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ERB's palsy is an injury of upper section of the brachial plexus (C5-6) leading to an internally rotated and adducted shoulder and a pronated forearm. Modified constraint-induced movement therapy improves the functionality of the affected limb, while electrical stimulation helps in the improvement of active range of motion and muscle strength in ERB's palsy patients. This study aims to investigate the effects of modified constraint-induced movement therapy with and without electrical stimulation on range of motion, muscle strength, and motor functions in patients with ERB's Palsy.
This randomized clinical trial will be conducted at the Children's Hospital. The sample size will consist of 34 participants. Participants who meet the inclusion criteria will be randomly allocated into two groups using an online randomization tool; Group A will receive modified constraint-induced movement therapy with electrical stimulation and Group B will receive modified constraint-induced movement therapy only. Both groups will receive routine physical therapy as a part of treatment. All participants will receive a 60-minute session, 6 times a week for 16 weeks.
Universal Goniometer will be used to assess range of motion, the Medical Research Council Scale for muscle strength, and the Active Movement Scale for motor function at baseline, 4th, 8th, 12th, and 16th weeks after treatment discontinuation. The data will be analyzed using SPSS version 26 for Windows software.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Group A: (Modified constraint-induced movement therapy + electrical stimulation) | Experimental | Group A will include 17 participants. The participants in this group will receive a 60-minute session daily. Each participant will perform 96 sessions (6 times per week over 16 weeks) for 60 minutes daily.
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| Group B: (Modified constraint-induced movement therapy) | Experimental | 17 participants will be included in this group. The participants in this group will also receive a 60-minute session daily (6 times per week over 19 weeks).
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Modified constraint-induced movement therapy | Other | The unaffected arm will be restricted by using an upper extremity sling that will strap to the child's trunk with a distal end fastened to prevent the movement of the unaffected limb. The modified constraint-induced movement therapy will include these exercises.
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| Measure | Description | Time Frame |
|---|---|---|
| Standard universal goniometer | It is a device used to measure the range of motion of joints. It consists of four parts: body, fulcrum, stationary, and the moving arm. | 16 weeks |
| Medical Research Council (MRC) Scale | It is scale used for testing muscle strength, ranging from Grade 5 (movement through full ROM with maximum resistance against gravity), Grade 4 (movement through full ROM with moderate resistance against gravity), Grade 3 (movement through full ROM without resistance against gravity), Grade 2 (movement through full ROM with gravity eliminated), Grade 1 (flicker of movement) to Grade 0 (no apparent contraction). | 16 weeks |
| Active Movement Scale | It is used to quantify movement and assess upper limb motor function. It assesses 15 joint motions (range of motion and muscle strength) from the shoulder to the hand on an 8-point scale (0 ¼ no muscle tone or contraction when gravity is removed, 7 ¼ full range against gravity). | 16 weeks |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Muhammad Kashif, PhD-PT | Riphah International University | Study Chair |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Riphah International University | Lahore | Punjab Province | 54660 | Pakistan |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 31814455 | Background | Zielinski IM, van Delft R, Voorman JM, Geurts ACH, Steenbergen B, Aarts PBM. 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. 2021 Aug;43(16):2275-2284. doi: 10.1080/09638288.2019.1697381. Epub 2019 Dec 8. | |
| 28132014 |
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| ID | Term |
|---|---|
| D020516 | Brachial Plexus Neuropathies |
| ID | Term |
|---|---|
| D010523 | Peripheral Nervous System Diseases |
| D009468 | Neuromuscular Diseases |
| D009422 | Nervous System Diseases |
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| ID | Term |
|---|---|
| D004558 | Electric Stimulation |
| ID | Term |
|---|---|
| D010812 | Physical Stimulation |
| D008919 | Investigative Techniques |
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The study would be single-blinded as the assessor of the study would be kept blind to the treatment groups to which patients will be allocated.
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| Electrical stimulation | Other | The participants in this group will first receive a 20-minute session of electrical stimulation (on time of 10 s, off time of 30 s, pulse rate of 35 Hz, the pulse width of 300 µs). |
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| Coroneos CJ, Voineskos SH, Christakis MK, Thoma A, Bain JR, Brouwers MC; Canadian OBPI Working Group. Obstetrical brachial plexus injury (OBPI): Canada's national clinical practice guideline. BMJ Open. 2017 Jan 27;7(1):e014141. doi: 10.1136/bmjopen-2016-014141. |
| 31284431 | Background | Frade F, Gomez-Salgado J, Jacobsohn L, Florindo-Silva F. Rehabilitation of Neonatal Brachial Plexus Palsy: Integrative Literature Review. J Clin Med. 2019 Jul 5;8(7):980. doi: 10.3390/jcm8070980. |
| 32583409 | Background | Palomo R, Sanchez R. [Physiotherapy applied to the upper extremity in 0 to 10-year-old children with obstetric brachial palsy: a systematic review]. Rev Neurol. 2020 Jul 1;71(1):1-10. doi: 10.33588/rn.7101.2020029. Spanish. |
| 34747579 | Background | Sicari M, Longhi M, D'Angelo G, Boetto V, Lavorato A, Cocchini L, Beatrici M, Battiston B, Garbossa D, Massazza G, Titolo P. Modified constraint induced movement therapy in children with obstetric brachial plexus palsy: a systematic review. Eur J Phys Rehabil Med. 2022 Feb;58(1):43-50. doi: 10.23736/S1973-9087.21.06886-6. Epub 2021 Nov 8. |
| 23930602 | Background | Chang KW, Justice D, Chung KC, Yang LJ. A systematic review of evaluation methods for neonatal brachial plexus palsy: a review. J Neurosurg Pediatr. 2013 Oct;12(4):395-405. doi: 10.3171/2013.6.PEDS12630. Epub 2013 Aug 9. |
| 31670385 | Background | Van der Looven R, Le Roy L, Tanghe E, Samijn B, Roets E, Pauwels N, Deschepper E, De Muynck M, Vingerhoets G, Van den Broeck C. Risk factors for neonatal brachial plexus palsy: a systematic review and meta-analysis. Dev Med Child Neurol. 2020 Jun;62(6):673-683. doi: 10.1111/dmcn.14381. Epub 2019 Oct 31. |
| 35848401 | Background | de Matos MA, Souto DO, Soares BA, de Oliveira VC, Leite HR, Camargos ACR. Effectiveness of Physical Therapy Interventions in Children with Brachial Plexus Birth Injury: A Systematic Review. Dev Neurorehabil. 2023 Jan;26(1):52-62. doi: 10.1080/17518423.2022.2099995. Epub 2022 Jul 17. |
| 36659827 | Background | Lewis SP, Sweeney JK. Comorbidities in Infants and Children with Neonatal Brachial Plexus Palsy: A Scoping Review to Inform Multisystem Screening. Phys Occup Ther Pediatr. 2023;43(5):503-527. doi: 10.1080/01942638.2023.2169091. Epub 2023 Jan 19. |
| 32151503 | Background | Eren B, Karadag Saygi E, Tokgoz 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 Jul-Sep;33(3):418-425. doi: 10.1016/j.jht.2019.12.008. Epub 2020 Mar 7. |
| 19489088 | Background | Brady K, Garcia T. Constraint-induced movement therapy (CIMT): pediatric applications. Dev Disabil Res Rev. 2009;15(2):102-11. doi: 10.1002/ddrr.59. |