So my 16 month old fell and broke her arm, just a buckle fractures, but has a full arm cast. She’s been in PT for a year for torticollis and has left sided weakness, front wheel torticollis and we were making such good progress LO working on her left arm, and of course that’s the one she broke. I’m so worried about the regression we’ll see. I’m trying to encourage her to still use that arm and lift the cast and pop bubbles with that arm and stuff, but is there anything else I can encourage her to do to prevent severe regression and loss of strength while she’s casted?
First question I have which side was her head tilt/torticolis? Did she injure her left arm landing on it bc it was outstretched to protect her fall?
If her left side is not only weak but tight in trunk it’s important to do trunk elongation exercises on both sides to keep that equal. Like weight shifting to both buttocks .weight on one hip at a time . Like sitting on a stool or small peanut ball and stomping her feet as to shift side to side. Of course with you right there! To help protect her from not falling on that casted arm again. It’s great that you are having her pop bubbles with that cast arm.! Keep her aware if just like that! A lot of torticolis is coming from trunk imbalances so maybe get with a pediatric PT who knows TMR technique. You can try with her laying on her back ( diaper change time ) bringing opposite elbow and knee towards each other for gentle trunk rotation stretches . This should be doable with a cast. These are suggestions with caution to the cast.
Always check in with your PT on what home exercises should be done
Jennifer Aguillard PT PCS
I’m not a PT or an OT but I am vastly experienced in broken bones in childhood. Especially early childhood. Myself and both my children have Osteogenesis Imperfecta (brittle bone disorder) and have dozens of fractures between us.
Though as a child we broke our legs (mostly femurs) and endured spinal compression fractures the most, muscle weakness was absolutely a side effect of being in casts for extended periods.
Does your child tolerate pressure on the casted arm yet? It’s not unusual for them to walk, crawl, on the casted and broken limb. Don’t discourage it, the cast keeps the bones safe. In fact to keep muscle strength up I would even encourage some crawling on that arm if she tolerates pressure and weight of her own accord. Don’t ask her to do this, only do it if she is doing it already on her own. The day my daughter walked in a body cast floored me (she was 23 months old), but it really helped retain some muscle strength.
Casts are heavy, even fibre glass ones, so the simple weight of the cast and just having her gently (when tolerable, you don’t want her in pain) is a lot of good muscle working out.
The chances are likely that there will be strength discrepancies regardless of exercises once the cast is removed. We noticed it returns to normal within 6 weeks though. Seek PT and OT after the cast is removed and they should help guide you on ensuring a return to where she was at.
Good luck! Honestly if you need any other broken bone or casts questions feel free to ask them Hope she mends well and fast.
Left sided tort. Yes, she fell protecting herself, over the side of a learning tower. PT works on her trunk a lot, stretching and extensions and crunches. I don’t follow what to do exactly with the opposite elbow and knee exercise. Could you tell me a little more? She has started trying to crawl on it a little, but it’s super hard while it’s at 90degree angle. Its only day 2, so I suspect she’ll get much better. I’ll also try the weight shifting stuff. She’s definitely still adjusting to the weight of the cast, balance wise. Thanks for the ideas. We have a lot of items here for PT to utilize so I’m open to anything!
Oh just read it’s a stretch, I got it! Thanks! We do a lot of stomping on playdoh too. I’ll keep encouraging her to be aware of her arm. I was so upset it was her weak side and instantly worried about her tort and regression
Yes it’s opposite knee to opposite elbow. Gentle stretching. And it sounds like you are really on top of it! The mom above is right. Casts are protective. It takes (generalization) about 6 weeks for a fracture to heal. Not sure if healing is slower in osteogenesis imperfecta. Everyone’s healing time is their own. Don’t want her weight bearing with ANY pain. I would absolutely clear with your doctor the crawling on the casted arm. He or she may have given you the clearance already (?) but they like some healing to occur before they allow weight or pressure. That is the reason they cast it at a 90 degree bend so you can’t crawl on it. Lol keep up the good no great job and don’t worry about regression. I feel all the trunk and head and neck exercises for torticolis can be done still with her cast. So hopefully no regression.
Jennifer Aguillard PT PCS
Thank you! I can’t imagine OI. I am not restricting her crawling, they said the cast will protect it enough since it was not a displaced fracture and most babies will self restrict. We’re hoping only 3 weeks, but we’ll see