Peripheral nerve damage, such as brachial plexus injury, typically occurs during birth when the baby’s passage through the pelvis is hindered by a physical problem in the mother’s body or abnormal positioning of the baby. The result may be a traction injury to the shoulder that stretches or tears the nerves that allow the arm to function.
“We have treated children with these injuries for years, but the establishment of this clinic helps get the word out to referring pediatricians that we are here to provide expertise for the management of peripheral nerve injuries,” says Dennis A. Hart, M.D., senior director for developmental and rehabilitation services, medical director for physical medicine and rehabilitation division at Johns Hopkins All Children’s.
A Team and Timeline for Healing
From the time a child sustains a peripheral nerve injury, whether at birth or due to an injury later in life, a multidisciplinary team of providers will collaborate on the child’s care, including a rehabilitation specialist, neurosurgeon and orthopedic surgeon.
“As a rehabilitation physician, I work closely with an occupational therapist to ensure the patient is maintaining range of motion and improving their functional ability with hands-on therapies,” Hart says. “The neurosurgeon is responsible for repairing a damaged nerve by removing scar tissue that is preventing conduction of impulse across the injury or by grafting a new nerve to try to get the patient’s body to heal itself and recover.”
Neurosurgery may be needed for infants at 6 months of age who have not recovered enough function. If by age 2 a child has not progressed with therapy and needs a muscle transfer to gain more motion, orthopedic surgery may be necessary. Occupational therapy continues to be a part of the treatment plan until goals are met.
“Each provider has a unique contribution to these children’s conditions,” Hart says. “We keep open communication to create the most successful outcome for the patient.”
Care Close to Home
The Peripheral Nerve Clinic is located in the Johns Hopkins All Children’s Outpatient Center in St. Petersburg, Fla. Surgeries take place in the hospital. Since patients come from the entire region, therapy will occur in the most convenient location for the child’s family: at one of our therapy locations throughout the west coast of Florida or from a local institution close to the family’s home.
“This has been an underserved population in Florida,” Hart says. “We felt there was a big need because so many families have had to go out of state for care. I think this will be a valuable clinic to the state because we will be able to see patients without having them drive those distances.”
To learn more about referrals to the Peripheral Nerve Clinic at Johns Hopkins All Children’s Hospital, call 727-767-7337.
From Brachial Damage to B-Ball
At 12 pounds, Shakita’s second child had a difficult birth. Dar’rell was so big that his head and right shoulder became trapped, damaging the brachial nerves in his arm.
After Dar’rell spent a month in a neonatal intensive care unit, his mother was referred to Johns Hopkins All Children’s Hospital, where she met Dennis A. Hart, M.D., senior director for developmental and rehabilitation services, medical director for physical medicine and rehabilitation division. He specializes in treating brachial plexus damage.
“Even before we established the Peripheral Nerve Disorders Clinic, we’ve been serving patients like Dar’rell every day,” Hart says. “Dr. Hart has been there from the beginning,” Shakita says. “He knew my son when his arm was completely limp and was able to see past his injury. Not only did he have a plan, but he also listened to my wishes for my son. As a mother, this made me feel at ease, knowing my voice was heard and that I was actively helping my son improve.”
Dar’rell attends weekly occupational therapy sessions at Johns Hopkins All Children’s led by Amanda “Mandy” Kelshaw, R.N., clinic coordinator, pediatric rehabilitation medicine, who has worked with Dar’rell since he started seeing Hart three years ago. Kelshaw and Hart meet regularly with Shakita to review Dar’rell’s progress. They consider Shakita part of the team.
Range of Motion Restored
Following Hart’s recommendation, Dar’rell had nerve graft surgery at age 2 and returned to therapy sporting a fiberglass cast, his hand held high in a position that mirrored the Statue of Liberty.
After trading the cast for a temporary brace, Dar’rell can now bring both hands to his face, a feat that once seemed impossible.
“My son has come so far,” Shakita says. “I remember when he had zero movement in his right arm, and now he is playing basketball with other kids his age.”