The role of botulinum toxin in the neuro-rehabilitation of young patients with brachial plexus birth palsy.

PURPOSE: To favour the active movements of the shoulder abductor/external rotator, elbow extensor and supinator muscles, through the partial inhibition of the uninvolved antagonistic muscles, in the Brachial Plexus birth Palsy (BPP).

METHODS

The type A Botulinum Neuro Toxin (BNT-Dysport, Ipsen) was injected in 50 outpatients (mean age: 4.7 +/- 3.4 years) with BPP according to the criteria: early and current neuro-rehabilitation (Reflex Locomotion-RL), age <14 years, no cognitive impairment. Repeat injections (1.9 +/- 0.8) were performed in 30 patients.

RESULTS

The range of active movements increased at the maximal benefit phase, compared to the baseline values (p < 0.05-0.01). The gain of shoulder's abduction was directly related to the youngest age (r = 0.6). An expanded compliance of the injected muscles and a faster response to the RL, in respect to that experienced in the pre-BNT sessions, was detected. The Global Clinical Rating Scale disclosed the temporal profile of the clinical outcome, with step-like increases of the function in 70% of the patients, and a 'plateau' trait in the remaining ones (+29.8 +/- 10.5%). The video-taped recordings showed an improvement in the global movements.

CONCLUSIONS

The employment of BNT in the management of young patients with BPP has beneficial effects in the integration of the bodily scheme.