Permanent brachial plexus birth palsy does not impair the development and function of the spine and lower limbs

Kinematic Analysis of Reaching Tasks at Different Execution Speeds in Children with Neonatal Brachial Plexus Palsy

The aim of this study was to compare the kinematics of reaching tasks at different speeds between children with neonatal brachial plexus palsy (NBPP) and unaffected controls. This cross-sectional study included thirteen children with NBPP (10 ± 2 years old, of which six had upper Erb's palsy and seven had extended Erb's palsy) matched for age and sex with thirteen unaffected controls. Kinematic data were acquired using a Motion Monitor unit with a 3D motion tracking electromagnetic system (Liberty, Polhemus). Scapular, upper limb, and head were recorded during forward reaching tasks (hand on overhead ball and hand to head) and a backward reaching task (hand on the back pocket). The study revealed reduced shoulder flexion and extension in children with NBPP during hand on ball and on the back pocket tasks compared to unaffected controls. Limited elbow flexion was also observed in children with NBPP during the hand on ball and hand on the head tasks. During the hand to head task, children with NBPP presented increased head flexion compared to unaffected controls. Scapular kinematics analysis showed increased posterior tilt in children with NBPP during forward reaching (the hand on ball and hand to head tasks). In the backward reaching task (hand on the back pocket), the NBPP group exhibited reduced scapular external rotation compared to unaffected controls. These findings indicate distinct kinematics in the scapula, shoulder, elbow, and head during reaching tasks for children with NBPP compared to controls. Furthermore, different execution speeds did not alter the kinematic differences between the groups.

QUALITY OF LIFE AND UPPER LIMB FUNCTION OF CHILDREN WITH NEONATAL BRACHIAL PLEXUS PALSY

OBJECTIVE

To compare the upper limb function and quality of life between children with neonatal brachial plexus palsy and controls with unaffected brachial plexus (typical children).

METHODS

Twenty-four children with neonatal brachial plexus palsy and 24 typical ones were evaluated, both groups with 10±3 years of age. The upper limb function was assessed by the Modified Mallet Scale and the Active Movement Scale, whereas quality of life was analyzed by the Pediatric Outcome Data Collection Instrument and the Child Health Questionnaire. Mann-Whitney U tests investigated the differences between groups in such scales.

RESULTS

Children with neonatal brachial plexus palsy presented lower limb function compared to typical children in both scales. These children also presented lower scores for most of the Pediatric Outcome Data Collection Instrument domains, except for comfort/pain. In addition, they had lower scores in the following domains of the Child Health Questionnaire: physical functioning, pain, behavior, mental health, overall health perception, emotional impact on parents, and psychosocial summarized score.

CONCLUSIONS

Neonatal brachial plexus palsy has a negative influence on upper limb function and quality of life, mainly considering overall health, basic mobility, physical and psychosocial functions, happiness, pain, behavior, mental health, upper limb function, and emotional impact on their parents.

Assessment of Spinal Curvatures in Children With Upper Trunk Obstetrical Brachial Plexus Palsy

PURPOSE

Effects of upper trunk obstetrical brachial plexus palsy (OBPP) on the spinal curvature and relationship between the curvature degrees and upper limb movements have not been reported.

METHODS

Spinal Mouse was used to assess spinal curvature characteristics in the sagittal and frontal planes. Upper limb movements were assessed with using the Active Movement Scale in only study group.

RESULTS

The degree of frontal plane curvatures was higher in the study group. In the OBPP group, 11 of 25 (44%) children had thoracal C-shaped scoliosis. Nine of these children had contralateral side scoliosis. Shoulder external rotation was inversely correlated with scoliosis angle. Moreover, shoulder external rotation and elbow flexion were lower in children with scoliosis in the OBPP group.

CONCLUSIONS

Upper trunk OBPP may affect frontal plane alignment. Especially insufficient shoulder external rotation scores may lead to constitute thoracal scoliosis as a result of trunk compensation.

Participation restrictions among adolescents and adults with neonatal brachial plexus palsy: the patient perspective

PURPOSE

To examine the impact of neonatal brachial plexus palsy (NBPP) on societal participation of adolescents and adults.

