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Le Roy L, van Bladel A, De Mits S, Vanden Bossche L, Van der Looven R. Three-Dimensional Upper Limb Movement Analysis in Children and Adolescents With Brachial Plexus Birth Injury: A Systematic Review. Pediatr Neurol 2024; 153:19-33. [PMID: 38309208 DOI: 10.1016/j.pediatrneurol.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 10/13/2023] [Accepted: 12/25/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND To synthesize the current evidence on clinical use of three-dimensional upper limb movement analysis (3D-ULMA) in children and adolescents with brachial plexus birth injury (BPBI). METHODS MEDLINE, Embase, and Web of Science were searched for relevant studies up to April 2022. An automatic e-mail alert was installed to ensure no eligible article was missed. Articles evaluating 3D-ULMA in children and adolescents with BPBI were included. Covidence web-based platform was used for blind screening of eligible articles. Twenty-one observational studies with a final sample size of 609, encompassing 493 BPBI cases, met the inclusion criteria. Data were extracted using a custom form to support standardized extraction conforming to the Cochrane Checklist of items. Risk of bias was assessed using the Newcastle-Ottawa Scale, the Strengthening the Reporting of Observational Studies in Epidemiology checklist, and a specifically established quality assessment form for kinematic analysis studies. RESULTS Study setups differed, including six different types of kinematic devices. Twelve studies used the (modified) Mallet positions for their 3D-ULMA. Throughout the studies, 3D-ULMA was used for various purposes. The Newcastle-Ottawa Scale scored 16 articles with five stars or more, indicating fair to moderate quality. CONCLUSIONS This systematic review summarizes the different 3D-ULMA kinematic devices, test protocols, and their clinical use for BPBI. The use of 3D-ULMA provides valuable, objective, and quantified data to clinicians with regard to movement strategies; it complements existing clinical scales and can be implemented to evaluate effectiveness of therapy interventions. Implications for future research and clinical practice are discussed.
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Affiliation(s)
- Laura Le Roy
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.
| | - Anke van Bladel
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - Sophie De Mits
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - Luc Vanden Bossche
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - Ruth Van der Looven
- Child Rehabilitation, Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
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Richardson RT, Russo SA, Chafetz RS, Warshauer S, Nice E, Richards JG, Zlotolow DA, Kozin SH. Evaluation of Upper Extremity Reachable Workspace in Children With Brachial Plexus Birth Injury. J Hand Surg Am 2024; 49:141-149. [PMID: 38099877 DOI: 10.1016/j.jhsa.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/18/2023] [Accepted: 11/13/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE Brachial plexus birth injury (BPBI) results in upper extremity (UE) movement limitations. Current assessments of UE function used to inform clinical decision-making only evaluate a limited set of static postures and/or movements and have been criticized for being insensitive to certain meaningful differences in function. Reachable workspace provides a numeric and visual assessment of global UE movement ability by quantifying the regions in space that patients can reach with their hands, and it can be collected using real-time feedback to elicit a best-effort acquisition of function. This study evaluated the ability of a real-time feedback reachable workspace tool to assess UE movement in BPBI. METHODS Twenty-two children with BPBI participated. Reachable workspace data were collected with three-dimensional motion capture using real-time visual feedback to measure UE reaching ability in all regions surrounding the body. All outer, far-from-body points reached by the hand were recorded and analyzed by region. A two-way, within-subjects analysis of variance was used to assess interlimb differences in percentage workspace reached and median reach distance for each of the six regions. RESULTS The affected limb had significantly less percentage workspace reached than the unaffected limb for all six regions (mean interlimb differences by region, 5.7%-38.6%). The affected limb had significantly less median reach distance than the unaffected limb for all six regions (mean interlimb differences by region, 3.1%-36.8%). CONCLUSIONS The workspace approach was capable of detecting UE movement impairments of the BPBI-affected limb. The reported deficits in workspace on the affected limb correspond to common movement impairments in BPBI, such as limitations in shoulder elevation, external rotation, extension, and elbow extension. CLINICAL RELEVANCE The real-time feedback reachable workspace tool is sufficiently robust for assessing UE movement impairments in children with BPBI.
