Better results in terms of external arm rotation were obtained when spinal accessory-to-suprascapular nerve transfer was performed using the posterior approach.
Background
Traumatic upper plexus injury affects daily living activities performance and participation of individuals. Physical therapy treatment has a fundamental role on functional recovery, but it is still an unexplored and challenging field.
Aim
To develop a protocol to evaluate the efficacy of Proprioceptive Neuromuscular Facilitation (PNF) compared to conventional physiotherapy (CPT group) on functionality and quality of life.
Methods
A committee was formed by four physical therapists to develop the treatment protocol. A Delphi study was carried out in order to quantify the level of agreement. A protocol for a randomized controlled trial was proposed to evaluate the effectiveness of the protocol in improving functionality and quality of life, according Consolidated Standards of Reporting Trials. Participants will be randomly assigned (1:1) to PNF or CPT group and two weekly sessions will be carried out for 12 months postsurgery, with a three‐month follow‐up. The main outcome measurements are: upper limb functionality, quality of life, range of motion, muscle strength, tactile sensitivity, and pain, which will be assessed at baseline, on the 6th, 9th, and 12th months postsurgery.
Result
A PNF protocol was developed for traumatic upper brachial plexus injury, consisting of 11 illustrated exercises, three for immediate postoperative and eight for postoperative. Biomechanical objectives, observations, positions of patients and therapists and PNF principles, procedures and techniques have been described. An 80% agreement on all items in the first round of the Delphi study was achieved.
Conclusion
A protocol based on the PNF‐concept was developed with the aim of improving the functionality and quality of life of individuals undergoing nerve transfer after traumatic injury to the upper plexus. The detailed description of a physical therapy treatment protocol through an appropriate method will allow its use in clinical practice and in future studies with this population.
Background:
Distal nerve transfers are an innovative modality for the treatment of C8-T1 brachial plexus lesions. The purpose of this case series is to report the authors’ results with hand restoration function by nerve transfer in patients with lower brachial plexus injury.
Methods:
Three consecutive nerve transfers were performed in a series of 11 patients to restore hand function after injury to the lower brachial plexus: brachialis motor branch to anterior interosseous nerve (AIN) and supinator branch to the posterior interosseous nerve (PIN) in a first surgical procedure, and AIN to pronator quadratus branch of ulnar nerve between 4 and 6 months later.
Results:
In all, 11 male patients underwent 33 surgical procedures. Time between brachial plexus injury and surgery was a mean of 11 months (range 4–13 months). Postoperative follow-up ranged from 12 to 24 months. We observed recovery of M3 or better finger flexion strength (AIN) and wrist extension (PIN) in 8 of the 11 surgically treated upper limbs. These patients recovered full thumb and finger extension between 6 and 12 months of surgery, without significant loss of donor function.
Conclusion:
Nerve transfers represent a way of restoring volitional control of upper extremity function in patients with C8-T1 brachial plexus injury.
Purpose: To assess the quality of evidence for the efficacy of manual therapy in improving hand function in relation to surgical decompression in women with CTS. Methodology: Seven electronic databases were searched to identify randomized controlled trials that compared the efficacy of exclusive manual therapies and surgical decompression in improving hand function in women with carpal tunnel syndrome. Quality assessment was conducted using the Cochrane risk of bias tool. The study was registered in PROSPERO under number CRD42018084250. Results: Two trials were identified and included in the review. The results of critical appraisal of quality was low risk of bias. Conclusion: Evidence suggest that manual therapy may have similarly effective in relation to surgery decompression in improving hand function in women with carpal tunnel syndrome. Future trials must assess the efficacy of manual therapies in different numbers of session looking for better results.
Traumatic brachial plexus injury (BPI) is one of the most disabling injuries of the upper extremity, often requiring specialized treatment and a prolonged rehabilitation period. This scoping review was carried out to identify and describe the physical therapy modalities applied in the rehabilitation of adult individuals with BPI. Electronic databases, gray literature, and reference lists were searched, and studies meeting the following eligibility criteria were included: (a) interventions including any physical therapy modality; (b) individuals age ≥18 years old; and (c) a clinical diagnosis of BPI. The literature search yielded 681 articles of which 49 met the inclusion criteria and had their outcomes, treatment parameters, and the differences between conservative and pre‐ and postoperative treatment phases analyzed. The most commonly used physical therapy interventions were in the subfields of kinesiotherapy (ie, involving range of motion exercises, muscle stretching, and strengthening), electrothermal and phototherapy, manual therapy, and sensory re‐education strategies. Although several physical therapy modalities were identified for the treatment of BPI in this scoping review, the combination of low levels of evidence and the identified gaps regarding the treatment parameters challenge the reproducibility of such treatments in clinical practice. Therefore, future controlled clinical trials with clearer treatment protocols for individuals with BPI are needed.
Introdução: Embora existam evidências de que as transferências de nervos intercostais (TIM) ou frênico (TFM) para o musculocutâneo, após lesões traumáticas de plexo braquial (LTPB), possam promover declínios da função pulmonar, não há um consenso sobre qual das técnicas é mais eficaz para a recuperação funcional biciptal promovendo menores danos à função pulmonar. Objetivo: Comparar a função pulmonar de pacientes submetidos à TIM ou TFM após LTPB. Metodologia: As buscas foram realizadas nas bases de dados MEDLINE/PubMed, LILACS, CINAHL, Scopus, Scielo, The Cochrane Librabry, Web of Science e Banco de Teses e Dissertações. Palavras-chave utilizadas foram plexo braquial, transferência de nervo, nervo frênico, nervos intercostais, função pulmonar e espirometria. Foram incluídos estudos observacionais que apresentassem dados de função pulmonar, dispneia, amplitude de movimento e força muscular para flexão de cotovelo em indivíduos com LTPB. A qualidade metodológica dos estudos foi analisada por meio da Newcastle-Ottawa Scale. Resultados: Foram identificados 14.104 estudos, dos quais sete foram incluídos nesta revisão. Dois estudos apresentaram resultados favoráveis à TIM no tocante à função pulmonar e seis estudos apresentaram indícios de melhor recuperação funcional biciptal por meio desta técnica. Os artigos apresentaram qualidade metodológica moderada. Conclusão: Embora a TIM apresente indícios de ser menos danosa para a função pulmonar e mais eficaz para a recuperação da força muscular do bíceps braquial em relação à TFM, necessita-se de estudos com melhor qualidade metodológica e que leve em consideração a experiência e escolha do cirurgião.
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