The Role of Early Habilitation in Infants with Congenital Brachial Palsy

Abstract

Abstract Congenital brachial palsy (CBP) can have long-term consequences such as deformities, contractures and growth imbalance of the affected arm and shoulder girdle that can lead to severe handicap. The aim of the paper was to determine the effectiveness of early habilitation in infants with CBP. This retrospective clinical study included 34 infants who were habilitated in the Physical Medicine and Rehabilitation Clinic, Clinical Center Niš, during the period from 2000 to 2017. The protocol consisted of passive and active-assisted range of motion exercises for the affected arm, neurodevelopmental treatment, warm packs and electrotherapy, starting from the 3rd week of life. At the Clinic, 20 sessions were conducted and parents were educated with handling and home exercise program. The infants were re-evaluated each month during the first year of life. The modification of the manual muscle test (MMT) was used to assess the muscle strength (grades 0- 3). At 6 and 12 months of age, the outcome was defined as a full recovery (grade 3 of the affected muscles) and partial recovery (grades 1-2). Male sex predominated (56%). The right arm was more commonly affected (65%). Birth weight was over 4000g in 65% of infants. Fifty-nine percent of infants had upper, 26.5% "extended" and 14.5% had complete root palsy. Associated injuries were noted in 10 infants. The habilitation started in the first month of life in 64.7% of infants. At 6 months of age, full recovery was achieved only in one infant, while at 12 months, 56% of infants were fully recovered (p < 0.05). The majority of fully recovered infants was from the group with the upper type of lesion (p < 0.05). Early habilitation program is effective in infants with CBP. It is especially effective in the upper root palsy.