Abstract
Date Presented 03/21/24
This pilot study assessed the use of passive range of motion (PROM) for decreasing the risk of shoulder contracture in infants with brachial plexus birth injury. Results suggest that early initiation of PROM may be more important than frequency.
Primary Author and Speaker: Jennifer Wingrat
Additional Authors and Speakers: Matthew J. Elrick
The purpose of this pilot study was to assess whether frequent passive range of motion (PROM) performed by caregivers decreases the risk of shoulder contracture and improves functional outcomes in children with brachial plexus birth injury (BPBI). The study also investigated what facilitators and barriers affect caregiver adherence to performing daily PROM. Five mothers of children with BPBI participated in retrospective interviews that asked them to recall what age PROM was initiated, the frequency that they performed PROM during the first year of their child’s life, and what facilitators and barriers affected their ability to adhere to PROM recommendations. Medical records were reviewed for documentation of caregiver report of adherence and whether shoulder contracture was documented by age one. Three of the five children had documented shoulder contractures while the other two had functional use of their shoulders by age one. All three of the children with shoulder contracture had delayed initiation (after 2 months of age) and/or inconsistent, infrequent PROM during their first year of life; for the two children without contractures, daily PROM was initiated before 2 months of age and their caregivers reported performing daily PROM consistently throughout the first year of life. The frequency that PROM was performed did not appear to increase the risk of shoulder contracture as long as it was started early and performed at least daily. All of the mothers reported that making PROM part of the daily routine was a facilitator, with family contextual factors identified as barriers to adherence. The results provide guidelines for OTPs to recommend early and consistent PROM throughout the first year of life in order to decrease the risk of developing a shoulder contracture and facilitate improved functional outcomes for infants with BPBI. The results also demonstrate the significance of considering family routines and context when making home therapy recommendations.
References
Muhlestein, W.E., et al., (2023). Early referral to multidisciplinary specialty centers to optimize outcomes in children with neonatal brachial plexus palsy. Developmental Medicine and Child Neurology, 00,1–8. https://doi.org/10.1111/dmcn.15658
Eldridge, B., et al. (2020). Recommendations for management of neonatal brachial plexus palsy: Based on clinical review. Journal of Hand Therapy, 33(3), 281–287. https://doi.org/10.1016/J.JHT.2019.12.00
Heise, C. O., et al., (2015). Neonatal brachial plexus palsy: A permanent challenge. Archives of Neuropsychiatry, 73(9), 803–808. https://doi.org/10.1590/0004-282X20150105
Yilmaz, V., et al., (2018). Timing of rehabilitation in children with obstetric upper trunk brachial plexus palsy. Child’s Nervous System, 34(6), 11531160. https://doi.org/10.1007/s00381-018-3790-1