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Affiliation(s)
| | | | | | | | - Emily Nice
- Shriners Hospital for Children, Philadelphia, PA
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Grip H, Källströmer A, Öhberg F. Validity and Reliability of Wearable Motion Sensors for Clinical Assessment of Shoulder Function in Brachial Plexus Birth Injury. SENSORS (BASEL, SWITZERLAND) 2022; 22:9557. [PMID: 36502259 PMCID: PMC9736020 DOI: 10.3390/s22239557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/24/2022] [Accepted: 12/02/2022] [Indexed: 06/17/2023]
Abstract
The modified Mallet scale (MMS) is commonly used to grade shoulder function in brachial plexus birth injury (BPBI) but has limited sensitivity and cannot grade scapulothoracic and glenohumeral mobility. This study aims to evaluate if the addition of a wearable inertial movement unit (IMU) system could improve clinical assessment based on MMS. The system validity was analyzed with simultaneous measurements with the IMU system and an optical camera system in three asymptomatic individuals. Test-retest and interrater reliability were analyzed in nine asymptomatic individuals and six BPBI patients. IMUs were placed on the upper arm, forearm, scapula, and thorax. Peak angles, range of motion, and average joint angular speed in the shoulder, scapulothoracic, glenohumeral, and elbow joints were analyzed during mobility assessments and MMS tasks. In the validity tests, clusters of reflective markers were placed on the sensors. The validity was high with an error standard deviation below 3.6°. Intraclass correlation coefficients showed that 90.3% of the 69 outcome scores showed good-to-excellent test-retest reliability, and 41% of the scores gave significant differences between BPBI patients and controls with good-to-excellent test-retest reliability. The interrater reliability was moderate to excellent, implying that standardization is important if the patient is followed-up longitudinally.
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Affiliation(s)
- Helena Grip
- Department of Biomedical Engineering, Radiation Sciences, Umeå University, 901 87 Umeå, Sweden
| | - Anna Källströmer
- Department of Surgical and Perioperative Sciences, Umeå University, 901 87 Umeå, Sweden
| | - Fredrik Öhberg
- Department of Biomedical Engineering, Radiation Sciences, Umeå University, 901 87 Umeå, Sweden
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Richardson RT, Russo SA, Topley MT, Chafetz RS, Kozin SH, Zlotolow DA, Richards JG. Assessment of approaches to estimate scapular orientation in children with brachial plexus birth injury. Gait Posture 2022; 98:17-23. [PMID: 36030706 DOI: 10.1016/j.gaitpost.2022.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/28/2022] [Accepted: 08/12/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Challenges in measuring dynamic scapular orientation limit assessment of scapulothoracic and glenohumeral contributions to shoulder function in children with brachial plexus birth injury (BPBI). Double calibration acromion marker cluster (D-AMC) and linear model approaches have been validated to estimate scapular motion in healthy adults, but neither has been evaluated in BPBI. RESEARCH QUESTION Are the linear model and D-AMC approaches able to accurately estimate scapular orientation in children with BPBI at functional arm postures? METHODS Seventeen children with BPBI positioned their affected limbs in 11 static positions while their segment orientations were measured with motion capture. Linear model and D-AMC estimates of scapular orientation were compared against palpation at six of the static positions with functional relevance to BPBI using a three-way repeat measures ANOVA and a comparison of root mean square errors (RMSE) against literature AMC values for healthy adults. RESULTS The D-AMC was similar to palpation across all positions and scapular axes while the linear model differed from palpation in a few instances. RMSEs of the D-AMC (3.7-14.8°) and particularly the linear model (4.6-24.8°) were generally at or beyond the upper range of past AMC analyses on healthy adults (1.6-14.2°), especially for more complex, multiplanar arm postures. Despite the D-AMC outperforming the linear model, this approach still produced clinically meaningful (>10°) errors for roughly (12.7-22.5%) of subjects. SIGNIFICANCE Current methods for estimating dynamic scapular orientation remain less than ideal for BPBI. Use of the D-AMC may be appropriate to gain broad insights into general dynamic scapulothoracic and glenohumeral function; however, given their potential for producing clinically meaningful errors, the D-AMC and linear model are not recommended for diagnostic purposes or outcomes assessment on an individual patient basis unless their patient-specific accuracy has been evaluated and confirmed prior to use.
