Modified constraint induced movement therapy in children with obstetric brachial plexus palsy: a systematic review

Monica Sicari, Maria Longhi, Giulia D'Angelo, Valentina Boetto, Andrea Lavorato, Lorella Cocchini, Maurizio Beatrici, Bruno Battiston, Diego Garbossa, Giuseppe Massazza, Paolo Titolo, Monica Sicari, Maria Longhi, Giulia D'Angelo, Valentina Boetto, Andrea Lavorato, Lorella Cocchini, Maurizio Beatrici, Bruno Battiston, Diego Garbossa, Giuseppe Massazza, Paolo Titolo

Abstract

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.

Conflict of interest statement

Conflicts of interest.—The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

Figures

Figure 1
Figure 1
—PRISMA flowchart.

References

    1. Chauhan SP, Blackwell SB, Ananth CV. Neonatal brachial plexus palsy: incidence, prevalence, and temporal trends. Semin Perinatol 2014;38:210–8. 10.1053/j.semperi.2014.04.007
    1. Yang LJ. Neonatal brachial plexus palsy—management and prognostic factors. Semin Perinatol 2014;38:222–34. 10.1053/j.semperi.2014.04.009
    1. DeFrancesco CJ, Shah DK, Rogers BH, Shah AS. The Epidemiology of Brachial Plexus Birth Palsy in the United States: Declining Incidence and Evolving Risk Factors. J Pediatr Orthop 2019;39:e134–40. 10.1097/BPO.0000000000001089
    1. Smania N, Berto G, La Marchina E, Melotti C, Midiri A, Roncari L, et al. Rehabilitation of brachial plexus injuries in adults and children. Eur J Phys Rehabil Med 2012;48:483–506.
    1. Zafeiriou DI, Psychogiou K. Obstetrical brachial plexus palsy. Pediatr Neurol 2008;38:235–42. 10.1016/j.pediatrneurol.2007.09.013
    1. Evans-Jones G, Kay SP, Weindling AM, Cranny G, Ward A, Bradshaw A, et al. Congenital brachial palsy: incidence, causes, and outcome in the United Kingdom and Republic of Ireland. Arch Dis Child Fetal Neonatal Ed 2003;88:F185–9. 10.1136/fn.88.3.F185
    1. Şahin N, Karahan AY. Effect of exercise doses on functional recovery in neonatal brachial plexus palsy: A randomized controlled study. North Clin Istanb 2018;6:1–6.
    1. Bahm J, Ocampo-Pavez C, Disselhorst-Klug C, Sellhaus B, Weis J. Obstetric brachial plexus palsy: treatment strategy, long-term results, and prognosis. Dtsch Arztebl Int 2009;106:83–90.
    1. Raducha JE, Cohen B, Blood T, Katarincic J. A Review of Brachial Plexus Birth Palsy: injury and Rehabilitation. R I Med J (2013) 2017;100:17–21.
    1. Kubota S, Mutsuzaki H, Yoshikawa K, Takeuchi R, Endo Y, Koseki K, et al. Safety and efficacy of robotic elbow training using the upper limb single-joint hybrid assistive limb combined with conventional rehabilitation for bilateral obstetric brachial plexus injury with co-contraction: a case report. J Phys Ther Sci 2019;31:206–10. 10.1589/jpts.31.206
    1. Gilbert A. Sequele precoci della paralisi ostetrica a livello della spalla. Tech Chir Ortop e Traumatol. 2005:1-4.
    1. Birch R. Sequele tardive a carico della spalla della paralisi ostetrica nei bambini. Tech Chir Ortop e Traumatol. 2005:1-8.
    1. Hulleberg G, Elvrum AK, Brandal M, Vik T. Outcome in adolescence of brachial plexus birth palsy. 69 individuals re-examined after 10–20 years. Acta Orthop 2014;85:633–40. 10.3109/17453674.2014.964614
    1. Ho ES, Curtis CG, Clarke HM. Pediatric Evaluation of Disability Inventory: its application to children with obstetric brachial plexus palsy. J Hand Surg Am 2006;31:197–202. 10.1016/j.jhsa.2005.10.007
    1. Yanes Sierra VL, de la Fe EC, Camero Alvarez D, Ojeda Delgado L. Obstetric Brachial Plexus Palsy in the Context of Early Physical Rehabilitation. Med Rev Cienc Med Cienfueg 2014;12:635–49.
