Prevalence of Posterior Shoulder Subluxation in Children With Neonatal Brachial Plexus Palsy After Early Full Passive Range of Motion Exercises

Justice, Denise; Rasmussen, Lynnette; Chang, Kai-Ting; Murphy, Susan L.; Nelson, Virginia S.; Yang, Lynda J.‐S.

doi:10.1016/j.pmrj.2015.05.013

Cited by 13 publications

(6 citation statements)

References 60 publications

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“…Infants and children with NBPP should be referred for occupational therapy as soon as the diagnosis is suspected. Contrary to previous thought and arguing against the old mantra of “don’t move the arm,” early initiation of range of motion activities does not appear to increase the risk of shoulder subluxation . Furthermore, early immobilization of the affected arm is not indicated except in the case of an orthopedic condition requiring it and may be counterproductive to the patient’s recovery.…”

Section: Managementmentioning

confidence: 92%

“…Contrary to previous thought and arguing against the old mantra of "don't move the arm," early initiation of range of motion activities does not appear to increase the risk of shoulder subluxation. 37 Furthermore, early immobilization of the affected arm is not indicated except in the case of an orthopedic condition requiring it and may be counterproductive to the patient's recovery. Goals of therapy include maintainingnormalpassivejointrangeofmotion,promotingfunctional use of the affected extremity, selectively strengthening affected muscles, and when necessary, providing compensatory techniques to promote independence.…”

Section: Managementmentioning

confidence: 99%

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An Update on the Management of Neonatal Brachial Plexus Palsy—Replacing Old Paradigms

et al. 2018

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restoration of function. Primary care physicians are the initiators of care for this pathology and can provide a major benefit on the outcomes. Surgery is but one part of the multidisciplinary care of NBPP. Primary care physicians, nerve surgeons, physiatrists, and occupational and physical therapists must partner to change the paradigm and provide high-quality care to neonates and children affected by NBPP.

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Section: Managementmentioning

confidence: 92%

Section: Managementmentioning

confidence: 99%

An Update on the Management of Neonatal Brachial Plexus Palsy—Replacing Old Paradigms

et al. 2018

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“…Standard therapy includes range of motion and muscle strengthening exercises to maintain muscle balance and prevent joint contractures that, otherwise, can lead to joint deformities, particularly about the shoulder 38,39 . Passive range of motion exercises are typically started early after diagnosis 40 and are effective in improving shoulder function 41,42 without leading to shoulder complications such as posterior shoulder subluxation 43 …”

Section: Discussionmentioning

confidence: 99%

“…38,39 Passive range of motion exercises are typically started early after diagnosis 40 and are effective in improving shoulder function 41,42 without leading to shoulder complications such as posterior shoulder subluxation. 43 Although traditional rehabilitation may lead to increased movement in the outpatient setting in response to clinician-driven therapy and/or assessments, it may not lead to increased movements of the arm in real-world settings. In other pediatric onset disorders such as cerebral palsy, children may stop using the affected limb because of muscle weakness and the effort required to move and instead, develop compensatory strategies using the unaffected limb.…”

Section: Discussionmentioning

confidence: 99%

Quantifying real‐world upper limb activity via patient‐initiated spontaneous movement in neonatal brachial plexus palsy

Gatward

Logue

Yang

et al. 2022

PM&R

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Background: Neonatal brachial plexus palsy (NBPP) results in muscle weakness and impaired somatosensory function of the arm. Current functional assessment is primarily based on clinician-elicited measurements including muscle strength and range of motion. To what extent these measures are representative of real-world arm movement is unclear. Objective: To determine the feasibility of using body-worn accelerometers to remotely assess arm movements in children with NBPP. Design: Prospective criterion validity study of accelerometry versus clinician assessment. Setting: Academic medical center. Participants: Nine adolescents with NBPP and nine age-and gender-matched control adolescents participated in the study. All were enrolled in school and participated in community activities.Interventions: Not applicable. Methods: Standard clinician-elicited measurements were collected. For assessing spontaneous arm movements, participants wore activity monitors during all waking hours for 7 days. Results were expressed as ratios of affected to unaffected arm motion for duration and magnitude and correlated with traditional clinic-based assessments. Spearman correlations were used to determine relationships between accelerometry results and traditional assessments. A p value <.05 was considered statistically significant. Main Outcome Measurements: Accelerometry measurements of arm motion and traditional clinical assessments. Results: Compared to control ratios, duration of arm movement and magnitude ratios were reduced in the NBPP group, particularly for arm magnitude due to reduced affected arm movement and an increase in unaffected arm movement. Ratios were highly correlated with shoulder function and, to a lesser extent, with elbow function. Conclusion: Real-world arm use is an appropriate outcome measure that reflects functional recovery. This study demonstrates the feasibility of wearable technology to quantify duration and intensity of spontaneous arm movement in children with NBPP. Accelerometry also allows for the association between traditional clinician-elicited assessment measures and spontaneous arm movements, demonstrating the importance of the shoulder as a focus of treatment in NBPP.

