erb's palsy

I have been treating quite a few number of babies with erb's palsy.Although most of them recover by 1 year ,recently i am treating a baby presented with erb's paly on the right side.the baby is a female child aged 4 months.She presented with total paralysis of the entire arm along with Horner's syndrome?After 3 months she started to get some movements in the shoulder - flexion .She is also able to do active elbow flexion.Please suggest me the best treatment.I would also like to know if electrical treatment will be of benefit to the child.If so ,at what month can i begin to stimulate the muscles? thanks. [email protected]

Hi Angel
There is 3 group of injury of plexus brachialis as a birth trauma.
Only 30% of all injured recovers from it totally and with small help from physical therapy in term of few days to few weeks (4-6) and lately to 3 moths of child life. That is smaller injury called neuropraxis (reason for interruption of neuron conduction is swelling and hemorrhagic).
The major number of injured children, about 55%, recovers in period of 6-12 months and lately to 18 month of life. That is axonothmesis. Finally recovery of this lesion may be different. Few of them recover with minimal weakness of muscles and discrete decrease of coordination. Group of children who show first sign of active movement after 3 or more months very often after first good results start to show characteristic manifestation: muscular-ligg. contractures mostly on shoulder region and elbow, but lately in life on distance segments (spine). Affected arm usually is shorter in length and velocity and weaker muscles strength, with appearance of contractures, co-contractions of antagonistic muscles (biceps-triceps) and paradoxes synergies (deltoideus-teres major), and no using arm in postural reactions and in daily activities. All this is very notable after 2 year of child life.
Smallest, 15%, of the injured children are the children with low or no recovery at all. That is either neurothmesis (total break) or avulsion of routs. No need to tell how much that affects motor and sensor conduction and how big that is handicap for the child.
So, positioning in first two weeks after birth, some mild thermo procedure like introduction in kinesytherapy- what is by my modest opinion the most important for the recovery (with using passive motion for full ROM and stimulation of active motion), yes you could use electro stimulation after 3 week of life one time per day (you could use before longitudinal galvanization as an intro procedure for stimulation).
I hope this would help. If you have more questions about that feel free to ask, I have 5 year experience in childe rehab and be glad to help if I could.
Best regards Nale

Thanks Nale for your suggestion.CAn you please let me know the following details:
1.how do you actually identify the active and the indifferent electrodes?
2.which electrode do you place on the muscle bulk- active or the indifferent?
3.Regarding stimulation for babies at a very young age do you place the electrodes directly on the baby or the mother forms the circuit - indirect stimulation?
4.what does the term "Longitudinal galvanization"actually refer to?
[email protected]

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erb's palsy

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electrical stimulation

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electrode placement

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In my opinion electrical stimulation should not be used in babies as it is not recommeded in persons who are unable to understand the type of modality given to them and feedback to you about that. As it is very easy in babies for the current to make its way to heart. So be care and avoid electrical stimulation in babies. See any good text book of electrotherapy regarding that for contra indications and precautions.

hi
hope this is of help

• Provide patient's parents with home program PROM sheets
• Begin gentle PROM exercise in supine to increase joint flexibility and muscle tone. 2-3 daily PROM x 10 reps in all motions
• Provide tactile stimulation to involved extremity using various textured materials, koosh balls, vibration and massage to increase sensory awareness of that extremity in overall body scheme
• Joint compression/weight bearing throughout involved extremity to increase proprioceptive input/muscle co-contraction
• Active use of involved extremity using a variety of developmentally appropriate activities to increase strength and coordination beginning in gravity eliminated then advance to against gravity
• Always include bimanual/bilateral motor planning activities
• Pool therapy