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Infants with Obstetric Brachial Plexus Injury:

General Information for Healthcare Providers


Refer a child with a OBPI to a pediatric OT or PT who has had specific and recent training immediately (within first few days after delivery) so that parents can be educated and monitored in positioning, range of motion and precautions. The therapist’s primary role should be to do everything possible to protect the alignment of the shoulder joint while working on awareness/sensory input of the affected limb and trying to keep the infant as symmetric (throughout the body) throughout development.  Frequency of treatment sessions may vary throughout the first few months depending on recovery and how comfortable the parents and the therapist are with home program follow through.  Once movement begins to return, frequency may increase.  For infants who do not completely recover in the first month, a referral to a physician who specializes in the treatment of children with OBPI should be considered within the first 3-6 months depending on the severity of the injury.


Probable outcomes based on early return of movement:


Biggest residual deficits (even when a full nerve recovery exists) are:


In Erb’s Palsy (85% of OBPIs are classified as Erb’s Palsy), the muscles which are strong and mostly unopposed are what cause deformities and orthopedic damage.

(Teres Major, Pectoralis, Lattisimus Dorsi, Trapezius, Levator Scapula)


To minimize deformities and joint damage, we have to work to avoid activities that promote strong internal rotation during the first 12-24 months of a child’s life. Participating in therapy activities without providing appropriate shoulder alignment will likely cause further damage.


Motor Development Issues: Prone tummy time is important, but once babies begin to pull their arms inward to prone prop, they need to be taken out of full prone. Rolling and side lying should be over the unaffected side with caution to protect the affected limb. Getting in/out of sitting should be taught using the unaffected side. Crawling should not be a priority in these babies. They typically will be expected to achieve motor skills (including walking) later than usual. Emphasis on achieving typical developmental motor milestones should be lessened.