    1. Murphy KP, Wunderlich CA. Orthopedics e musculoskeletal conditions. New York, NY: DEMOS Medical; 2010. p.361-423.
    1. Sarac C, Duijnisveld BJ, van der Weide A, Schoones JW, Malessy MJ, Nelissen RG, et al. Outcome measures used in clinical studies on neonatal brachial plexus palsy: A systematic literature review using the International Classification of Functioning, Disability and Health. J Pediatr Rehabil Med 2015;8:167–85, quiz 185–6. 10.3233/PRM-150335
    1. Boyd RN, Morris ME, Graham HK. Management of upper limb dysfunction in children with cerebral palsy: a systematic review. Eur J Neurol 2001;8:150–66. 10.1046/j.1468-1331.2001.00048.x
    1. Sterr A, Elbert T, Berthold I, Kölbel S, Rockstroh B, Taub E. Longer versus shorter daily constraint-induced movement therapy of chronic hemiparesis: an exploratory study. Arch Phys Med Rehabil 2002;83:1374–7. 10.1053/apmr.2002.35108
    1. Campbell SK. Decision Making in Neurological Physical Medicine. Philadelphia, PA: Churchill Livingstone; 1999. p.235-259.
    1. Taub E, Griffin A, Uswatte G, Gammons K, Nick J, Law CR. Treatment of congenital hemiparesis with pediatric constraint-induced movement therapy. J Child Neurol 2011;26:1163–73. 10.1177/0883073811408423
    1. Wolf SL, Winstein CJ, Miller JP, Taub E, Uswatte G, Morris D, et al. ; EXCITE Investigators. Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. JAMA 2006;296:2095–104. 10.1001/jama.296.17.2095
    1. Brady K, Garcia T. Constraint-induced movement therapy (CIMT): pediatric applications. Dev Disabil Res Rev 2009;15:102–11. 10.1002/ddrr.59
    1. Buesch FE, Schlaepfer B, de Bruin ED, Wohlrab G, Ammann-Reiffer C, Meyer-Heim A. Constraint-induced movement therapy for children with obstetric brachial plexus palsy: two single-case series. Int J Rehabil Res 2010;33:187–92. 10.1097/MRR.0b013e3283310d6e
    1. Gordon AM, Charles J, Wolf SL. Methods of constraint-induced movement therapy for children with hemiplegic cerebral palsy: development of a child-friendly intervention for improving upper-extremity function. Arch Phys Med Rehabil 2005;86:837–44. 10.1016/j.apmr.2004.10.008
    1. Etoom M, Hawamdeh M, Hawamdeh Z, Alwardat M, Giordani L, Bacciu S, et al. Constraint-induced movement therapy as a rehabilitation intervention for upper extremity in stroke patients: systematic review and meta-analysis. Int J Rehabil Res 2016;39:197–210. 10.1097/MRR.0000000000000169
    1. Chiu HC, Ada L. Constraint-induced movement therapy improves upper limb activity and participation in hemiplegic cerebral palsy: a systematic review. J Physiother 2016;62:130–7. 10.1016/j.jphys.2016.05.013
    1. de Sire A, Bigoni M, Priano L, Baudo S, Solaro C, Mauro A. Constraint-Induced Movement Therapy in multiple sclerosis: safety and three-dimensional kinematic analysis of upper limb activity. A randomized single-blind pilot study. NeuroRehabilitation 2019;45:247–54. 10.3233/NRE-192762
    1. de Sire A, Mauro A, Priano L, Baudo S, Bigoni M, Solaro C. Effects of Constraint-Induced Movement Therapy on upper limb activity according to a bi-dimensional kinematic analysis in progressive multiple sclerosis patients: a randomized single-blind pilot study. Funct Neurol 2019;34:151–7.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6:e1000097. 10.1371/journal.pmed.1000097
    1. Hardin AP, Hackell JM, Simon GR, et al. ; COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE. Age limit of pediatrics. Pediatrics 2017;140:e20172151. 10.1542/peds.2017-2151
