Review of rehabilitation protocols for brachial plexus injury

Abstract

Brachial plexus injury (BPI) is one of the most serious peripheral nerve injuries, resulting in severe and persistent impairments of the upper limb and disability in adults and children alike. With the relatively mature early diagnosis and surgical technique of brachial plexus injury, the demand for rehabilitation treatment after brachial plexus injury is gradually increasing. Rehabilitation intervention can be beneficial to some extent during all stages of recovery, including the spontaneous recovery period, the postoperative period, and the sequelae period. However, due to the complex composition of the brachial plexus, location of injury, and the different causes, the treatment varies. A clear rehabilitation process has not been developed yet. Rehabilitation therapy that has been widely studied focusing on exercise therapy, sensory training, neuroelectromagnetic stimulation, neurotrophic factors, acupuncture and massage therapy, etc., while interventions like hydrotherapy, phototherapy, and neural stem cell therapy are less studied. In addition, rehabilitation methods in some special condition and group often neglected, such as postoperative edema, pain, and neonates. The purpose of this article is to explore the potential contributions of various methods to brachial plexus injury rehabilitation and to provide a concise overview of the interventions that have been shown to be beneficial. The key contribution of this article is to form relatively clear rehabilitation processes based on different periods and populations, which provides an important reference for the treatment of brachial plexus injuries.

Early detection and rehabilitation in Erb-Duchenne paralysis before age 1 year: A Case Report From Lusaka Zambia

“…It is worth noting that brachial plexus injuries typically require a lengthy recovery period due to the complexity of the injuries and the slow recovery tempo. Studies show that complete recovery of overall function of the upper limb following Erb's palsy sometimes can only occur late over the child's first 2 years, and even when recovery is incomplete, the sequelae remain minimal without 13,15 hindering the function of the limb involved.…”

Early post-surgical rehabilitation and functional outcomes of a traumatic ulnar nerve injury: a pediatric case report

“…At the same time, at present, a clear rehabilitation process for the treatment of brachial plexus injuries has not been developed yet ( 20 ). Despite much knowledge exists on the mechanisms of nerve injury and regeneration, the current literature lacks guidance and solid treatment algorithms for the postoperative management of UN injuries especially within the pediatric population ( 10 , 19 , 21 ), which instead could be crucial to preserve intrinsic motor function, while preventing hand deformities or sensory abnormalities.…”

Contralateral C7 nerve transfer to three recipient nerves-an optional surgical method in total brachial plexus avulsion combined with accessory and phrenic nerve injury

“…Brachial plexus avulsion injury (BPAI) is very di cult to treat despite advances in technology, and treatment results are not always satisfactory. The modern-day management of BPAI involves a combination of various neurotization with intraplexus and extraplexus ipsilateral/contralateral nerve donors, which include the spinal accessory nerve, phrenic nerve, intercostal nerves, and contralateral C7 nerve (CC7) [1][2][3][4][5]. The spinal accessory nerve is mainly used for direct neurotization of the suprascapular [6][7].…”