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Methods for In Vivo Biomechanical Testing on Brachial Plexus in Neonatal Piglets
Published on: December 19, 2019
Conservative Treatment of Neonatal Brachial Plexus Palsy: A Narrative Review
Valentina Boetto1, Anna Markova1, Federica Malgrati1
1Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy.
Insights
Neonatal brachial plexus palsy (NBPP) rehabilitation requires a comprehensive approach. Combining therapies like botulinum toxin, CIMT, and virtual reality offers the most functional outcomes for affected infants.
Area of Science:
- Pediatrics
- Neurology
- Rehabilitation Medicine
Background:
- Neonatal brachial plexus palsy (NBPP) affects approximately 0.4% of live births, causing upper limb flaccid paralysis.
- Permanent disabilities can result from NBPP, yet consensus on rehabilitation protocols remains elusive.
- Current management often relies on traditional physical therapy, with limited exploration of diverse conservative treatments.
Purpose of the Study:
- To provide an overview of conservative treatments for NBPP beyond standard physical therapy.
- To identify and discuss various therapeutic options for comprehensive infant rehabilitation.
- To synthesize evidence on non-traditional approaches for managing NBPP.
Main Methods:
- A narrative review of articles published over the last 50 years.
- Searches conducted on PubMed, Cochrane Library, Scopus, and Web of Science.
- Included studies focused on conservative and non-traditional rehabilitation strategies for NBPP.
Main Results:
- Analysis of 1275 articles yielded 11 studies exclusively on conservative NBPP approaches.
- Key conservative methods identified include botulinum toxin, constraint-induced movement therapy (CIMT), virtual reality, neuromuscular electrical stimulation, and kinesiotaping.
- No single conservative approach demonstrated superiority when used in isolation.
Conclusions:
- Various conservative rehabilitation approaches for NBPP show promise.
- A multimodal treatment strategy integrating multiple therapies is essential for optimal functional outcomes.
- Further research is needed to establish evidence-based, comprehensive rehabilitation guidelines for NBPP.
Abstract:
Neonatal brachial plexus palsy (NBPP) is a flaccid paralysis of the upper limbs that occurs in about 0.4 percent of live births. This condition can produce permanent disabilities; to date, there is no consensus on protocols to be applied for the rehabilitation of children with this condition. The aim of this article is to provide a concise overview of conservative treatment beyond traditional physical therapy for the management of the child with NBPP and to offer a number of useful options for creating the most comprehensive and functional rehabilitation treatment possible. We conducted a narrative review after analyzing articles from the past 50 years on PubMed, Cochrane Library, Scopus, and Web of Science with the following search string [("neonatal brachial plexus palsy" OR "obstetric brachial plexus palsy" OR "birth brachial plexus palsy") AND ("rehabilitation" OR "physiotherapy" OR "conservative treatment")]. We identified a potential of 1275 articles, but only 11 were exclusively about conservative approaches. The most represented rehabilitation approaches in the literature were botulinum toxin, constraint-induced movement therapy (CIMT), virtual reality, neuromuscular electrical stimulation, and kinesiotaping. In conclusion, the various rehabilitation approaches for NBPP are promising, but none can be considered the best option when used alone. In light of the current evidence, a multimodal approach is needed.
