Botulinum toxin A and casting for the functionality of paretic arm in children with obstetrical upper brachial plexus palsy

Abstract

Background : Electrical stimulation, physical therapy and occupational therapy remain the main treatment for children with obstetrical upper brachial plexus palsy (UBPP), when surgery has been excluded. We undertook a pilot study to investigate whether botulinum toxin type A (BoNT-A) and plaster casting, as adjunct to the physical therapy, improved the position and function of the impaired arm in children with mild UBPP. Method : Thirty children (mean age 5.6±3.4 years) with mild UBPP who previously underwent serial cast treatment, unsuccessfully, were enrolled. Neurological impairment and functional status were quantified using Medical Research Council (MRC) and Mallet scales, and the Nine-Hole Peg Test (NHPT). Biceps brachii, brachialis, pronator teres and pectoralis major muscles were injected with 22 U/kg BoNT-A (Dysport ® , Ipsen). Assessments of elbow extension, MRC, Mallet Scale, and NHPT were made at baseline, 3, 6 and 12 months. Multiple paired data for the scale scores and goniometric values obtained after casting and BoNT-A treatment at 3, 6 and 12 months of follow-up were compared with the baseline values using ANOVA, adjusted for repeat measurements. Results : After BoNT-A injection and plaster cast treatment, children had significant improvement of active elbow extension (15.2±16.1° at 12 months after injection, compared with 44.5±10.5° at baseline; p p Conclusion : The children showed a reduction in muscular contracture and improvements of posture, active elbow extension and dexterity in the affected arm. Our data support the use of BoNT-A and plaster casting as an adjunct to physical therapy, in the treatment of children with mild UBPP.