Restraint Therapy

[kathy]

Hold me back please. I cannot imagine this. As an adult BPI, I can tell you, if the nerve is not there you CANNOT move, no matter how much you want to. I would make absolutely sure that your child has the ability (nerve innervation) before you assume they are choosing not to use the affected arm. Some people have told me just to try harder, and I get so furious. Just like I choose not to use my arm. Imagine your foot falling asleep. Now stand up and walk like normal. Can't be done, no matter how hard you try. And just think, your foot is just asleep, not stretched, avulsed, or damaged.

Sorry, I'll get off my soapbox now.

Kathy

[m&mmom]

At times, not to often we put Matthew's unaffected arm in his shirt and offer something to the right. Once we see him trying we offer assistance. We'll offer an Oreo and let him try and reach for hit, then hold his arm up for him to eat with the affected arm.Cindy

[tina arvizu]

We used this method when Gabrielle was very small one to three months old, maybe a little older. I used tape on her PJ's. Now I just gently hold her non affected arm down while we are playing. I think she is so use to it that it does not bother her. I tell her "this is a right arm game". Now she knows which toys are right handed (BPI) and which ones she can use her left hand to help.

[TNT1999]

Julie, I wanted to add something else. I have found that the most effective way of getting Nicole to use her left arm is to do as many 2-handed tasks / toys, etc. as possible. If you think about it, it must really get tiring and frustrating to be told to use the other hand all the time, so I feel that it's easier on Nicole mentally / emotionally to be asked to use BOTH hands. Another thought is to take turns as someone else pointed out, which is something else we do. When we went to TX last month for Nicole's surgery, I realized how many 2-handed toys I have b/c I was thinking to myself it seemed that everything I'd brought with us to TX for Nicole to play with required 2 hands to some extent. So, anyway, I'd recommend the "use both hands" requests / reminders. -Tina

[Kristie]

Kathy,
It is nice to have your input since you have been through what our kids are dealing with. I just want to ease you mind on the sake of Ian. He can and does use his BPI arm for many things. When I use this "restraint" method my goal it is to help him with better and more movement, and to gain a realization that this arm can to it too. I always stay with him and help him do stuff. And as I posted in my first response there are several ways that we to this. Arm inside shirt... holding the unaffected arm down... ect. And I don't do it to the point of all out frustration. He might struggle but I am right there and I help his arm move if I need to. If that doesn't stop the frustration (and it usually always does) we end the restriction of the other arm. Ian is only 12 months old. He doesn't necessarliy understand the "use your other arm please" comments... he choses what is easiest. I doubt that I would use Restraint Therapy on him if he were older. And I don't think I would be doing this if Ian hadn't shown the ability to move the arm.

I am actually suprised what a hot topic this has turned out to be. To me this has been a simple way to encourage use of his affected arm. And I think it has been effective.
Kristie

[Lisa D]

Okay, I'm going to through my two cents in here too. I discussed this a lot with my daughter's PT because many people who weren't familiar with BPI suggested it. The PT did not advise restraint therapy for my daughter (now 18 months, severe stretch only - no avulsion, will probably not have a "full" recovery"). Her reasoning was not just the frustration aspect, but also you are constantly using the unaffected arm as the benchmark in development in order to figure out what is lacking, what you need to work on, etc. If you inhibit the unaffected arm for any significant length of time, you lose the ability to get a clear benchmark of where in the develop stage the affected arm "should" be. Her PT is constantly reviewing movement and motion of the unaffected arm to help guide the therapy for the affected arm.

[TNT1999]

Lisa, I think it is a good point that by restraining the uninjured arm for a length of time might lead to delays in motor skills with that arm, which might lead to overall developmental delays. However, I don't think that function in the child's other arm is necessary to use as a benchmark. There are many developmental guidelines written up that therapists use in order to determine areas to work on, developmental delays, etc. When they do evaluations, it is always based on standards for the age. In fact, I would not want them to determine what is lacking by comparing to the uninjured arm b/c what if the child was delayed in that arm for unrelated reasons? Also, how would the therapist benchmark if it was a bilateral injury? I agree with the PT's advised course, just not her reasoning. No offense, just giving MHO. -Tina

[Tessie258]

I have always believed and still believe that tying down the unaffected arm is very cruel.

This sounds rude and I don't mean it to but I wish to paint a picture for all parents when I say when you can turn your head all the way around like an owl then I think you can assume it's o.k. to try force a child to do something that is physically impossible!

I do think you should encourage and give 2 handed activities but to restain the arm would just be a huge slap in the face to a person who can't move.

I think it is the doctor's inability to tell the extent of damadge from the tests. If the nerve isn't there it isn't there! Do they think the kids are faking or being lazy! Oh my gosh! These kids would use their arms if they could believe me!

I know I'm venting a little but I'm shocked that a doctor in this day and age would be so ignorant. It seems very much like you need a new doctor!

[Julie]

I guess I'm a little confused because some people keep mentionig that they can't believe that a doctor would recommend this type of therapy. It was our PT who mentioned it and she said that she has heard that it works for BPI children. I want to thank everyone for their input and I realize again that the type of therapy we choose should be a personal decision based on research and on our gut instincts!

[Kristie]

At this point I realize I am taking a lot of what is being said very personally and maybe most people aren't even talking to me. They are most likey just stating opinion. But since I am a parent that uses the Restraint Therapy I feel like my choice hasn't been respected. I feel like people have called me mean and cruel. Again if I step outside of my feelings I can understand that it is very likely that people aren't even thinking of me when they are typing thier responses.

A lot of times people go over board with making sure we say things like... I respect your right to chose whether or not to have surgery... or what doctor you go to.. which is good we need to respect each other. We often times remind one another that things are dependant upon the nature of the injury and how your child is using his/her affected arm. In this particular thread it seems that we have forgotten thoes ideas.

I am frustrated because the point that I have tried to get acrossed seems to have been overlooked. When people began mentioning that they feel it is wrong to try and make a child use the BPI arm when it is quite likely they can't due to the nerve damage I have tired to stress that for us Ian does use his arm. He does have some nerve innervation of his muscles. When I have restrained the unaffected arm I am not leaving him helpless. And we are right there with him. I don't just tie up the arm and have the attitude use it or you will just sit there and cry. And don't we all continually encourage our kids to do more... try more even if it is out of reach. And hasn't it been posted in the past that "can't (often) means won't."

I can totally understand the view points others have posted that about this feeling this method is inappropriate if we are looking at a child that has very little or no use of the affected arm. And I respect the right to chose not to use this therapy regardless of the child's level of function. I guess what I am hoping for is the same respect and understanding of my choice. I feel for my child that we have not been cruel, mean, or tried to get him to do the impossible. We are making choices for Ian that might not always be the most popular or even easy but I think they are choices that will add in his recovery. And in the end isn't that what we all what... the best recovery for our kids.

I have thought carefully over what I have written and I hope that nothing in my post will offend anyone. My desire is to be understood. I offer my deepest regrets if anyone is upset with my words. I appericate this community of people... it is a blessing to have others that know my situation. I enjoy having the opportunity to give and receive advice.

Kristie