The Boy Who Could Run But Not Walk by Karen Pape

Author:Karen Pape
Language: eng
Format: epub
Publisher: Barlow Publishing

Sometimes you don’t need a shot of Botox or a restraint to uncover the recovery of the nerve that has been hidden under layers of bad habits. Jenna is a bright little girl who had a brachial plexus injury at birth. Immediately after the injury, Jenna’s arm was paralyzed and this lasted for months. As the nerve gradually recovered, she used only those muscle groups that recovered first and ignored the ones that were not working. Her brain wired in the pattern of using only some of her muscles. As the abnormal movement pattern was repeated, thousands of times, it became her habitual movement. Jenna’s abnormal arm lift halfway up was an early-learned habit that was automatic to her.

She started in therapy with Pia Stampe when she was three years old. Early treatment for brachial plexus injury is highly variable, and many children do not qualify for early intervention programs. “At the start,” Pia said, “she could not lift her arm up at all. She was not activating the muscles around her wrist or elbow very well. There was a lot of weakness.” Pia put Jenna on TES for a couple of months to get some muscle growth, and then used EMG-triggered stimulation to activate the muscles to the point where she could also do resistance and functional training.

By age six, Jenna could lift her arm to about eighty degrees, just about shoulder height, but no higher. Then, on the spur of the moment, Pia asked her to do something new—jumping jacks. All of a sudden, Jenna’s arm came way up over her head. Here was a girl who couldn’t lift her arm above her shoulder, but when she did jumping jacks, she had a full range of movement. It was an incredible sight. Her nerves had obviously healed, but we didn’t see it because her early habit of lifting her arm up only halfway was hiding the actual extent of her recovery.

The explanation was simple: an early-learned habit hid her recovered nerve function. But doing jumping jacks was new, and because it was new, it didn’t activate the habit. She was helped by momentum—jumping and flinging her arms in the air—but even so, she was actively elevating her arm higher above her shoulder, a skill that seemed to be impossible when she was asked to lift her arm. It was a huge moment for Jenna, and a big opportunity for Pia to help her regain the everyday use of her arm. As a child recovering from a brachial plexus injury, she had already passed the first stage—her nerve had recovered. Now she had to overcome the challenge of developmental non-use and learn to voluntarily lift her arm above her shoulder. We now knew she could; she did the jumping jacks. But she had to learn how to do it every day. It takes time and practice and often we have to wait for brain maturity to assess the full extent of recovery from an injury. Fortunately, the child’s brain continues to grow and mature, allowing new functions.

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