Efficacy of a combined physical and occupational therapy intervention in patients with subacute neuralgic amyotrophy: A pilot study

Abstract

BACKGROUND: Neuralgic Amyotrophy (NA) is characterized by neuropathic pain, subsequent patchy paresis and possible sensory loss in the upper extremity. Many patients experience difficulties in performing activities of daily life and are unable to resume work. We developed a combined physical-and occupational therapy program for patients recovering from NA. OBJECTIVE: Evaluation of the effectiveness of a multidisciplinary intervention program for patients with subacute NA. METHODS: We performed a within subject proof-of-principle pilot study in eight patients with subacute NA. Patients followed 8 hours of physical and 8 hours of occupational therapy spread over a 16-week period. Primary outcome measures: The Canadian Occupational Performance Measure (COPM) and Shoulder Rating Questionnaire (SRQ). Secondary outcome measure: Disability of Arm Shoulder and Hand (DASH). RESULTS: Improvements (mean (95% CI)) were found in the performance and satisfaction scores of the COPM +2.3 (0.9-3.7) and +1.4 (0.4-2.4) points, respectively and the SRQ +14.8 (7.4-22.0) points. The majority of patients (6 out of 8) also demonstrated improvements in the DASH. CONCLUSION: The proposed physical and occupational therapy program, may be effective for patients with subacute NA, as demonstrated by improvements in activity, performance and participation.

Neuralgic amyotrophy: An update on diagnosis, pathophysiology, and treatment

“…With rehabilitation focused on normalizing scapular coordination and stability, scapular dyskinesia and its complications (i.e., strain and fatigue of the muscles involved) can be reversed, indicating that the altered motor control can be restored in NA patients via a motor retraining strategy. 79,80 Exercise Intolerance or Decreased Endurance of Affected Muscles. Almost all NA patients exhibit increased fatigability of the affected arm and shoulder muscles during repeated movements or postures.…”

“…In a recent pilot study, such a specific outpatient multidisciplinary rehabilitation program for NA patients was proven to be effective in improving daily life activities, performance, and participation. 79 The aim of this program is for patients to improve scapular coordination, overall fitness, and knowledge about how to regain control over their own complaints and again manage their lives with the existing residual symptoms. The specific components addressed in the program are depicted in Figure 8.…”

“…For patients with paresthesias in the forearm and hand caused by subpectoral nerve entrapment due to a protracted, elevated, and adducted shoulder, extra attention is paid to attaining and maintaining a correct glenohumeral position in combination with gentle neural mobilization techniques. 79 Occupational therapy focuses on enabling daily activities, including work, by training problemsolving and role-management skills, planning, and pacing, using practical solutions for practical situations (e.g., better arm support or use of speech recognition during keyboard work), and improving self-management. It addresses both necessary adaptation of activities and the context of these activities (environment), with the purpose of preventing or reducing overuse of the affected and compensating muscles and teaching patients how to control their pain and other complaints.…”

“…The program that has been successfully implemented in our outpatient plexus clinic consists of 8 sessions of 1 hour of physical therapy and 1 hour of occupational therapy over a period of 16 weeks. 79 This core rehabilitation program can be supported by additional medical interventions if needed. They may include NSAIDs in cases of musculoskeletal pains that impede therapy progress, or corticosteroid infiltration for shoulder capsulitis or tendinitis.…”

NA-CONTROL: a study protocol for a randomised controlled trial that compares specific outpatient rehabilitation, that targets cerebral mechanisms through relearning motor control and uses self-management strategies to improve functional capability of the upper extremity, to usual care in patients with neuralgic amyotrophy.

“…We introduce the concept that peripheral nerve damage in NA may lead to adaptations in motor planning and representations that are compensatory in the acute phase, but lead to impaired and dysfunctional motor control in the chronic phase (see Figure 1). This suggested involvement of maladaptive motor planning is illustrated by the promising results of specific rehabilitation after NA (14). Through rehabilitation that focuses on relearning motor control, and thus targets cerebral mechanisms, NA patients can relearn how to correctly position and move their shoulder and arm, which normalises scapular coordination and stability and improves functional capability of the upper extremity.…”