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 degrees versus -3 degrees, p = 0.047). 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.

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