Activity Suggestions for Brachial Plexus Toddlers

The brachial plexus is a group of nerves that runs from the spine through the neck, armpit and into the arm. It is essential for controlling muscle movements and receiving sensation to the shoulders, arms and hands. In infants, damage to this nerve bundle is called Erb's Palsy and can occur during a difficult birth. Toddlers may cause injury to this area through falling or roughhousing. Most toddlers will recover with no side effects, though a few activities may help the healing process along.

Symptoms and Treatment

• In infants and toddlers, symptoms may be very pronounced, and present with an arm that is turned into the body and has very little or no movement. The severity of the injury, whether the nerves were pulled, ruptured or torn completely will dictate the type of treatment and amount of movement that will result. Simple stretching and physical therapy may be required, and in some cases surgery may be the only fix. Any type of brachial plexus injury may cause a loss of feeling and difficult or inability to move the shoulder, hands and fingers.

Benefits of Physical Therapy

• Infants and toddlers with brachial plexus injuries will almost always benefit from some physical therapy. Simple exercises can help maintain existing strength and movement and over time, help these aspects improve. Physical therapy is an important step to regaining use of the shoulder, arm or hand and will aid the child in leading a more normal life. Although it is not always possible to completely cure the issue with therapy, it is one step in a multi-faceted treatment plan. Additionally, the therapist can aide in preventing serious damage and malformations that can occur with muscle injuries, including contraction of the joints, which can make recovery more difficult.

Shoulder Exercises

• Shoulder shrugging is one way to build strength and range of motion in the neck. Since most toddlers with brachial plexus injuries will have weakness or difficulty moving, parents may be required to assist in this exercise. To perform the exercise, the child should stand strait and shrug as high as possible. Hold the position for one or two seconds then return to relaxed position. This is one repetition; children should do three sets of 10, two to three times per week.

Hand and Arm Exercises

• Since the brachial plexus runs along the shoulder and through the hands, the effects of damage can be found anywhere along that line. Some simple forearm rotations--pronation and supination--can help maintain and build strength. Toddlers can lie on their back while a parent or physical therapist holds the injured arm. One hand should be on the elbow and one on the wrist. The affected arm should be gently rotated toward and away from the body by the wrist. As strength develops over time, the child should be able to do these himself. Similarly, simple finger activities can help with weak fingers. Assist toddlers in flexing and spreading fingers, make fists and extend them three or four times per day.