Effects Of Physiotherapy on Strength, Range and Function in Children with Erb’s Palsy; An Experimental Study

Effects of Physiotherapy on Children with Erb’s Palsy


  • Sarwat Anees Punjab Social Security Health Management Company Hospital, Raiwind
  • Hafiz Syed Ijaz Ahmed Burq Lahore General Hospital, Lahore, Pakistan
  • Muniba Afzal Nur International University, Lahore
  • Muhammad Asrar Yousaf Riphah International University, Lahore
  • Tooba Amin Physical Therapy Department, Fatima Memorial Hospital, Lahore
  • Muhammad Rizwan University Institute of Physical Therapy, University of Lahore




Physiotherapy, Strength, Function, Range of Motion, Erb’s Palsy


Children who sustain brachial plexus injuries after birth face significant functional limitations due to a variety of sequelae affecting the shoulder, elbow, or forearm. These effects could be permanent or temporary. It is critical for proper joint development to maintain complete passive mobility while neurological function is being restored. Children with Erb’s palsy are more likely to have weak muscles, which can be found by ultrasonography Objective: To determine the effects of physiotherapy on strength, range and function in children with Erb’s palsy. Methods: It was a clinical trial conducted at physiotherapy department outpatient at General hospital Lahore. A sample of 46 children aged between 0-10 years, with the C5 and C6 lesion and with limited range of motion were included while children with any history of previous or recent trauma or surgery to upper limb and to the other roots of brachial plexuses was excluded. Modified Mallet scale and active movement scale was used as outcome measures. The coin toss technique of randomization was adopted, with 'Heads' assigned to strengthening exercises and 'Tails' assigned to general treatment. Independent sample test was employed to assess pre and post differences. Physiotherapy treatments included neurodevelopmental approaches to improve proprioception input, orthosis, and electrical current stimulation. Free weights, resistance bands and manual resistance were used in the strength training. The active range of motion was evaluated using goniometry, and a baseline measurement was generated using a modified mallet scale. The treatment was given every day for six months. Post-intervention measures were implemented two, four, and six months following the intervention. SPSS 25.0 was used for data analysis. Results: The finding showed that pre-interventional oxford scale muscle strength for experimental group showed the mean and standard deviation (1.434± 0.5068), control group (1.65± 0.48) while Oxford scale muscle strength post intervention showed the results with the mean and standard deviation for the experimental group 3.13±  0.54 and control group 2.65± 0.48 and showed significant p value less than 0.005. Conclusions: The study concluded that physiotherapy integrated approach improved upper limb strength, ranges and functional abilities in patients with Erb’s Palsy.


Alekaki E, Lytras D, Iakovidis P, Kottaras A, Chatziprodromidou IP, Kopsidas C. The role of kinesiotherapy in treating the symptoms of obstetric palsy. 2021. doi.org/10.33545/orthor.2021.v5.i3b.301.

Basit H, Ali CDM, Madhani NB. Erb Palsy. 2022 Feb 27. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–.

Price A, Tidwell M, Grossman JA. Improving shoulder and elbow function in children with Erb's palsy. Semin Pediatr Neurol. 2000 Mar;7(1):44-51. doi: 10.1016/s1071-9091(00)80009-1.

Awad AS, Ali MS, Elassal MI. Correlation between age, muscle architecture, and muscle strength in children with Erb’s palsy. Bulletin of Faculty of Physical Therapy. 2021 Dec;26(1):1-9. doi.org/10.1186/s43161-021-00029-9.

Rahlin M, Cech D, Rheault W, Stoecker J. Use of music during physical therapy intervention for an infant with Erb's palsy: a single-subject design. Physiother Theory Pract. 2007 Mar-Apr;23(2):105-17. doi: 10.1080/09593980701211804.

Sedky Faheim S, El-Sayed Ali Hegazy A, Medany Helaly Mohamed N. Effect of Health Educational Guidelines on knowledge and practices of Mothers having Children with Bell's Palsy. Egyptian Journal of Health Care. 2021 Sep 1;12(3):1437-50. DOI: 10.21608/EJHC.2021.196350.

Ogwumike OO, Adeniyi AF, Badaru U, Onimisi JO. Profile of children with new-born brachial plexus palsy managed in a tertiary hospital in Ibadan, Nigeria. Niger J Physiol Sci. 2014 Jun 19;29(1):1-5.

Raducha JE, Cohen B, Blood T, Katarincic J. A Review of Brachial Plexus Birth Palsy: Injury and Rehabilitation. R I Med J (2013). 2017 Nov 1;100(11):17-21.

