A New Yoga-Based Stretching Protocol for Children with Birth
Brachial Plexus Palsy: Development of the Protocol for Ages 3-5
Kara Miller, OTR/L & Maya Spaeth, MD
Division of Clinical Therapies at Nationwide Children’s Hospital
Columbus, Ohio
background
• Although they are commonly recommended, there is limited
research on Obstetric Brachial Plexus Palsy (OBPP) home
programs
• There is some evidence for the effectiveness of stretching
(Weekley et al., 2012; Julka & Vander Have, 2011; Hogendoorn et
al., 2010; Nikolaou et al., 2011). Key stretches include:
Scapular stabilization and retraction
Shoulder abduction, flexion, external rotation
Supination
• In addition, there is some preliminary evidence for the
effectiveness of yoga (Akhtar et al., 2013; Bryan et al., 2012, Ross
& Thomas 2010; Birdee et al, 2009)
• Yoga can be more engaging and child-friendly than traditional
stretching, and offers additional benefits such as relaxation and
decreased stress
• Proposed program: A Day at the Beach, a yoga stretching protocol
for children with OBPP ages 3-5
methods
Efficacy
• Narakas Injury
Severity
Classification
System (Borschel
& Clark, 2007;
Narakas, 1985)
• Active Movement
Scale (Curtis et al.,
2002)
• Brachial Plexus
Outcome Measure
(Ho et al., 2012)
• Mallet Score
(Mallet , 1972)
Compliance
• Parent Survey
• Weekly Log
Scapular
Retraction/Stabilization
Up dog to down dog
Cat/Cow
Crab
Camel/Seahorse
Superman/swimming
Warrior
Tree Pose
Child’s Pose
Shark
External Rotation
Cow’s Head
Tree Pose
Crab
Superman/swimming
Shark
Elbow Flexion
Tree pose
Shark
Superman/swimming
Mountain
Supination
Tree pose
Crab
Shoulder Flexion
Up dog to down dog
Superman/swimming
Shoulder Abduction
Cow’s Head
Mountain
Warrior
Tree Pose
Up dog to down dog
Jellyfish
Elbow Extension
Crab
Cat/cow
Camel/Seahorse
Shark
Superman/swimming
Pronation
Up dog to down dog
Child’s pose
Crab
Camel/Seahorse
Shark
Superman/swimming
Tree
Mountain
Internal Rotation
Cow’s Head
Up dog to down dog
Crab
Cat/cow
Child’s pose
Camel/Seahorse
Superman/swimming
Shark
Mountain
Figure 2. Key muscles affected by OBPP receive stretch through
multiple poses.
Function and QoL
• Pediatric
Evaluation of
Disability
InventoryComputer
Adaptive Test
(Haley et al., 2012)
Figure 1. Proposed outcome measures by area of emphasis.
Today we are going to take a trip to the beach!
It is time to put on our sunscreen.
I see a palm tree swaying in
the breeze.
Figure 4. Demonstrating poses while filming the video.
conclusions & future directions
• Although there is limited evidence at the time, research suggests that
regular stretching may improve outcomes for patients with OBPP
• Therefore, this information provides introduction to other practitioners
about the development of a new home program for the brachial plexus
population that is evidence-based and easily accessible
• More research is needed to determine whether this protocol is effective
for reducing muscle imbalances in the affected upper extremity and
whether there is increased compliance with a yoga home program
• Next steps: obtaining grant funding and IRB approval for research, and
development of protocols and videos for ages 6-12 and 13-18
• Interested in participation from other centers:
Kara.Miller@nationwidechildrens.org
Maya.Spaeth@nationwidechildrens.org
acknowledgements
Kelly Tanner, PhD, OTR/L. Occupational Therapy Research
Coordinator, Nationwide Children’s Hospital
references
Let’s go surfing!
We had better swim to shore!
The sun is starting to set and it’s time to go home.
Figure 3. A Day at the Beach yoga protocol features a child-friendly
story line and imagery.
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