On examination, Mrs. V was walking with an antalgic gait, using a walker (two weeks previously, she did not need the walker).  Upon further examination, she had full pain free range of motion of the lumbar spine.  Hip range was 110 degrees of flexion, ½ range internal rotation and external rotation slightly limited.  Muscle strength was within normal limits except flexion, which was weak and painful.  There were active trigger points in adductors, psoas and gluteus medius.  Reflexes and SLR were within normal limits.  My diagnosis at that time was muscle strain.  Goals for the first treatment were to reduce hip pain, restore function and clarify diagnosis re: hip flexion weakness.  Treatment was acupuncture for general pain relief as well as dry needling to release the trigger points in the affected muscles.  Following treatment, there was improved range of motion and decreased pain.  Gentle ROM exercises were taught to the patient.  On follow up visit, Mrs. V reported 1 – 2 days relief following the treatment then her pain returned – to the same severity as prior to the treatment.  This was a red flag – when pain returns so quickly – further investigation is required.  I contacted the doctor and requested further x-rays.  A fracture was found and Mrs. V was admitted to the hospital for surgery.  Following surgery, Mrs. V went home and went through standard post op therapy.  She made an excellent recovery and continued to life happily and independently in her own apartment for many more years.

Janet Delorme

*For more information on dry needling, visit www.neseminars.com

We met with Dr. Chantal Janelle and an OT Nathalie. We had our first visit last Thursday. On our first visit there was a lot of observation and talk about steps and diagnosis for Spencer; nothing concrete about what to do other than a stretch and follow up OT appointment on the Tuesday. We were given a stretch to work on some external rotation. It’s called the Chicken Wing stretch. We pull the arm down tight to the side of the body and then stretch at the elbow in a chicken wing position. He will have to do this stretch for the rest of his life. He hated it at first, until I found a way to distract him while I did the stretch. This is pretty difficult with an active 9 month old. Although most parents are excited about their child walking and they do everything they can to encourage walking, it was suggested that in order to strengthen the shoulder and rotation of the shoulder that I should try and delay the walking and encourage more crawling. Spencer crawls very fast. Sometimes he uses the combat crawl and other times he pushes up on the arm like ‘normal’ crawling. Obviously this is the ideal crawl but any crawl that encourages the shoulder rotation is being encouraged.

We followed up with the OT appointment after 5 days of stretching. Nathalie was pleased to see some relaxing of the muscles—they were not as tight—and she was encouraged by this result. She then did the Toronto Active Movement Scale. Spencer scored 2.5 on the scale; therefore he failed the test. This means that he will more likely require surgery—either exploratory or possibly grafting. This will be decided in the coming months after consultation with Dr. Janelle. Nathalie then showed us two more stretches to encourage movement. The first is to encourage proper movement among the scapula. We hold down the muscle under the arm and stretch like the chicken wing and then up into a 45 degree angle. This is done while Spencer is sitting on my knee. The other stretch is to encourage the wrist rotation. We have to hold on to the two bones and then rotate in and out without overstretching the wrists.

We have a follow up OT appointment on Friday. Spencer will be getting fitted for a Splint to encourage the fingers to stretch out. It’s been hard today as Spencer is moving forward with wanting to stand up. The poor little guy has nothing but bruises all over his face from falling. Not only this but he’s got a bad rash going on, I will have to pull out the cornstarch for this.

Overall, while the decision to move back to Canada has come with mixed emotions I am pleased with our decision to make the move. I loved our life in Shanghai and I don’t regret any of it; however I love being back home. I have enjoyed all the delicious food that I have missed while overseas. We are subletting from someone who is travelling for the summer and she left us a patio garden to use as we please, so tomatoes, lettuce, squash, beets, green beans and cucumbers have been growing on the balcony.

Pictures will follow our appointment on Friday.

Prior to meeting Peter he had done a lot of work with children with disabilities. He had also worked with adults in a palliative care situation. I’ve worked with children and youth who are socially, emotionally and behaviourally challenged. So we both know how to advocate for Spencer to get his needs met. It’s not to say that parents of disabled or challenged children are not advocates in their own right, however; we were doing it before it entered into our own back yard.

