United Brachial Plexus Network, Inc.

Does anyone know how the specialists decide if a brachial plexus injury is mild, moderate, or severe?
Does it depend on the movement the child can accomplish at a given time? For example if my child could not do the hand to mouth or supinate at one year old, but could do that by two - would her injury severity go from a severe injury to a mild/moderate? I'm guessing it must change as they grow but I'm not sure. I'd appreciate any input please - it has been on my mind lately and I am curious. Thank you, Christy

My guess to how they determine the different levels comes from what damage has been done to the nerves. Which can only be truly be discovered through surgery. I had thought that since Ian hasn't had surgery yet that maybe his injury is less severe (meaning moderate to mild) but it is looking as if it will be permanent (long lasting effects). None of my actualy BPI Specailists have used any level to term him at. I have heard of docs saying severe for other kids. Depending on what your daughters orginal injury looked like you could say "my child's injury was serve." Good question!
Another,
Kristie

This would be my guess of course but here it is...

I think mild might be a child who has had spontaneous recovery. Because sometimes even if they have spontaneous recovery there might some issues later on that may crop up. This would be a simple stretch injury where the sheath is stretched and not the nerves inside.

I think that moderate might be someone who has a more severe stretch injury - where the sheath and the nerves are stretched. This child will not need primary surgery as their movements will be coming in - however delayed. But later on in life, other issues, contractures and imbalances may still be apparent and they may need some type of secondary surgery down the road.

I think that the child who is noted as having a "permanent and severe" injury is a child whose nerves were ruptured or avulsed. In either case, there will be the need for surgical repair in order to try and regain any degree of "functional" movement.

sounds logical to me...I hope others add to the pile...
-francine

I agree with Francine's explanation. When our son was 4 months old, Dr Waters used the same terminology.
Justin fell into the moderate or middle category. He had started to bend his arm to his chest at 4 months. He was not recommended for primary surgery. Now he is 21/2 and will be having surgery the end of the month.
Melissa

What about kids who don't necessarily have nerve damage but still require secondary surgery? Is that moderate or severe?

Hi All

Just thought I would jump in.

I feel the worst injury is the one you live with day to day no matter how others may have progressed or you have progressed it is the injury you live with that really effects your lives -------

I talked about this subject with a friend this week again who is a Bradley Birthing instructor... I was amazed at her response and wondered about the way she felt.
She said "if a child does not get 100% use of their arm in her eyes it is severe." When I questioned her she said that she felt that any injury that deprives you of the full normal use of your arm and the ability to preform all of the ordinary tasks that it should do is SEVERE...

I found her answer very interesting. Since I only know I was paralyzed totally at first and did not gain movement for a very long time. In photos my arm just hung there and when I walked I lead with my shoulder. My parents were told the nerve was severed and that the brace I wore would help it to grow back and knit together.. stop laughing it was 1940..LOL..

It took years before I could reach high enough to touch my face and then only elbow out and I can't supinate nor can I feed my self right handed... would a doctor term that mild? Only if he did not have the same injury. All bpi children are injured and all are now or will become dependent on one hand and that hand will be overworked so I don't think now that any injury is mild unless the child gains the ability to feed themselves and to supinate and to use their arm almost exactly the same as the unaffected arm. This injury effects the entire body not just our arms. While one arm is the focus the other arm will get involved later on and become overused. Our ego is effected and so is the entire family. Would I have been a poor speller probably not-- but now I know that the other obpi (right like me are, so it is something I can now blame on obpi)

I found most of my life doctors who really did not know anything about Erb's told me I must have had a mild injury because I hide it so well and functioned at such a high level... but they really never checked my arm for rom or even touched it -- just commented on it and then when I began to ask how many others they had seen with this injury the answer was always the same NONE... They never noticed that I had Horner's nore did they ever check to see how my arm functioned.

So now I think now my friend was right... with out 100% recovery no injury is mild. She won this one!!!!!... But I won the one on the fact that this is a preventable birth injury!!!! Now all the information from Awareness and Injurednewborn site will now be given to her students to ask their doctors about... Win some and loose some...

just my thought on this and I think Francine you did a great job with the different degrees of this injury.. I like the way you described it.
Now was that enough on the pile... LOL...

