Neuromuscular Electrical Stimulation for Infants with Neonatal Brachial Plexus Palsy: A Pilot Study

Background: Biceps recovery is a critical determinant for treatment decision-making in patients with neonatal brachial plexus palsy (NBPP). One treatment intervention used by therapists is neuromuscular electrical stimulation (NMES), but its use remains controversial. This study’s aim was to determine the effect and safety of NMES on biceps function in infants with NBPP compared to standard therapy. Methods: In this pilot, randomized controlled study, patients were randomized to the NMES treatment or control/sham group. Inclusion criteria were infants 3 to 9 months of age with a confirmed diagnosis of NBPP and biceps weakness, without other comorbidities. The parents administered the NMES (treatment or control) 30 min daily. Outcomes of active range of motion (AROM), muscle strength, and morphometric measurements were assessed by one of two blinded therapists at enrollment and 1-, 2-, and 3-month follow-up intervals. Results: Seventeen patients (10 NMES, seven control) participated in the study. Despite equal group demographics, the treatment group demonstrated significant improvement in elbow flexion AROM after the first month of NMES compared to the control group (improvement 31° vs. -3°, P = .047). No adverse effects were reported. Conclusion: Use of NMES can be beneficial and should be considered in the early rehabilitation protocol for infants with NBPP

Use of Neuromuscular Electrical Stimulation in the Treatment of Neonatal Brachial Plexus Palsy: A Literature Review

Background: The purpose of this study was to conduct a review of current literature on the effectiveness of neuromuscular electrical stimulation (NMES) for restoring motion and function in neonatal brachial plexus palsy (NBPP). Method: A database search was conducted for NMES articles published between 1947 and 2015. Pre and posttreatment data were extracted for muscle power, active range of motion (AROM), and morphometric measurements. Results: An initial search yielded 2,721 articles. A further title/abstract review produced 27 articles; of these, four met the inclusion criteria. Treatment protocols varied. There were no changes in average Medical Research Council (MRC) scores following treatment for elbow flexion, shoulder abduction, or wrist extension. Shoulder flexion increased from MRC 1 to 4. AROM improved following treatment. Conclusions: Evidence for improved muscle strength after NMES is mixed. Improvement in AROM is more consistent. Due to variations in treatment modalities, patient profiles, and adjunct treatment, a clinical trial to isolate the effects of NMES in NBPP is required. Since improved motion and function has been reported, NMES in NBPP therapy remains reasonable

Home Exercise DVD Promotes Exercise Accuracy by Caregivers of Children and Adolescents With Brachial Plexus Palsy

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147221/1/pmr2924.pd

An Assessment of the Compliance and Utility of a Home Exercise DVD for Caregivers of Children and Adolescents With Brachial Plexus Palsy: A Pilot Study

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146875/1/pmr2190.pd

School Counseling Site Supervision: Training Recommendations to Benefit School Counselor Interns and Site Supervisors

The importance of supervision is supported in the research literature. Site supervision in school counseling does not require formal training. The absence of formal training has potential implications for the novice school counselor, the P-12 students they serve, and future school counseling supervisees. The authors compare current training models and explore best practices to improve site supervision for school counseling interns. accreditation, ethics, and current needs in school counseling for the school counselor intern and the site supervisor. Finally, the authors review supervision training and models, accreditation, ethics, and current needs for the school counselor intern and the site supervisor, including a recommendation for a school supervisory endorsement

Prevalence of Posterior Shoulder Subluxation in Children With Neonatal Brachial Plexus Palsy After Early Full Passive Range of Motion Exercises

BackgroundChildren with neonatal brachial plexus palsy (NBPP) are often prescribed shoulder range of motion (ROM) exercises; however, the extent and timing of exercise implementation remains controversial in the context of shoulder joint integrity. The association of ROM exercises to delayed posterior shoulder subluxation (PSS) is unknown.ObjectiveTo determine prevalence of PSS in children with NBPP who began full passive ROM exercises before 6 months of age, and characteristics associated with development or absence of PSS in children.DesignCrossâ sectional study.SettingTertiary care NBPP referral center.ParticipantsFortyâ six children with NBPP, aged 24â 57 months, who began full ROM exercises before 6 months of age.MethodsOne radiologist conducted bilateral shoulder ultrasound (US) on each child to evaluate for PSS. One occupational therapist evaluated each child clinically for PSS using defined parameters without knowledge of US results.Main Outcome MeasuresBy US, 20% of children had PSS; 46% had PSS by clinical examination. Shoulder active ROM limitations and history of shoulder surgery were associated with presence of PSS. Extent of NBPP was not associated with PSS.ResultsNine of 46 children (20%) met US criteria for PSS; α angle was 58° ± 21° (mean ± standard deviation [SD]). Twentyâ one children (46%) met clinical criteria. Mean age at examination was 35 ± 10 months. Shoulder active ROM (P â ¤ .004) was associated with PSS, whereas passive ROM was not (P â ¥ .08). History of secondary shoulder surgery and primary nerve graft repair were associated with PSS (P = .04). Extent of NBPP by Narakas classification was not associated with PSS (P = .48).ConclusionsEarly use of fullâ arc passive ROM home exercise program is not associated with increased prevalence of PSS in children with NBPP compared to prevalence of PSS in published literature. We suggest careful clinical examination, based on defined criteria, provides a reasonable screening examination for evaluating PSS that can be confirmed by noninvasive US.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147125/1/pmr21235.pd

