http://brachialplexus.wustl.

edu/BrachialPlexusPalsybr
ochure.pdf (link imagini localizare plex brahial)
Occupational Therapy
The Occupational Therapist on the Brachial Plexus Palsy Team has an important role in evaluating how a
child with a brachial plexus injury functions in daily activities. This helps the team to provide appropriate
recommendations for rehabilitation and surgical planning if any secondary reconstructive procedures are
necessary.
Ergoterapie
Ergoterapeutul din cadrul echipei care se ocup de paralizia plexului brahial are un rol important n
evaluarea comportamentului unui copil cu leziuni ale plexului brahial n cadrul activitilor cotidiene.
Acest lucru ajut echipa s ofere recomandri adecvate cu privire la reabilitarea pacientului i la
planifcarea chirurgical, n caz c este nevoie de proceduri reconstructive ulterioare.
Occupational Therapy Assessment Areas
The Occupational Therapist works with the child and family to evaluate their functional concerns by
observing the child while performing a task. The areas assessed by the Occupational Therapist are:
Shoulder, Elbow and Hand Functional Range of
Motion
Fine Motor Skills
Activities of Daily Living (e.g., Dressing, Grooming,
Feeding)
School Work (e.g., Handwriting, typing)
Leisure (e.g., Sports, musical instruments)


Fine Grasp (Use of precision pinch)
Gross Grasp (Power grips and/or carrying large loads)
Zonele de evaluare ale ergoterapiei
Terapeutul ocupaional lucreaz cu copilul i cu familia acestuia pentru a le evalua preocuprile
funcionale prin observarea copilului n timpul efecturii unei sarcini. Domeniile evaluate de ctre
terapeutul ocupaional sunt: micarea umrului, a cotului i a minilor
abiliti motorii
activiti zilnice (de exemplu mbrcarea, ntreinerea, alimentarea)
activitile colare (de exemplu scrisul de mn, dactilograferea)
activitile din timpul liber (de exemplu sportul, muzica)
Occupational Therapy Treatment Areas
When a child with a brachial plexus palsy presents with difculties in function in any of the above areas
the therapist will work with the team to provide proper treatment. Some treatment recommendations
involve therapy to directly improve the childs use of their hand. These types of recommendations include
stretching, hand orthotics and exercises or activities to improve hand skills.
Zonele de tratament ale terapiei ocupaionale
Cnd un copil cu paralizie de plex brahial prezint disfuncii n oricare dintre domeniile de mai sus,
terapeutul va lucra cu echipa sa pentru a-i oferi un tratament adecvat. Unele tratamente recomadate
implic terapia pentru a-i nlesni copilului folosirea propriei maini. Aceste tratamente includ stretching,
orteze de mn i exerciii sau activiti pentru a-i perfeciona dexteritatea degetelor (mainilor).
Stretches
Stretches may be recommended to best improve the childs passive range of motion in their joint(s) in
preparation for future surgery. An example of this type of recommendation is for a child who has a stif
wrist joint and cannot lift up their wrist on their own. Achieving the maximum passive range of motion in
wrist extension (i.e. lifting wrist up) is needed for the best surgical result.
Stretching-ul poate f recomandat pentru mbuntirea micrii articulare pasive a ncheieturilor
copilului, n vederea pregtirii pentru o viitoare intervenie chirurgical. Un copil cruia i s-ar putea
recomanda acest tip de pregtire este, de exemplu, unul care are articulatia minii rigid i nu i poate
ridica ncheietura pe cont propriu. Obinerea amplitudinii maxime de micare articular pasiv n
extindere ncheieturii minii (de exemplu ridicarea ncheietura minii) este necesar pentru un rezultat
chirurgical bun.
Orthotics
Hand orthotics may be recommended to either stretch stif joints or to position the childs hand in the best
position for function. This is often done for a trial period to assess whether reconstructive surgery is
appropriate for the child.
The picture on the right shows how a wrist cock-up splint can be used to help a child with cannot lift their
wrist up on their own. This is a good example of the type of splint that is used before a child is
considered for wrist extension surgery.
Orteza
Ortezele de mn pot f recomandate pentru a ntinde articulatii rigide sau pentru a plasa mna copilului
n cea mai bun poziie. Acest lucru se face de multe ori pentru o scurt perioad de timp, pentru a
evalua dac, ntr-adevr, chirurgia reconstructiv este potrivit pentru copil.
Imaginea din dreapta arat cum o atel pentru ncheietur poate f folosit pentru a ajuta un copil care
nu-i poate ridica ncheietura minii pe cont propriu. Acesta este un exemplu bun de atel care se
folosete nainte ca un copil s fe considerat eligibil pentru operaia de mrire a fexibilitii ncheieturii
minii
Fine Motor Activities
Activiti motorii
Fine motor activities that aim to improve specifc hand skills are also an important part of occupational
therapy for children with a brachial plexus palsy. Some children need encouragement to use their
afected arm in daily activities. Parents are often given suggestions for activities using both hands to
encourage their child to develop their hand skills.
