Physical Therapy Interventions to Improve Function in
Children with Brachial Plexus Palsy
Nick Pucillo SPT & Erik Rice SPT
Background
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Obstetric brachial plexus palsy is a
complication of childbirth characterized
by one or more nerve conduction blocks
within the brachial plexus.1
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Brachial Plexus injuries occur in .15 – 3
out of every 1000 live births.2
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Common risk factors of Brachial Plexus
injuries include:
Previous deliveries with Brachial
plexus injuries
Prolonged labor
Breech Delivery
Assisted Delivery (vacuum or forceps)
Gestational Diabetes2
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Clinical Evidence
Electrical stimulation
• 16 subjects were randomly assigned into electrical stimulation and conventional physical therapy
group.
• Both groups were seen three times weekly for 6 weeks. E-stim was provided to shoulder
abductors, elbow flexors, and wrist extensors for 15 minutes on each muscle group.
• The e-stim group demonstrated increased ROM compared to traditional therapy in shoulder
abduction, elbow flexion, and wrist extension.3
Movement Therapy
• This article looked at Modified constrained movement therapy compared to traditional treatment.
• MCIMT program involved restraint of the noninvolved upper extremity to encourage movements
in the affected arm.
• There were significant improvements in both traditional and MCIMT groups; however, a the
MCIMT group showed greater improvements in the Mallet Score Outcome Measure which
assesses arm motion.1
Scapular Mobilization
• Thirty children were randomly assigned to either a Scapular mobilization with traditional therapy
or traditional therapy only groups.
• The treatment period was 12 weeks.
• There were significant improvements in shoulder flexion ROM in both groups from baseline, but
the scapular mobilization group showed significantly greater improvements compared to the
traditional therapy group.4
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A brachial plexus palsy will have
different presentations depending on
the involved areas.
Erb’s Palsy includes an injury to the
upper Brachial Plexus (C5, C6,
sometimes C7) where the child will
present with the elbow fully extended,
internally rotated, and adducted.
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These children still have good
wrist flexion, but they lack
extension
The entire plexus (C5-T1) may be
involved in which the child will present
with a flail arm.
Klumpke’s Palsy is more rare, but
involves the lower Brachial Plexus C8T1.2
• Many studies are showing that
traditional Physical Therapy
interventions help improve limb
function and ROM in children with
Obstetric Brachial Plexus Palsy.1,3,4
• The literature describes that
complementary therapy interventions
such as Electrical Stimulation,
Modified Constrained Movement
Therapy, and Scapular Mobilization
can further improve outcomes in
upper limb function and ROM.1,3,4
• A thorough clinical assessment of the
child’s impairments may help
determine the appropriate treatment
intervention.
Further Research
Presentation
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Conclusions
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A key limitation to the previous studies is that
the etiology was not specified as a neurotomesis
(rupture of axon and sheath), axonotmesis
(axon rupture), or neurapraxia (crush injury).
Further high quality studies need to be
conducted to further evaluate the efficacy of
these interventions on Obstetric Brachial Plexus
Palsy.
References
1. Ehab M. Abdel-Kafy, Hebatallah M. Kamal, Samah A. Elshemy. Effect of modified
constrained induced movement therapy on improving arm function in children with
obstetric brachial plexus injury. Egyptian Journal of Medical Human Genetics. 2013; 14
(3), 299-305.
Presentation of Erb’s Palsy
Assisted Delivery Devices that may
contribute to Brachial Plexus Palsy
2. Sebastin SJ, Chung KC. Pathogenesis and management of deformities of the elbow,
wrist, and hand in late neonatal brachial plexus palsy. J Pediatr Rehabil Med.
2011;4(2):119-30.
3. Okafor UA, Akinbo SR, Sokunbi OG, Okanlawon AO, Noronha CC. Comparison of
electrical stimulation and conventional physiotherapy in functional rehabilitation in Erb's
palsy. Nig Q J Hosp Med. 2008;18(4):202-5.
4. Azzam AM. Effect of Scapular Mobilization on Improvement of Shoulder Flexion
Range in Erb’s Palsy Children. J Nov Physiother. 2013; 3:153
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