Effect of reaching training combined with electrical stimulation in infants with brachial plexus palsy: a single subject design

ABSTRACT This study aimed to evaluate the effect of reaching training combined with functional electrical stimulation (FES) on active upper limb movement in infants with perinatal brachial palsy (PBP). Experimental single-case A-B design with follow-up. Two infants participated in the study, one girl of 7 months and one boy of 10 months of age. Data on infant’s upper limb function (Active Movement Scale) were documented weekly. After six baseline assessments (A), 3 times per 2 weeks, intervention consisted of applying FES Neurodyn® to the deltoid muscle combined with objects reach training, encouraging abduction and anterior shoulder flexion above 90º, for six weeks, totaling 15 visits (B). The infants were reevaluated twice after a period of 15 and 30 days without intervention (follow up). The total score obtained on each evaluation day was plotted graphically. Electrostimulation was well accepted, with no side effects. Both infants showed improvement in the active movement of the affected upper limb after the intervention and the gains were maintained at follow-up, an increase of 9 and 7 points for infants 1 and 2, respectively. Six weeks of intervention resulted in individual changes in infant’s upper limb function, mainly increased active range of motion in shoulder flexion and abduction and elbow flexion. The results of this study suggest the use of electrical stimulation as an adjunct to training the use of the affected upper limb of infants with PBP.摘要 本研究旨在评估功能性电刺激（functional electrical stimulation, FES）结合伸手抓握训练，对围产期臂丛麻痹（perinatal brachial palsy, PBP）患儿上肢主动活动的改善效果。本研究采用单病例A-B实验设计并设置随访环节，共纳入2名婴幼儿受试者，分别为1名7月龄女婴与1名10月龄男婴。研究采用主动运动量表（Active Movement Scale）对受试者上肢功能进行评估，相关评估数据每周采集并记录一次。在完成6次基线评估（阶段A，每2周开展3次评估）后，受试者接受为期6周的干预（阶段B，共计15次随访）：将Neurodyn®型功能性电刺激施加于三角肌，同时结合物体伸手抓握训练，指导患儿完成肩外展及前屈角度超过90°的动作。在停止干预后的第15天与第30天，分别对两名婴幼儿进行2次随访评估。将每次评估当日获得的总评分以图表形式可视化呈现。受试婴幼儿对电刺激耐受性良好，未出现任何不良反应。干预结束后，两名患儿的患侧上肢主动活动能力均得到改善，且该改善效果在随访阶段得以维持：受试者1与受试者2的评分分别提升了9分与7分。为期6周的干预使受试者上肢功能出现个体化改善，主要表现为肩前屈、肩外展及肘关节屈曲的主动活动范围显著提升。本研究结果表明，电刺激可作为辅助手段，用于改善围产期臂丛麻痹患儿患侧上肢的功能训练效果。