Evaluation of bone mineral density in children with perinatal brachial plexus palsy: Effectiveness of weight bearing and traditional exercises

Purpose1) To investigate any evidence of bone mineral density (BMD) changes in children with Perinatal Brachial Plexus Palsy (PBPP). 2) To detect any relationship between these changes and the child age, weight, height, BMI, power index, gender, ethnicity, and the side affected. 3) To determine any possible effects of a designed weight bearing exercise program and the traditional one upon BMD of those children.Study designRandomized single blind controlled trial.MethodA convenience sampling strategy was used to obtain 45 children with unilateral PBPP. Their ages ranged from 3 to 10 years. They were randomly divided to three equal groups. Groups were, then, randomly assigned to either interventions [Weight Bearing Exercises Program (WBEP) or Traditional Exercises Program (TEP)] or to the control treatment. Dual Energy X-Ray Absorptiometry (DXA) was used to evaluate BMD for all children at entry and approximately after six months treatment period.ResultsWe detected significant low entry level measurements of all BMD parameters of the affected side when compared to that of the unaffected sides (p = 0.000). The mean value of the entry level calculated Z score for the affected side of all study children was equal to − 1.12 ± 0.327 being in the osteopenic risk range. Furthermore, thirty children (66.7%) recorded less than (− 1) Z score being in this risky range. Also, we recorded a significant improvement of all BMD parameters of the affected side after treatment in favor of the WBEP group when compared to that of the control and TEP groups (p = 0.02, p = 0.03 respectively for the affected both bones BMD parameter).ConclusionsBMD is significantly reduced in PBPP children. The retardation of bone accrual increases as the child height and weight decreases and the degree of paralysis increases. WBEP significantly promoted BMD improvement when compared to the TEP.

Research highlights► There is no available data on bone density status in children with perinatal brachial plexus palsy (PBPP). ► Bone mineral density (BMD) is significantly low in PBPP children. ► The retardation of bone accrual increases as the child height and weight decreases and the degree of paralysis increases. ► Weight bearing exercises significantly promote BMD improvement.