N.A. Yeboah1, N.A. Yeboah1, A. Acquah2, G. Nyante1
1University of Ghana, Physiotherapy, Accra, Ghana, 2University of Health and Allied Sciences, Physiotherapy, Accra, Ghana
Background: The incidence of Brachial Plexus Birth Palsy (BPBP) is on the rise globally especially in lower middle-income countries (LMICs) like Ghana where there is evidence of poor usage of health professionals for delivery despite the availability of free obstetric care. BPBP is known to cause lifelong disabilities in affected children. Despite the increase in BPBP and its associated disabilities in Ghana, there is limited evidence on the benefits of physiotherapy on functional recovery and decreasing residual disability in children with BPBP who are managed in Ghana.
Purpose: The aim of this study was to determine the level of residual disability in children with Brachial Plexus Birth Palsy (BPBP) who were managed conservatively at the physiotherapy department of the Korle Bu Teaching Hospital (KBTH) in Accra, Ghana.
Methods: The study was a cross-sectional study involving 60 children with BPBP who received treatment at the physiotherapy department of Korle-Bu Teaching Hospital between 2010-2015. The Naraka’s Classification system was used to classify the severity of the brachial plexus injury among participants. The Mallet Score and Paediatric Outcome Data Collection Instrument (PODCI) were administered to measure participants’ shoulder function and overall functional outcome respectively. Descriptive statistics were used to summarise obtained data. Spearman's rank-order correlation was used to determine the correlation between functional scores and demographic variables as well as clinical profile data of participants. Statistically significant values were set at p<0.05.
Results: The dominant brachial plexus classification was the Naraka’s II, (35.0% of participants) which presents with shoulder adduction, internal rotation, elbow extension, forearm pronation and wrist drop . BPBP was more common in the right limb (80% of participants). It also occurred more in female children (61.7%) compared to males (38.3%). The physiotherapy treatment period for participants ranged from 0 to 48 months with a mean therapy period of 12.64±11.96 months. Majority of the participants (81.7%) had been voluntarily discharged by their mothers from physiotherapy against medical advice. The most prominent disabilities from BPBP were lack of the ability to move the hand to spine, limited abduction as well as reduced external rotation and hand to mouth movements which were reported in 55%, 50%, 45% and 43% of participants respectively. There was a significant negative correlation between the length of time a child had undergone physiotherapy and the overall functional outcome scores (r=-0.421, p=0.002).
Conclusion(s): Residual disabilities were identified in children with BPBP who were managed conservatively with physiotherapy. Functional outcome of children with BPBP however, was negatively correlated with duration of physiotherapy. The possible reasons that accounted for this unusual finding needs to be explored further.
Implications: This study provides preliminary data on residual disability in children with BPBP. The study findings however indicate a possible gap in patient’s compliance to therapy that may have contributed to residual disabilities identified. This calls for implementation of stringent measures to improve patients’ adherence to physiotherapy interventions.
Funding, acknowledgements: None
Keywords: Brachial Plexus Birth Palsy, Residual disability, Physiotherapy
Topic: Paediatrics
Did this work require ethics approval? Yes
Institution: School of Biomedical and Allied Health Sciences
Committee: Ethics and Protocol Review Committee
Ethics number: SBAHS-PT./10561665/SA/2018-2019
All authors, affiliations and abstracts have been published as submitted.
