The Occupational Therapy role following a Brachial Plexus Injury can be broken down into different stages:

Acute phase

Non-surgical patients will be encouraged to use their affected limb in activities of daily living to help promote upper limb function. Patients may benefit from aids and adaptations to assist with activities of daily living. Assessment and treatment will be completed at ward and department level and referral to community services completed as appropriate.

Patients who have had surgical intervention will have received specific post-operative instructions which the occupational therapist will take into consideration in assessment and treatment. The majority of patients will have their arm immobilised in a sling for approximately 6 weeks post-operation. The occupational therapist will teach the patient techniques to manage activities one-handed while the affected arm is immobilised. Options for showering and bathing will be discussed.

Rehabilitation phase

As the sling is removed and recovery commences the occupational therapist will look at extended activities of daily living, roles within the family, work, interests and hobbies. Interventions will be dependent on the patient’s goals and roles within the home and community.

Community Living

As patients settle into community living interests and hobbies are an area in which patients often require advice and support. At present a resource for sport and hobbies is being created and this website will be updated regarding this as appropriate.

Inpatient Advice and Support

Inpatient referrals to Occupational Therapy are received when the patient is attending hospital in the acute phase of medical management.

Outpatient Advice and Support

Outpatient referrals are received from the multi-disciplinary Brachial Plexus Injury Service clinics which are held at the New Victoria Hospital. Referrals outwith this are welcome from therapists, nursing staff and consultants.

When assessing a patient it is important to take the following into consideration:

• Mechanism of injury.
• Associated injuries – shoulder injuries, other fractures, head injuries.
• Hand Dominance.
• Surgical intervention and post-op instructions.
• Past Medical History.
• Patient roles – social, work and leisure
• Pain management and how activity increases or reduces pain.

Occupational Therapy Intervention should address the following:

• Ensure the patient has an understanding of their injury.
• Maintain and restore range of movement through active participation in activities of daily living (ADLs). In promoting independence in ADLs assess current function, educate regarding one-handed techniques and prescribe equipment as appropriate.
• Complete education regarding positioning of upper limb. Discuss sensation and how this is impacting in ADLs; in the kitchen ensure patient can handle hot liquids safely and independently.
• Energy conservation techniques – ensure the patient is not over-using their unaffected side as this may put stress and strain on joints and muscles; encourage the patient to break down tasks and take frequent breaks.
• Discuss employment and return to work at an early stage – complete a Disability Employment Advisor referral as appropriate and refer to any other local services that look at return to work issues. Each area in Scotland appears to have different projects up and running with regard to return to work.

A patient with a Brachial Plexus Injury should have a holistic and comprehensive rehabilitation programme to promote upper limb function.