NMES Efficacy on Patients With NBPP

Neonatal Brachial Plexus Palsy (NBPP), characterized by weakness and sensory loss in the
affected arm, results from damage in the prenatal period to the nerves extending from the
spine to the arm. Proper stretching and exercise of the joints and affected arm from the time
of diagnosis can greatly assist in the development of healthy movement of the limb.
Additionally, neuromuscular electrical stimulation has been shown to be an effective
treatment in other neural disorders and therefore its effectiveness in NBPP is worth
studying.

In the case of NBPP patients, the loss in normal arm function can be observed very early.
Young patients will often neglect using the affected arm or modify motions to avoid the use
of the biceps muscle, specifically in hand to mouth actions such as gripping a bottle or
placing toys or other objects in the mouth. A goal of this study is to test the effectiveness
of NMES on improving the biceps muscle Medical Research Council (MRC) strength and active
range of motion (AROM).

The subjects of this study are newborns between the ages of 3-9 months who are already a part
of the University of Michigan Brachial Plexus program. Parents of the children will be
trained to perform the neuromuscular electrical stimulation therapy at home using the EMPI
Continuum unit for 30 minutes each day and monthly follow up appointments will be performed
be the research occupational therapists throughout three month study period.

Parents of the participants will complete a questionnaire before and during the study period
to help analyze for confounders and gather data regarding parent compliance and NMES
effectiveness. To detect the effectiveness of NMES, two cohort groups using standard units
and sham units will be recruited and compare with data analysis.

The investigators predict that the NMES will effectively improve the ability of the neonate
to increase use of the affected arm, specifically in muscle strength biceps MRC score and
AROM.