Q: Doctor, please guide me about Erb’s Palsy. My daughter is 5 months old.
A: A thorough history and physical examination with a focus on neurologic examination is used to confirm diagnosis. Erb's palsy or Erb–Duchenne palsy is a form of obstetric brachial plexus palsy. It occurs when there's an injury to the brachial plexus, specifically the upper brachial plexus at birth. The injury can either stretch, rupture, or avulse the roots of the plexus from the spinal cord. It is the most common birth-related brachial plexus injury (50- 60%). This may happen during delivery of the head, the head may be deviated away from the axial plane. There can also be compression of the brachial plexus causing it to stretch and tear. Sometimes, pulling on the infant's shoulder during delivery or excessive pressure on the baby's raised arm during a breech delivery can cause brachial plexus injury. The classical sign of Erb's palsy is called Waiter's tip deformity. Some brachial plexus injuries may heal without treatment. Many children who are injured during birth improve or recover by 3 to 4 months of age, although it may take up to two years to recover. Fortunately, between 80% to 90% of children with such injuries will attain normal or near-normal function. Treatment for brachial plexus injuries includes physiotherapy and, in some cases, surgery. During the first 6 months treatment is directed specifically at prevention of fixed deformities. Exercise therapy is administered daily to maintain ROM and improve muscle strength. Parents are taught to take an active role in maintaining ROM and keeping the functioning muscles fit. Exercises include bimanual or bilateral motor planning activities.

Initial treatment in the first 1-2 weeks after birth will consist of: Careful handling is required and extremes of motion are to be avoided for the first 1 to 2 weeks to allow for the initial inflammatory response to the injury to calm. Avoid picking a child up by the arm. or from under the armpit. This can compress or stretch the brachial plexus and cause further injury. Placing a child on their back or side-lying, with the affected limb up, to avoid compression of the injured limb. Place the affected arm into the sleeves before the unaffected arm. This will help avoid extreme movement at the shoulder and will help make dressing quicker and easier. Activities and exercises to promote recovery of movement and muscle strength Exercises to maintain range of movement in the joints to prevent stiffness and pain Sensory stimulation to promote increased awareness of the arm. Provision of splints to prevent secondary complications and maximize function. Educating parents on appropriate handling and positioning of the child and home exercises to maximize the child’s potential for recovery Constraint-induced movement therapy may be useful.

Q: What is foot drop and its physical therapy treatment?
A: Foot drop also known as drop foot is not a disease, but rather a commonly encountered symptom of a neurological, anatomical, or muscular problem. Foot drop is the inability to lift the forefoot due to the weakness of the dorsiflexors of the foot. The peroneal nerve is involved. The condition can lead to steppage gait. Foot drop can therefore hinder walking and increase the risk of tripping and falling.
It can occur due to a compression, trauma, or neurological disorder. A physical therapist assesses the foot, ankle, and gait of the patient. One way to improve function while the foot drop resolves is the use of splinting. Physiotherapy interventions normally are focused on graded exercises to encourage active dorsiflexion and muscle recruitment. These exercises have been shown to prevent atrophy and speed up recovery. Preventing contractures and stiffness is also an important maintenance goal of physiotherapy as this is more likely in neurological disease patients than after trauma to the knee. Electro-stimulation of the affected muscle groups has also been shown to improve recovery times.