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“…To ensure comparability, the babies in both groups will receive two sessions of physiotherapy per week. Physiotherapy will be standardised and based on evidence from studies of early physiotherapy management 29 30. It will involve (1) maintaining passive ROM of all the upper limb joints, in particular shoulder external rotation, elbow extension and forearm pronation; (2) active-assisted and active movements of the involved shoulder; (3) bimanual functional training; (4) training to integrate the involved upper limb in functional activities and (5) parent education: child positioning, stimulation of active movement and function at home.…”

Section: Methodsmentioning

confidence: 99%

Effectiveness and safety of early intramuscular botulinum toxin injections to prevent shoulder deformity in babies with brachial plexus birth injury (POPB-TOX), a randomised controlled trial: study protocol

Pons

Eddi

Gal³

et al. 2019

BMJ Open

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IntroductionIn children with brachial plexus birth injury (BPBI), denervation of the shoulder muscles leads to bony deformity in the first months of life, reducing active and passive range of motion (ROM) and causing activity limitation. The aim of this multicentre randomised controlled trial is to evaluate the effectiveness of botulinum toxin injections (BTI) in the shoulder internal rotator muscles of 12-month-old babies in limiting the progression of posterior subluxation of the glenohumeral joint, compared with a sham procedure mimicking BTI. The secondary aims are to evaluate the effectiveness of BTI in (1) limiting the progression of glenoid retroversion and three-dimensional (3D) deformity and (2) improving shoulder ROM and upper limb function, as well as to confirm the tolerance of BTI.Methods and analysisSixty-two babies with unilateral BPBI and a risk of posterior humeral head subluxation will be included. Only those with at least 7% posterior subluxation of the humeral head compared with the contralateral shoulder on the MRI will be randomised to one of two groups: ‘BTI’ and ‘Sham’. The BTI group will receive BOTOX injections at the age of 12 months in the internal shoulder rotator muscles (8 UI/kg). The sham group will undergo a sham BTI procedure. Both groups will undergo repeated shoulder MRI at 18 months of age to quantify changes in the percentage of posterior migration of the humeral head (primary outcome), glenoid version and 3D bone deformity. Clinical evaluations (passive shoulder ROM, active movement scale) will be carried out at baseline and 15 and 18 months of age. The mini-assisting hand assessment will be rated between 10 and 11 months and at 18 months of age. Adverse events will be recorded at least monthly for each child.Ethics and disseminationFull ethical approval for this study has been obtained. The findings will be disseminated in peer-reviewed publications.Trial registration numberEudraCT: 2015-001402-34 in European Clinical Trial database;NCT03198702in Clinical Trial database; Pre-results.

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Prevalence of Posterior Shoulder Subluxation in Children With Neonatal Brachial Plexus Palsy After Early Full Passive Range of Motion Exercises

Cited by 13 publications

References 60 publications

An Update on the Management of Neonatal Brachial Plexus Palsy—Replacing Old Paradigms

An Update on the Management of Neonatal Brachial Plexus Palsy—Replacing Old Paradigms

Quantifying real‐world upper limb activity via patient‐initiated spontaneous movement in neonatal brachial plexus palsy

Effectiveness and safety of early intramuscular botulinum toxin injections to prevent shoulder deformity in babies with brachial plexus birth injury (POPB-TOX), a randomised controlled trial: study protocol

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