We go to Gillette's in St. Paul, Minnesota and they gave us a handout on our first visit. They rate it in degrees, like burns. Here goes:

First degree-Injury shows no physical disruption of the nerve. The nerve is temporarily "bruised" and usually recovers within a few days to a few weeks.

Second degree-Injury to the fascicles within the nerve, but the larger nerve tube is not disrupted. The fascicles extending from the brain need to regrow down the nerve tubes to restore function. Return of nerves is usually nearly complete, but requires time (three to six months).

Third degree-Injury to the fascicles within the nerve, as well as their individual casings. The fascicles extending from the brain need to re-grow down the nerve tubes but may show some incomplete return of nerve function. This may be due to scarring or mix-up of the nerve fascicles as they re-grow.

Fourth degree-Injury to all contents of the nerve, except that the larger outer nerve tubing has not been disrupted. The fascicles extending from the brain nee to re-grow down the nerve tube, but have little guidance for direction of growth. Significant impairment of nerve function is observed, and surgery is usually recommended.

Fifth degree-Complete disruption of the nerve. No return of function is seen without nerve surgery.

They consider avulsion to be beyond fifth degree. Hope this helps! Jen

Hi I have a question for LOL. You said your friend is a Bradley Birth Instructor? I am curious what Dr. Bradley's thoughts are on obstetrical brachial plexus injuries. I chose the Bradley method for my births. I know they have strong beliefs around cesareans, and I'm interested to know their {Bradley Method Folks} thoughts on this subject. Thanks-Pam

Totally opposed to it!!! and I am sure you know this...

My friend is my daughters birthing coach... I am obpi and my daughter who like me is a small woman has huge babies... her last was 9lb. 9oz. ...this year....

We have had many long talks on this subject... She would never choose a C Section....

I tell her she is not obpi and does not know the full impact on a person life...

She admitted she is a birthing coach and she was in that position with a baby over 10 lbs... and knew what to do....

The average woman does not!!! It is up to the expert she hires to deliver the baby safely. Most people have never heard of Erb's Palsy or OBPI until it impacts their life... so they do not properly question their doctors as to the methods of delivery...

I am OBPI and asked when I was having babies if this could happen... the doctor said NO.. well my first was SD and he knew what to do...!!! he fractured my tail bone to deliver her safely.... I did not have any red flags... I was underweight... small... gained only 13 lbs... and had an 8lb 3oz baby...she was my smallest...

my point is that when you put your self in the hands of a Dr. he should know off the top of his head all he would do should the baby present with SD....

My daughters OB when questioned told her all the options right off the top of his head... he did not have to look it up in a book......and she did not even have a stitch... so it can be done...

My friend agreed to talk about it and have her students informed consumers.. not to advise them to have C-Sections...
that is still on my talking points...

When I said LOL... It was because in the 1940's and up until the 1960's it was believed and taught that nerves do not grow... so when my Drs. told this to my mother everyone laughed and said impossible...

Hope this helps since it is the method you use... I feel it was great for my daughter and she has had three very large babies.. none under 9 lbs... but should she ever be in the position where they suspect the baby will be over 10lbs... you bet your life I will be pushing her to have a C-Section... and praying she listens to me....

Kath

Thank you all for taking the time to reply to my question. I've heard others refer to the severity of their child's injuries and I've referred to mine as having a moderate injury only because that is what she is described as having most recently. At birth the doctors just said she has "Erb's .." Fran's descriptions made since - but I guess I would think that a child with some movement (even if not completely functional yet)would not be classified as 'permanent and severe' but only those with no movement at all (total avulsion)?? would be in that category. I think there should be a category between moderate and severe maybe - just a thought. JenH - I had never heard them listed as degrees before. That's interesting. Kristie - I think it does make since to just say what injury your child started with - and then say but "now has a mod ..." Another good point made was that just because an injury is mild, mod, ... - the injury still is severe if it affects normal life - - I guess the ratings come in to describe how 'badly' these normal life tasks are affected BUT that seems to change with time too. Thanks again for your help. Love, Christy