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BPI - vision problems?

PostPosted: Mon Dec 04, 2006 8:44 pm
by slpearen
Hi, my daughter Katie, age 6 RBPI, recently failed her vision screening at school. As I was telling her we were going to an eye dr this week, she replied "Oh, to take care of my bumpy eye?" WHAT? She knows, and has known, that she does not see well out of her right eye. She says everything appears bumpy, she can make out shapes, colors but unable to read or tell details. She acted as if this was everyday knowledge. Which to her it apparently is, I can't believe I had NO idea. Anyway, has anyone come across this before? She did have a bit of Horners with her injury although unless she is very tired, it's not noticable.

Vision Problems

PostPosted: Tue Dec 05, 2006 8:37 pm
by hfranks

My son is also 6 years old. He just failed his eye exam at school. He had very severe damage from his OBPI, with all nerves on the left side being affected. He still has noticible Horner's syndrome. Dr. Nath told us at his age it will not correct itself. I have not yet taken him to the eye doctor, as we just got notice on Friday. I will have to ask him about his vision being "bumpy." His school exam did state that he is far-sighted.

Keep us updated on what you find out. Good Luck!

Vision Problems

PostPosted: Wed Dec 06, 2006 6:42 am
by slpearen
We are going this afternoon for the 'official' eye exam, I will send an update. FWIW, I spent a few hours the other night trying to find any associations between Horners and vision problems (as well as BPI) and there does not seem to be any. In reading more about it, I am finding that she has more symptoms of the syndrome than we previously thought. (pupil size especially).

Must be the time of year for all of the schools to perform the vision screenings, which I am now very grateful to them for pointing this out.

Thank you for your reply & luck!

horner's syndrome

PostPosted: Thu Dec 07, 2006 10:43 am
by hfranks
I found this information at the brachial plexus palsy foundation website. They are a very resourseful site. I am pasting the info, but the website is


A brachial plexus injury that occurs during birth is not something that affects only the arm. Although no scientific studies have been conducted to survey these secondary issues, parents have found the following symptoms to be commonly associated with BPI (this information has also been confirmed by adults who have suffered an obstetric BPI):

Horner's Syndrome: Characterized by droopy eyelid and a difference in pupil size. Children with BPI should consult with a pediatric eye doctor to confirm whether or not they have Horner's Syndrome and address any other eye problems that may be related to BPI.

Lung/Diaphragm Issues: Many children with BPI have asthma and other lung issues that need to be treated by a pulmonary specialist. If you notice periods in which the function in your child's arm is drastically reduced, this may be due to a change in lung function.

Changes in the Hair & Face: Many adults with OBPI state that the hair on their face is different on the affected side. Other comments indicate changes in perspiration on the affected side, inconsistencies in how hair dye colors the hair, and differences in aging.

Nails: Nail growth appears to be affected on the injured side. Mothers also report a higher incidence of hang nail.

Smelly Skin Rash: Yeast rashes are common on the affected limbs due to differences in motion and use. Rashes should be appropriately treated and kept as clean and dry.

Hypotonia: Nerve damage that is associated with birth trauma can often result in hypotonia or "low tone". Children with hypotonia will require physical therapy at different times of their lives. Physical therapy also addresses secondary issues that are related to the long-term effects of low muscular tone. A healthy posture can be maintained if physical activity is started early and continued throughout the child's life.

Balance & Gait Issues: Problems with balance are commonly observed in children with BPI. Changes in a child’s normal walking gait can actually be directly correlated to OBPI due to spinal cord involvement at the level of the injury. Parents report that their children often walk and run differently. Some physical therapists are successful in using orthotics to treat gait and balance issues.

Sunburn: Extreme caution should be taken when a child is in the sun because the affected side is often more prone to serious sunburn. Sunblock and other appropriate measures should be to avoid sun damage.

Sensory Integration: In the spectrum of BPI secondary issues, sensory integration issues (SI) seem to be very common. Many OT's specialize in treating the various levels of sensory integration .Many parents suggest reading the book "The Out of Sync Child" by Carol Kranowitz.

Biting Hand and Fingers: At certain levels of recovery, parents have reported that their children may bite the fingers/hand of the affected side. Children who don't have sensation in their fingers may do a great deal of damage (biting off nails, biting through the skin without realizing it) to themselves and may require wound care by a physician and possibly neoprene gloves, as a protective measure.

Temperature Sensitivity: Decreased circulation in the affected arm may result in heightened sensitivity to temperature (both hot and cold).

Weakened Affected Arm When Sick or Tired: Parents of children with BPI relate that their children’s arms do not function as well or even at all when they are ill. Actually, many parents see this decrease in function and pain in the arm as a barometer to a child's current level of health.

Excessive Drooling & Eating Issues: This can be evaluated and treated by an OT. This can possibly be related to the nerve damage.

