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Dr. Madiha Tariq
Dr. Aamna Hassan
Dr. Gull Mahnoor Hashmi
Dr. Sarah Khan
Dr. Shiza Ghani PT
Amina Saeed
Dr. Wajeeha Bakhat
Dr. Eram Aslam
Dr. Muneeb Iqbal


Brachial plexus Neuropathy, Constraint Induced Movement Therapy, Erb’s Palsy, Neuromuscular Electrical Stimulation, Klumpke paralysis, Erbs Duchene paralysis


Background: Erb's Duchene paralysis a paralysis of the arm caused by the injury to the upper group of the main nerves supplying it, specifically the upper trunk C5-C6 of the brachial plexus. It causes functional impairments in the child which limits activity. Constraint-induced movement therapy (CIMT) has been used to promote functional gains in individuals with neurological dysfunctions. Whereas, neuromuscular electrical stimulation (NMES) has been used for muscle strengthening, maintenance of muscle mass and strength during prolonged periods of immobilization.

Objective: To compare the effects of neuromuscular electrical stimulation with and without constraint induced movement therapy on upper limb function in children with Erb’s palsy.

Methods: A randomized controlled trial performed with-in 6 months from July 2022 to December 2022 in which 22 children with age of 6-8 years (mean and SD=10.45±1.29) were taken randomly after meeting inclusion criteria. Children were divided into two groups. Group 1 received constraint induced movement therapy for a period of 3 weeks for at least 6 hours per day combined with the application neuromuscular electrical stimulation for a period of 6 weeks four times a week. Group 2 received only neuromuscular electrical stimulation for a period of 6 weeks, four times a week. Statistical Package for Social Sciences (SPSS 25) was used to analyze the data.

Results:  Constraint-induced movement therapy plus electrical stimulation group showed both a greater rate of improvement in integrated EMG of the involved wrist extensors and cocontraction ratio compared to the other group at 3 and 6 months, as well as improving in root mean square of the involved wrist extensors than traditional occupational therapy group (p<0.05).

Conclusion: Constraint-induced movement therapy plus electrical stimulation is likely to produce the best outcome in improving muscle recruitment and coordination in children with erbs palsy compared to alone therapies. CIMT has been proven to be effective in the enhancement of impaired upper limb in several neurological conditions and NMES has also been effective in improving function in children with Erb’s palsy.

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