Effect of Constraint-Induced Movement Therapy and Electrical Muscle Stimulation on Upper Limb Function in Children with Erb’s Palsy: A Quasi-Experimental Study

Background: Erb’s palsy is a form of obstetric brachial plexus injury that frequently results in motor and sensory dysfunction of the upper extremity. While electrical muscle stimulation (EMS) and constraint-induced movement therapy (CIMT) have demonstrated benefits individually, their combined effectiveness in children remains underexplored. Objective: To compare the effects of EMS alone versus EMS combined with CIMT on upper limb motor function and muscle strength in children with Erb’s palsy. Methods: This quasi-experimental, two-group, pretest-posttest study was conducted at pediatric physical therapy departments in two tertiary care hospitals in Lahore, Pakistan. Thirty-two children (mean age 4.25 ± 1.1 years) with Erb’s palsy were allocated to an experimental group (CIMT+EMS, n = 16) or a control group (EMS only, n = 16). The experimental group received CIMT for 6 hours/day over 3 weeks along with EMS (20 minutes, 4 days/week for 6 weeks). Functional outcomes were assessed pre- and post-intervention using the Mallet Classification and Oxford Muscle Grading Scale. Results: The experimental group showed significantly greater improvement across all Mallet domains compared to controls (p < .05), including external rotation, abduction, hand-to-neck, hand-to-spine, hand-to-mouth, and supination. Muscle strength also improved significantly (3.06 ± 0.57 vs. 2.63 ± 0.50; p = .034). Conclusion: The combination of CIMT and EMS significantly enhances upper limb function and strength in children with Erb’s palsy compared to EMS alone. This dual-modality therapy may offer a more effective early intervention strategy in Erb’s palsy.