Rehabilitation of Neonatal Brachial Plexus Palsy: Integrative Literature Review.

Fátima Frade,Juan Gómez-Salgado,Lia Jacobsohn,Fátima Florindo-Silva

doi:10.3390/jcm8070980

Abstract

This integrative literature review has been carried out with the aim of analyzing the scientific literature aimed at identifying and describing existing rehabilitation treatments/therapies for neonatal brachial plexus palsy (NBPP). NBPP is a frequent consequence of difficult birthing, and it impairs the function of the brachial plexus in newborns. This is why knowledge on rehabilitation strategies deserves special attention. The data collection was carried out in January 2019, in the EBSCOhost and BVS (Biblioteca Virtual em Saúde) platforms, in the CINAHL Complete, MEDLINE Complete, LILACS and PubMed databases. Thirteen articles were included in this integrative literature review, based on a literature search spanning title, abstract and full text, and considering the inclusion criteria. Two main treatments/therapies for NBPP rehabilitation were identified: conservative treatment and surgical treatment. Conservative treatment includes teamwork done by physiatrists, physiotherapists and occupational therapists. These professionals use rehabilitation techniques and resources in a complementary way, such as electrostimulation, botulinum toxin injection, immobilizing splints, and constraint induced movement therapy of the non-injured limb. Professionals and family members work jointly. Surgical treatment includes primary surgeries, indicated for children who do not present any type of spontaneous rehabilitation in the first three months of life; and secondary surgeries, recommended in children who after primary surgery have some limitation of injured limb function, or in children who have had some spontaneous recovery, yet still have significant functional deficits. Treatment options for NBPP are defined by clinical evaluation/type of injury, but regardless of the type of injury, it is unanimous that conservative treatment is always started as early as possible. It should be noted that there was no evidence in the literature of other types of rehabilitation and techniques used in clinical practice, such as preventive positioning of contractures and deformities, hydrotherapy/aquatic therapy, among others, so we consider there is a need for further studies at this level in this area.

Highlights

Neonatal Brachial Plexus Palsy (NBPP) is caused by traction of the brachial plexus during birth and can limit the function of the affected arm in various ways
There is no consensus on indication and length of surgical treatment for obstetric brachial plexus palsy
As an alternative to conservative treatment, studies performed at the University of Toronto indicate that there is a surgical option for children without bicep function at the age of 3 months

Summary

Introduction

Neonatal Brachial Plexus Palsy (NBPP) is caused by traction of the brachial plexus during birth and can limit the function of the affected arm in various ways. The clinical classification of NBPP is based on body structures, namely the complex of nerves that controls the affected finger, hand, arm, and shoulder muscles. In this sense, brachial plexus lesions are classified as “severing of the upper trunk” when the affected nerves are C5 and C6; “severing of the middle trunk” when the affected nerve is C7; and “severing of the lower trunk” when the affected nerves are C8 and T1. Complete severing is considered when affecting C5–T1 nerves [6]

Results

Discussion

Conclusion