Mumtaz Jabeen Babar, Shakeel Ahmed.
Rehabilitation management of Obstetrical Brachial plexus palsy (OBPP) in infants.
Pak Paed J Jan ;25(2):39-43.

Objective:To investigate the value of Electromyography (EMG) and Nerve Conduction Study (NCS) in determining proper diagnosis and prediction of prognosis in obstetrical brachial plexus palsy of the neonate. Setting: Outpatient physical medicine & rehabilitation clinic of the Children`s Hospital, Lahore Subject: 30 neonates with obstetrical brachial plexus palsy (OBPP). Method: A prospective descriptive study was designed (February 1999 - April 2001) . I he neonates were diagnosed on clinical examination to have a brachial plexus palsy which was defined anatomically as upper, intermediate, lower and total. EMG and NCS was performed preferably at 21 days of age to differentiate between axonotmesis and neurapraxia of the brachial plexus. Following this the infants underwent an appropriate rehabilitation management protocol. A monthly follow up was attempted in these infants using the modified Medical Research Council (MRC) Muscle Grading System and Active Movement scale to monitor progress. Results: An early spontaneous neurological recovery, often complete with better functional outcome was noted in neurapraxic brachial plexus palsy. Whereas neonates and infants with axonotmesis of the brachial plexus presented with absent or delayed neurological recovery often incomplete with frequent complications and a poorer functional outcome. Conclusion: These findings suggest that obstetrical brachial plexus palsy can be managed more efficiently by an early referral of the newborn to a physical medicine & rehabilitation facility.

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