Maintaining Range of Motion and Preventing Contractures

• • Passive Range of Motion (PROM) exercises: Gentle, regular movements of the shoulder, elbow, wrist, and hand by the therapist or parents/caregivers. This is vital to prevent joint stiffness (contractures) and maintain flexibility, especially during the initial recovery phase when active movement is limited.
  • Positioning: Advising parents on proper positioning of the infant’s arm during sleep, feeding, and play to support the limb and prevent abnormal postures (e.g., “waiter’s tip”).
  • Splinting/Orthotics: In some cases, custom-made splints or braces may be used to maintain optimal joint alignment, provide support, and prevent deformities.

Facilitating Muscle Activation and Strengthening

• Neuromuscular facilitation techniques: Using gentle tapping, stroking, vibration, or approximation (gentle compression into the joint) to stimulate nerve and muscle activity and encourage active movement.
• • Graded strengthening exercises: Once some active movement returns, the therapist will introduce age-appropriate exercises to strengthen weak muscles. This can involve:
    • Assisted active movements: Helping the child perform movements.
    • Active exercises: Encouraging the child to move independently.
    • Resisted exercises: Gradually adding resistance (e.g., against gravity, resistance bands, light weights for older children) as strength improves.
    • Weight-bearing activities: Incorporating exercises where the child bears weight through the affected arm to promote muscle activation and joint stability.
• Sensory Integration and Awareness:
• • Tactile stimulation: Gentle massage, different textures, and tapping to improve sensory awareness in the affected limb, as sensation can be diminished.
  • Proprioceptive activities: Activities that provide feedback about body position and movement (e.g., joint compression, weight-bearing).
•  Functional Training and Bimanual Activities:
• • Task-specific training: Practicing activities that are meaningful and functional for the child’s age (e.g., reaching for toys, feeding oneself, dressing, playing with blocks).
  • Bimanual (bilateral) activities: Encouraging the use of both hands together to promote motor learning and integration of the affected arm into daily activities.
  • Constraint-Induced Movement Therapy (CIMT): For older children, this involves restraining the unaffected arm for periods to force the use of the affected arm, promoting neural rewiring and functional recovery.
• Pain Management and Scar Tissue Management:
• • Massage: Gentle massage can help improve circulation, reduce discomfort, and manage scar tissue if surgery has been performed.
  • Stretching: To alleviate pain and improve flexibility in tight muscles.