The role of habilitation in infants with congenital brachial palsy

Background Congenital brachial palsy (CBP) can have long-term consequences such as deformities, contractures, and growth imbalance that can lead to severe handicap. Aim To determine the effectiveness of habilitation in infants with CBP. Material and method Retrospective clinical study included 34 infants who were habilitated in the Clinic of Physical and Rehabilitation Medicine during the period from 2000 to 2017. The protocol consisted of passive and active assisted range of motion exercises for affected arm, neurodevelopmental treatment, warm packs, and electrotherapy starting from the III week of life. Twenty sessions were conducted at the Clinic, and parents were educated with handling and home exercise program. The infants were re-evaluated each month during the first year of life. The modification of the Medical Research Council scale was used to assess muscle strength (grades 0–3). At 6 and 12 months of age, the outcome was defined as full recovery (grade 3 of affected muscles) and partial recovery (grades 1–2). Results Male sex predominated (56%). The right arm was more commonly affected (64.7%). Birth weight was over 4000 g in 22 infants (64.7%). The mode of delivery was spontaneous in 70.6%, assisted in 20.6% and breech in 5.9%. Fifty-nine percent of infants were in Narakas group I, 26.5% in group II and 14.7% in group III. Associated injuries were noted in 10 infants: 7 clavicular and 1 humeral fracture, 2 cases with myogenic torticollis and 1 with cephalhaematoma. The habilitation started in the first month of life in 64.7% of infants. At 6 months of age, there were 33 cases with partial recovery. At 12 months of age, full recovery was noted in 19 children (56%) and partial in 15. Conclusion Early habilitation program is effective in infants with CBP.