METHODS

This cross-sectional study was conducted among patients with NBPP, aged ≥16 years, who had visited our NBPP clinic. Patients completed questions on the influence of NBPP on their choices regarding education/work and their work-performance, the Impact on Participation/Autonomy questionnaire and the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P). In addition, health-related quality of life (HRQoL) was assessed.

RESULTS

Seventy-five patients participated (median age 20, inter quartile range 17-27). Twenty were full-time students, 28 students with a job, 21 employed, two unemployed, and four work-disabled. Sixty-six patients had had a job at some stage. Patients' overall HRQoL was comparable to the general population. 27/75 patients reported that NBPP had affected their choices regarding education and 26/75 those regarding work. 33/66 reported impact on their work performance. On the Impact on Participation/Autonomy questionnaire, 80% (49/61) reported restrictions in the work-and-education domain, 74% in social-relations and 67% in autonomy-outdoors. 37/61 reported participation restrictions on the USER-P.

CONCLUSIONS

Although their overall HRQoL was not impaired, a substantial proportion of adolescent/adult patients reported that NBPP had an impact on choices regarding education and profession, as well as on work-performance. Restrictions in participation, especially in work and education were also reported. Guiding patients in making choices on education and work at an early stage and providing tailored physical as well as psychosocial care may prevent or address restrictions, which may improve participation. Implications for Rehabilitation Adolescent and adult patients with neonatal brachial plexus palsy perceive restrictions in societal participation, especially regarding the work-and-education domain. All patients with neonatal brachial plexus palsy may perceive restrictions in societal participation regardless of lesion severity, treatment history and side of the lesion. Adolescents and adults with neonatal brachial plexus palsy report that their choices regarding education and work, as well as their work-performance are influenced by their neonatal brachial plexus palsy. Patients with neonatal brachial plexus palsy should be followed throughout their life in order to provide them with appropriate information and treatment when health- or participation-related issues arise. Rehabilitation treatment is the best option to address all of the aforementioned issues, as surgical options in adolescents and adults are limited.

Concepts of functioning and health important to children with an obstetric brachial plexus injury: a qualitative study using focus groups

AIMS

The aims of this study were to explore and understand the perspectives of children with an obstetric brachial plexus injury (OBPI) regarding functioning and health, and to create an overview of problems and difficulties that patients encounter in daily life.

METHOD

We conducted a focus group study with 48 children (25 male, 23 female), aged 8 to 18 years, with an OBPI. Eleven open-ended questions regarding problems or difficulties in daily life were asked in group sessions with 4 to 7 children within the same age range. These group sessions were tape-recorded and transcribed verbatim. All problems and difficulties mentioned in each focus group were linked to corresponding categories of the International Classification of Functioning, Disability and Health - Children & Youth Version (ICF-CY).

RESULTS

Eight focus groups were conducted. A total of 143 unique ICF-CY categories were identified. Of these categories, 61 (43%) were related to the ICF-CY component 'activities and participation', 31 (22%) were related to 'body functions', 29 (20%) were related to 'environmental factors', and 22 (15%) were related to 'body structures'.

INTERPRETATION

This study shows that children with OBPI experience difficulties in all areas of functioning, as well as in both environmental and personal factors.

Effects from birth brachial plexus injury and postural control

Of 32 children with birth brachial plexus injury, 31 had postural control deficits, including asymmetrical posture and atypical movements. Management of children with birth brachial plexus injury should address motor development of the entire body, not merely the affected extremity.

Current concepts in the management of brachial plexus birth palsy

Brachial plexus birth palsy, although rare, may result in substantial and chronic impairment. Physiotherapy, microsurgical nerve reconstruction, secondary joint corrections, and muscle transpositions are employed to help the child maximize function in the affected upper extremity. Many present controversies regarding natural history, microsurgical treatment, and secondary shoulder reconstructive surgery remain unresolved in infants with brachial plexus birth palsies. Recent literature has enhanced our understanding of the pathoanatomy and natural history of the injury as well as the surgical indications, expected outcomes, and complications; this literature has led to improved care of these patients. Based on the present evidence, recommendations for both microsurgery and shoulder reconstruction with tendon transfer and arthroscopic and open reductions are presented.