Hey,
I took some liberties with your letter that follows. And I would also suggest that you offer a more specific check list. In recently placing my daughter I generated one that I have also shared just as an example. I also made a modified copy of the UBPN statement regarding kids and school that I found enornmously helpful.
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Greetings from Ashley’s Parents, George and Lenni Porter.
With great excitement, our Ashley will soon be placed in your classroom. While in general she is a typical child, she also has a disability: an injury of paralysis to her [left/right] arm inflicted at birth. Specifically, she suffered a little-known Brachial Plexus Injury (BPI). If the Brachial PLexus Injury is unfamiliar to you, we will write briefly that it is the result of her delivering OB exerting too ... [I would provde the UBPN as a site for more information, ans I wouldn’t write about Ashley's surgical history because it is not only private, but too much for a lay-teacher to absorb. Save the details for a parent-teacher meeting where you can read the teacher's level of interest..]
In order to provide Ashley with more movement, she underwent corrective surgery; at some point you may notice that she has a rather large scar on her right forearm. This surgery has offered great promise toward Ashley’s recovery. Yet, she will receive ongoing medical evaluation to further more her recovery. Thus she may be absent from school somewhat more often than other children, and she may return to school in recovery from prehaps another surgery.
Having said the above, we hope we have not scared you off. It is not as horrible as it sounds. Ashley is a perfectly abled child with determination and a very good understanding of her own abilities; she can take very good care of herself. Nevertheless, we have big concerns at two levels: Ashley does not fall well and is not able to break her falls. Secondly, many BPI children are prone to shoulder dislocations. Ashley is quite brave and curious. She will try all activities. Yet during these activities, as to not discourage her or draw too much attention to her, she needs close yet discreet supervision. For example, when engaged in bilateral activities – where she may be stressing both of her arms – she will require assistance to hold the hand of another, to reach for that higher higher or awkward place, etc..
As parents, the bracial plexus injury was entirely new to us. It took us some time to recognize those occasions when Ashley engaged in a vulnerable activity. Very much we appreciate that you will need some time as well. Very fortunately, also enrolled with Ashley are two little girls that she trusts dearly and they are Cassidy Safurik and Sierra Ashton-Hopkins. As you become more familiar with Ashley’s needs, you may want to buddy Ashley up with either of these girls. They know how to help her with her arm and Ashley is comfortable with that.
Otherwise, you’ll see Ashley is a very shy little girl, focused and thoughtful and loves to help others just for a smile. We are very proud of her and wish you all a wonderful year together. If ever you have a question or a concern please call and we will be delighted to help or even just talk.
Yours truly,
George and Lenni Porter
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Greetings,
Our Ashley is enrolled in our school! We are very excited. In our cover letter, we spoke of our concern for Ashley with regard to falling and shoulder dislocation. That concern is indeed great. There as also other matters that we would also like to share with emphasis.
With regard to Ashley’s physical care, recall that Ashley has paralysis in her [left/right] arm and during her attendance she may depart from school to undergo surgery and then return to school highly vulnerable and with a very significant splint or brace.
With greater text from the United Brachial Plexus Network later, following is an abbreviation of Ashley’s physical needs in a school environment as one inflicted with a Brachial Plexus Injury to her [right/left] arm:
1. Foremost, I ask that the teachers and even the students, once they understand Ashley's injury, constantly yet discreetlly remind Ashley to "USE BOTH ARMS." USE BOTH ARMS has been the mantra in our home since Ashley was about one-year old. She understands what it means, and does not feel punished by that reminder.
2. Please provide Ashley with a Cubby (storage) area that she can reach.
3. Ashley is a very messy eater. While she can use a fork and spoon, she prefers to eat with her [right/left] hand.
4. When asked to draw, color or write, Ashley will get frustrated quickly because she cannot support the paper with her [left/right] arm.
5. ABSOLUTELY no pulling or tugging at her [left/right] arm. If there is a game or a structured process that involves hand-holding by a child, then only Ashley's [right/left] hand should be held. Thus, No Red Rover, no Tug-Of-War, yet if those games are pursued Ashley should not feel isolated...
6. If the water fountain is [left/right] handed, she will need help to take a drink.
7. Please apply sunscreen on her [left/right] arm as it is particularly sensitive to the sun. We will gladly provide the sunscreen.