Ear Infections: We have learned that the ear and all associated tubes, etc. on the affected side, grow differently. In some the ear canal is much smaller and the ear drum itself is smaller. This may lead to increased ear infections on that side. One parent has informed us that she does what she coins as "Crunch Therapy" with her child. Every day her child gets a carrot to crunch on or an apple to bite into as a snack. This jaw movement has helped her child move fluids out of the ear canal - which in her child was defined by two ear specialists as being literally half the size of her other ear!

Scoliosis Risk: Because of the compensation that the children do on a day-to-day basis to account for their muscle imbalances, children with BPI are at risk for scoliosis. This is something that your pediatrician can assess at each visit. X-rays are now used as a diagnostic tool in children with severe injuries to monitor the health of the spine and the possible progression of scoliosis. Scoliosis can be treated with bracing and possibly surgery for the most severe cases.

Edema: Decreased circulation in the arm may show up as "edema" – also known as puffiness or swelling of the arm. Your OT can help assess this and teach you how to massage and/or wrap the arm to enhance circulation. One parent whose child has severe edema has observed that doing nightime electrical stimulation therapy - TES - has helped to reduce the swelling in her daughter's arm.

Speech Delays and Developmental Delays: Specialists have told us that whenever a child has surgery before the age of 3, in most cases the child will have some developmental delays and possibly speech delays. This is because the child is spending much of their time doing tasks related to their post surgical health rather than being active and working on "normal" development. PT and OT and speech therapy can help a child catch up developmentally.

Delayed Self Help Skills: Children with BPI may have trouble with dressing and hygiene issues. An OT would be able to show you how to teach your child to dress, potty and bathe. Have no fear because there are ways to do all of this one-handed.

Torticollis: This is a tightening of the neck muscles early on after the birth. Often a chlid with an injury doesn't want to move their head on that side - so the neck muscles tighten. An OT or PT can show you exercises to do to relieve the torticollis. At home you can do things like put a light show toy on that side of the crib so that the baby is more likely to use that side and thus stretch those muscles. A good therapist will teach you how to be inventive and develop new techniques to help your child be active and healthy.

Lightning Strikes / Fascilculations / Nerve Pain / Never Ending Itchies: As the nerve grows in and as the child develops - he or she may experience a myriad of sensations. Some say that it feels like lightening going down their arm. Others say that it's like a movement "tick" (fasciculation). There can be nerve pain, buzzing sensations or itching that may never go away. Unfortunately, this is all part of the injury.

Apraxia: A child with apraxia is often unaware that they are carrying or using their affected limb for a particular task. Some children with BPI are slower at doing tasks because they have to "motor plan" – or figure out how to direct their body appropriately. Dr. Karen Pape ( can give you good information about apraxia. Dyspraxia might also be an issue with some children.

Issues Concerning Changing Handedness

For those affected with Horner's Syndrome: Issues with overhead lighting.

Vision Problems

PostPosted: Thu Dec 07, 2006 11:49 am
by slpearen
Wow, it's interesting to see it all laid out that way.

We have been referred to a pediatric eye doc. She is extremely far-sighted which means she can't really see anything close up either. From what I saw during the exam yesterday, she is fairly blind in her right eye. So, there are some different treatment plans that he'd like for us to get a second opinion on. Glasses and an eye patch at the minimum.

vision problems

PostPosted: Thu Dec 07, 2006 12:06 pm
by hfranks
I was thinking about skipping the opthomologist and going straight to the Pedicatric eye doctor. I am checking to see if there is a pediatric eye doctor at Arkansas Childrens Hospital that has experience with Horner's Syndrome.

Does your daughter have a lot of the symptoms for Horner's? Jaxxon has ptosis, he does not perspire on that side of his face, and his eye is a slightly different color - just a bit lighter. I have not really noticed a difference in his pupils, but I have not really looked for it either.

He has had most of the symptoms on that list at one time or another. I am going to try to find the book mentioned. I will keep you updated on our progress.

PostPosted: Sun Dec 10, 2006 1:06 pm
by Sandy
My daughter has a robpi and has worn glasses since she was 4. Her pediatrician discovered a problem w/ her right eye during a routine exam. We saw an opthamologist and was told she is severely far sighted in only her right eye, while the left eye is fine. I truly believe this is due to the obpi- it seems to affect many aspects of their little lives, not just "the arm." Luckily glasses corrected her vision and we continue to do all we can to improve the quality of her life!


PostPosted: Sun Jan 07, 2007 4:06 pm
by slpearen
I would say she has mild Horners symptoms. The difference in her pupil size is the only one she is asked about from others. These questions seem to bother her more than any questions re: her arm. We are going to the pediatric opth. this week, and I will post once I have more news. I wonder what her opinion will be - Horners/BPI related. Perhaps I shouldn't separate the two...

Thank you for your input.

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