Physical Therapy Protocol for the Management of Obstetric Brachial Plexus Palsy

Background: There are 125 patients undergoing brachial plexus exploration and bilateral sural nerve graft at King Faisal Specialist Hospital and Research Center between 2005-2015. 80% of them needs extensive physical therapy post-surgery, which is proven to enhance the full recovery of the arm function, according to the evidence based studies.

Study design: The case study was used to high light the role of physical therapy in the treatment of brachial plexus palsy post-surgery.

Case description: 4 Months old Saudi girl had been diagnosed with left C5-C6 brachial plexus injury (Narakas 1) patient underwent exploration and bilateral nerve grafting on the age of three months old, placed in baby holder for three weeks. Then the pediatric orthopedic surgon referred her to the physical therapy clinic for Obstetric Brachial Plexus Palsy (OBPP) protocol.

Management and outcomes: The patient received one session per month included: positioning and   instructions to handle the patient in proper way, passive range of motion, active range of motion and strengthening exercises. Sensory stimulation and certain program to facilitate normal posture and motor development. At the second visit the patient started to improve gradually in Range of Motion (ROM) and Muscle Power (MP). After six months of treatment, the patient able to pull herself to stand alone, cruising independent, and crawling with left hand opened on the floor.

Discussion:This case study showed that theearly physical therapy interventionpost – surgery for brachial plexus injury upper region can improve/cure the patient condition.