    1. Vaz DV, Mancini MC, do Amaral MF, de Brito Brandão M, de França Drummond A, da Fonseca ST. Clinical changes during an intervention based on constraint-induced movement therapy principles on use of the affected arm of a child with obstetric brachial plexus injury: a case report. Occup Ther Int 2010;17:159–67. 10.1002/oti.295
    1. Santamato A, Panza F, Ranieri M, Fiore P. Effect of botulinum toxin type A and modified constraint-induced movement therapy on motor function of upper limb in children with obstetrical brachial plexus palsy. Childs Nerv Syst 2011;27:2187–92. 10.1007/s00381-011-1609-4
    1. Zielinski IM, van Delft R, Voorman JM, Geurts AC, Steenbergen B, Aarts PB. The effects of modified constraint-induced movement therapy combined with intensive bimanual training in children with brachial plexus birth injury: a retrospective data base study. Disabil Rehabil 2019. [Epub ahead of print]. 10.1080/09638288.2019.1697381
    1. Eren B, Karadağ Saygı E, Tokgöz D, Akdeniz Leblebicier M. Modified constraint-induced movement therapy during hospitalization in children with perinatal brachial plexus palsy: A randomized controlled trial. J Hand Ther 2020;33:418–25. 10.1016/j.jht.2019.12.008
    1. Verhagen AP, de Vet HC, de Bie RA, Kessels AG, Boers M, Bouter LM, et al. The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol 1998;51:1235–41. 10.1016/S0895-4356(98)00131-0
    1. Taub E, Ramey SL, DeLuca S, Echols K. Efficacy of constraint-induced movement therapy for children with cerebral palsy with asymmetric motor impairment. Pediatrics 2004;113:305–12. 10.1542/peds.113.2.305
    1. Charles JR, Wolf SL, Schneider JA, Gordon AM. Efficacy of a child-friendly form of constraint-induced movement therapy in hemiplegic cerebral palsy: a randomized control trial. Dev Med Child Neurol 2006;48:635–42. 10.1017/S0012162206001356
    1. Shumway-Cook A, Woollacott MH. Motor Control: Translating Research into Clinical Practice. Fourth Edition. Alphen aan den Rijn: Wolters Kluwer; 2014.
    1. Eyre JA, Miller S, Ramesh V. Constancy of central conduction delays during development in man: investigation of motor and somatosensory pathways. J Physiol 1991;434:441–52. 10.1113/jphysiol.1991.sp018479
    1. Kuhnke N, Juenger H, Walther M, Berweck S, Mall V, Staudt M. Do patients with congenital hemiparesis and ipsilateral corticospinal projections respond differently to constraint-induced movement therapy? Dev Med Child Neurol 2008;50:898–903. 10.1111/j.1469-8749.2008.03119.x
    1. Eliasson AC, Krumlinde-sundholm L, Shaw K, Wang C. Effects of constraint-induced movement therapy in young children with hemiplegic cerebral palsy: an adapted model. Dev Med Child Neurol 2005;47:266–75. 10.1017/S0012162205000502
    1. Taub E, Griffin A, Nick J, Gammons K, Uswatte G, Law CR. Pediatric CI therapy for stroke-induced hemiparesis in young children. Dev Neurorehabil 2007;10:3–18. 10.1080/13638490601151836
    1. Charles JR, Gordon AM. A repeated course of constraint-induced movement therapy results in further improvement. Dev Med Child Neurol 2007;49:770–3. 10.1111/j.1469-8749.2007.00770.x
    1. Berggren J, Baker LL. Therapeutic application of electrical stimulation and constraint induced movement therapy in perinatal brachial plexus injury: A case report. J Hand Ther 2015;28:217–20, quiz 221. 10.1016/j.jht.2014.12.006
    1. Sutcliffe TL, Gaetz WC, Logan WJ, Cheyne DO, Fehlings DL. Cortical reorganization after modified constraint-induced movement therapy in pediatric hemiplegic cerebral palsy. J Child Neurol 2007;22:1281–7. 10.1177/0883073807307084

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