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Updated: Jun 27, 2026
Development of a Neonatal Rat Model for Brachial Plexus Birth Injury
Published on: March 27, 2026
Neuromuscular Electrical Stimulation in Brachial Plexus Birth Injury Rehabilitation: A Systematic Review
Barış Celbek1,2, Zeynep Hoşbay3, Eda Urhun Keleş1,4
1Department of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Biruni University, 34015 Istanbul, Türkiye.
Insights
Neuromuscular electrical stimulation (NMES) may aid rehabilitation for brachial plexus birth injury (BPBI) in children, improving motor function and strength. However, evidence quality is low, necessitating further research for definitive recommendations.
Area of Science:
- Pediatrics
- Neurology
- Rehabilitation Medicine
Background:
- Brachial plexus birth injury (BPBI) causes upper-extremity weakness and functional deficits in newborns.
- Effective rehabilitation strategies are crucial for improving long-term outcomes in affected children.
Purpose of the Study:
- To systematically review the effects of neuromuscular electrical stimulation (NMES) on children with BPBI.
- To evaluate NMES's impact on motor function, muscle strength, range of motion, and upper-extremity function.
Main Methods:
- A systematic review adhering to PRISMA guidelines.
- Inclusion of randomized controlled trials (RCTs) from major databases.
- Assessment of methodological quality using the PEDro scale and risk of bias with RoB 2 tool.
Main Results:
- Seven RCTs with 197 participants were analyzed.
- NMES showed potential improvements in shoulder abduction, elbow flexion, wrist extension, muscle strength, and motor function.
- Combined NMES and constraint-induced movement therapy yielded favorable functional outcomes, despite significant heterogeneity and low-to-very-low evidence certainty.
Conclusions:
- NMES shows promise as an adjunctive therapy for BPBI rehabilitation in children.
- Low evidence certainty, high risk of bias, and heterogeneity limit current clinical recommendations.
- High-quality RCTs with standardized protocols are needed to establish efficacy.
Abstract:
Background and Objectives: Brachial plexus birth injury (BPBI) is a peripheral nerve injury occurring during birth that may result in upper-extremity weakness and functional impairment. This systematic review aimed to evaluate the effects of neuromuscular electrical stimulation (NMES) on motor function, muscle strength, range of motion, and upper-extremity function in children with BPBI. Materials and Methods: This systematic review was conducted according to PRISMA guidelines and registered in PROSPERO. PubMed, CINAHL, Scopus, Web of Science, PEDro, and the Cochrane Library were searched from inception to 5 May 2026. Only randomized controlled trials were included. Methodological quality was assessed using the PEDro scale, and risk of bias was evaluated using the RoB 2 tool. Results: Seven randomized controlled trials involving 197 participants were included. Several studies reported improvements in shoulder abduction, elbow flexion, wrist extension, muscle strength, and motor function following NMES compared with conventional therapy. The combination of NMES and constraint-induced movement therapy demonstrated favorable outcomes in functional performance. However, substantial heterogeneity was observed across studies regarding participant characteristics, NMES parameters, treatment duration, and outcome measures. The certainty of evidence ranged from low to very low. Conclusions: Current evidence suggests that NMES may serve as a potential adjunct to conventional rehabilitation in children with BPBI. However, given the low to very low certainty of the evidence, high risk of bias, and substantial clinical and methodological heterogeneity among the included studies, definitive clinical recommendations cannot currently be made. Future well-designed randomized controlled trials using standardized protocols, consistent outcome measures, and longer follow-up periods are warranted.
