I have a patient with a damaged Brachial Plexus, leaving his entire left arm flaccid. I would like to explore the possibility of using e-stim to at least assist in pulling the humorous back up into the shoulder girdle.

 Do you know of a clinic or center that specializes in the use of e-stim for parallelized extremities?

I don't know of anyone who specializes in that, but have used E-stim for that purpose many times. It takes about two weeks to see if it will work. Once you determine it is working use it to your best outcome. Results tend to last 2-4weeks and beyond. I say beyound because usually the patient has been discharged before the effect wore off, so I do not have a clear outcome to give you , but it works! I like to enhance this with biofeedback. My idea is to provide feed in and feed out from the area I am enhancing.

I have used estim to reduce subluxed shoulders due to hemiparesis from CVA with very good results. You would want to stim the rotator cuff muscles, I believe we did the supraspinatus/teres minor and anterior deltoid/infraspinatus 2-3x week for 4 weeks. If the patient had active movement, I followed up with isometric ex to shoulder in hyperextension, external rotation, internal rotation, and abduction. Good luck

First you need to determine where the damage is. If there is nerve root damage e-stim will not be successfull and adaptation, teaching self prom and positioning/protection should be your goal.  Has a nerve study been done?  Knowing the results will help guide your plan of care.

It's humerus, not humorous (especially for the patient).

It's paralyzed, not parallelized (although the arms can be parallel to each other at times).

 

Hi,

Get the neurologists involved and ask what kind of damage there is. Think about it, if the brachial plexus is completely severed, e-stim is worthless. The impulse only travels to where the injury is. You can get a temporay muscle contraction...but nothing lasting. If this is the case, make ororder a subluxation sling or use the taping method to prevent subluxation/ prolonged stretching of those muscles. The subluxation sling provides more support but most of them are rather complicated to donn and pt's/ caregivers use them only temporarily. Make sure they understand how important this is, so they are compliant.

The reason why e-stim is sometimes effective in CVA patients is that the neurological pathway is still intact and what you are hoping for is to send messages one way to provoke a message to be sent the opposite way.

In a brachial plexus injury, if the injury is incomplete you need to wait it out. Nerve regeneration is very slow. You may have total recovery or partial recovery or no recovery depending upon how much damage is done.

If the damge is permanent (per neuro) spend your time on educating him on injury prevention (due to lack of sensation) and don't forget your psychosocial aspects of this condition. Especially if this is a man. Men are raised to be strong/ invincible in our society and a permanent flaccid limb very "manly". There will be a lot of emotional stuff that needs to be addressed, if he is not already on one, you may want to recommend a anti-depressant.

Hope this helps, let me know if I can elaborate on anything.

---

Tracey Palmer

Scary that the next generation of therapists may be illiterate --