Intensive Therapy of Shoulder External Rotators in Erb's Palsy
Condition: Erbs Palsy
MeSH terms: Brachial Plexus Neuropathies
Study type: Interventional

Summary: 
      Erb's palsy is a common neurological injury occurs at the time of birth. It causes injury to
      the upper trunk nerve root c5-c6, i.e., supply is around shoulder and muscles of forearm and
      these nerves network from the spine and pass through the cervicoaxillary canal in the neck
      and the ribs and emerge into the axilla. Restoring external rotation in erb's palsy is quite
      difficult and mostly surgery is recommended but if physiotherapy sessions are given with
      extended time up to 2 hours and latest techniques are applied to strengthen external rotators
      then range of external rotation can be improved.
    

Detailed description: 
      Erb's palsy is form of brachial plexus palsy which involves injury to cervical nerve roots c5
      c6 causing loss of movements and deformities i.e., internally rotated shoulder, hanging arm
      and waiter's tip hand deformity. Most common risk factors are shoulder dystocia, maternal
      obesity, breech presentation and high birth weight of child. Its incidence is 0.42 per 1000
      live births in which 25% experience permanent impairment and injury.

      Both Conservative and non-conservative treatment protocols are applied in erb's palsy but key
      interventions are positioning in early infancy, passive range of motions and gentle
      stretching. Another latest treatment approach is intensive physical therapy in which single
      session duration is extended to three to four hours with combination of treatments. This
      study will be randomized control trial, used to check effectiveness of intensive physical
      therapy to restore shoulder external rotation in erb's palsy. Subjects with erb's palsy
      meeting the predetermined inclusion and exclusion criteria will be divided into two groups by
      using lottery method. Pre assessment will be done by using AROM on goniometer as objective
      measurement. Subject in one group will be treated with intensive physical therapy and the
      other with conventional treatment. Each subject will receive 5 Treatment sessions per week
      for 6 months.

      Recorded values will be analyzed by using SPSS version 25
    

Intervention name(s): Intensive physical therapy; Non intensive physical therapy
Intervention type(s): Other; Other
Intervention description(s): Intensive physical therapy treatment protocol was given for 3 months 3 times a week including 1.5- 2-hour session. Pre and post treatment assessments were taken. It included stretching for 20 min, Proprioception on ball for 20 minutes, quadruped for 10 min, vibration therapy for 20 min, tapping twice a month for 5 days, sensory therapy with beans for 20 min, supine lying with hand below head for 10-15 min, texturing for 15 min and activity of making tower with cups and hitting in outward direction for 15-20 min.; Non intensive therapy included 45 min session 3 times a week for 3 months. Pre and post treatment assessments were taken. The protocol included stretching for 20 min, cross friction massage for 15 min, Ball catch and throw for 15 min. progression was made from light to heavy weight ball.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: external rotation, Intensive session, C5-C6