Журнал новых физиотерапевтических методов

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Perspective: Early Sensorimotor Intervention in Neonatal Brachial Plexus Injury to Mitigate Developmental Apraxia

Eileen Graessle

This perspective article expands on the home program described with use of a crawling orthosis to strengthen a neurologically impaired arm, including Neonatal Brachial Plexus Injury (NBPI), and provides support for an intent focus on providing sensory input to promote sensorimotor mapping of the arm to increase motor output. Research with animals demonstrates impaired motor control of a forelimb with early sensory deprivation postnatally, even with reversal of the impairment, leading one to conclude the lack of development of early motor patterns including the limb impairs future motor control of the limb. This phenomenon has also been found in children post NBPI, demonstrating an inability to recruit motor units available in the affected arm, termed developmental apraxia. The implications support a proposal that a therapeutic program heavy in sensory input post NBPI has the potential to increase motor control of the affected arm by taking advantage of the nervous system plasticity and the developmental window for establishing motor planning, through detailed sensory mapping of the arm during this critical period.