Neuromuscular Electrical Stimulation With and Without Constraint Induced Movement Therapy in Erb's Palsy
Condition: Erb's Palsy
MeSH terms: Brachial Plexus Neuropathies
Study type: Interventional

Summary: 
      Erb's Duchenne paralysis constitutes the single commonest form of brachial plexus injury,
      brachial plexus injury (BPI) is unfortunately a rather common injury in newborn children.
      Incidence varies between 0.15 and 3 per 1000 live births in various series and countries. The
      constraint-induced movement therapy (CIMT) has been used to promote functional gains in
      individuals with neurological dysfunctions .The constraint-induced movement therapy consists
      of constraining movement of the non-affected upper extremity and providing intensive training
      to the involved upper extremity. Neuromuscular electrical stimulation (NMES) has been used
      for muscle strengthening, maintenance of muscle mass and strength during prolonged periods of
      immobilisation, selective muscle retraining, and the control of oedema.The aim of this study
      is to compare the effects of Neuromuscular Electrical Stimulation with and without Constraint
      Induced Movement Therapy on Upper limb Function in Children with Erb's Palsy.

      It is a Randomized Controlled Trial.The sample size calculated by using OpenEpi or GPower.
      Data will be collected from Jinnah Hospital,Children Hospital,Lahore medical city
      hospital,Farooq hospital,Rising sun institute and PSRD. The patients will be selected through
      non-probability convenience sampling,will be divided into two groups. The Group A will
      receive habituation exercises for six weeks, three times per week for thirty minutes, along
      with application of neuromuscular electrical stimulation for a period of 6 weeks four times a
      week and perform Constrained induced movement therapy techniques, each for 8 weeks.The
      interventions are consisted of 3weeks of casting the unaffected limb followed by 5 weeks of
      transference activities.. The Group B will be given neuromuscular electrical stimulation for
      a period of 6 weeks four times a week.Range of motion ,Flexibility exercises will be given as
      baseline treatment to both groups. The arm function was evaluated by the Mallet score system,
      while active abduction and external rotation range of motion were measured by a standard
      universal goniometer. Data will be analyzed by SPSS 25.
    


Intervention name(s): EMS with CIMT; EMS
Intervention type(s): Other; Other
Intervention description(s): The interventions are consisted of 3weeks of casting the unaffected limb followed by 5 weeks of transference activities.The assisting hand assessment AHA was used to measure bimanual activity performance at baseline,8 weeks, 16 weeks. 20-minute application of currents and resistance exercises for the respective muscles of the area. The intervention group with 11 patients underwent a program of CIMT for one hour daily for 14 consecutive days or two hours per day, six days per week and a total of 12 weeks. A follow-up will be performed 12 weeks after the intervention. The healthy upper limb will be immobilized by orthosis or cast for six hours a day . Electrotherapy will be applied with TENS for 15 minutes at intervals of 1000ms and with a pulse duration of 50ms. The square wave will be chosen to ensure that there will be sufficient muscle contraction; this group will only receive baseline exercises (ROM and flexibility exercises) than apply electrical stimulations at specific motor points. Electrotherapy will be applied with TENS for 15 minutes at intervals of 1000ms and with a pulse duration of 50ms. The square wave will be chosen to ensure that there will be sufficient muscle contraction
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Investigator)
Primary purpose: Treatment