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Modified constraint induced movement therapy in children with obstetric brachial plexus palsy: a systematic review
Monica Sicari1, Maria Longhi2, Giulia D'Angelo3
1Department of Neurorehabilitation, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy.
Insights
Modified constraint-induced movement therapy (mCIMT) shows promise for improving arm function in children with obstetric brachial plexus palsy (OBPP). However, current evidence lacks a standardized protocol, necessitating further research for optimal treatment.
Area of Science:
- Pediatric Rehabilitation
- Neurology
- Occupational Therapy
Background:
- Obstetric brachial plexus palsy (OBPP) is a birth-related injury affecting upper limb function.
- Modified constraint-induced movement therapy (mCIMT) is a promising rehabilitation approach for neurological motor impairments.
- This systematic review evaluates mCIMT's efficacy in children diagnosed with OBPP.
Observation:
- Studies included a case report, case series, cohort study, and a randomized controlled trial (RCT).
- Interventions varied, with some combining mCIMT with botulinum toxin (BTX-A) or comparing it to conventional therapy.
- Patient samples ranged from single cases to groups of 19 OBPP and 18 unilateral Cerebral Palsy patients.
Findings:
- A minimum program duration of two weeks for mCIMT is consistently recommended.
- Significant heterogeneity exists, preventing the establishment of a single, common mCIMT protocol for OBPP management.
- Evidence supports mCIMT's potential to improve arm function in OBPP, but requires further investigation.
Implications:
- High-quality studies with larger sample sizes are needed to optimize mCIMT protocols for OBPP.
- Standardized mCIMT approaches could enhance care appropriateness and improve the quality of life for infants with OBPP.
- Further research will guide evidence-based clinical practice for pediatric brachial plexus palsy rehabilitation.
Introduction:
Obstetric brachial plexus palsy (OBPP) is a flaccid paralysis occurring in the upper limb during birth. The OBPP includes mild lesions with complete spontaneous recovery and severe injuries with no regain of arm function. Among the most promising rehabilitation treatments aimed at improving upper extremity motor activities in individuals with neurological dysfunctions, there is the modified constraint-induced movement therapy (mCIMT). The aim of this systematic review is to assess and synthesize the critical aspects of the use of mCIMT in children with OBPP.
Evidence Acquisition:
This systematic review has been carried out according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis). A comprehensive search of the literature was conducted using PubMed, MEDLINE and Evidence Based Medicine Reviews, databases. We enclosed experimental and original articles, case reports and book chapters. Four articles were finally included.
Evidence Synthesis:
One case report tested the feasibility of mCIMT to encourage use of the affected arm in a child with Erb-Duchenne palsy and documented the clinical changes observed. A case series had the purpose to determine if mCIMT in combination with botulinum toxin (BTX-A) improved arm function in 2 children with OBPP. A cohort study compared the use of mCIMT in 19 OBPP and 18 unilateral Cerebral Palsy. A prospective single-blind RCT described mCIMT versus conventional therapy in a group of 39 children with OBPP.
Conclusions:
This systematic review on the use of mCIMT in children with OBPP shows that there is unanimous agreement that a program should last 2 weeks at least. However, there is no scientific evidence supporting a single common mCIMT protocol in the management of OBPP because of a considerable heterogeneity. Further high methodological studies regarding the application of mCIMT for OBPP and based on larger patients' sample should have the potential to optimize the appropriateness of care provided to infants with OBPP and, therefore, their quality of life.
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