Fetch the popcorn - Love Island is back on our screens again and that can only mean one thing: a summer of fake tans, "Turkey teeth" and underboob-baring bikinis. Love Island may be one of the most popular reality series on TV but it doesn't have a great track record when it comes to representating disabilities.
Author
Adam Taylor
Professor and Director of the Clinical Anatomy Learning Centre, Lancaster University
In previous seasons, the show has faced criticism for a lack of diversity in the cast and the promotion of an unrealistic body image. In 2021, Hugo Hammond became Love Island's first physically disabled contestant. Hammond was born with clubfoot but, after several childhood operations, his disability is barely visible, which led to further criticism.
The following year, Tasha Ghourhi was the show's first cochlear implant user and Ron Hall the first partially blind cast member. Ghouri, however, was subjected to a wave of ableist abuse and trolling on social media from viewers.
This year, Patsy Field became the first contestant on the show with Erb's palsy (also known as Erb-Duchenne paralysis or obstetric brachial plexus palsy), a weakness or paralysis in parts of the arm caused by nerve damage.
After a few days in the Love Island villa, Field spoke to a fellow contestant about her condition: "I've got a disability, basically … It's a disability in my arm -I've got no strength, anything above shoulder height I can't lift."
Erb's palsy is seen in an average of 2.6 out of 1000 live births and can also develop later in life. It occurs when the nerves coming out of the spine from the bottom of your Adam's apple are damaged.
The condition is the most common type of palsy of the brachial plexus. This is the main nerve highway from the spinal cord in the neck running to and from every structure in the arm including skin, muscles, bones and joints. Typically, the top three of the five major nerves going into the arm are affected.
Causes
The two most common risk factors for developing Erb's palsy are large foetal size (macrosomia), often from maternal diabetes, and shoulder dystocia. This is where the foetal head is born but the shoulder closest to mum's front becomes trapped behind the pubic symphysis, a joint sandwiched between the pelvic bones. As in Field's case, abnormal or long labour may increase the risk of Erb's palsy.
The development of Erb's palsy in later life is most commonly due to traffic accidents, usually involving motorcyclists, where the head and shoulder are forced apart, stretching the neck and causing damage to the major nerves of the brachial plexus. Other causes can be weight falling on the shoulder from height, as well as bullets and sharp objects penetrating through the shoulder, above the collarbone.
Symptoms
A hand position known as the "waiter's tip" - where the arm is limp, bent at the elbow and held against the body like a waiter subtly hinting for a tip - is a classic sign of Erb's.
Depending on the severity of the nerve damage, other symptoms can include limpness of the shoulder, elbow and wrist. There may also be numbness and tingling in the arm or hand.
Treatment
Field has undergone several surgical procedures since birth. In press interviews to promote the latest series of Love Island, she said: "I have had a few operations, muscle transplants, nerve transplants to get it to where it is now, which I am happy with and I know for other people with the condition, it is in a good way."
Where Erb's develops following delivery trauma, symptoms resolve spontaneously in 80%-96% of cases, particularly if improvement in function is seen soon after injury. If symptoms persist after 18-24 months, the injury is potentially irreversible.
Hydrotherapy reduces pain and increases mobility in newborns, as well as offering enough resistance to strengthen muscles. It can also be used in conjunction with physiotherapy. Recently, fascial manipulation, a kind of deep massage of specific points, has been shown to be beneficial.
In young children, constraint-induced movement therapy (CIMT) has a positive outcome. The child's non-affected limb is limited in its movement to encourage the child to undertake everyday tasks with their affected limb, increasing use and strengthening the tissues. This therapy is used in other palsies and stroke treatment.
For those palsies that don't disappear or completely remedy, symptoms worsen through differing muscle function capabilities causing power imbalances. Muscle groups that should work against each other begin to "co-contract" to try to improve joint stability and finally this can lead to joint distortion. Botox injections can help with muscle imbalances and co-contractions.
Surgery is considered the final option, usually either nerve decompression to remove scar tissue from around the nerve or nerve grafting.
In nerve grafting, better results are typically seen when a nerve or part of it is redirected from the same area, rather than brought in from another area of the body. The removal of the nerve must also not cause detrimental function to what it originally controlled.
Hopefully, Love Island's (slightly) increased representation of disability over the last few seasons is a sign of progress.
Adam Taylor does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
