Hydrotherapy as an Adjunct to Physiotherapy Management in an Infant with Obstetric Brachial Plexus Palsy

INTRODUCTION: Obstetric brachial plexus palsy (OBPP) is one of the most complex traumatic peripheral nerve injuries, which frequently leads to considerable physical disability with progressive psychological and socioeconomic problems. A dynamic and comprehensive physiotherapy programme is highly important and absolutely necessary for its management. A variety of physiotherapeutic procedures are performed to support any spontaneous nerve recovery as well as to prevent and treat the consequences of denervation, such as pain, muscle weaknesses, atrophies, contractures, somatosensory deficits, subluxations/dislocations and motor dysfunctions. Hydrotherapy is used as an additional physiotherapeutic modality in the OBPP rehabilitation. However, there is no evidence in the published literature to suggest the use of hydrotherapy for the management of infants with OBPP. The purpose of this study was therefore to investigate for first time the feasibility and efficacy of a specific 4-month hydrotherapy programme, as an adjunct to early physiotherapy intervention, on upper extremity functional movement in an infant with OBPP.

METHODS: In this case report a 3-month-old female infant with left Erb’s palsy, presented with muscle weakness and loss of motion with typical “waiter’s-tip”position of the arm. The infant participated in 17 hydrotherapy sessions of 45 minutes each (once a week). The hydrotherapy programme was conducted in an indoor therapy pool, heated to 32oC, by a specialized and experienced paediatric physiotherapist. The hydrotherapy programme included specific therapeutic exercises, through therapeutic handling and holding strategies based on the philosophy of Halliwick®-Aquatic Therapy and Bobath/Neurodevelopmental Treatment, for facilitating the active movement, maintaining the range of motion and enhancing the sensory perception of the involved arm. The infant received a standardized physiotherapy programme twice a week (since she was 25 days old). Active Movement Scale (AMS) and videotaping prior to and after the intervention were used for recording potential improvements.

RESUL TS: Improvements in upper-extremity joint movements were found on AMS. Specifically, measures have shown an increase in shoulder flexion by 3 points (from 2 to 5), in shoulder abduction by 3 points (from to 2 to 5) and in shoulder external rotation by 2 points (from 0 to 2). There was an increase in elbow flexion by 4 points (from 2 to 6) and in forearm supination by 1 point (from 0 to 1). The wrist extension was increased by 2 points (from 5 to 7). Overall, there was a significant enhancement in the six tested movements that averaged 36%. Also, improvements in functional use of the affected arm were documented by videotaping the use of the arm in functional bilateral activities, such as splashing around in water, reaching and grasping a toy, bring the hands or/and a toy to mouth.

CONCLUSION: The findings demonstrate that hydrotherapy combined with physiotherapy intervention, may improve the motor function in an infant with OBPP. It is recommended that hydrotherapy may has a role in maintaining muscle extensibility and joint range of motion as well as in enhancing motor recovery of the involved limb.