Traumatic brachial plexus injury rehabilitation using neuromuscular electrical muscle stimulation in a polytrauma patient

Abstract

We report a 28-year-old man admitted postmotorcycle versus car in September 2017. The patient sustained multiple injuries in both the upper and lower limbs. He sustained a complex brachial plexus injury on his left side and was transferred immediately to Stanmore Hospital to undergo specialist surgery (supraclavicular brachial plexus exploration and neurolysis) to repair his brachial plexus injury. The patient was transferred back to the specialist trauma ward for additional surgeries for his subsequent injuries. Due to the complexity of the injury and surgery the patient was not able to start rehabilitation until six weeks post operation, at which point he was referred to outpatient physiotherapy. Prior to this his left upper limb was in a sling but was instructed to move it as able. The patient commenced his comprehensive physiotherapy programme in January 2018.

Clinical, Electrodiagnostic Findings and Quality of Life of Dogs and Cats with Brachial Plexus Injury

“…Physiotherapy plays an important role in the rehabilitation process to enhance the chances of recovery avoiding contractures and maintaining the limb mobility [ 13 , 14 , 15 , 16 , 17 , 18 ]. To the author’s knowledge, there are no studies addressing the long-term outcome of dogs and cats with traumatic BPI undergoing physiotherapy.…”

“…The QoL questionnaire to the owners was aimed to investigate the presence of discomfort in animals as a possible sign of neuropathic pain consequent to BPI. In humans with BPI, neuropathic pain is reported from 30% to 80% of patients [ 8 , 16 , 17 , 18 , 19 ]. In these patients, the presence of neuropathic pain has the greatest negative impact on their quality of life and seems to be highly refractory to treatments [ 7 , 20 , 21 , 22 , 23 , 24 , 25 ].…”

Brachial Plexus Injury: Recent Diagnosis and Management

“…A passive range of movements can be used to maintain joint mobility and muscle strength in the arms. Electrical stimulation and therapeutic massage can also be done for edema and scar management [1], [2], [41], [60].…”

“…The results of the intervention varied depending on several parameters [8], [9], [40], [41], [43], [44], [60], [67]:…”

The Role of Functional Electrical Stimulation in Brachial Plexus Injury Repair

“…Although the progress of peripheral nerve surgery has significantly improved the treatment effect of BPI, scar will be produced at the nerve repair site, which will inevitably distort the contour of nerve pulse reaching the sensory and motor cortex, and eventually make the injured peripheral nerve unable to regenerate effectively. Some regenerated axons will not be able to reach the receptors affected by the scar interface, and other relatively normal axons will also be misled, so that they can only re-dominate the wrong scar sensory receptors or irreversibly degenerate receptors, which will lead to impaired sensory function of shoulder joint and upper limb with loss of muscle strength [1]. Therefore, it is particularly important to find an effective method to improve the dysfunction after BPI.…”