Stretch-Shortening Cycle Exercise: Potential Implications For Children With Obstetric Brachial Plexus Injury
Condition: Erb Palsy
MeSH terms: Brachial Plexus Neuropathies
Study type: Interventional

Summary: 
      This study was set out to evaluate the effect of a 12-week stretch-shortening cycle exercise
      (SSC-Ex) on muscle strength, bone mineral density, and upper extremity function in children
      with obstetric brachial plexus injury (OBPI). Fifty-six patients with OBPI were randomly
      allocated to the SSC-Ex group (n = 28, received SSC-Ex program, twice/week, over 12 weeks) or
      the control group (n = 28, received standard exercise program). Both groups were assessed for
      muscle strength, bone health, and upper extremity function before and after treatment.
    

Detailed description: 
      Fifty-six children with OBPI were recruited from the Physical Therapy Outpatient Clinic of
      Prince Sattam Bin Abdulaziz University and three referral hospitals in Riyadh provenience,
      Saudi Arabia. The study included children who had a confirmed diagnosis of upper arm type of
      OBPI, classified as level I or II per Narakas classiﬁcation system, aged 10-16 years, had a
      functional level of grade III according to the Mallet scoring system, and were consuming a
      balanced diet. Children who had a history of corrective neuromotor or musculoskeletal
      surgery, shoulder dislocation/subluxation, calcium supplements, or cognitive issues were
      excluded.

      Outcome measures

        1. Muscle strength: The peak isometric muscle strength of the shoulder flexors, abductors,
           external rotators, elbow flexors, and extensors was measured using a hand-held
           dynamometer.

        2. Bone mineral properties: Bone mineral density and bone mineral content of the humeral,
           radial, and ulnar shafts were measured through Dual-Energy X-ray Absorptiometry (DEXA)
           scanning.

        3. Upper-extremity function: The functional performance was assessed using the brachial
           plexus outcome measure (BPOM) activity scale.

      The SSC-Ex group received a 12-week therapist-led SSC-Ex training, for approximately 35
      minutes per session, two times a week for 12 consecutive weeks, in conformity with the
      National Strength and Conditioning Association guidelines and American Academy of Pediatrics
      safety standards. The SSC-Ex program consisted of ten unilateral and bilateral upper
      extremity exercises in the form of push-ups and ball slams/throws/passes activities. The
      SSC-Ex program preceded with a warm-up for 5 minutes and ended with a cool-down for 5
      minutes. The control group received the standard exercise program, 35 minutes per session,
      two times a week for 12 consecutive weeks. The program consisted of flexibility exercises,
      strength training, weight-bearing exercises, proprioceptive neuromuscular facilitation,
      manual guidance, and functional training.
    

Intervention name(s): Stretch-shortening exercise; Standard exercise program
Intervention type(s): Other; Other
Intervention description(s): The SSC-Ex program was conducted for 35 minutes/session twice weekly over 12 weeks. The program was directed by a pediatric physical therapist in accordance with the safety performance guidelines defined by the American Academy of Pediatrics and the US National Strength and Conditioning Association. The program consisted of ten unilateral and bilateral upper extremity exercises in the form of push-ups and ball slams/throws/passes activities and was preceded by a warm-up for 5 minutes and ended with a cool-down for 5 minutes.; The standard exercise program lasted for 35 minutes/session and repeated two times a week for 12 consecutive weeks. The program was conducted by a pediatric physical therapist and consisted of flexibility exercises, strength training, weight-bearing exercises, proprioceptive neuromuscular facilitation, manual guidance, and functional training.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: A prospective, two-arm, randomized controlled trial
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment