[Neurorehabilitation in children with thoracic outlet syndrom and its assessment]. / Postepowanie neurorehabilitacyjne u dzieci z zespolem górnego otworu klatki piersiowej i ocena jego wyników.

OBJECTIVES: Thoracic outlet syndrome (TOS), a rare clinical condition develops as a consequence of compression of the brachial plexus and/or subclavian vessels in the thoracic outlet area. THE AIM: The aim of this research was the clinical and electrophysiological evaluation of results of therapeutic rehabilitation in female patients diagnosed with TOS. MATERIAL AND METHODS: 3 girls diagnosed in the Department of Pediatric Neurology and Neurophysiology Laboratory and treated in the Neurorehabilitation Division at the University Children's Hospital were evaluated. The TOS diagnosis was established in children aged 12-14 years with the use of doppler examination of subclavian vessels. Two girls underwent conservative management and in the third case surgical decompression and subsequent neurorehabilitation was provided. The methods of conservative management were addressed to relaxation of scalenic muscles, flexibility of cervical and thoracic vertebral column, stretching of pectoral smaller muscles, relaxation and relief of cervical vertebral column, and postural correction of shoulder girdle. The treatment plan assumed improvement of balance of muscle tone, postural correction and diaphragmatic mode of breathing. The first evaluation was conducted before rehabilitation, the control evaluation after 12 months of treatment using Lowet test, load tests, Doppler examination of subclavian vessels and electrophysiological tests (ENG, EMG and SEP) as well. RESULTS: Rehabilitation treatment increased the muscle strength, without significant proficiency improvement of patient upper extremities. The control electroneurography, electromyography and Doppler examinations did not reveal improvement after a conservative management. However, the surgical decompression led to deliberation of subclavian artery, stopped progress of muscle atrophy and normalization of SEP latencies as well. CONCLUSIONS: A 12-months of comprehensive rehabilitation treatment of children with TOS improved significantly a muscle mass and strength. Significant improvement of range of motions, however neurophysiological improvement was not observed. The surgical decompression combined with neurorehabilitation in 1 child caused normalization of somatosensory potentials.