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Q: An OT writes, “As older children mature in gross motor skills, I find that they want to climb, play on monkey bars and suspend themselves. Is there a time when it is safe for them to do this type of activity, or is the precaution for avoiding shoulder stretch unsupported necessary throughout their lifespan. I would greatly appreciate any feedback on precautions regarding BPI, from infancy on up.
Response First the easy part. There are no comprehensive guidelines published about shoulder safety in the child with a brachial plexus injury. There are a lot of “individual” experiences put out by BPI clinics, but their recommendations vary. At our next professional courses, we will be handing out a questionnaire...that also goes to the therapists in our network, asking for anonymous information about what they do at the various ages and stages. Then a very experienced group, with a variety of backgrounds, will review the information to see what, if any, has any scientific validity. Then we will try to publish it as some “best practice” guidelines. Hopefully this will help with questions such as yours and maybe even spark some research!
But until there are some reviewed guidelines, there are some general statements that are based on the anatomy of the developing shoulder. If the shoulder joint is not in alignment...typically it is internally rotated and adducted.... then the risk of dislocation is real and they should not participate in shoulder strenuous activities.
The operated shoulder is also vulnerable after surgery and you should follow the guidelines of the individual surgeon in the postoperative period. Once they are able to exercise, it will take quite awhile to get the shoulder muscles balanced and strong. Once they are aligned and strong, then reasonable activities should be fine. Note the word “reasonable”. Gymnastics may be fun, but it is unreasonable for growing bodies, with or without a BPI injury. Look at the literature about injuries to the shoulder in young gymnasts or even in Little League pitchers.
Human Shoulders were not designed to support body weight, by hanging off monkey bars or wheelbarrow walking, for prolonged periods of time.
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