Effectiveness of Rehabilitation Interventions in Children with Brachial Plexus Birth Injury: A Systematic Review

Abstract

Background: Erb’s palsy commonly refers to an upper-trunk brachial plexus birth injury affecting shoulder and elbow movement. Rehabilitation may include caregiver-guided range-of-motion activities, positioning, task-oriented training, splinting, constraint-induced movement therapy, neuromuscular electrical stimulation and therapy after nerve reconstruction. The evidence is diverse and often difficult to compare.
Objective: To synthesize available evidence on physiotherapy and closely related rehabilitation interventions for infants and children with Erb’s palsy or brachial plexus birth injury, focusing on upper-limb motor function, range of motion, strength, activity, participation and longer-term outcomes.
Methods: This draft developed by cross-checking indexed reviews and primary-study information available through 13 October 2026, including PubMed records and open-access publisher pages. It uses a PRISMA-informed structure and proposes reproducible searches for MEDLINE/PubMed, Embase, Scopus, CENTRAL, CINAHL and PEDro. It is not presented as a completed de novo systematic review: database exports, duplicate removal, independent screening and full-text extraction have not been completed for this manuscript.
Results: A 2023 systematic review of randomized trials included seven studies after screening 932 titles and abstracts and reported low-certainty evidence across heterogeneous interventions and outcomes. A 2024 scoping review of rehabilitation following primary nerve surgery included 36 full-text articles and found that postoperative protocols and their stated aims varied. A 2024 systematic review and meta-analysis examined occupational-therapy interventions, while a 2025 review of long-term outcomes synthesized 19 studies. A 2026 systematic review of neuromuscular electrical stimulation reported low-to-very-low certainty and substantial heterogeneity. These findings support the clinical relevance of rehabilitation but do not establish one universally superior protocol.
Conclusion: Rehabilitation for Erb’s palsy should be individualized according to lesion severity, age, spontaneous recovery, surgery status and functional goals. The key research need is rigorous, transparent comparison of clearly described interventions using standardized measures and meaningful follow-up. No new pooled effect estimates or PRISMA study count is claimed in this draft.