protocols after nerve reconstuctive sx for obpi

[otjoan]

Hi,

I'm an OT working with a 6 month old s/p nerve reconstruction C5-7. I had seen this baby prior to the surgery as well. I am looking for protocols to follow other than what the surgeon suggested (ROM) as we all know as therapists there is more we can do. I welcome your suggestions and will be glad to come back and post as I find outcome-focused research that applies. I read one place to never immobilize, but I am concerned about wrist subluxation due to poor return distally, so at this time I am using a custom-fitted theratog to give more wrist stability. We used kinesiotape previously but have to take frequent breaks due to skin integrity issues.

How long should this parent wait before looking into mod-quad sx? The surgeon here says wait a year or more to "see" about the wrist and hand, while studies I read say it is dangerous to wait that long due to muscles being replaced with non-muscle tissue naturally from non-use.

Thanks for your feedback!