Symposium Tidbit: Why Wheelbarrelling for our kids is a "no-no".

[B.V.]

or pull ups???

[Francine_Litz]

are pullups in the same category as hanging? or are they pure biceps? (can you tell I've never done a pullup????? hahahahaha and NEVER WILL btw!!) (rofl)

[admin]

It is VERY dangerous to generalise as all the injuries are so different. Check with YOUR threapist/doctor, Dr Pape does NOT know this for sure in each case.

[claudia]

When I spoke to one of Juliana's therapists a few days after the symposium (I couldn't stay for day 2) she said that Pape had really come down on the therapists...and told me about the wheelbarrow thing. She told me that she had enough common sense to know that putting that much stress on a joint as unstable and surgically reconstructed as Juliana's was a mistake and that she never would.

So, that in mind, one hopes that all therapists are as logical as mine is. Unfortunately, I know that this is not true. Many therapists just do not understand that a bpi arm is not a "normal" arm. The lack of ennervation caused a permanent change in the muscles and bones of the joints. Not only is the shoulder "different" but the elbow, wrist and hand are also. So is wheelbarrowing bad for ALL bpi kids, probably not. Are pushup bad for ALL bpi kids, probably not. But as a rule, I would say that there is too big a window of possibly injuring the joints. I would not permit it.

I think hanging falls into this category as well. Some kids are ok hanging and others (Juliana included) will never hang.

I think you also have to look at the kid. Some of us had very large babies who are turning out to be rather large children (Juliana again!!!) Some of the kids are small. I guess what I am trying to say is that my kid weighs about 50 pounds...that is alot of pressure on a joint. If you have a 25 pound sprite of a kid, then perhaps the pressure is just not a severe...

I would never let Juliana wheelbarrow, hang or do push ups. Perhaps when she is much older, and she can tell me if it hurts, I will (with a doc's okay) let her try.

So, that is my opinion.

hope it helps,
claudia

[njbirk]

This is a really interesting discussion.

I wonder if the other adult obpi's could chime in and tell us what their experiences are with both wheelbarrelling and pushups. I know I could never do either of them, but for a reason not mentioned here yet. In my case, the difference in the arm lengths made it very difficult. I did learn to do one armed pushups, but now I think that that puts too much strain on the uninjured arm.

Nancy

[Matt's Dad]

Just from a my own non-medical point of view, why would you have your child perform an unnatural activity(we were meant to walk on our feet, not hands) using an already abnormal (BPI) joint. Just try wheelbarreling yourself, doesn't it seem to put extra pressure and strain on normal shoulder joints.
I can see the idea of strenghtening the joint through weight bearing but I think crawling is a much better and less joint straining activity.

[admin]

Hi, We asked DR. Kozins about the wheelbarrow thing and push ups and he said not to limit any of Richard's activities and it should be ok, and I've had supposedly knowledgable therapists who have worked with all the bpi's in calgary tell me to really go for strength and do pushups best he can etc. then others have cautioned me not to - so who knows who is right- and they can't even agree on whether a particular child should or shouldn't let alone the advice to the whole varied spectrum of bpi patients.

[admin]

I wasn't going to post but I need to VENT. I just find all of this so overwhelming and frustrating at times. The truth is no one really knows and unfortunately no one is really even researching it.

I also feel somewhat frustrated when people get information from ONE source, such as Dr. Pape and take it for gold. I am NOT saying Francine or anyone in particular did that here, but I do know it happens ALL of the time. Dr. Pape said this, Dr. Kozin said this, Dr. Nath said this, Grossman, Waters, etc., etc., etc. I STRONGLY believe it is dangerous for us to just listen to any one opinion because odds are they REALLY don't know and will be changing their opinion in the years to come (even the best of them). Even surgeries that people thought would correct something indeed did not. I just hope that Pape is CERTAIN of what she is saying and has actual proof of what she can base that on because it was just told to many therapists. If indeed it is that dangerous and bad than PLEASE let's get all therapists educated but it MUST be based on more than PERSONAL opinion. I know kids who have done more wheelbarrowing than you can imagine and hanging too and were subluxing and were severely injured and they are currently doing GREAT. Kids that were told they would have a few inch difference in length due to the severity of their injury yet they have no difference or very, very little difference, yet they did TONS of weight bearing and wheel barrowing.

