2-year-old boy who had brachial plexus birth injury peers out of a curtain in a medical exam room.
These days, Beckett uses both arms when he plays peekaboo. (Images: Michael Goderre/Boston Children's Hospital)
Beckett Stone-Lyman is an adorable, fun 2-year-old who loves to run, sprint, and climb. If he’s not charging around the playground, he’s probably doing a pirate puzzle. Or maybe he’s staring at his fingers as he wiggles them, amazed that his right hand can now do many of the same things as his left. Thanks to his hard work (and that of his parents), he can also clap his hands over his head and use both hands to cover his eyes in a game of peekaboo.
A crash course in brachial plexus birth injury
It was clear something was wrong with Beckett’s right arm as soon as he was born. He could grip a finger placed in his palm, but otherwise his arm was immobile and hung at an odd angle. His parents, Megan and Mark, would later learn that Beckett had suffered a brachial plexus birth injury (BPBI).
“It was a difficult birth,” explains Megan. “His head went in one direction and his shoulder went in the other.” The strain of the delivery damaged Beckett’s brachial plexus, a network of nerves located between the neck and shoulder that send signals from the brain to the arm. If the nerves of the brachial plexus get stretched or torn during delivery, an infant may have limited movement, or in some cases no movement, in their affected arm.
2-year-old boy peers out from the curtain that is wrapped around his head.
Now that he has use of his right arm, Beckett makes good use of it.
The family met Dr. Andrea Bauer when Beckett was 3 months old. With the help of intensive physical therapy (PT) and occupational therapy (OT), he could lift his right arm slightly, but mostly, his parents still had to position it for him. Given this slow rate of progress, Beckett’s physical therapist recommended the Brachial Plexus Program at Boston Children’s Hospital.
Will his arm recover?
The couple had a lot of questions for Dr. Bauer. What were the chances Beckett’s arm would recover? What could they do to help him? And how much experience did she have with injuries like this?
“We really liked her,” says Mark. “The way she communicates is fantastic.” As one of a small number of pediatric orthopedic surgeons who specialize in brachial plexus nerve repair, Dr. Bauer was well acquainted with Beckett’s injury. Nonetheless, it would take some time to know how extensive the damage was and whether his arm would recover without surgery.
One of the challenges of BPBI — for doctors and parents — is figuring out whether therapy alone will be enough to support function as an infant’s nerves repair themselves. Nerves grow about one millimeter a day, about the width of the tip of a pencil. The symptoms of a minor injury, therefore, often resemble those of a severe injury for months after birth. An MRI could have shed light on whether Beckett’s nerves were torn or simply stretched, but he wouldn’t lay still long enough for that.
2-year-old boy gets physical therapy after brachial plexus birth injury.
Beckett shows physical therapist Kathleen Strawn how he can blow kisses with both hands.
“Dr. Bauer told us to keep encouraging him and bringing him to PT and OT,” says Megan. The coming months would tell if he would gain use of his arm with therapy alone.
After three months, when Beckett’s arm remained mostly motionless, Dr. Bauer told his parents he was a candidate for surgery. Not a small matter for such a young infant, but Megan and Mark wanted their child to have the most arm function possible. It was time, they decided, to take the next step.
Setting Beckett on the path to greater arm function
Dr. Bauer performed two surgeries, 18 months apart. The first, nerve repair surgery, took place in early December 2022, when Beckett was 6 months old. During the five-hour procedure, Dr. Bauer found that two of the five nerve roots of the brachial plexus were avulsed, torn out of the spinal cord completely. She rerouted healthy nerves around the torn ones, creating new pathways along which signals could travel to his arm.
2-year-old boy on his mother's lap, claps his hands over his head.
Beckett shows off for Dr. Andrea Bauer and Strawn while his mother laughs. “There’s a new energy to him,” says Megan.
When Beckett was 2, Dr. Bauer performed tendon-transfer surgery, positioning healthy muscles around the weaker ones. In the following weeks and months, his arm mobility improved dramatically. He started to feed himself with his right hand and he could angle his hand over his eye for peekaboo. “In our house, that’s amazing,” says Megan.
On the move with growing confidence
As his parents describe his recovery, Beckett is a continuous blur of motion in the background, bouncing and doing handstands on the couch. Pretty soon, he’s tugging on his father’s sleeve. His message is clear: Enough talk, let’s play.
“There’s a new energy to him,” says Megan as Mark and Beckett head to the living room. “He knows he can do things he couldn’t do before.” Meanwhile, he continues to go to PT and OT every week to continue strengthening his right arm.
Despite his injury, Beckett has hit all of his developmental milestones. His parents credit this achievement to his strong mind and determination — and the care he received at Boston Children’s. “We’re eternally grateful for Dr. Bauer,” says Megan. “She gave Beckett opportunities he wouldn’t have had otherwise.”
Learn more about the Brachial Plexus Program.
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