Samuel A, Rajput M, Gupta C, Kalra S. Indian Journal of Physiotherapy and Occupational Therapy.2013.

Massimino L, Mulrain E, Scheponik K, Wiley R, Ziai H. Rehabilitative Interventions to Improve Biomechanical or Functional Outcomes for Children with Obstetric Brachial Plexus Palsy.2013.

Loren Massimino OT, Erin Mulrain OT, Katherine Scheponik OT, Rachel Wiley OT, Houman Ziai OT, Benevides T. Rehabilitative Interventions to Improve Biomechanical or Functional Outcomes for Children with Obstetric Brachial Plexus Palsy: A Systematic Review.2013.

Okafor UA, Akinbo SR, Sokunbi OG, Okanlawon AO, Noronha CC. Comparison of electrical stimulation and conventional physiotherapy in functional rehabilitation in Erb's palsy. Nig Q J Hosp Med. 2008 Oct-Dec;18(4):202-5. doi: 10.4314/nqjhm.v18i4.45029.

Justice D, Awori J, Carlson S, Chang KW, Yang LJ. Use of neuromuscular electrical stimulation in the treatment of neonatal brachial plexus palsy: A literature review. The Open Journal of Occupational Therapy. 2018;6(3):10.

Frade F, Gómez-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.

Kasnakova P, Tornyova B, Ivanova S, Atanasov P, Dragusheva S, Petkova V. Analysis Of Applied Medical Rehabilitation In Cases Of Obstetric Brachial Plexus Lesion–Erb’s-Duchenne Palsy. 2018.

Dekkers KJ, Rameckers EA, Smeets RJ, Janssen-Potten YJ. Upper extremity strength measurement for children with cerebral palsy: a systematic review of available instruments. Phys Ther. 2014 May;94(5):609-22. doi: 10.2522/ptj.20130166.

Yarfi C, Elekusi C, Banson AN, Angmorterh SK, Kortei NK, Ofori EK. Prevalence and predisposing factors of brachial plexus birth palsy in a regional hospital in Ghana: a five year retrospective study. Pan Afr Med J. 2019 Apr 29;32:211. doi: 10.11604/pamj.2019.32.211.17914.

Mehta SH, Blackwell SC, Bujold E, Sokol RJ. What factors are associated with neonatal injury following shoulder dystocia? J Perinatol. 2006 Feb;26(2):85-8. doi: 10.1038/sj.jp.7211441.

Gherman RB, Ouzounian JG, Miller DA, Kwok L, Goodwin TM. Spontaneous vaginal delivery: a risk factor for Erb's palsy? Am J Obstet Gynecol. 1998 Mar;178(3):423-7. doi: 10.1016/s0002-9378(98)70413-2.

Srilakshmi D, Chaganti S. A holistic approach to the management of Erb's palsy. J Ayurveda Integr Med. 2013 Oct;4(4):237-40. doi: 10.4103/0975-9476.123713.

Ouzounian JG, Korst LM, Phelan JP. Permanent Erb palsy: a traction-related injury? Obstet Gynecol. 1997 Jan;89(1):139-41. doi: 10.1016/s0029-7844(96)00312-2.

Price A, Tidwell M, Grossman JA. Improving shoulder and elbow function in children with Erb's palsy. Semin Pediatr Neurol. 2000 Mar;7(1):44-51. doi: 10.1016/s1071-9091(00)80009-1.

Phipps GJ, Hoffer MM. Latissimus dorsi and teres major transfer to rotator cuff for Erb's palsy. J Shoulder Elbow Surg. 1995 Mar-Apr;4(2):124-9. doi: 10.1016/s1058-2746(05)80066-7.

Al-Qattan MM. Rotation osteotomy of the humerus for Erb's palsy in children with humeral head deformity. J Hand Surg Am. 2002 May;27(3):479-83. doi: 10.1053/jhsu.2002.33198.



DOI: 10.54393/pbmj.v5i5.462
Published: 2022-05-31

How to Cite

Anees, S., Ahmed Burq, H. S. I. ., Afzal, M. ., Asrar Yousaf, M., Amin, T. ., & Rizwan, M. (2022). Effects Of Physiotherapy on Strength, Range and Function in Children with Erb’s Palsy; An Experimental Study: Effects of Physiotherapy on Children with Erb’s Palsy . Pakistan BioMedical Journal, 5(5), 68–72. https://doi.org/10.54393/pbmj.v5i5.462



Original Article