The researchers’ aim for this study evaluate the accuracy of home exercise performance by caregivers of children with neonatal brachial plexus palsy (NBPP) who use digital versatile disc (DVD) guidance. They conducted this prospective cohort study at the Brachial Plexus Clinic at the University of Michigan. The study consisted of 77 adult caregivers of a consecutive cohort of pediatric patients with NBPP. The participants received the Home Exercise Program for Brachial Plexus Palsy DVD and an initial demonstration of proper hand placement and movement patterns by 1 of 2 occupational therapists. At times A, B, and C (approximately 3, 6, and 12 months), caregiver accuracy in exercise performance at each joint and standard measurements of arm function were recorded. Caregiver accuracy in correct hand placement and movement pattern during exercise performance was evaluated with use of a dichotomy scale (yes/no) at each joint. Active and passive range of motion were assessed as indicators of arm function. The mean patient age was 38 months, and the median Narakas score was 2. No significant difference in exercise accuracy for all upper extremity joints between the initial evaluation and times A, B, and C or between individual times was observed, except at the shoulder (98.9% initially to 88.3% at time A; P = .0002) and elbow (100% initially to 96.6% at time A; P = .04). As for arm function, they observed an increase in active range of motion for shoulder flexion, elbow flexion, forearm supination, wrist extension, and finger flexion during the study period.
Their study concluded that shoulder and elbow exercises could be more complicated and require more frequent performance review with the caregiver. However, the home exercise DVD may benefit patients with NBPP and their caregivers and could offer an adjunct to formal therapy sessions.