erb's palsy & electrical stimulation

[linbin]

Hi friends, There is a 1 month old baby with erb's palsy visiting our OPD. A suggestion came of giving electrical stimulation. I searched but couldn't get much info. It says stimulation should be given via mother completing the circuit. Since the description is too vague, I need a clear explanation regarding the electrode placement and other relevant info. Thanks in advance

[estherderu]

dear linbin,

please!!!!! the reason why you will not find information about giving electro-therapy to babies is because nobody does this and for good reasons!!!!
One of the most important reasons being that spontaneous recovery is possible in the first months depending on the lesion type.
There is a lot of information about the background and development of the Erb,s palsy on this various sites on this forum. Please look into these first. The parents brochures on the Irish site are very illustrating and informative as well.

I hope that you will agree with me after reading the infomation I have posted on this subject on this forum before. For more information go to:
www.estherderu.com klik on disorders and search for plexus brachial lesions

kind regards
Esther de Ru

[estherderu]

On the other hand.....

TES The Threshold Electrical Stimulation is sometimes effectively used in paediatric neuro rehabilitation.
The following website contains more information about the use of TES.TASC Network

kind regards

Esther de Ru

[emad]

I agree with Esther regarding no need for using electro. in Erb´s ,because it is just nerve injury which needs appropriate intervention which might be rest and gentle movment in form of neural mobilization to maitain mobility of the nerves , following that encourging the baby to use the affected limb because most of them tend to use the non-affected limb in ADL.
cheers
Emad

[phunphysio]

How can you do any sensation testing on a 1 month old baby? Let alone one that has had nerve damage? Surely this is a contradindication of its own accord?

[estherderu]

sorry phunphysio if I gave you the wrong impression

As paediatric physiotherapists, the only way to assess a newborn is to observe spontaneous movement, the way the child reacts after to a sudden change in posture and of course the quality of the GM´s and that is not easy at all. A good developmental neurologist may be able to say more about sensation and be able to test it.

The TES I was talking about has been used on an much older child effectively apparately... go to TASC Network for more information.
I have personally never used electrotherapy with very young children/babies at all. As far as I know, the Dutch specialialized Brachial Plexus University Teams have never advocated its use.


For more information on the GM´s go to Ontwikkelingsneurologie|Developmental Neurology

kind regards
Esther de Ru

[neurospast]

I had a quick look around and as far as I can see there is no evidence what so ever for the use of e.g. electrotherapy and erb's paralysis. The discussion is if stimulation of e.g. a muscle will contribute to the restoration of the connection between the central nervous system and the target e.g. muscle. The assumption can be that it would help but on which grounds? One can argue that a signal (stimulation) would help to lead the way. but the signal could also trigger the opposite reaction; e.g markers for a disfunction (hormones and neurotransmitters) are not send and hitero no response for repair.
If there is any research which is sound please let me know.
The best remark so far is that electro tehrapy can only be used if the therapist has in fact a marker(s) for stimulation of nerves in a baby, also we have to understand that the nervous system of a child is fully developed at the age of 6-8 years old (for that reason there is a reluctance on putting a diagnose on e.g. CP)
The use of TES is at least in the information provided not related to e.g erb's paralysis but to e.g. CP which is a centralised problem with bodily symptoms.

[dapoi]

Hi! I think I've replied quite late. I have been treating infants with erb's palsy for 5 years at most. In my experience, i realized that the best way to treat erb's palsy initially is PROPER POSITIONING and gentle ROMEx. Teach parents to position the infant in adduction,internal rotation and supination so as to protect the limb.You can tell them to pin the sleeve to the baby's shirt or diaper.As the baby grows use active exercises appropriate for his age,i.e.,reaching,grasping and releasing.When doing ROMEx, be sure to allow scapular movement,and avoid overstretching flaccid muscles.Until now, neuromuscular stimulation is controversial,but if you want to try,use the probe to stimulate specific muscles.Good luck!

[linbin]

you mean you will allow the hand to be in more or less disability position except adding supination??? it will only facilitate the stronger normal muscles overacting and worsening the "policeman's tip hand "position of arm according to me. i would like to see others openion regarding this
cheers

[estherderu]

dear dapoi en linbin

Rest, after the initial injury, is only called for in the first 7-10 days. In that time, the arm can be positioned gently across the abdomen ( Volpe Neurology of the Newborn 2001) giving the haemorrhage and edema time to decrease.

kind regards

Esther

[dapoi]

Hi lin,
As stated in my post, proper positioning is optimum in the initial stages or few days post injury only.