I would HATE, HATE, HATE for kids to stop doing something that may truly be beneficial because of fear instilled by ONE persons personal opinion. I also would HATE for any child to damage themselves further if one particular person was right on. And how does one doctor or several say it is just fine to hang and others say never to allow that. Come on...we are talking COMPLETE opposites here. Why does all of this have to be so darn confusing and complicated? It really does drive me nuts.

Please check with MULTIPLE sources. Please encourage research and actual data to back personal opinions. We are just talking about such important stuff here....our childrens well-being.

Sorry for venting. I am just so very tired of it all and I believe there is so much more that can and should be known regarding this injury. There has just been such a lack of true research. Also, please be careful when sharing information that others will take as gospel. It is just one person's opinion. Let's keep working together to do our best to sort through all of this. I am hoping people will talk to their therapists, doctors, anatomy professors, whoever and gather what information that they can and maybe we can make some sense of all of this.

[Kathleen M]

Nancy was hoping one of us would jump in... So I will.

I did wheelbarrows all the time as a child... I fell over most of the time but they kept playing this game with me for strength. My brother even held me by my feet and I would try to walk on my hands... he of course supported the weight of my body, I think it was just a matter of getting me to move my arms one after the other left than right possibly good for brain pattern -- I of course enjoyed it because I would see the older kids doing it and I could not... I use to hang from a bar across the doorway (it was placed there just for me) for short periods to stretch my arm. I move my arm by using my scapular. I never had any surgery and was taught to do cartwheels of course I was good at faking two hands and never put the weight on my right arm.

When I was young my parents were told to do this to build muscle... well that never really happened.... I could never do a push up but tried often... Hanging from the bar was used to give me a good stretch someone would pick me up to the bar and we played a counting game to see if I could hang on I could never do it for very long just a few seconds... it was never over done and I was never hurt to my memory during these exercises.

I don't think any one form of therapy is good for all children... I have Horner's and my EMG shows c-5, c6, c7, c8 & t1 are involved... at present spinal compression and I guess you would not call it a mild injury since I cannot supinate and have internal rotation with scapular winging.

Aside from hurting the bpi arm there is always the danger of hurting or over taxing the unaffected arm most adult/obpi suffer from secondary conditions relating to overuse of the unaffected arm... before doing any home therapy you should consult with YOUR physician/pt/bpi specialist regarding your child.

There are certain things that are universal to obpi arms and cautions - no picking up by the arms - no blood pressure - no blood tests/IV inserted in bpi arm etc...
Instruction for PT is very personal to each child and should be given according to that child’s needs as determined by your physician. When in doubt check with your physician and see if the exercise is correct for your child - each injury is so different.

Kath

[Anna]

Angie, the length of the arm issue is because the long bones grow when there is weightbearing/stress placed on them (GOOD stress, I mean!). Tha is the reason so many kids BPI arms are shorter - because they never could weight bear in a typical way or the same amount as the non-inj. arm.

And yes, pull-ups require hanging.

I think what a lot of you are saying about judging by the extent of the injury is right, but I would like to hear what Dr. Nath says too. It sounds like Dr. Pape was saying nobody (BPI or non-BPI) should wheelbarrow walk. When I do therapy with a kid and do WB walk, I assess their ability and often get on my knees and support them under the chest to take some of the weight off their upper body. As they get stronger, I gradually move the support back to their trunk, then their hips, then knees, then ankles (anyone who knows about physics, think about a lever arm, and how much work would be required - less work on the kid's part at the chest, the most at the ankles).