Use of Neuromuscular Electrical Stimulation in the Treatment of Neonatal Brachial Plexus Palsy: A Literature Review

Background: The purpose of this study was to conduct a review of current literature on the effectiveness of neuromuscular electrical stimulation (NMES) for restoring motion and function in neonatal brachial plexus palsy (NBPP). Method: A database search was conducted for NMES articles published between 1947 and 2015. Pre and post-treatment data were extracted for muscle power, active range of motion (AROM), and morphometric measurements. Results: An initial search yielded 2,721 articles. A further title/abstract review produced 27 articles; of these, four met the inclusion criteria. Treatment protocols varied. There were no changes in average Medical Research Council (MRC) scores following treatment for elbow flexion, shoulder abduction, or wrist extension. Shoulder flexion increased from MRC 1 to 4. AROM improved following treatment. Conclusions: Evidence for improved muscle strength after NMES is mixed. Improvement in AROM is more consistent. Due to variations in treatment modalities, patient profiles, and adjunct treatment, a clinical trial to isolate the effects of NMES in NBPP is required. Since improved motion and function has been reported, NMES in NBPP therapy remains reasonable

Erratum: Author Correction: Identification of genes required for eye development by high-throughput screening of mouse knockouts.

[This corrects the article DOI: 10.1038/s42003-018-0226-0.]

Alcohol Use and Sustained Virologic Response to Hepatitis C Virus Direct-Acting Antiviral Therapy.

IMPORTANCE: Some payers and clinicians require alcohol abstinence to receive direct-acting antiviral (DAA) therapy for chronic hepatitis C virus (HCV) infection. OBJECTIVE: To evaluate whether alcohol use at DAA treatment initiation is associated with decreased likelihood of sustained virologic response (SVR). DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used electronic health records from the US Department of Veterans Affairs (VA), the largest integrated national health care system that provides unrestricted access to HCV treatment. Participants included all patients born between 1945 and 1965 who were dispensed DAA therapy between January 1, 2014, and June 30, 2018. Data analysis was completed in November 2020 with updated sensitivity analyses performed in 2023. EXPOSURE: Alcohol use categories were generated using responses to the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire and International Classification of Diseases, Ninth Revision and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnoses for alcohol use disorder (AUD): abstinent without history of AUD, abstinent with history of AUD, lower-risk consumption, moderate-risk consumption, and high-risk consumption or AUD. MAIN OUTCOMES AND MEASURES: The primary outcome was SVR, which was defined as undetectable HCV RNA for 12 weeks or longer after completion of DAA therapy. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% CIs of SVR associated with alcohol category. RESULTS: Among 69 229 patients who initiated DAA therapy (mean [SD] age, 62.6 [4.5] years; 67 150 men [97.0%]; 34 655 non-Hispanic White individuals [50.1%]; 28 094 non-Hispanic Black individuals [40.6%]; 58 477 individuals [84.5%] with HCV genotype 1), 65 355 (94.4%) achieved SVR. A total of 32 290 individuals (46.6%) were abstinent without AUD, 9192 (13.3%) were abstinent with AUD, 13 415 (19.4%) had lower-risk consumption, 3117 (4.5%) had moderate-risk consumption, and 11 215 (16.2%) had high-risk consumption or AUD. After adjustment for potential confounding variables, there was no difference in SVR across alcohol use categories, even for patients with high-risk consumption or AUD (OR, 0.95; 95% CI, 0.85-1.07). There was no evidence of interaction by stage of hepatic fibrosis measured by fibrosis-4 score (P for interaction = .30). CONCLUSIONS AND RELEVANCE: In this cohort study, alcohol use and AUD were not associated with lower odds of SVR. Restricting access to DAA therapy according to alcohol use creates an unnecessary barrier to patients and challenges HCV elimination goals