United Brachial Plexus Network, Inc.

My daughter (mild LOPI, 8 months, no surgeries) can't suppinate over neutral. I thought she was doing better because I noticed that when she sleeps on her back her palm is often faced up. In the past she always slept with the palm down or neutral.

Now our PT told us that het wrist/forearm is getting tight. This might be an indication that true suppination is still far away.

I'm interested in your stories/opion about the return of suppination.

John

My son is 4 1/2 months old and he can suppinate some. He also sleeps w/ it in that position some, but he also will turn his wrist in and scratch his head with that hand occasionally. He will also sometimes put his wrist into the stop sign position when playing with toys. My therapist hasn't mentioned tightness. I do know from other moms that the suppination is the hardest and the last thing to come.

Draw a smily face on her hand with a marker so she
will try to turn hand to look at it over. We would also draw a smily on our hands and say here is my
smily face, where is yours etc.


We did water therapy too and the
PT would work on her supination in a heated pool. My
child could not fully supinate until post 10 months old. We kept on working and working on it.

Keep in mind, that suppination is usually one of the last things to return for function if it is to return. My daughter is 3 1/2 years old, and she slowly gained a little bit of suppination, but couldn't get past neutral until after she had surgery for a subluxed shoulder. She did make some progress with stretching and a McKie suppination strap that was easily worn.

Some tips to encourage suppination are:

-Stickers on the palm or wrist area
-Food such as applesauce, pudding, yogurt on the palm/wrist area to lick off
-Trying to balance a small object on the palm (like a small toy animal)

Good luck.

Tanya in NY
Amber's Mom, ROBPI, 3 1/2 years old

It will come, my daughter is 3 years old and she is doing better and better. Don't forget keep doing ROMs. Most likely the suppination comes around 1 year old.

For children with severe injuries supination may never come. I just wanted to clarify once again that every child's injury is different and there's no telling when or IF it will come for any child. Supination seems to be one of things that we all strive for but some of us never get it. There's an article in the awareness area if you want to read more about it.

supination, not suppination if you are looking it up or researching.

I just wanted to point out that John specified that his daughter has a mild BPI so responses were given accordingly. Parents of non severely injured children were responding with what happened with their children. Of course every child is different and I don't think that John would assume that absolutely his child would get supination by a certain age, but it helps to know what other people have experienced. Also, John did say that his daughter DOES supinate but not past neutral. This is supination! She CAN do the movement just not all the way yet. So I would say to John to keep working on it with stretching and some of the other strategies that parents suggested and hopefully her supination will continue to improve. I think you absolutely HAVE to have a positive attitude about your child's recovery especially since she is so young and doing so well. The fact that she is sleeping like this says to me that she can do the movement just not in every situation. So don't think that this isn't progress...it is! It's not all the way there yet, but it's getting closer than it was when she wasn't sleeping that way...get what I'm saying. Good luck John and I'm sure she's going to do great!

I really hope your little girl continues to improve. I must point out that our child got to neutral and never got any better on supination without surgical intervention. To me not being able to turn palm up is not having supination. Isn't palm up the definition of supination?

I don't think it's unwise for people to point out that it's best to watch and see what happens without assuming supination will definitely come back by waiting and seeing what happens. There is a window of time on certain movements where you are best off doing something about it. No criticism of the half-full glass people on here, but it's best to look at both sides.

Mom to ROPBI

Well null I agree with you and want to add also that we experienced a problem with the glass half full concept. When my daughter could get to neutral and got no further we continued to stretch and motivate and we did this for years and years. Finally SHE said to me, "Mom, enough! I can't do this, I'm not going to be able to do this, So stop pushing me!" The day that her therapist started teaching her how to do things one-handed was the first day of her freedom. I'll never forget that day because it was the day that she was finally given a stress-free life. She didn't have to try to push herself to do things that she just couldn't do and she learned that it was OK to just do things one-handed (even with having to change domination). Now she continues to do everything one-handed and she's completely changed her life and is successful at many things. And her spirit is free and soars. So my point is that IT's OK to assess and know when you've reached the end point and allow your child the freedom to just accept that end point. And as parents we also have to accept the end point.

Not everything can be fixed. Not everything can be recovered and every child is different. Just because a child can get to neutral doesn't mean that she may ever get any further and that's ok - the glass can still be full AND even overflowing as my child has shown me. And if a child can get to neutral, they may in fact be able to get more. Parents and therapists need to be able to keep a watch for frustration and stress.