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European Journal of Physical and Rehabilitation Medicine 2021 Nov 08

DOI: 10.23736/S1973-9087.21.06886-6


lingua: Inglese

Modified constraint induced movement therapy in children with obstetric brachial plexus palsy: a systematic review

Monica SICARI 1, Maria LONGHI 2 , Giulia D'ANGELO 3, Valentina BOETTO 4, Andrea LAVORATO 5, Lorella COCCHINI 1, Maurizio BEATRICI 1, Bruno BATTISTON 6, Diego GARBOSSA 5, Giuseppe MASSAZZA 7, Paolo TITOLO 6

1Department of Neurorehabilitation, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy; 2 Rehabilitation Medicine, Department of Neuroscience, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy; 3 Division of Physical Medicine and Rehabilitation, ASLTO3, Turin, Italy; 4 Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; 5 Neurosurgery Unit, Department of Neuroscience Rita Levi Montalcini, University of Turin, Turin, Italy; 6 Hand and Upper Limb Surgery Unit, Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center, AOU Città della Salute e della Scienza di Torino, Turin, Italy; 7 Division of Physical Medicine and Rehabilitation, Department of Surgical Sciences, University of Turin, Turin, Italy


INTRODUCTION: Obstetric brachial plexus palsy (OBPP) is a flaccid paralysis occurring in the upper limb during birth. The OBPP includes mild lesions with complete spontaneous recovery and severe injuries with no regain of arm function. Among the most promising rehabilitation treatments aimed at improving upper extremity motor activities in individuals with neurological dysfunctions, there is the modified constraint-induced movement therapy (mCIMT). The aim of this systematic review is to assess and synthesize the critical aspects of the use of mCIMT in children with OBPP.
EVIDENCE ACQUISITION AND SYNTHESIS: This systematic review has been done according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis). A comprehensive search of the literature was conducted using PubMed, MEDLINE and Evidence Based Medicine Reviews, databases. We enclosed experimental and original articles, case reports and book chapters. Four articles were finally included. One case report tested the feasibility of mCIMT to encourage use of the affected
arm in a child with Erb-Duchenne palsy and documented the clinical changes observed. A case series had the purpose to determine if mCIMT in combination with botulinum toxin (BTX-A) improved arm function in 2 children with OBPP. A cohort study compared the use of mCIMT in 19 OBPP and 18 unilateral Cerebral Palsy. A prospective single-blind RCT described mCIMT versus conventional therapy in a group of 39 children with OBPP.
CONCLUSIONS: This systematic review on the use of mCIMT in children with OBPP shows that there is unanimous agreement that a program should last 2 weeks at least. However, there is no scientific evidence supporting a single common mCIMT protocol in the management of OBPP because of a considerable heterogeneity. Further high methodological studies regarding the application of mCIMT for OBPP and based on larger patients sample should have the potential to optimize the appropriateness of care provided to infants with OBPP and, therefore, their quality of life.

KEY WORDS: Constraint induced movement therapy; Obstetrical brachial plexus palsy; Childhood; Brachial plexus injury; Developmental disregard

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