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Children and Adolescent Hand and Arm (CHArm) Center

CHArm Center Frequently Asked Questions

Who should contact the CHArm Center?
Parents of children and adolescents with acute injuries or long standing neurological or congenital issues of the hand, arm, and upper extremity, should call the CHArm Center at 1-888-CHArm40. 

What kinds of conditions do doctors and therapists at the CHArm Center treat?
Some of the conditions the CHArm Center treats include, but are not limited to:

How will the CHArm Center help me find the right specialist?
You will be screened over the telephone and then referred to the appropriate CHArm Associate, matching your condition with the right doctor's clinical expertise. We seek to eliminate the hassle of seeing multiple physicians prior to seeing the appropriate specialist. Patient wait time is therefore reduced, and treatment is accessed in a timely manner. Parents with questions and concerns regarding their child's hand and arm condition can also email questions to the CHArm Center at charmcenter@hss.edu.

Will I have to participate in research studies if I am a CHArm patient?
Participation in CHArm Research Studies is strictly voluntary.  CHArm patients will be asked to participate in observatory studies, where they will be asked questions throughout the course of their treatment. CHArm patients have many options - they can choose to participate or not participate at all, and if they do decide to participate, they can discontinue their research participation at any point in time.

What is orthopedic surgery?
Orthopedic surgery is surgery performed on bones, muscles and joints.

For patients with cerebral palsy, which parts of the body can be helped with orthopedic surgery?
Orthopedic surgery is performed both in the lower extremity (feet, legs, and hips) and the upper extremity (hand, forearm and elbow) for patients with cerebral palsy. This portion of the site will focus on upper extremity (UE) surgery for patients with cerebral palsy (CP).

How can orthopedic surgery help when spasticity, tone and movement difficulties encountered in cerebral palsy are caused by problems in the brain (or CNS)?
Since there are no known ways to operate on the brain to make cerebral palsy (CP) better, orthopedic surgery can help to "rebalance" muscles that are getting inappropriate signals from the brain.

Please give me examples of how muscles in the upper extremity can be "rebalanced" by orthopedic surgery?
Two common problems in cerebral palsy are muscles "overworking" and muscles "underworking". Overworked muscles would include increased tone or spasticity. Spastic or high tone muscles can be weakened by surgically sectioning (cutting) some of the fibers so they cannot pull as strongly. 

Under-worked muscles would include flaccidity, weakness or decreased tone. Some muscles under-work so much that they do not fire at all. One option of aiding these muscles is to find a less-needed muscle that is working well and move a part of that working muscle to the weak area.

How do I know if my child is appropriate for orthopedic surgery in the upper extremity (UE)?
Anyone with muscle problems caused by cerebral palsy (CP) can be appropriate for surgery. However, your child will need an evaluation by an experienced team in order to assess his or her specific situation.

What is the best age for surgery on the arm and hand?
For patients with cerebral palsy (CP), the best age for surgery is about 6 years old. At 6 years of age, many children can follow simple directions but are still developing new skills, so they can integrate their new muscle patterns very well. Some children benefit from waiting until they are a little older. As an adult, surgery is still indicated, just more of the rehab will focus on retraining the muscle. A child will pick things up more spontaneously.

Is UE orthopedic surgery better for a certain severity of CP or type of disability? (i.e. quadriplegia, hemiplegia, etc)
Most types of patients with cerebral palsy (CP) can benefit from orthopedic surgery. Goals of surgery can range from improving a dependent patient's hand position in order to make dressing easier for their caretaker to changing mild muscle tightness in independent patients.