EFFECTS OF NEUROMUSCULAR ELECTRICAL STIMULATION WITH AND WITHOUT CONSTRAINT INDUCED MOVEMENT THERAPY ON UPPER LIMB FUNCTION IN CHILDREN WITH ERB’S PALSY

Main Article Content

Dr. Madiha Tariq
Dr. Aamna Hassan
Dr. Gull Mahnoor Hashmi
Dr. Sarah Khan
Dr. Shiza Ghani PT
Amina Saeed
Dr. Wajeeha Bakhat
Dr. Eram Aslam
Dr. Muneeb Iqbal

Keywords

Brachial plexus Neuropathy, Constraint Induced Movement Therapy, Erb’s Palsy, Neuromuscular Electrical Stimulation, Klumpke paralysis, Erbs Duchene paralysis

Abstract

Background: Erb's Duchene paralysis a paralysis of the arm caused by the injury to the upper group of the main nerves supplying it, specifically the upper trunk C5-C6 of the brachial plexus. It causes functional impairments in the child which limits activity. Constraint-induced movement therapy (CIMT) has been used to promote functional gains in individuals with neurological dysfunctions. Whereas, neuromuscular electrical stimulation (NMES) has been used for muscle strengthening, maintenance of muscle mass and strength during prolonged periods of immobilization.


Objective: To compare the effects of neuromuscular electrical stimulation with and without constraint induced movement therapy on upper limb function in children with Erb’s palsy.


Methods: A randomized controlled trial performed with-in 6 months from July 2022 to December 2022 in which 22 children with age of 6-8 years (mean and SD=10.45±1.29) were taken randomly after meeting inclusion criteria. Children were divided into two groups. Group 1 received constraint induced movement therapy for a period of 3 weeks for at least 6 hours per day combined with the application neuromuscular electrical stimulation for a period of 6 weeks four times a week. Group 2 received only neuromuscular electrical stimulation for a period of 6 weeks, four times a week. Statistical Package for Social Sciences (SPSS 25) was used to analyze the data.


Results:  Constraint-induced movement therapy plus electrical stimulation group showed both a greater rate of improvement in integrated EMG of the involved wrist extensors and cocontraction ratio compared to the other group at 3 and 6 months, as well as improving in root mean square of the involved wrist extensors than traditional occupational therapy group (p<0.05).


Conclusion: Constraint-induced movement therapy plus electrical stimulation is likely to produce the best outcome in improving muscle recruitment and coordination in children with erbs palsy compared to alone therapies. CIMT has been proven to be effective in the enhancement of impaired upper limb in several neurological conditions and NMES has also been effective in improving function in children with Erb’s palsy.

