Erb's Palsy is a very common disorder in our country. After birth or between one or two months parents can easily find out this condition. But they don't know about proper treatment of Erb's Palsy. Most of the doctors show wrong positioning which is not correct. It occurs in about 1.5 in 1000 live births.
What is Erb's Palsy?
Erb's Palsy (also known as Brachial Plexus Paralysis) is a condition which is mainly due to birth trauma. It is a paralysis of the arm that can affect 1 or all 5 of the primary nerves that supply the movement and feeling to an arm (specifically the upper trunk C5-C6 is severed to cause the palsy, but not exclusively). These nerves form part of the brachial plexus. They come out of the spinal cord between the bones of the neck (the vertebrae), comprising the ventral rami of spinal nerves C5, C6, C7, C8 and T1.
After birth when your child's hand is not the same as the other hand and when it remains in abnormal pattern or shows following symptom then you can easily find out:
l Arm flexed at elbow and held against the body
l Decreased grip on the affected side
l Absent Moro reflex on the affected side
l Lack of spontaneous movement in the upper or lower arm or hand
Occupational Therapy Treatment
For the babies that do not fully recover on their own (usually evident within 3 to 4 months), specialist intervention is required. Range of movement is usually recovered within a year, but individuals that have not healed after this point will rarely gain full function in their arm, but may continue to improve. They may also be prone to developing arthritis.
Qualified Occupational Therapists play an important role to improve the child's condition. At first a therapist plans for treatment according to patient's condition. Treatment includes gentle range of movement exercises to maintain joint range of motion. The aim is to increase joint flexibility and muscle tone as well as sensory awareness with tactile stimulation using various textured materials. The extremity of the limb needs vibration and massage to increase its sensory awareness in the overall body scheme.
l Joint compression/weight bearing throughout involved extremity will increase the proprioceptive input/muscle contraction.
l The active use of the arm in purposeful activities that are developmentally appropriate will encourage range of movement and increase strength and co-ordination. These movements should be graded beginning in gravity eliminated and then advancing to against gravity.
l Bilateral motor planning activities should always be included.
l Sometimes splinting may be necessary e.g. to hold the arm in supination and external rotation. The Occupational Therapist will advise on suitable and necessary splinting methods.
Usually the last movements to return are:
l Full shoulder flexion/abduction using deltoid musculature
l Supination (children do not actively and spontaneously do this until 11 months of age)
l External rotation
l Full elbow extension using triceps
Prognosis
Prognosis of Erb's Palsy depends upon the degree of damage. Effective therapeutic management can provide better result. Function can return within a few months. Some may have been left with permanent damage.
Positioning strategies
Positioning strategies may include a period of casting, which typically lasts 4 to 6 weeks, followed by use of the Sup-ER splint or a shoulder spica splint for several months.
What should you have to do?
Always include bilateral upper extremity in play to use uninvolved arm as a guide to allow involved arm to experience everything that the other arm is doing, to always offer toys, food, or any other objects to involved arm first, to allow child to reach and grasp objects in a place where he/she can succeed to obtain these objects and then slowly increase the range to avoid frustration which leads to increased levels of motivation to use that arm.
Do not allow child to use compensatory movements especially in the trunk to obtain desired objects when reaching.
Children are extremely adaptable and will always try to use uninvolved extremity to perform the tasks. It will require constant verbal/tactile cuing to reprogram the child to use the involve arm.
From where you get treatment?
If you have any relatives with Erb's Palsy then please contact with qualified occupational therapist that can help the patients to independent in daily life.
Centre for the Rehabilitation of the Paralyzed (CRP) is the only Centre where this type of patient gets this facility. Please contact following address:
Centre for the Rehabilitation of the Paralyzed (CRP) Savar, Dhaka.
Tel: (880)2 7745464/5; Fax: (880)2 7745069 email: contact@crp-bangladesh.org
CRP has also different branches at Mipur-14, Dhaka, Sylhet, Chittagong and Barisal.
The writer is Clinical Occupational Therapist, Centre for the Rehabilitation of the Paralyzed (CRP), Mirpur-14, Dhaka.
Email: rabeya1988@gmail.com
Occupational Therapy management for Erb\\\'s Palsy
Rabeya Ferdous | Published: July 04, 2015 00:00:00 | Updated: November 30, 2026 06:01:00
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