Your Child's Appointment with the Brachial Plexus Injury Program

For infants, children, and adolescents with brachial plexus injuries, please call the multidisciplinary Brachial Plexus Injury Program at 215-590-1527 to begin the scheduling process. The lead occupational therapists for the Brachial Plexus program (Sandy Schmieg or Meagan Pehnke) will reach out to you to learn your child’s story and help plan your first visit with the Brachial Plexus Team.

For infants with brachial plexus birth palsy

Your child’s initial office evaluation is typically done by a pediatric neurologist, an orthopaedic surgeon and an occupational therapist. If possible, the first visit should be scheduled within one month of your child’s birth. Please bring a paper copy of the obstetrical (birth) records and any prior radiographs (X-rays) on a CD.

The visit starts with a medical history, a developmental history, a physical exam and a neurological exam. In children with brachial plexus birth palsy, a complete natural recovery is seen in 60 to 90 percent of cases, but 10 to 40 percent of infants will have residual muscle weakness. Often, a series of visits is required to assess potential for a natural neurologic recovery. Treatment is personalized based on the type and severity of the brachial plexus injury, and could include BOTOX injection, bracing and casting, and surgery.

For children with new traumatic injuries of the brachial plexus

Your child’s initial office evaluation is typically done by a pediatric neurologist, an orthopaedic surgeon and an occupational therapist. If possible, the first visit should be scheduled within one month of the traumatic injury.

The visit starts with a medical history, a developmental history, a physical exam and a neurological exam. Please bring a paper copy of any emergency department (ED) records and inpatient hospitalization records. Also bring a copy of all prior radiographs (X-rays) and CT/MRI scans on a CD, along with a paper copy of the radiologist’s interpretation.

For children with an old brachial plexus injury

Your child’s initial office evaluation is typically done by an orthopaedic surgeon and an occupational therapist.

The visit starts with a medical history, a discussion of functional limitations, and a physical exam. Evaluation of an old brachial plexus injury by our team may uncover unexpected treatment alternatives opportunities, as we try to bring a fresh perspective to your child’s chronic condition. If your child has had surgery in the past, please bring a paper copy of any operative reports. Also bring a copy of all prior radiographs (X-rays) and CT/MRI scans on a CD, along with a paper copy of the radiologist’s interpretation. 

Additional post-visit testing

Some children may need additional tests during their care to help the Brachial Plexus Injury team get a better understanding of their condition and determine best treatment options.

• An electromyogram (EMG) may be performed by our neurologist to assess muscle contraction.
• An MRI of the brachial plexus and/or cervical spine or a CT myelogram may also be ordered through the Department of Radiology.
• In some cases, X-rays may be done to look at the bones, particularly if there is a history of a fracture.
• An ultrasound may be ordered to evaluate the shape of the shoulder joint or to assess the diaphragm for paralysis.

For all patients

We encourage regular sessions with occupational therapy, whether it is at Children’s Hospital of Philadelphia or closer to home for those families who live outside the Philadelphia area.

Patients are closely followed by our team for signs of functional recovery of the upper extremity. If there are no signs of recovery or not enough muscle recovery, then your child may get additional testing and evaluations to discuss surgical options to improve function.

After each visit, our recommendations will be shared with your pediatrician and local therapist, so that they remain up to date with regards to child’s recovery process.