Effects of Modified Constraint-induced Movement Therapy With and Without Electrical Stimulation in Erb's Palsy

NCT ID: NCT06303427

Last Updated: 2024-10-15

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

34 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-03-15

Study Completion Date

2024-10-01

Brief Summary

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ERB's palsy is an injury of upper section of the brachial plexus (C5-6) leading to an internally rotated and adducted shoulder and a pronated forearm. Modified constraint-induced movement therapy improves the functionality of the affected limb, while electrical stimulation helps in the improvement of active range of motion and muscle strength in ERB's palsy patients. This study aims to investigate the effects of modified constraint-induced movement therapy with and without electrical stimulation on range of motion, muscle strength, and motor functions in patients with ERB's Palsy.

Detailed Description

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This randomized clinical trial will be conducted at the Children's Hospital. The sample size will consist of 34 participants. Participants who meet the inclusion criteria will be randomly allocated into two groups using an online randomization tool; Group A will receive modified constraint-induced movement therapy with electrical stimulation and Group B will receive modified constraint-induced movement therapy only. Both groups will receive routine physical therapy as a part of treatment. All participants will receive a 60-minute session, 6 times a week for 16 weeks.

Universal Goniometer will be used to assess range of motion, the Medical Research Council Scale for muscle strength, and the Active Movement Scale for motor function at baseline, 4th, 8th, 12th, and 16th weeks after treatment discontinuation. The data will be analyzed using SPSS version 26 for Windows software.

Conditions

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Erb's Palsy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
The study would be single-blinded as the assessor of the study would be kept blind to the treatment groups to which patients will be allocated.

Study Groups

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Group A: (Modified constraint-induced movement therapy + electrical stimulation)

Group A will include 17 participants. The participants in this group will receive a 60-minute session daily. Each participant will perform 96 sessions (6 times per week over 16 weeks) for 60 minutes daily.

1. Electrical stimulation for 20 minutes
2. Routine physical therapy for 10 minutes
3. Modified constraint-induced movement therapy for 30 minutes.

Group Type EXPERIMENTAL

Modified constraint-induced movement therapy

Intervention Type OTHER

The unaffected arm will be restricted by using an upper extremity sling that will strap to the child's trunk with a distal end fastened to prevent the movement of the unaffected limb.

The modified constraint-induced movement therapy will include these exercises.

1. Playing with ball.
2. Playing with modeling clay.
3. Playing with LEGOS (building towers or different shapes from the toy bricks).
4. Tearing a paper towel from a roll.
5. Holding and eating biscuits.
6. Eating with a spoon.
7. Drinking from a glass.
8. Combing hair.
9. Brushing teeth.
10. Making bubbles using a bubble blower.
11. Pulling a toy.
12. Placing a hat or piece of cloth on the head.
13. Applying lotion to the trained caregiver.

Electrical stimulation

Intervention Type OTHER

The participants in this group will first receive a 20-minute session of electrical stimulation (on time of 10 s, off time of 30 s, pulse rate of 35 Hz, the pulse width of 300 µs).

Group B: (Modified constraint-induced movement therapy)

17 participants will be included in this group. The participants in this group will also receive a 60-minute session daily (6 times per week over 19 weeks).

1. Routine physical therapy for 10 minutes.
2. Modified constraint-induced movement therapy for 50 minutes.

Group Type EXPERIMENTAL

Modified constraint-induced movement therapy

Intervention Type OTHER

The unaffected arm will be restricted by using an upper extremity sling that will strap to the child's trunk with a distal end fastened to prevent the movement of the unaffected limb.

The modified constraint-induced movement therapy will include these exercises.

1. Playing with ball.
2. Playing with modeling clay.
3. Playing with LEGOS (building towers or different shapes from the toy bricks).
4. Tearing a paper towel from a roll.
5. Holding and eating biscuits.
6. Eating with a spoon.
7. Drinking from a glass.
8. Combing hair.
9. Brushing teeth.
10. Making bubbles using a bubble blower.
11. Pulling a toy.
12. Placing a hat or piece of cloth on the head.
13. Applying lotion to the trained caregiver.

Interventions

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Modified constraint-induced movement therapy

The unaffected arm will be restricted by using an upper extremity sling that will strap to the child's trunk with a distal end fastened to prevent the movement of the unaffected limb.

The modified constraint-induced movement therapy will include these exercises.

1. Playing with ball.
2. Playing with modeling clay.
3. Playing with LEGOS (building towers or different shapes from the toy bricks).
4. Tearing a paper towel from a roll.
5. Holding and eating biscuits.
6. Eating with a spoon.
7. Drinking from a glass.
8. Combing hair.
9. Brushing teeth.
10. Making bubbles using a bubble blower.
11. Pulling a toy.
12. Placing a hat or piece of cloth on the head.
13. Applying lotion to the trained caregiver.

Intervention Type OTHER

Electrical stimulation

The participants in this group will first receive a 20-minute session of electrical stimulation (on time of 10 s, off time of 30 s, pulse rate of 35 Hz, the pulse width of 300 µs).

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

1. Children with a confirmed diagnosis of ERB's palsy.
2. Muscle power of the affected limb should be between 1 to 4.
3. Active finger range of motion,10-degree wrist extension, and thumb abduction.