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Affiliation(s)
| | | | - Matthew T Topley
- University of Delaware, Newark, DE, USA; Shriners Hospitals for Children, Philadelphia, PA, USA.
| | | | - Scott H Kozin
- Shriners Hospitals for Children, Philadelphia, PA, USA.
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Quantifying
Real‐World
Upper Limb Activity Via
Patient‐Initiated
Spontaneous Movement in Neonatal Brachial Plexus Palsy. PM R 2022; 15:604-612. [DOI: 10.1002/pmrj.12780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 12/22/2021] [Accepted: 01/17/2022] [Indexed: 11/07/2022]
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Maurel N, Diop A, Lallemant-Dudek P, Fitoussi F. Upper limb kinematics after Latissimus Dorsi transfer in children with brachial plexus birth palsy. Clin Biomech (Bristol, Avon) 2021; 87:105413. [PMID: 34174673 DOI: 10.1016/j.clinbiomech.2021.105413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Brachial plexus birth palsy remains a frequent condition and one of its treatments is to transfer the Latissimus Dorsi tendon to the infraspinatus muscle. The aim of this study was to analyse, for the first time, the three-dimensional kinematic effects of this operation on the upper limb joints during the five Mallet tasks and their correlation with clinical parameters. METHODS Kinematic analysis was performed using an electromagnetic device. An Index of Improvement taking into account the angle in preop and postop, the reproducibility and the angle of a control group was developed. Three groups of patients were analysed: sixteen patients (mean: 10,5 years) for the reproducibility, thirty children (mean: 9,5 years) for the control group and ten patients (mean: 8 years 7 months) who were operated. FINDINGS The humerothoracic and glenohumeral external rotations improved during the external rotation, the neck and the abduction tasks and worsened during the spine task. The glenohumeral external rotation worsened during the mouth task. The Humerothoracic abduction improved during the abduction and the neck tasks. The elbow flexion improved for the neck task. Differences were observed between patients and correlations were obtained between the Index of Improvement and clinical parameters. INTERPRETATION Using kinematics allows to better analyse the evolution of joint angles after the latissimus dorsi transfer. The Index of Improvement allows to quickly analyse the effect of the operation for each angle and each patient. This effect depends on clinical parameters.
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Affiliation(s)
- Nathalie Maurel
- Arts et Metiers Institute of Technology, EPBRO, HESAM Université, 151 Boulevard de l'Hôpital, F-75013 Paris, France.
| | - Amadou Diop
- Arts et Metiers Institute of Technology, EPBRO, HESAM Université, 151 Boulevard de l'Hôpital, F-75013 Paris, France.
| | - Pauline Lallemant-Dudek
- Hôpital Trousseau, Service de Médecine Physique et de Réadaptation pédiatrique, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Faculté de Médecine Sorbonne Université, 91 Boulevard de l'Hôpital, 75013 Paris, France.
| | - Franck Fitoussi
- Hôpital Trousseau, Service de chirurgie orthopédique et reconstructrice de l'enfant, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Faculté de Médecine Sorbonne Université, 91 Boulevard de l'Hôpital, 75013 Paris, France.
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Pons C, Lempereur M, Houx L, Alter K, Bailly R, Thepaut M, Damiano D, Brochard S. Compensatory strategies lead to efficient movement in children with brachial plexus birth injury. Ann Phys Rehabil Med 2021; 65:101515. [PMID: 33901706 DOI: 10.1016/j.rehab.2021.101515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/09/2021] [Accepted: 03/16/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Christelle Pons
- Department of Pediatric Physical and Medical Rehabilitation, Fondation ILDYS, Brest, Bretagne, France; Laboratory of Medical Information Processing, INSERM U1101, Brest, Bretagne, France; Department of Physical and Medical Rehabilitation, CHRU Morvan, Brest, Bretagne, France.
