With growth and development the child with an early acquired neurologic injury
develops bone, joint and muscle distortions caused by an imbalance between stronger
and weaker muscles. Teenagers going through puberty have an opportunity to improve
their situation dramatically.
Richard has a mild to moderate right sided Brachial Plexus Injury. He did not
have any primary or secondary surgeries. His parents actively follows through
with all his prescribed therapies. At 12 years of age, he presents with bi-lateral
winging scapula, as seen in the first photograph.
A winging scapula is very common with children with Brachial Plexus Injury
due to an imbalance between the stronger anterior rotator cuff muscles and the
weaker posterior rotator cuff muscles. The “good” shoulder frequently
also develops a winging scapula. In this case, it is not due to the primary
neurologic lesion but rather overuse and overwork of the normal shoulder. Many
people persist in prescribing crab walking, wheelbarrow walking or gymnastics
to children with Brachial Plexus Injury as part of their rehabilitation. These
techniques were thought to improve weight bearing and thus growth in the shoulder.
Unfortunately, humans were not meant to walk or bear significant amounts of
weight through their shoulders and bi-lateral winging scapula is the result.
Richard was treated with a combination of bracing and Threshold Electrical
Stimulation (TES). The bracing helped reduce the overstretched muscles while
they were treated with Threshold Electrical Stimulation (TES) at night during
sleep. In the daytime, still in the bi-lateral shoulder brace, he participated
in a graduated shoulder exercise program. The results after one year are demonstrated
in the second photograph. It is clear that not only has new muscle grown and
developed, Richard can also activate it and maintain both scapula in a good
anatomical alignment. The residual of the right Brachial Plexus region is still
obvious in that his scapula on the right is still smaller than the scapula on
the left. Vanda, Richard’s mother, has written her story of the change
that occurred in Richard over the first year as part of the TASC Network.
A Mother’s Story read more...
For more Information on Threshold Electrical Stimulation (TES) (click here)
Important Notice:
The TASC Network is an information only site. Individual medical advice is
not given. If you have questions that relate to your personal situation or your
child's care, please print the article and take it to your health care professional
with your questions.
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