Toddler can move arm for first time thanks to ground-breaking rehab programme

A toddler who couldn’t move her arm can now use it thanks to a pioneering rehabilitation programme at Evelina London Children’s Hospital.

Two-year-old Isabella Dominguez, from Bromley in south east London, was born at 26 weeks, and suffered a brain injury which caused hemiparesis, a condition which causes weakness and limited movement of her left side of the body.

Isabella had no movement in her left arm and hand, and was referred to the REACH (Rehabilitation at the Evelina London Children’s Hospital) service for specialist rehabilitation.

Pioneered by Dr Anne Gordon, consultant occupational therapist at Evelina London Children’s Hospital, the Evelina REACH service is the first of its kind to be set up in the UK.

The service offers upper limb focused intensive rehabilitation programmes for children aged between 6 months to 16 years, with, or at risk of, hemiparesis.

The six week programme focuses on improving how a child or young person uses their arms and hands in daily life.

Isabella’s mother Chanel, 30, said: “The REACH service has made a huge difference to Isabella’s life. Before she received the therapy she had no use in her left arm and hand and I didn’t think she would ever be able to use them.

“Isabella is now like a different child and is much more independent. She can do everyday tasks such as drinking from her water bottle, feeding herself with a knife and fork, and playing with her toys and younger brother Sunny. We can now take her to the playground and let her play with other children and use a climbing frame without worrying that she might lose her balance and fall.

“Isabella still has some difficulties with movement in her arm and will continue to require support but the improvements she’s made so far are life-changing and have made a massive difference to our family.”

Isabella completed two intensive upper limb programmes with the Evelina REACH rehabilitation service. She was seen five days a week, for six weeks in partnership with her local therapist.

Chanel said: “I’m extremely grateful to everyone in the team. They were absolutely brilliant with Isabella. She loved going to her sessions at Evelina London. They made it really fun and for her it was just playtime. She was given toys to play with that forced her to use her left arm. It became like a second home.

“The team was also really supportive to me as a parent. As part of her treatment Isabella also had virtual sessions at home. The team provided lots of advice and ideas on how to encourage her to use her arm at home. I could email them at any time with questions which they always responded to. They even provided advice on what types of presents to get Isabella for her birthday and Christmas to help her use her arm. I couldn’t thank them enough.”

Dr Anne Gordon said: “Evidence shows that for hand and arm function, intensive bursts of therapy work best. We have created the Evelina REACH programme to enable children to access this intensive course of therapy.

“The programme combines weekly face-to-face and virtual sessions with the REACH team, and weekly appointments with a child’s local therapist. The remainder of the sessions are delivered at home, led by the parents who we coach throughout the programme. This is really important as we work in partnership with the family and local therapist throughout.”

When referred to the Evelina REACH service, children receive a detailed assessment to determine the most appropriate support based on their needs.

Rehabilitation programmes are individualised with aims and goals that are set in collaboration with the family and community therapist, to support children to achieve their best outcome.

Dr Gordon said: “During the sessions children are typically seated, so they can see both of their hands as they're playing and moving, and can learn about what their hand can do. This is really important but we also want children to have fun and stay motivated through the programme as this will help develop their skills.

“Children who have completed the programme have been able to go from not being able to do everyday tasks such as picking up a pencil or holding a spoon, to being able to feed themselves.”

After the end of the programme, the child is reviewed at six weeks and six months to reassess and monitor progress.

The Evelina REACH service is available to children and young people across south London and the south east of England. The team also offers one-off consultation and advice appointments for children outside of these areas. To support local therapists, the Evelina REACH team hold regular workshops on therapy practice.