Motor recovery after bilateral brachial plexus injury using motor irradiation: a case report

Abstract

Background/Aims Brachial plexus injuries impair functionality, interfere with the performance of activities and affect participation in social events, thus decreasing an individual's quality of life. In cases where there is a total loss of muscular strength, complete rehabilitation is challenging. Motor irradiation is a basic proprioceptive neuromuscular facilitation procedure that is used to activate weak muscles. It is a promising procedure for rehabilitation following brachial plexus injuries, mainly in those with total loss of muscle strength. Methods The patient in this case study had suffered bilateral brachial plexus injuries as a result of mechanical restraint during a psychiatric episode. He presented with decreased muscle strength in the proximal segments of the upper limbs, no movement of the wrists and fingers, tactile hypoesthesia and no pain sensation. Motor irradiation was the main intervention used to improve motor function. Findings At the end of treatment, complete and partial recovery of muscle strength was observed in the proximal and distal segments, respectively. Conclusions The efficacy of motor irradiation in improving muscle strength following brachial plexus injuries should be investigated in future clinical trials.

Physical therapeutic treatment for traumatic brachial plexus injury in adults: A scoping review

“…Two case reports 39,40 classified the BPI according to the affected region (ie, infra‐ or supra‐clavicular sites), and other authors 16‐18,29‐31,36,41 detailed the injuries by including more than a single classification category, such as root avulsion injury and degree of peripheral nerve injury. Eight studies 24,25,42‐47 either did not mention or did not make clear their criteria for injury classification (Table 1).…”

“…Six studies 22,24,26,42‐44 did not mention whether surgical procedures had been carried out or not, whereas the other studies that considered patients who had undergone any form of reconstructive surgery provided details regarding type of surgery, such as neurotization, neurolysis, and grafts 16,20,23,25,29,31,33,34,40 ; nerve transfers 16‐20,23,27,29,31‐36 ; and muscle transfers 17,23,27,45 . In nine studies, 9,21,28,30,37,41,46‐48 patients only underwent physical therapy.…”

“…Muscle strength was the most frequently assessed outcome (66.7%), 9,16,19,20,22‐24,27‐30,32,34,36‐38,40,41,43‐45,47 followed by superficial and/or deep sensitivity (42.4%), 9,20,22,24,27,28,37,38,40,41,43,45‐48 range of motion (ROM), 23,27‐29,32,34,38,40,43,46‐48 and pain 9,18,20,21,26,31,33,39,40,42,44,46 (36.4%). Limb function was assessed in six studies 17,18,32‐34,41 and quality of life 33,42,43,46 in four.…”

“…Limb function was assessed in six studies 17,18,32‐34,41 and quality of life 33,42,43,46 in four. Other parameters assessed were deep tendon reflexes, 9,28,40,46,47 handgrip strength, 34,45 limb girth, 32,43 postural analysis, 40 anthropometric measurements, respiratory aspects and the occurrence of trigger points, 40 activities of daily living (ADLs) performance, 45 anxiety levels, 42 phantom limb pain and movements, 26 and patient satisfaction and preference regarding the rehabilitation setting 21…”

“…Several instruments were used to assess the reported outcomes. For evaluating muscle strength, the Muscle Manual Testing and the Medical Research Council 9,16,19,22‐24,29,30,32,34,36,37,44,45 were reported in some studies, whereas the modified Kendall test and Oxford scale were used in others 38,41,47 . Pain intensity was measured through the Visual Analogue Scale (VAS) 20,21,31,33,42,44,46,48 and the Numeric Rating Scale (NRS).…”