Five oriented tasks in manual skills of a baby child with obstetric brachial plexus palsy

Abstract

Brachial plexus (BP) injury during labor is called obstetric brachial palsy (OBP). It is an abnormality that occurs in the upper extremity of the body due to excessive stretching of the neural roots of the BP. Every motor skill that the child with OPB acquires will be hampered by the deficiency in the movement of an upper limb (MS), impacting his motor experimentation. To modify their motor behavior, task-directed therapy can contribute to the function of the affected upper limb, because it is characterized by a protocol of functional exercises, which is still scarce in researches aimed at this morbidity. The objective of the study was to evaluate the effect of a motor intervention by means of five directed tasks on the manual skills of the upper limb of a child with OBP, as well as on his gross motor function. The child in the study was 17 months old, with left OBP, with weakness of shoulder abduction, external rotation, elbow flexion and wrist drop. He underwent 24 physiotherapy sessions with directed tasks for 45 minutes, three times a week. The Manual Ability Classification System (MACS) was used to classify the degree of severity of the MSE. The Gross Motor Function Measure (GMFM-66) quantitatively measured motor and static aspects and the Gross Motor Function Classification System (GMFCS) was used to determine which level best represented the abilities and limitations in the child's gross motor function. The targeted tasks were based on the model of the Induced Constraint Therapy (ICT) protocol, being: find the surprise; orange spoon; hair elastic fitting; fishing for bottle caps; stacking blocks. In the post-intervention assessments, the MACS showed improvement in the tasks of finding the surprise, orange spoon, and fishing for lids, but remained the same in the level of the activities of fitting the rubber bands and stacking the blocks. The GMFM-66 obtained an increase in the final score and the GMFCS remained at the level I. The GMFM-66 showed a 4.99% improvement at the end of the intervention. The activities finding the surprise, picking oranges, and fishing for bottle caps showed an improvement in the MACS level classification compared to the initial assessment. The findings show better muscle recruitment, with refinement in elbow flexion movements, forearm supination and external rotation (ER) of the shoulder.