Early Intervention for Brachial Plexus Birth Injury

Early intervention for infants with brachial plexus birth injury (BPBI) is recommended by specialists, but referrals are often delayed by providers who recommend a “wait and see” approach. Early initiation of passive range of motion (PROM) is used by occupational therapy practitioners as an intervention to support occupations to decrease the risk of shoulder contracture, a common complication, and the most common cause for functional impairments affecting motor development and participation in occupations. This study sought to determine whether delayed initiation of care resulted in increased risk of lifelong shoulder internal rotation contracture, which subsequently will lead to lifelong functional deficits. We completed a retrospective chart review of all infants with upper trunk BPBI who were seen in a regional multidisciplinary brachial plexus clinic before 12 months of age to determine the rate of shoulder contracture among those who received early intervention and those whose care was deferred or delayed. The overall rate of shoulder contracture by 1 year of age was 19%; only 9% of infants who received early intervention, prior to 2 months of age, developed contracture compared to 28% of those who received delayed intervention after 2 months of age. These findings support the need for timely initiation of care, including PROM used as an intervention to support occupations embedded within a family’s unique routines and contexts. The findings also suggest the need for further research on methods to support families in carrying over recommendations aimed at reducing the risk of shoulder contracture, including PROM.