| | - Mathieu Lempereur
- Laboratory of Medical Information Processing, INSERM U1101, Brest, Bretagne, France; Department of Physical and Medical Rehabilitation, CHRU Morvan, Brest, Bretagne, France; Université de Bretagne Occidentale, Brest, France
| | - Laetitia Houx
- Department of Pediatric Physical and Medical Rehabilitation, Fondation ILDYS, Brest, Bretagne, France; Laboratory of Medical Information Processing, INSERM U1101, Brest, Bretagne, France; Department of Physical and Medical Rehabilitation, CHRU Morvan, Brest, Bretagne, France
| | - Katharine Alter
- Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, US National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Rodolphe Bailly
- Department of Pediatric Physical and Medical Rehabilitation, Fondation ILDYS, Brest, Bretagne, France; Laboratory of Medical Information Processing, INSERM U1101, Brest, Bretagne, France; Department of Physical and Medical Rehabilitation, CHRU Morvan, Brest, Bretagne, France
| | - Matthias Thepaut
- Department of pediatric surgery, CHRU Morvan, Brest, Bretagne, France
| | - Diane Damiano
- Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, US National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Sylvain Brochard
- Department of Pediatric Physical and Medical Rehabilitation, Fondation ILDYS, Brest, Bretagne, France; Laboratory of Medical Information Processing, INSERM U1101, Brest, Bretagne, France; Department of Physical and Medical Rehabilitation, CHRU Morvan, Brest, Bretagne, France; Université de Bretagne Occidentale, Brest, France
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Alsakhawi RS, Atya AM. Effect of augmented biofeedback for improvement of range of motion and upper extremity functionality in obstetric brachial plexus injury: a randomised control trial. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2020. [DOI: 10.12968/ijtr.2019.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims The loss of mobility and functional activities of the upper limb are the main longstanding complications of obstetric brachial plexus injury. The aim of this study was to investigate the effect of the augmented biofeedback system in conjunction with traditional physical therapy on the range of motion and functional activities in children with obstetric brachial plexus injury. Methods A total of 45 children aged from 6 to 10 years with obstetric brachial plexus injury were assigned into two groups. The control group received a traditional physical therapy programme, and the study group received the same programme with augmented biofeedback for 6 weeks. The main outcome parameters were the upper limb active range of motion, Mallet scale and Active Movement scale. Results The children in the study group showed greater significant improvement in all measured parameters compared with those in the control group. Conclusions Adding augmented biofeedback to the physical therapy programme provided greater improvement in upper limb mobility and functional activities for children with obstetric brachial plexus injury children.
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Affiliation(s)
- Reham Saeed Alsakhawi
- The Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Rehabilitation Sciences Department, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Azza Mohamed Atya
- Rehabilitation Sciences Department, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
- Basic Sciences Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Kinematic differences between children with obstetric brachial plexus palsy and healthy controls while performing activities of daily living. Clin Biomech (Bristol, Avon) 2018; 59:143-151. [PMID: 30241094 DOI: 10.1016/j.clinbiomech.2018.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/10/2018] [Accepted: 09/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Residual shoulder dysfunction and deformity impacts on functional performance in children with obstetric brachial plexus palsy. Clinical understanding of upper limb dynamic movement patterns is difficult with observation alone. This case-control study describes the significant kinematic differences between children with obstetric brachial plexus palsy compared to typically developing children while performing tasks of the modified Mallet Scale. METHODS Eleven children with obstetric brachial plexus palsy (mean 10 years, range 7-15 years, Narakas group I-III) and 10 typically developing children (mean 9 years 9 months, range 6-15 years) completed three-dimensional upper limb motion analysis using the acromion method to track dynamic scapular movement. Kinematic data were captured by a 4-CODA cx1 optoelectronic tracking system. Participants performed three trials of the modified Mallet scale tasks. Local coordinate systems, segment and joint rotations were defined as recommended by the International Society of Biomechanics. FINDINGS Joint rotation angles against time of the glenohumeral, thoracohumeral and scapulohumeral joints were calculated. Kinematic findings demonstrated increased internal rotation in all postures, reduced glenohumeral excursion, habitual "trumpet" posture of glenohumeral abduction/elevation and variability in movement strategies. Scapulohumeral rhythm during abduction task was 1.88:1 in typically developing children and 1.04:1 in children with obstetric brachial plexus palsy. INTERPRETATION Children with obstetric brachial plexus palsy demonstrate deficient external rotation in all tasks. Despite increased postural internal rotation, ability to move through internal rotation range is compromised. The glenohumeral joint showed the greatest range deficit, contributing to abnormal scapulohumeral rhythm. Future sub-group analysis of Narakas Classification is recommended.
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