8. Ashley is potty trained, but she has lots of problems with zippers and buttons. And she also has alot of trouble getting on and off the potty; she'll put her hands ALL OVER the toilet. Once on the potty she is not well balanced, and she will pee-pee outside of the bowl. Please be sure that her hands are washed thorough after using the potty.
9. Students should understand Ashley's difference. With that, there should not be any teasing or ridicule.
10. The stairs are a very big deal. With her injured arm, she will reach for the banister if it is on her [left/right] side. But she doesn't have the strength to support a fall with a grasp from the right. Ashley should use stairs with a [left/right] banister on ascend and descend of stairs, otherwise she will need supervision but not help.
11. If she should fall, she cannot break it properly. And she cannot protect her face from anything on the [left/right]. We understand that all children of Ashley’s age will fall. For the moment, our Ashley is learning in PT/OT how to fall and protect her face better. Until that lesson on her part is well learned, we ask that you examine and question her particularly in such an event.
12. Any activity that involves sitting on the floor, crawling, climbing, Ashley must be required to not only use both hands, but she must do those things with both of her hands, flat and open.
13. If you ever see Ashley permitting her arm into a "passivity": her arm resting on her side at a 120 degree angle; her arm in her lap while she is sitting at a table; dragging her arm while she walks or runs; her arm tucked under her body while she is on the floor resting, then you need to encouragel her to move her arm and use it as appropriate.
Otherwise these are more general, yet relevant and important guidelines, as borrowed from the United Brachial Plexus Network,
www.ubpn.www:
"Most children with brachial plexus injuries have difficulty lifting their affected arm up over their head or even above shoulder level, causing difficulty in dressing and grooming. Some children develop strategies for coping with most situations; however, others may require assistance with putting on clothing and outerwear like jackets, shoes, boots, gloves and hats. Tying shoes, buttoning and zipping clothing can be especially challenging to these children.
The child may have difficulty using the restroom. For example, pulling underwear, pants and tights up and down can be quite time consuming if the child's grasp is weak or elbow function is poor. Parents teach their children adaptive strategies to manage the best they can. There are children with brachial plexus injuries, however, who require assistance for considerable time even though they prefer to be as independent as possible and may find it embarrassing to ask for assistance. These children may need discreet help.
If a child's naturally dominant arm is damaged, he/she adapts by using the non-dominant hand. A right-handed child, in other words, must adapt by becoming a left-handed person when the right arm or hand is affected by paralysis.
Carrying heavy objects or wearing a backpack may not be advised because it might overstress the injured limb or overuse the dominant limb. It would be very helpful for a child with a brachial plexus injury to have an extra set of books at home so that they can avoid carrying a heavy weight to and from school.
Many children with brachial plexus injuries have difficulty with fine motor skills. Simple things such as cutting, coloring, and even handwriting are more difficult for them and may take longer to master. They may not be able to hold a paper in place because they don't have the requisite strength in their affected arm to do so. One solution may be to place the paper onto a clip board. Other challenges may include using a ruler, compass, protractor, or computer. Extra time may be required for the child to complete the task.
Caution is advised for children with brachial plexus injuries involved in playtime, physical education or recreation. Physiological imbalance may affect the child's sense of balance and gross motor coordination. Supervision is recommended for some activities such as climbing or swinging from playground equipment. In many cases, the affected shoulder is underdeveloped and/or deformed and a fall or jerking of the arm can cause dislocation. In extreme cases a BPI child cannot break a fall because of the flaccid limb and injuries to the head can occur. Physical fitness tests may need to be adapted. Occasionally, children with BPI also suffer from damage to the diaphragm which could affect the time and distance they can run. The child's parents or occupational therapist will advise you if this is likely to be a concern.
One of the most frustrating situations for those affected by brachial plexus injuries can be lunch or snack time! Opening lunch boxes, a lid on a Tupperware container, Ziploc bags, pudding, yogurt, milk cartons or snack bags usually requires two hands. For children who purchase school meals, carrying a tray can be prohibitive because grasping both sides of the tray to support its weight can be difficult. Some children may not be able to perform a "sawing" action if the meal purchased needs to be cut into smaller pieces. Some students with brachial plexus injuries will need assistance with tasks that require two hands.
Depending on which arm is injured, the student with a brachial plexus injury may need assistance boarding or getting off of the school bus. Help may be needed with the seat belt, if applicable. The bus driver should be made aware of the injury so that assistance is given properly during any bus evacuation drills."