Supracondylar humerus fracture are common upper extremity injuries in children accounting for over 400 fractures per year and approximately 25% of all fractures treated at Seattle Children's Emergency Department. Most of these fractures are treated with splints and casts though more than one-third undergo surgical fixation followed by casting. Healing is usually complete after 3-4 weeks, when casts (and pins, if fixed operatively) are removed and motion begun. Though stiffness is often a problem after immobilization of adult elbow fractures, stiffness after pediatric elbow fractures is regarded as typically transient. This study addresses the question "Does early motion of the arm with physiotherapy promote the return of function and motion in patients with supracondylar humerus fractures?" The investigators will conduct a prospective randomized trial to determine the effect of six occupational therapy visits over a five week period of time on elbow function and mobility after supracondylar humerus fracture. The investigators will measure motion of the elbow and administer the child and parental Activity Scale for Kids performance versions (ASKp) assessment tool to answer this question.

Inclusion Criteria:

• Have a supracondylar fracture which is isolated, non - comminuted, and less than one week old.
• Will be treated with either casting or surgery.
• Lack head injuries or other fractures.
• Are not cognitively impaired or critically ill.
• Are 5 - 12 years old
• Speak English or Spanish

Exclusion Criteria:

• Requires open reduction to align
• Comminuted or t - intercondylar fracture
• Other fractures on the same limb
• Head injury
• Cognitive impairment
• Critically ill
• Mental disorders
• Fracture occurred more than one week prior to visit.