Exclusion Criteria

1. Children having contracture and stiffness of affected limb.
2. Muscle power of affected limb 0 or 5.
3. Children with cerebral palsy, visual, hearing, and cognitive problems, or any neuromuscular, and skeletal disorders.
4. Previous history of neurological and orthopedic surgery
Minimum Eligible Age

2 Years

Maximum Eligible Age

6 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Riphah International University

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Muhammad Kashif, PhD-PT

Role: STUDY_CHAIR

Riphah International University

Locations

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Riphah International University

Lahore, Punjab Province, Pakistan

Site Status

Countries

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Pakistan

References

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Zielinski IM, van Delft R, Voorman JM, Geurts ACH, Steenbergen B, Aarts PBM. The effects of modified constraint-induced movement therapy combined with intensive bimanual training in children with brachial plexus birth injury: a retrospective data base study. Disabil Rehabil. 2021 Aug;43(16):2275-2284. doi: 10.1080/09638288.2019.1697381. Epub 2019 Dec 8.

Reference Type BACKGROUND
PMID: 31814455 (View on PubMed)

Coroneos CJ, Voineskos SH, Christakis MK, Thoma A, Bain JR, Brouwers MC; Canadian OBPI Working Group. Obstetrical brachial plexus injury (OBPI): Canada's national clinical practice guideline. BMJ Open. 2017 Jan 27;7(1):e014141. doi: 10.1136/bmjopen-2016-014141.

Reference Type BACKGROUND
PMID: 28132014 (View on PubMed)

Frade F, Gomez-Salgado J, Jacobsohn L, Florindo-Silva F. Rehabilitation of Neonatal Brachial Plexus Palsy: Integrative Literature Review. J Clin Med. 2019 Jul 5;8(7):980. doi: 10.3390/jcm8070980.

Reference Type BACKGROUND
PMID: 31284431 (View on PubMed)

Palomo R, Sanchez R. [Physiotherapy applied to the upper extremity in 0 to 10-year-old children with obstetric brachial palsy: a systematic review]. Rev Neurol. 2020 Jul 1;71(1):1-10. doi: 10.33588/rn.7101.2020029. Spanish.

Reference Type BACKGROUND
PMID: 32583409 (View on PubMed)

Sicari M, Longhi M, D'Angelo G, Boetto V, Lavorato A, Cocchini L, Beatrici M, Battiston B, Garbossa D, Massazza G, Titolo P. Modified constraint induced movement therapy in children with obstetric brachial plexus palsy: a systematic review. Eur J Phys Rehabil Med. 2022 Feb;58(1):43-50. doi: 10.23736/S1973-9087.21.06886-6. Epub 2021 Nov 8.

Reference Type BACKGROUND
PMID: 34747579 (View on PubMed)

Chang KW, Justice D, Chung KC, Yang LJ. A systematic review of evaluation methods for neonatal brachial plexus palsy: a review. J Neurosurg Pediatr. 2013 Oct;12(4):395-405. doi: 10.3171/2013.6.PEDS12630. Epub 2013 Aug 9.

Reference Type BACKGROUND
PMID: 23930602 (View on PubMed)

Van der Looven R, Le Roy L, Tanghe E, Samijn B, Roets E, Pauwels N, Deschepper E, De Muynck M, Vingerhoets G, Van den Broeck C. Risk factors for neonatal brachial plexus palsy: a systematic review and meta-analysis. Dev Med Child Neurol. 2020 Jun;62(6):673-683. doi: 10.1111/dmcn.14381. Epub 2019 Oct 31.

Reference Type BACKGROUND
PMID: 31670385 (View on PubMed)

de Matos MA, Souto DO, Soares BA, de Oliveira VC, Leite HR, Camargos ACR. Effectiveness of Physical Therapy Interventions in Children with Brachial Plexus Birth Injury: A Systematic Review. Dev Neurorehabil. 2023 Jan;26(1):52-62. doi: 10.1080/17518423.2022.2099995. Epub 2022 Jul 17.

Reference Type BACKGROUND
PMID: 35848401 (View on PubMed)

Lewis SP, Sweeney JK. Comorbidities in Infants and Children with Neonatal Brachial Plexus Palsy: A Scoping Review to Inform Multisystem Screening. Phys Occup Ther Pediatr. 2023;43(5):503-527. doi: 10.1080/01942638.2023.2169091. Epub 2023 Jan 19.

Reference Type BACKGROUND
PMID: 36659827 (View on PubMed)

Eren B, Karadag Saygi E, Tokgoz D, Akdeniz Leblebicier M. Modified constraint-induced movement therapy during hospitalization in children with perinatal brachial plexus palsy: A randomized controlled trial. J Hand Ther. 2020 Jul-Sep;33(3):418-425. doi: 10.1016/j.jht.2019.12.008. Epub 2020 Mar 7.

Reference Type BACKGROUND
PMID: 32151503 (View on PubMed)

Brady K, Garcia T. Constraint-induced movement therapy (CIMT): pediatric applications. Dev Disabil Res Rev. 2009;15(2):102-11. doi: 10.1002/ddrr.59.

Reference Type BACKGROUND
PMID: 19489088 (View on PubMed)

Other Identifiers

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REC/RCR & AHS/23/0292

Identifier Type: -

Identifier Source: org_study_id

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