Passive Range of Motion for Conservative Management of Brachial Plexus Birth Injury: A Survey of Expert Therapists

Abstract

Brachial plexus birth injury (BPBI) occurs in almost 1/1000 live births potentially resulting in lifelong upper extremity weakness and joint contracture. Early referral and initiation of passive range of motion (PROM) are recommended but there is no standard of care to guide treatment. A descriptive survey study design was used to target occupational and physical therapists who work in brachial plexus clinics to identify current practices for early therapeutic intervention. With 26 respondents, therapists recommend initiating PROM by 4 wks of life performed at every diaper change. Seventy-four percent of therapists report differences in outcomes for children whose caregivers are more adherent, however, there was no significant relationship between frequency of PROM and outcomes. More outcome research is needed to identify an optimal frequency and duration, examine the efficacy of methods for parent education, and identify training methods to facilitate adherence.

Keywords:

• Brachial plexus birth injury
• early intervention
• occupational therapy
• passive range of motion
• therapy guidelines

Acknowledgements

The authors are grateful to Dr. Amanda Jozkowski for her ongoing assistance with data analysis and to Megan Lieb, research assistant, who assisted with data management. The authors would also like to acknowledge the entry-level doctoral students who participated in collecting the data.

Declaration of interest

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Jennifer Wingrat

Jennifer Wingrat, ScD, OT/L is Assistant Professor of Occupational Therapy and Occupational Science at Towson University in Towson, MD, and clinical manager of the multi-disciplinary brachial plexus clinic at Kennedy Krieger Institute in Baltimore, Maryland. She has over 25 years of experience as a pediatric occupational therapist. Her research focuses on best practices in evaluation, treatment, and management of brachial plexus birth injury. Caitlin Berger, OTR/L, OTD is an occupational therapist at the International Center for Spinal Cord Injury at Kennedy Krieger Institute in Baltimore, Maryland. She earned an entry-level occupational therapy doctorate degree from Towson University in 2023. Lauren Bauer, OTR/L, OTD is an occupational therapist in the Comprehensive Medical Rehabilitation department at the University of Maryland Rehabilitation & Orthopedic Institute in Baltimore, Maryland. She earned an entry-level occupational therapy doctorate degree from Towson University in 2023.