Occupational therapy role in erb's palsy

Dr S Sivapriya *

Erb’s palsy, a brachial plexus injury often occurring during childbirth, throws a curveball at families, leaving them grappling with questions and concerns. This condition, named after the physician Wilhelm Erb, disrupts nerve signals to the arm, leading to weakness, paralysis, and sensory loss.

While the diagnosis can be overwhelming, understanding the causes, symptoms, and treatment options empowers individuals and their loved ones to navigate this journey effectively.

Causes: Difficult childbirth scenarios can put undue stress on the brachial plexus, leading to Erb’s palsy.

These scenarios can include:

1. Cephalopelvic disproportion: When the baby’s head is too large for the mother’s pelvis, creating a tight fit during delivery.
2. Forceps or vacuum extraction: When instruments are used to assist delivery, sometimes unintentionally stretching the nerves.
3. Breech delivery: When the baby is born feet first, increasing the risk of neck hyperextension and nerve damage.
4. Forceful arm pulling: During delivery maneuvers, excessive pulling on the baby’s arm can stretch the nerves beyond their limits.

Recognizing the Signs
Symptoms of Erb’s palsy usually become apparent soon after birth and may include:

1. The characteristic “waiter’s tip” posture: The affected arm hangs limply at the side with the wrist rotated inward, resembling a waiter holding a tray.
2. Diminished grip strength: The weakened muscles make it difficult to grasp objects, hindering simple tasks like holding toys or utensils.
3. Restricted arm movement: Raising the arm above the shoulder or bending the elbow becomes challenging due to limited muscle control.
4. Numbness in the arm: Loss of sensation in the affected area can be another telltale sign.
5. Partial or complete paralysis: The severity of the injury determines the degree of muscle weakness or paralysis.

Diagnosis and Treatment:

Diagnosing Erb’s palsy involves a combination of approaches:

1. Physical examination: A doctor assesses muscle tone, movement, and reflexes to identify the affected area.
2. Imaging tests: X-rays or MRIs may be used to rule out bone fractures or nerve root avulsions.
3. Nerve conduction studies: These tests measure electrical signals in the nerves, providing insights into nerve function and the extent of damage.

Treatment aims to improve muscle function and prevent long-term complications. Depending on the severity, a multi-pronged approach may be recommended:

1. Occupational therapy: A cornerstone of treatment, it focuses on regaining range of motion, strength, and functional skills through targeted exercises, splinting, and the use of adaptive equipment.

Occupational therapy role in Erb’spalsy

Occupational therapy (OT) plays a crucial role in managing Erb’s palsy, a condition affecting the arm and hand due to nerve damage. Here’s how OT helps

o Maintaining and improving range of motion: OT exercises focus on preventing joint stiffness (contractures) and promoting flexibility in the shoulder, elbow, wrist, and hand.
o Enhancing muscle strength and function: Specific exercises aim to strengthen weakened muscles and improve overall arm function.
o Promoting sensory awareness and motor skills: OT works on improving your child’s ability to feel and use their affected arm in daily activities.
o Addressing functional limitations: OT helps children find strategies and adaptations to perform daily tasks like dressing, eating, and playing despite their limitations.
o Supporting psychological well-being: OT can address emotional and social challenges associated with having Erb’s palsy.

Specific OT interventions:

o Constraint-induced movement therapy (CIMT): Encourages use of the affected arm by limiting the use of the unaffected arm.
o Splinting and orthotics: Support proper positioning and prevent contractures.
o Sensory stimulation: Activities like massage and brushing help improve awareness of the affected limb.
o Adaptive equipment: Tools like modified utensils or writing aids can facilitate daily tasks.
o Education and training: OT guides parents and caregivers on how to support their child’s therapy at home.

2. Physical therapy: Through specialized exercises, physical therapists work to improve muscle strength and movement patterns, promoting overall function.

3. Surgery:

In severe cases, surgery may be considered to repair damaged nerves, transfer healthy nerves to improve function, or address the contractures.