Activitile motorii care au ca scop mbuntirea abilitilor specifce ale minii sunt, de asemenea, o
parte important a terapiei ocupaionale pentru copiii cu o paralizie a plexului brahial. Unii copii au
nevoie de ncurajare pentru a-i utiliza braul afectat n activitile de zi cu zi. Parintilor le sunt adesea
sugerate activiti care implic utilizarea ambelor mini ale copiilor, pentru a-i ncuraja pe acetia s i
dezvolte abilitile motorii.
Adaptations for Activities of Daily Living
Other treatment recommendations involve teaching techniques and using adaptive equipment to improve
the childs day to day function. These include therapy such as teaching the child the steps to dress and
groom independently and sharing tips on the best suited garments and fasteners. Adaptive equipment
such as Dycem anti-slip mats, built-up handles are helpful in helping the afected arm to participate
more efectively in day to day tasks. The challenges encountered by each child and family are unique.
The Occupational Therapist works together with the child and family to problem solve and fnd ways to
make day to day activities easier.
Adaptri pentru activitile zilnice
Alte recomandri de tratament implic tehnici de predare i utilizare a echipamentului de adaptare pentru
a-i mbunti copilului funciile zi de zi. Acestea includ terapie ca: nvarea copilului paii pe care
acesta trebuie s-i urmeze pentru a se mbrca singur i pentru a se ngriji i sfaturi cu privire la hainele
i curelele cele mai potrivite. Echipamente adaptive de genul covoarelor anti-alunecare sau a mnerelor
marca Dycem i sunt utile copilului i l ajut s-i foloseasc bratul afectat la rezolvarea sarcinilor de
zi cu zi. Provocrile cu care se confrunt fecare copil i familia sa sunt unice. Terapeutul ocupaional
lucreaz mpreun cu copilul i cu familia acestuia pentru a-i rezolva problema celui dinti i pentru a
gsi modaliti de a-i uura activitile cotidiene.
Connecting with the Child, Family and Their Community
The Occupational Therapist on the Brachial Plexus Team plays an important role as a facilitator between
the clinic and professionals in the community. At times, a child with a brachial plexus palsy may need
therapy in the community at a pediatric rehabilitation facility or at school. The Occupational Therapist can
help with this referral process and will speak with community professionals to provide the best care for
the child.
Conectarea cu copilul, cu familia i cu comunitatea lor
Terapeutul ocupaional din echipa care se ocup cu identifcarea i tratarea plexului brahial joac un rol
important, find un mediator ntre clinic i profesionitii din comunitate. Se poate ntmpla ca un copil cu
o paralizie de plex brahial s aib nevoie de terapie n instituii sau centre de recuperare medical pentru
copii sau sau la coal. Ergoterapeutul poate nlesni procesul birocratic printr-o recomandare i poate
vorbi cu profesioniti din comunitate pentru a-i oferi cea mai buna ingrijire copilului.
!!!!!!!!
Occupational Therapy
During occupational therapy efforts are concentrated on maintaining ROM in the shoulder;
fabricating appropriate orthoses to support the function of the hand, elbow, and arm; and
addressing edema control and sensory deficits, with testing and therapy.
Occupational therapy may address issues related to the patient's ability to write, type, and find
alternate ways of communicating.
Additionally, occupational therapy provides help with retraining for activities of daily living AD!s",
including the use of #$arm techni%ues, adaptive e%uipment, and self$ranging and strengthening
e&ercises.
'rgoterapia
(n timpul terapiei ocupaionale, eforturile se concentrea)* pe meninerea ROM +n um*r, pe
fabricarea de orte)e adecvate pentru a spori funcionalitatea m,inii, a coatelor i pe cea a
braelor, i controlarea edemului i a deficitelor sen)oriale, prin testare i terapie.
-erapia ocupaional* poate aborda probleme legate de capacitatea pacientului de a scrie i de a
tasta, i +ncearc* s* g*seasc* modalit*i alternative de comunicare.
(n plus, terapia ocupaional* ofer* a.utor +n leg*tur* cu educarea +n ceea ce privete activitatile
cotidiene, prin +nv*area unor tehnici de folosire a unui singur bra, utili)area echipamentelor
adaptive, i prin e&erciii de control i +n)dr*venire.
Recreational Therapy
Recreational therapy should address compensatory strategies and activities that can substitute
for altered or lost function in e&tremities that were re%uired for recreation prior to in.ury.
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Occupational therapy
Occupational therapists evaluate and treat children with brachial ple&us palsy in order to help
them feed, dress, and ta0e care of themselves and participate in school and leisure activities to
the best of their abilities. -he occupational therapist is able to guide the surgeon by defining
problems in the use of the arm when surgery is being considered in older children.
-erapia recreaional*
-erapia recreaional* abordea)* strategii compensatorii i activit*i care pot substitui pierderea
sau modificarea funciilor e&tremit*ilor necesare recre*rii inainte de le)iune.
'rgoterapie
-erapeutii ocupaionali evaluea)* si tratea)* copiii cu parali)ie de ple& brahial, cu scopul de a +i
a.uta s* se hr*neasc*, s* se +mbrace, s* aib* gri.* de ei +nii i s* participe la activit*i colare
i recreaionale. -erapeutul ocupaional este capabil s* ghide)e chirurgul prin identificarea
problemelor +n folosirea braului, atunci cand operaia este luat* +n considerare la copiii mai mari.