This can have a negative effect with other professionals. We are those annoying parents who research everything, ask millions of questions and challenge professionals in their opinions. I know what it’s like to be on the receiving end of those questions and challenges.

Spencer is also lucky that I am now working in an ECE setting. I have a huge repertoire of action songs that I use with him. This will benefit him with his PT–as we will do action songs that help build the strength of his little arm without using the ‘exercise’ word. Also, because I work in the education field I have worked with many professionals including OT’s, so I know a little bit about what he needs to work on some of the fine motor skill development and other sensory related activities.

Spencer has another huge advocate in his corner who is highly educated and understands a lot about the biology and science behind his injury and challenges us to ask the questions of the professionals. Peter and I are not hard scientists, we’re social scientist. His biggest advocate, beside his mama and baba, is his NaiNai-which is chinese for grandma. She challenges his parents who challenge the doctors.

So for all the trauma and tears there is a silver lining in Spencer’s birth injury.

The little movements started when he was two weeks old. He started with the gripping. When we placed our finger in his right hand there were signs of tightening. Shortly after we noticed the strength in his grip we started to noticed his shoulder move when he squirmed. Everyday we continued to massage and move Spencer’s right arm and everyday we started to notice muscle definition. Then he started to raise his arm-straight at first and then he started to bend. His wrist continued to be limp so we focused in on building the muscled and strength in this area. In the past couple of days we’ve noticed strength and movement return to this area. As stated above today we noticed finger relaxing and curling.

Yesterday we went to the doctor for the 4 month check-up and needles. During the check-up we had the pediatrician do a thorough exam. We asked to check for muscle loss/compensation and signs of “winging” as well as what his thoughts were on Spencer’s chance of full recovery. According to the doctor there is no muscle loss or muscle compensation. Spencer is using his muscles correctly as he gains control through nerve rejuvenation. He checked over the shoulder blades and said that the muscles were working correctly in that area so that winging would probably not occur. He said that with the showing of recovery at this stage that we need to continue to wait to see if he’s going to have full to almost full range of motion. I am hopeful and thinking positively about it and I hope that with these positive thoughts and support from my communities that Spencer will make that recovery I so desire. Today’s little movement gives me so much hope.

Through our research we discovered that Spencer can make a full recovery if certain signs are there and with early intervention. We would have to be diligent about exercises and massaging his right arm. I searched high and low for information about Range of Motion exercises. I was only able to find one instructional pamphlet for infants and a few videos aimed at older children. I read over the pamphlet and searched on massage techniques for infants. I felt confident in my ability to get started on the healing process.

In the first week of Spencer being home we started to notice a gripping grasp in his right hand. If we placed our finger in his right hand he would tighten his grip. Albeit, it wasn’t noticeable to the naked eye, we could feel the slight tightening. We continued to massage and do ROM exercises throughout the day. Every day we noticed a tighter grasp and in about the 4th week mark we notice him begin to move his shoulder up and down.

By this time we had begun to see a Pediatrician, but not a specialist. He looked over Spencer’s arm and with every visit there seemed to be improvement. Our doctor said that he showed signs of making a full recovery. This was great news for us, but we knew we still had a lot of work a head of us if Spencer was to make the full recovery. So we continued to search for information online. We became ever increasingly frustrated with our search results. A lot of searching resulted in legal advice and not much in the way of help.

By the second month Spencer started to move his arm up and down–only slightly–from the shoulder. There was no bending at the elbow and when I did exercises with him I noticed that resistance was starting to set in. It meant that his arm was beginning to have working muscles. By about Christmas time we noticed that when he lifted his arm, Spencer was beginning to bend at his elbow, albeit a slight bend.

We continued our massaging and exercises and by mid January we noticed a full bend of his own and he has even begun sucking on his arm. He will push with his right hand up to his face using his left hand. He will force his right fingers into his mouth with his left hand. When Spencer lifts with his right arm he can now raise it–laying down on back–to about ear level.

I only hope that with our continued early intervention that the healing process continues. I have found an online parents group for Erb Palsy and I hope that through my interaction with them that I will find further information for Spencer’s continued healing.

Here’s a video of us working together to strength his arm: Some exercise