Role of Physiotherapy

The role of physiotherapy is to help you to achieve the maximum function possible after injury through a supportive, goal orientated rehabilitation programme. This will take place at various stages after your injury from hospital stay (if applicable) to your local outpatient physiotherapy department.

Clinical Specialist Physiotherapist

The clinical specialist physiotherapist is based at the New Victoria hospital and works closely with the full brachial plexus team. They assist and coordinate your physiotherapy input and you will meet them at clinic appointments to review your progress. They can liaise with your inpatient and local outpatient therapists to update them and provide rehabilitation support and advice as required.

Out-with clinic appointments you are free to contact the physiotherapist at any time for advice and support on the contact details here.

What Does Physiotherapy Consist Of?

Exercise

You will be advised on exercises to move your limb. This will help to prevent or improve any stiffness and strengthen weak muscles as a result of your injury.

These exercises will depend on what your needs are at the time and may be restricted and very basic initially. They will likely progress to help you return to using your arm and get back to day-to-day activities, work and hobbies.

It is important that you feel you can do what is prescribed for you. If you don’t feel comfortable or are unable to do them, it is important to discuss this with your physiotherapist as soon as you can.

Splints and Supports

Working closely with the team occupational therapist and orthotist, the physiotherapist may advise on splints to wear for your limb that can support and prevent stiffness in the hand, elbow or shoulder and assist with function. This is on an individual basis and can be discussed at your clinic appointments or communicated with your local therapists.

Pain Management

Working closely with the full team, the physiotherapist can assist with advice, techniques and strategies to help with pain management. They can liaise with local services to discuss medication and other management options and can direct you to other pain education resources.

Returning to Day-to-Day Activities, Work and Hobbies

Physiotherapy plays a key role in helping you to cope with your injury and integrate back into day-to-day life. It aims to achieve this through individualised support and encouragement to achieve your goals.

Examples of this include specific exercises around your hobbies, finding alternative activities if that is not possible, providing written support for your employer or referring to local services and groups within your local community.

If you are finding returning to particular activities difficult, please discuss with the team for their support.

Local Physiotherapy Support

Patients who require follow-up treatment are referred on to their local hospital or health centre for MSK physiotherapy. The clinical specialist physiotherapist will review patients at their brachial plexus clinic appointments. They will feed back locally as required. There are therapy-led appointments with the Specialist Nurse, OT and Orthotist available for routine follow-up for patients who do not require consultant-led care.

As the service will see patients from all over Scotland, Northern Ireland and Northern England, this liaison role is a crucial part of the service and clinical specialist role. The team therefore can offer support via email and telephone to discuss individual cases including referral to the service. They can also offer joint review sessions through video calls to support patient management. Contact the physiotherapist directly to discuss further (the easiest mode of communication is via email).

Physiotherapy Protocols

The team will ensure that local physiotherapy has all the relevant information upon referral e.g. operation notes, post-operative instructions etc. they will require for patient management. There is an Information for Physiotherapists* booklet and a Physiotherapy Protocols booklet for further information.

*This booklet is currently under review. Contact details and telephone numbers may be out of date.

The service accepts referrals from therapists and consultants throughout Scotland. The majority of patients are referred to the clinical specialist physiotherapist from the BPI clinic or the ward following trauma. However, it is possible to refer directly. Speak to the physiotherapist if you have a patient you think may benefit from attending.

Journals

1. Birch R. Traction Lesions of the Brachial Plexus. British Journal of Hospital Medicine September 1984


2. Frampton V. Management of Brachial Plexus Lesions. Physiotherapy 1984; vol 70 no 10,


3. Frampton V. Management of Pain in Brachial Plexus Lesions. Journal of Hand Therapy 1996; 9:339-343


4. Holtsag H, Post, M, van der Werken, C, Lideman, E. Return to work after major trauma. Clinical Rehabilitation 2007; 21:373-383


5. Jivan S, Kumar N, Wiberg M, Kay S. The influence of pre-surgical delay on the functional outcome after reconstruction of brachial plexus injuries. Journal of Plastic, Reconstruction and Aesthetic Surgery 2009; 62:472-479


6. Moseley, L. Graded motor imagery for pathologic pain. Neurology 2006; 67: 2129-2134


7. Moseley L, Gallace A, Spence C. Is mirror therapy all it is cracked up to be? Current evidence and future directions. Pain 2008; 138: 7-10


8. Ramachandran, V, Altschuler. The use of visual feedback, in particular mirror visual feedback in restoring brain function. Brain 2009; 132: 1693-1710


9. Spinner R, Shin A, Bishop A. Update on brachial plexus surgery in adults. Current Opinion in Orthopaedics 2004; 15: 203-214


10. Vekris M, Beris A, Lykissas M, Korompilias , Vekris A, Soucacos P. Restoration of elbow function in severe paralysis via muscle transfer. Injury, International Journal of the Care of the Injured 2008; 395: 15-22

Books

1. Examination of the Hand and Wrist. Tibiana. Thomine, Mackin. Published by Martin Dunitz. Chapter 4 ISBN 1 -85317- 544-77


2. Surgical Disorders of the Peripheral Nerves. Birch, Bonney, Parry 1998. Published by Churchill Livingstone. Chapter 9, ISBN 0443-04443-0


3. Rehabilitation of the Hand. Hunter, Mackin, Callahan. Published by Mosby. Chapter 35, 36 ISBN0-8016-7125-6


4. Nerve injury and repair. Regeneration, Reconstruction and Cortical Remodelling. Lundborg, G (2004). Published by Elsevier Churchill Livingstone. Salter. M, Cheshire. L (2000)


5. Hand Therapy: Principles and Practice: Maureen Salter, Lynn Cheshire (Eds.). Butterworth-Heinemann, Oxford, 2000. ISBN 0-7506-1686-5