United Brachial Plexus Network, Inc.

I have a 20 month old daughter with left brachial plexus injury. I have noticed that she will not try to walk down the stairs if I am holding her left arm. Has anyone else experienced this? I am also interested in any suggestions on how I can get her to try this, everytime I attempt, she sits down. I know that it is important for her to use her left side to strengthen it. Any suggestions?

Karen, at 20 months, I am guessing it is balance issues. I think ANY 20 month old might have balance issues while going DOWN the stairs, OBPI or not.

It has been a few years since mine were that young....now ages 24,22,21 LOBPI...but if my memory serves me right, they usually, most of the time, went DOWN the stairs on their BUM. I wouldn't worry about it at this age.

I have always lived in 2 story houses with the bedrooms all upstairs.....so a lot of up & down experience, to draw upon.

Ashley,

I think this is pretty typical. It's just another sign of dominance of the non-BPI arm because it just plain works better and easier. It's hard for them to balance and feel secure using the BPI arm to hold on. All the muscles don't work as well, or respond as quickly, as the other arm. Basically, it doesn't work so good so they want to use the "good" arm because they feel safer.

The problem is, the injured arm won't get better unless it's used! Balancing while holding on with the BPI arm sends a lot of useful feedback signals back up the arm and helps trigger the muscles, so it is good to keep encouraging it as much as you can. Just recognize that that arm might not be up to as much as the other arm right now, so try to challenge them to use it in ways that aren't overwhelming. A set of stairs might be too much right now, but how about walking up and down slopes, or over stuff lying on the ground?

When Joshua was first learning to walk and he simply refused to hold with the left hand at all. We coaxed him into it by holding both the left hand AND the back of his shirt to help him feel secure enough. You might try that. Also, you might try giving her something to hold in the non-BPI arm, which helps take the focus off of using it to hold on with.

Kate

Javier (14 months) just started stairs about a month ago. He goes up fine, but coming down... he climbs down like a ladder. I have been trying to get him to do the bottom scoot, but he won't.

Marlyn

Going down stairs is a difficult task for all children to manage. They start out doing two feet on each step and eventually progress, as their balance improves, to one foot per step. Most kids will not get to the "reciprocal stepping" until preschool.

As for not wanting to go down stairs if you hold the affected arm, I think it is a sensory issue. Juliana has very poor sensation and doesn't let anyone hold her hand (except for me). The feed back she gets from that hand is strange and uncomfortable.

As for learning the stairs properly, this is where physical therapy (as opposed to OT) comes in. This is the job of the PT--to help the kids learn to use their bodies better. Juliana did a lot of walking up and down the stairs of our house with a PT to learn how to do it.

If you are not getting PT now, you can have your child evaluated, step walking is a "reason" for getting services.

I would say, however, that more important than which hand she holds on with, is learning to move down the stairs reciprocally. Juliana still holds on with only her right hand (her left wouldn't do much to help her anyway). If she HAS to be with a bannister on her left, she will put her hand on it, but she isn't really "holding on", she does it to look like the other kids. (she is LOBPI)

You can help with stairs by having your kids practice with just the last step or two. A whole stair case is pretty scary to look down at.

good luck,
claudia

Claudia,

Good point that it may be a sensory issue. I didn't think of that!

I know it isn't sensory for Joshua, though... he has full hand use and good sensation. But he still doesn't like to balance by holding with his left (BPI) arm. Whenever we get to anything really scary or difficult, he typically will try to reach across and take my hand with his right hand. He manages less challenging obstacles and small steps by holding on with his left, but he also doesn't use me for as much support at those times. When he first started walking, he really needed to be "coaxed" into supporting with his left side at all, so he's definitely improving.

Kate

When we were at Camp UBPN we talked a great deal about the sense of touch. I did not realize how many numb spots I have on my face,arm, hand, neck etc... on robpi side. During the pain session Dr.Belzberg explained that our brains get the wrong message. Simple touch sometimes sends a pain signal. I hate anyone to touch my arm and when I was small I would complain that someone hurt me when they only touched my right arm or hand. I don't like anyone to take my hand or touch me... NEVER tap me on the back... grrr...
If I slip or fall I will protect my right arm... I could not save my self with it... Like Juliana I put my right hand on the rail because it looks normal... I hang on with my unaffected arm. Most adult/obpi report that we forget we have an arm.

Kath adult/obpi

Hi, Karen. Welcome to the board. I can't believe that there are three new Moms here on the same day. It's kind of discouraging how much this injury is still happening. Anyway, I see that you already got some good input, but just wanted to add a suggestion. Maybe for now you can hold her right hand while walking down the stairs and her left hand while walking up the stairs (and at other times like when you're just walking on flat surfaces). While it's important for us to get in whatever therapy we can, we also have the difficult job of trying to balance that with not trying to challenge them beyond what they're ready for yet. Maybe you could trying going down the stairs holding her L hand every so often and see if she's ready yet. Perhaps sometimes you can walk down the hall holding her L hand swinging it front and back and having fun and then just continue to the stairs and she might not think about it as much. Just an idea.

It's funny b/c I think that I was just the opposite and I tended to not hold my daughter's L / BP hand as much esp. when there was a greater risk of falls (going down stairs / unlevel or slippery surface, etc.) b/c I was worried that if she were going to fall I wouldn't know if I should just let her fall or try to break her fall by pulling her arm. Either way, it was a risk of injury and made me nervous.

Also, as far as strengthening the arm, I always felt that weight-bearing activities were the best opportunity to do that and that any hand holding / arm swinging we did was more to "remind" her that her L arm was there. Of course, everyone's injury is different and my daughter had very limited sensation esp. below the elbow. Anyway, I hope this helps.

~Tina, bpmom@comcast.net, Mom to Nicole (6 y.o. w/LOBPI) & Joshua (1 y.o. w/NOBPI)

Thanks for all the info.