United Brachial Plexus Network, Inc.

O.K. we've dealth with this for so long maybe I should know but I'm not sure so I'm asking if anyone else knows.... My daughter asked me tonight, "what happens to the nerve that is in the arm if it is avulsed, does it shrink up and go away or does the body reject it or what"? The question that it brought to my mind was about e-stim....I have no experience with it so I don't know how it really works but it seems like if the nerve does shrink and kind of atrophe away to nothingness then the e-stim wouldn't really work on that nerve after awhile right??? I guess that's 2 questions...does anyone know?
T.

well the way I understand it is that if there is any kind of nerve injury, the nerve dies back to the source and has to regrow.

About the e-stim - from what I understand, the estim (regular NMES) stimulates the muscles by making them contract- keeping them alive until they get fully re-innervated? I know that TES doesn't contract muscles but just brings increased blood flow (and hormones) to the muscles and in order for TES to work, the muscles have to be innervated and not completely atrophied.

So other than feed the nerves blood, I don't think e-stim does anything for the nerves, just the muscles...but I might be wrong. I hope someone else who knows more about this posts...

-francine

Hmmmm I wonder if my muscle is there but does not function could TES work??? increased blood flow and hormones sounds like it might keep the muscles from complete atrophy... Just wondering if this would work on old injuries... really old injuries.... LOL
Kath

A nerve that is avulsed dies. It is disconnected from its root at the spinal cord so the cell body of that nerve is dead. That is why you cannot graft to an avulsed nerve. The nerve dies from tip up to its point of breakage. If the point of breakage is at the spinal cord, then the cell body is destroyed and nothing can be done to salvage the nerve. In a rupture, the nerve is severed at some point away from the spinal cord, therefore it still has live portions from the spinal cord (the cell body),up to the point of breakage. However, any nerve past the breakage point to the muscle it innervates dies. The cell body at the spinal cord is alive in a stretched and ruptured nerve and therefore can be salvaged. The axon (nerve) is covered by a myelin sheath which carries nerve impulses from the brain. In the connective tissue surrounding the axon (nerve), are Schwann cells that provide nourishment to the nerve. Once injured, Schwann cells are killed which hence cuts off nourishment of the nerve axon and thus results the death of the myelin sheath and in nerve death as well. When injured, nerve portions still alive at the point of injury, start new sprouts of axon in attempts to heal itself. At the same time, fibroblasts start making collagen in the connective tissue surrounding the axon, forming scar tissue. If the connective tissue develops faster than the sprouts trying to grow, then the collagen squahes them out(killing the new growth)and results in a neuroma. These neuromas are dense bodies of collagen and cannot conduct electric impulses. Therefore, a stretched nerve is unable to get signals to the muscle it innervates to tell it to move. Without innervation, muscle bundles start to diminish. As the muscle bundles become smaller and fewer in number, and the connective tissue between the bundles increases, muscles shrink and scar tissue increases. After 12-18 months from date of injury, innervation cannot restore function. If innervation is restored, you are left with many less muscle bundles to perform the function of the muscle. That is why strengthening and bulking the muscle bundles left is so important. This is where TES(e-stim) comes in. Remember, to be effective you have to have active innervation to the muscle. TES therapy causes growth hormone emitted during sleep to migrate to the muscle that is being stimulated by low amplitude electrical impulses. This causes an increase in size of the muscle, muscle bulk. We have seen trmendous effects of TES therapy on our daughter. Her bicep on the affected side is now larger than her unaffected side. However, she has no strenghth in this muscle. That is why we are working so hard at strengthening her muscles in her affected arm. Unfortunately, the only way to do this is by repetitions. She pulls on rubber cords and ribbons for resistance exercises as well as pulling on putties of varying stiffness. In addition, we have integrated forced use therapy into her program. As cruel as your son may think this sounds, he needs to understand the context in which a lot of us parents use this "therapy". If I can just get her to eat say ten minutes a day a special treat with lefty while righty is restrained, do you know how many reps that is? Just that simple of an exercise can give her bicep better strength. We are not cruel with it. We know that she has the ability to do it, she just has to work at it. When I broke my ankle, my leg was jello from the knee down. My bone was healed, so I could weight bare on it and use it. Think I wanted to after carrying that leg with a crutch for 6 weeks? No. It was easier to just drag it around limp than to make my muscles work. I HAD to MAKE myself learn to use it again. Body builders have to alternate sides they lift weights on to increase bulk. If they did it on one side only they would look silly. So please help him understand that some of these kids DO have function, they just need to work on making the muscles stronger so that there arms do work better. For young kids, restraining that arm a lot of times is the best way to get single sided repetitions out of them. Our daughter is 3 1/2. When she is 6, I'm sure I can tell her to do the reps alone without righties help, but until then, if I take righty out of the picture, she is willing to use lefty. She doesn't get mad. She doesn't go around all day with her right arm tied down. She only does it for specific activities for a limited time. And then righty gets turns by himself too. Sorry so long, just trying to better explain my point of view.
Kelli

that was very very informative- thankyou
Has anyone talked about the benefits of large amounts of EFA oils ? When Max was first born I took H U G E amounts of these I was advised to by a doctor who does eastern medicine- and I think this may have largely affected the growth of the nerves as opposed to the growth of the scar tissue-(well I was nursing Max exclusively for...many many months so he got what I ingested)-
mmm
I did the same thing as you Kelli regarding restraint with Max- altho restraint is a harsh word ...maybe...I'll just say it the long way because it sounds nicer- I made him use the one he would not have chosen to use by making it more difficult to use the one he would have chosen to use- we started when he was an infant by holding him on the left hip and thereby corniering his right arm in the back so to manipulate or reach anything he was required to use his left(injured)- we continued to do this in unaggressive ways as a part of everyday life- still do- altho now he can do it on cue-" Max use your left hand please" will result in him using his left hand- unless ofcourse he doesnt want to -in which case we just do it and some other time in the day-

Wow Kelli - that was a great post!! It's a saver!
-francine

I think marymom has a point... about the terms....

The word restraint really sound harsh...

Kelli I think the term ENCOURAGEMENT therapy sounds better...LOL... even though it is the same thing...

As an adult obpi I know that this type of therapy was used on me without holding my arm down...just preventing me from using it... It was frustrating but I am sure they felt it was necessary.

I still do not use my arm unless I remind myself to!! Each of my arms have assigned tasks because that is what I was forced to do. But most times I am not even aware of my arm nor do I think to use it.

I worry about Frustration because it is the constant companion of the obpi child/adult. Attempting to do things requires those of us who are obpi to face constant challenges... nothing comes easy... everything must be attempted several times before we can do what is ordinary to others...


I wonder if this type of therapy could help re -training the brain so that we remember we have another hand and arm...
Will it help establish body boundary?
If not... now matter how a child is forced to use their hands they will only use it when reminded.... It will not come naturally.

Thanks for all the information. This is an important topic for all concerned. Because I can understand some of the reasons why my parents forced me to use my arm... and appreciate the fact that they did what they thought was best. I was so tired of hearing can't means you won't and just try!...LOL...

By the way obpi cannot use crutches nor a walker..if they can't weight bear...
I broke my foot and had three small kids...... I was up and around so fast I hated being held back...LOL...
The doctors kept telling me to use the walker! he did not understand that it was more painful to try to weight bear on the arm then walk on the foot.... He really did think that I should be able to use a walker some how did not get it that I could not put the crutch in my arm pit either... He kept insisting I stay off the foot...and try harder to manage to weight bear..... but that was impossible...
Kath