Abstract 254 | Pdf Downloads 44

References

1. Eren B, Saygı EK, Tokgöz D, Leblebicier MA. Modified constraint-induced movement therapy during hospitalization in children with perinatal brachial plexus palsy: A randomized controlled trial. Journal of Hand Therapy. 2020;33(3):418-25.
2. Justice D, Awori J, Carlson S, Chang KW, Yang LJ. Use of Neuromuscular Electrical Stimulation in the Treatment of Neonatal Brachial Plexus Palsy: A.
3. Justice D, Awori J, Carlson S, Chang KW, Yang LJ. Use of neuromuscular electrical stimulation in the treatment of neonatal brachial plexus palsy: A literature review. The Open Journal of Occupational Therapy. 2018;6(3):10.
4. Singh P, Kolamala K. Development of a protocol for the management of Obstetric Erb's Palsy. Indian J Occup Ther. 2015;47(1):1-6.
5. Van der Looven R, Le Roy L, Tanghe E, Samijn B, Roets E, Pauwels N, et al. Risk factors for neonatal brachial plexus palsy: a systematic review and meta‐analysis. Developmental Medicine & Child Neurology. 2020;62(6):673-83.
6. Sakzewski L, Ziviani J, Abbott DF, Macdonell RA, Jackson GD, Boyd RN. Randomized trial of constraint‐induced movement therapy and bimanual training on activity outcomes for children with congenital hemiplegia. Developmental Medicine & Child Neurology. 2011;53(4):313-20.
7. Islam M, Nordstrand L, Holmström L, Kits A, Forssberg H, Eliasson AC. Is outcome of constraint‐induced movement therapy in unilateral cerebral palsy dependent on corticomotor projection pattern and brain lesion characteristics? Developmental Medicine & Child Neurology. 2014;56(3):252-8.
8. KRUMLINDE‐SUNDHOLM L. Reporting outcomes of the Assisting Hand Assessment: what scale should be used? Developmental Medicine & Child Neurology. 2012;54(9):807-8.
9. Chang KW, Wilson TJ, Popadich M, Brown SH, Chung KC, Yang LJ. Oberlin transfer compared with nerve grafting for improving early supination in neonatal brachial plexus palsy. Journal of Neurosurgery: Pediatrics. 2017;21(2):178-84.
10. Torrey M. Therapeutic Implementation of a Custom Dynamic Elbow Brace for Children With Neonatal Brachial Plexus Palsy: A Case Report. Pediatric Physical Therapy. 2020;898(5669/110):3301-0E23.
11. Frade F, Gómez-Salgado J, Jacobsohn L, Florindo-Silva F. Rehabilitation of neonatal brachial plexus palsy: integrative literature review. Journal of clinical medicine. 2019;8(7):980.
12. Bekou EA, Iakovidis P, Chasapis G, Kottaras I, Kottaras A, Lytras D. Comparison of the efficacy of electrotherapy and neuromuscular retraining techniques in restoring function of children with obstetric palsy. International Journal of Advanced Research in Medicine. 2021;3(1):419-22.
13. Anees S, Burq HSIA, Afzal M, Yousaf MA, Amin T, Rizwan M. Effects Of Physiotherapy on Strength, Range and Function in Children with Erb’s Palsy; An Experimental Study: Effects of Physiotherapy on Children with Erb’s Palsy. Pakistan BioMedical Journal. 2022:68-72.
14. Farooqui B, Shastri K, Motar P. Implication of Functional Electrical Stimulation on Upper Limb Recovery in A Rare Case of Adolescent Chronic Obstretic Brachial Plexus Injury: A Case Report. Annals of the Romanian Society for Cell Biology. 2021;25(6):4729-34.
15. Abdelaziz ER, Elnegmy EH, Elhendawy A, El-Bagalaty AE. Effect of Reciprocal Electrical Stimulation in Erb's Palsy Children. The Egyptian Journal of Hospital Medicine. 2022;89(1):5561-6.
16. Awooda HA, Kamal-Eldeen R, Abd El-Maksoud G. S76. Effectiveness of Kinesio tape on wrist extensor muscles in children with obstetric brachial plexus injuries. Clinical Neurophysiology. 2018;129:e170.
17. DZULKIFLI NH, AZIZAN A, RAHMAN RA. Physical Rehabilitation for Children with Erb’s Palsy: A Systematic Review. INTERNATIONAL JOURNAL OF ALLIED HEALTH SCIENCES. 2022;6(1):2584-90.
18. Frade F, Neves L, Florindo-Silva F, Gómez-Salgado J, Jacobsohn L, Frade J. Rehabilitation of a child with neonatal brachial plexus palsy: Case report described by parents. Children. 2022;9(9):1298.
19. Asghar M, Safdar Z, Tahir M. Quality of life and functional Outcomes among Burn Patients: A Cross Sectional Survey. Journal of Health and Rehabilitation Research. 2023;3(2):293-8.
20. Justice D, Chang KW-C, Rasmussen LT, Yang LJ. Neuromuscular Electrical Stimulation for Infants with Neonatal Brachial Plexus Palsy: A Pilot Study. The Open Journal of Occupational Therapy. 2023;11(2):1-13.
21. Makki ARK, Tahir M, Amin U, Tabassum MMB, Kamran M, Tahir F. Mechanism of Meniscal Injury and its Impact on Performance in Athletes: Meniscal Injury in Athletes. The Healer Journal of Physiotherapy and Rehabilitation Sciences. 2022;2(3):232-7.
22. Tahir A, Fatima A, Khan MT. Association of depression in patients with fibromyalgia syndrome. Pakistan Journal of Rehabilitation. 2022;11(1):174-83.
23. Alon G. Obstetric Brachial Plexus Injury (OBPI): Is Functional Electrical Stimulation (FES) a Viable Intervention Option. J Nov Physiother. 2019;9(419):2.
24. Safdar Z, Asghar M, Tahir M. Level of Quality of Life among Post Stroke Patients; A Cross Sectional Survey. Journal of Health and Rehabilitation Research. 2023;3(2):299-304.
25. Tahir M, Maqsood M, Azhar N, Safdar Z, Amin U, Waheed TS. Association of Knee Pain in Long Standing and Sitting among University Teachers: Association of Knee Pain in University Teachers. The Healer Journal of Physiotherapy and Rehabilitation Sciences. 2023;3(1):314-21.
26. Abdelaziz AM, Aldahshan W, Elsherief FAH, Ismail MA, Fouaad AA, Mahmoud WS, et al. Teres major transfer to restore external rotation of shoulder in Erb palsy patients. Journal of Shoulder and Elbow Surgery. 2020;29(5):941-5.
27. Tahir M, Tariq F, Saeed HW, Nauman M, Usman M, Ali S. Impact of Air Pollution on Respiratory Health of Traffic Wardens in Lahore: Air Pollution and Respiratory Health. The Healer Journal of Physiotherapy and Rehabilitation Sciences. 2023;3(7):703-9.
28. Tahir M, Tehzeeb K, Javaid F, Khan UA, Ayyaz A, Usama M. EFFECTS OF ROUTINE PHYSICAL THERAPY WITH AND WITHOUT HIGH INTENSITY INTERVAL TRAINING ON BALANCE, QUALITY OF LIFE AND FUNCTION IN PARKINSON’S DISEASE PATIENTS. Journal of Population Therapeutics and Clinical Pharmacology. 2023;30(19):483-90.
29. Hussain MA, Sajid M, Hafeez S, Sarfraz M, Rashid R, Riaz A, et al. RELATIONS OF COLORECTAL CANCER WITH GENDER, AGE AND LIFESTYLE DIFFERENCE OVER AGE 45 YEARS SCREENED BY COLONOSCOPY IN LAHORE FROM 2022-2023. Journal of Population Therapeutics and Clinical Pharmacology. 2024;31(1):1328-38.
30. Chinchalkar SJ, Larocerie-Salgado J, Cepek J, Grenier M-L. The use of dynamic assist orthosis for muscle reeducation following brachial plexus injury and reconstruction. Journal of Hand and Microsurgery. 2018;10(03):172-7.
31. Omer A, Moghadam BA, Shadmehr A, Hafeez T, Azfar H, Arif M, et al. Effects of Kinesio Taping and Modified Constraint-Induced Movement Therapy on Upper Extremity Function, Quality of Life, and Spasticity in Individuals Recovering from Stroke. Journal of Health and Rehabilitation Research. 2024;4(1):167-72.