'd over hear me telling my baby "Your right arm is not sharing very well - let your left arm try too!" Good luck to you!

[Stephanie B]

We used a form of this therapy with our son Grant. He had decent range at the time and did not need the primary surgery, but was reluctant to use his bpi arm...so during some meal times we would use a towel and an ace bandage to make an imobilizer so that he could not bend his unaffected arm. This encouraged him to eat with his bpi arm. If he ever became frusterated and upset we discontinued until another time. We found it to be a positive way to encourage him to use his left arm. But, as I said he already had pretty good range to begin with.