Brachial Plexus Center Celebrates Fourth Anniversary
The Brachial Plexus Center at Cincinnati Children's Hospital Medical Center marked its fourth-year anniversary in August 2006. The center was formed to give consistent, evidence-based care for brachial plexus injuries, offering families a multidisciplinary team approach that incorporates specialists from Orthopaedics, Physical Medicine and Rehabilitation, Plastic and Reconstructive Surgery, and Occupational Therapy.
The center provides evaluation and treatment of children in one comprehensive program, which benefits the families by eliminating the need to seek services through multiple agencies and departments.
Although staff initially scheduled a clinic to meet once every other month, they quickly realized they needed to hold several clinics each month to serve the number of patients seeking treatment. Kevin Yakuboff, MD, plastic and reconstructive surgeon, believes the center offers an essential service to the community and outlying area. He says, "Prior to its existence, children had to leave the area to seek treatment. Now children are coming from all over the country to be seen here. It is the multidisciplinary input from our specialists that makes our center unique and will be the reason we continue to expand at a rate that exceeded our initial expectations. We are on the path to become one of the largest and busiest centers in the country."
What Is the Brachial Plexus?
The brachial plexus is a network of nerves that provides movement and feeling to the shoulder, arm and hand. The center sees children with injuries ranging from mild stretching of nerves to complete plexus damage that often occurs during the birth process. Center physicians prescribe treatments that include microscopic nerve repair, arthroscopic surgery, shoulder and elbow reconstruction, muscle and tendon transfers, rotational oseotomies, therapy, neuromuscular electrical stimulation and Botox treatment.
Neonatal brachial plexus injuries occur in 1.5 of every 1,000 births. The recovery rate is approximately 64 percent with minimal intervention within the first three months. Traumatic brachial plexus injuries can also occur as a result of motor vehicle, sports and bike accidents and gunshot wounds.
Patient care and education have been the foundation of the clinic's success. According to Tonya Holman, whose daughter has been in the center's care since 2003 and has undergone two successful surgeries, her family's experience has been absolutely wonderful. "Cincinnati Children's Brachial Plexus Center not only offers a medical perspective but takes a personal approach to each child," she explains. "they give you all the medical information you need to make the right decision for your child. They even go out of their way to connect families who can help support one another. I don't know any other hospital that does that."
Putting Families First
Charles T. Mehlman, DO, MPh, pediatric orthopaedic surgeon and co-director of the Brachial Plexus Center, explains how the center works closely with each family to develop "family-derived goals for the child." At each visit, the child and family are asked to list three goals they would like to achieve. "We once had a parent whose wish was for her child to touch and fix her own hair," says Mehlman. "It seemed next to impossible at the time, but the team made it happen."
Linda Michaud, MD, pediatric physiatrist and co-director of the Brachial Plexus Center, agrees with Mehlman that this child's case "is a great example of the individualized approach we take with each child. The specific nerves involved in these injuries vary a lot, so to meet our overall goals of minimizing disability and maximizing functional outcomes, it's necessary to be specific with treatment planning -- non-surgical as well as surgical -- for each child."
In addition to its strong commitment to family-centered care and evidence-based practice, the team is actively involved in research and is currently taking part in a multicenter research study investigating the optimal time for surgical intervention in brachial plexus birth palsy. The Brachial Plexus Center will be hosting its first conference in June 2007 with keynote speaker Dr. Alain Gilbert, a world-renowned expert on brachial plexus injuries.
