Erb's palsy is a type of injury to the nerves in the neck and shoulder called the brachial plexus. When these nerves are damaged, the arm can become weakened or even paralyzed. Infants are most commonly affected, as the brachial plexus can be stretched as a baby is pulled through the birth canal during labor. Fortunately, most children are able to recover over time with a proper home exercise program designed to reduce stiffness of the arm and enhance sensation.
Range of Motion Exercises
Range of motion exercises are the cornerstone of rehabilitation for Erb's palsy. The goal of these exercises is to alleviate stiffness of the joint due to disuse so that when function is restored to the child's arm, he will be able to use it normally. These exercises involve moving the shoulder, elbow, wrist and finger joints through various ranges of motions, for example flexion, extension and abduction. Dr. Rahul Nath of the Nath Brachial Plexus Institute recommends you perform these exercises with your child every time you change his diaper. For each exercise, move the joint only to the point of slight resistance, never to the point of pain. Hold each exercise for 30 seconds and do 10 to 15 repetitions.
Functional Exercises
Functional exercises incorporate daily functional activities to encourage development of your child's arm. For example, if your child is an infant, you may place her on her back and hold a toy above her head. Urge her to use her weak arm to reach for the toy. Alternatively, you may place your child on her stomach and then place a toy in front of her. You can progress these activities as your child gets older or develops function of the arm.
Sensory Stimulation Exercises
Damage to the brachial plexus can also result in loss of sensation or feeling in your child's arm. Often, reduced sensation can cause a child to be less aware of his arm and thus neglect to use it. Sensory stimulation exercises can help with this problem as well as encourage your child to use his arm more often. Perform sensation exercises by rubbing objects with differing textures on your child's arm, such as a washcloth, a fleece blanket or a brush. To improve positional awareness of the arms in terms of the entire body, place your child's hand on different areas of the body, such as the mouth or the opposite hand.
Considerations
These exercises should be performed only under the direction of your child's physician or physical therapist. Recovery time varies from child to child; but in general, surgery to repair the nerve is indicated if the condition has not improved within six months. Dr. Nath says if there are no deficits in the shoulder, arm or hand by the age of 3 months, the expected recovery rate is 70 percent by 5 years of age. If deficits remain at age 3 months, the recovery rate drops to only 5 percent.
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