Management of Brachial Plexus Birth Injuries at British Columbia Children's Hospital.

A multidisciplinary team at BC Children's Hospital provides brachial plexus birth injury management for our provincial catchment area. Although compared with many centers we service a relatively small clinic population, we have the benefit of universal health care, province-wide reach, and accessible research infrastructure. In 2008, we created the Sup-ER protocol, which includes an orthosis that passively positions the neonatal shoulder into more idealized glenohumeral contact during early growth.

How Institution of the Sup-ER Protocol in a Clinic Changed Procedure Patterns in Upper Brachial Plexus (Erb's Type) Birth Injuries.

Background: For children with upper brachial plexus birth injury (BPBI; C5, C6, ±C7 roots), most clinics first recommend nonsurgical treatment followed by primary and/or secondary surgical interventions in selected patients. Since 2008, we have used an infant shoulder repositioning protocol (supination-external rotation [Sup-ER]) designed to prevent shoulder internal rotation contracture and its potential effects on the shoulder joint. This study characterizes our clinic's current choice, number, and timing of primary and secondary procedural interventions (including Botox) and compares Sup-ER protocol patients with those of our historical controls.

Correction of neonatal auricular deformities with DuoDERM: A simple technique.

Ear moulding in neonates has been shown to successfully correct congenital auricular anomalies. There are several available moulding techniques. However, commercially available moulding devices (e.

Shoulder Rotation Function Following the Sup-ER Protocol in Children with Brachial Plexus Injuries.

: Our group previously developed an upper extremity repositioning (Sup-ER) protocol for brachial plexus birth injuries (BPBIs) that may improve supination and external rotation (ER) at 2 years of age. Questions were raised about the potential for the protocol to cause internal rotation (IR) deficits. The goal of this study was to explore the longer-term outcomes of the Sup-ER protocol and investigate IR/ER function.

Parents' experiences of splinting programs for babies with congenital limb anomalies.

Purpose: To explore parent experiences with participation in splinting programs for their child with a congenital limb anomaly in the child's first year of life. While parent participation is recognized as integral to successful outcomes of splinting programs for these children, little is known about factors influencing their participation.

Methods: Through purposive sampling, 10 families recruited from outpatient clinics at a pediatric tertiary care facility participated in semi-structured interviews in this qualitative study utilizing interpretive description methodology.

Sup-ER orthosis: an innovative treatment for infants with birth related brachial plexus injury.

Impairments in active and passive range of upper extremity supination and shoulder external rotation are common sequelae for children with delayed recovery from birth related brachial plexus injury. Orthotic intervention may complement traditional treatment strategies commonly employed in the newborn period. These authors describe their custom fabricated orthosis designed to balance shoulder growth and muscular function, and improve prognosis of long term functional outcomes for children with birth related brachial plexus injury.

An early shoulder repositioning program in birth-related brachial plexus injury: a pilot study of the Sup-ER protocol.

Background: Birth-related brachial plexus injury (BRBPI) occurs in 1.2/1,000 births in British Columbia. Even in children with "good" recovery, external rotation (ER) and supination (Sup) are often weaker, and permanent skeletal imbalance ensues.

The use of botulinum type A toxin in the treatment of idiopathic clubfoot: 5-year follow-up.

Background: Continued monitoring and reporting of outcomes in clubfoot patients are important for providing an indicator of functional outcomes and surveillance and treatment for problems or recurrences. The purpose of this study is to report the 5-year outcomes of the updated cohort of 44 patients with 65 idiopathic clubfeet treated with manipulation, casting, and Botulinum toxin A (BTX-A).

Methods: As part of the original study, the patients underwent the corrective treatment phase of manipulation and casting followed with BTX-A injection and then the maintenance phase of bracing.