PHYSICAL THERAPY

The importance of physical therapy cannot be overstated. Sometimes complementary occupational therapy (or “ergotherapy,” as it is called in Germany) can also be beneficial. In this post, I am not differentiating between the two terms. The bottom line is that it makes sense to seek help from professional physical or occupational therapists to maximize function in addition to surgery.
In TAR kids, not only radial aplasia but also other skeletal abnormalities might be present. In our case, we had a severe form of hip dysplasia and had treatment for it. Fortunately, the treatment for hip dysplasia was successful. Also, there might be genu varum – bowing of the legs. The bowing of the legs is something that might resolve itself (this happens, but for TAR kids we need to be watching out in case this persists). The bowing of the legs can otherwise be “easily” treated with an eight-plate surgery, a short and straightforward procedure.

Pre-surgical Physical Therapy:
We started stretching regularly and bandaging the wrists at two weeks of age. Stretching regularly meant: at least at every diaper change but ranging up to 30 times daily and stretching fingers, elbows, and wrists. Regular stretching has the additional benefit that the kid gets used to having their arms touched and worked on. You incorporate it into the daily routine. In addition, we went to physiotherapy twice per week to look at the entire body: arms, shoulders, back, hips, rotations, etc. It was helpful to have an additional person looking for potential “additional issues.” We did not have an explicit recommendation to put bandages on the wrists, but we were convinced it made sense that she had her hands in the closest-to-normal position to start using them the most usual way. Our physiotherapist also suggested this approach, and seeing how our daughter was managing hand function with the bandages on reassured us. Several surgeons and orthopedists in Germany also supported pre-surgical stretching and splinting. The goal is to keep the soft tissue elastic and flexible so that it does not put any force on the wrist, preventing it from bending back. However, we were surprised that we were told only to start splinting at around 5-6 months. We wanted to start earlier. Read more about our reasoning regarding splinting in the section on Custom Orthoses.

Post-surgical Physical Therapy:
After Ulnarization surgery, the PT plan varies slightly depending on whether you do the physical therapy at Paley European Institute or in Palm Beach. We believe it is best to start with PT as early as possible after surgery and as soon as the child tolerates it. We did not do extensive PT after the Ulnarization procedure, as our
daughter was in a splint-like cast. We also did not receive an explicit PT plan, so we continued with our German physiotherapy regime. We did look out for finger exercises and shoulder movement so that she would remain active and flexible. After the second surgery, where the K-Wires were removed, we immediately started with PT on post-op day one at Paley European Institute. We worked on elbow,
wrist, and finger movement with various exercises. Our daughter initially hesitated to put her weight on her hands, but this improved after a few months. It was incredible to see her crawling (something she could not do before – she always used to do the army crawl instead).

Physical therapy exercises:

• Stretching the elbow
• Stretching shoulder and back
• Stretching the wrist
• Fine motor skills exercises
• Thumb exercises
• Stretching and expanding the fist
• Stretching each finger
• Bearing weight (after surgery)
• Sensoric stimulation (after surgery)