Rehabilitative Interventions to Improve Biomechanical or Functional Outcomes for Children with Obstetric Brachial Plexus Palsy

Background: Obstetric brachial plexus palsy (OBPP) affects children worldwide, with incidence rates ranging from 0.5 to 3 per 1000 live births (Foad, Mehlman & Ying, 2008). Injury characteristics vary greatly and therefore, discrepancies exist regarding the most effective rehabilitation interventions. These children receive conservative management (through occupational and physical therapy), Botulinum toxin, surgery, or a combination of treatments (Benjamin, 2005). Objective: To present the results of a systematic review of the literature to identify rehabilitative interventions that demonstrate statistically significant functional/biomechanical outcomes in children with OBPP. Methods: A systematic search of the databases PubMed, CINAHL, and MEDLINE (2003-2013) yielded 256 results. Authors agreed on 16 articles for qualitative review based on strict inclusion/exclusion criteria pertaining to age of subjects, interventions, quality of study, and date of publication. Two authors independently critiqued (using Law, M. & McDermid, J. (2003). Appendix M and N) and subsequently synthesized each article for identification of common themes. Findings: Overall, there is intermediate to low quality evidence to support the effectiveness of rehabilitative interventions for OBPP. Statistically significant gains in strength and ROM were associated with mCIMT, electrical stimulation, DVD home program, and serial casting/splinting. Statistically significant gains in functional task performance were measured using standardized and non-standardized instruments and associated with casting, mCIMT, conventional OT/PT and kinesiotaping. However, several studies used co-interventions (including botox-A and surgery), and positive results may not be attributable to the experimental condition alone. Results suggest the following patient factors may affect outcomes: age, surgical history, level and severity of OBPP injury, presence/severity of contracture, and caregivers’ proficiency and/or program compliance. Conclusion: Results suggest that rehabilitative interventions produce significant biomechanical and functional improvements among children with OBPP whether performed alone or after surgery and/or Botox-A. To support these interventions in clinical practice, further studies with larger sample sizes and more rigorous validity standards will help determine isolated effects of the interventions, the generalizability of the interventions, and the optimal time to initiate treatment. References: Benjamin, K. (2005). Part 1. Injuries to the brachial plexus: Mechanisms of injury and identification of risk factors. Advances in Neonatal Care, 5 (4), 181-189. doi:10.1016/j.adnc.2005.03.004 Foad, S. I., Mehlman, C. T., & Ying, J. (2008). The epidemiology of neonatal brachial plexus palsy in the united states. Journal of bone and joint surgery, 90, 1258-64. doi:10.2106/JBJS.G.0085