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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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Metwaly MM, Salem EE, Abbass ME. Correlation between scapular alignment and upper extremity function in children with hemiparetic cerebral palsy. Physiother Theory Pract 2023; 39:2163-2170. [PMID: 35430957 DOI: 10.1080/09593985.2022.2066587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/10/2022] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To investigate the relationship between scapular alignment and upper extremity function. METHODS Eighty-five children (63 boys and 22 girls) with spastic hemiplegic cerebral palsy aged 3 to 6 years were included in the study. Scapular upward rotation was assessed using Postural Zone software, and upper extremity function was assessed using the Pediatric Arm Function Test. RESULTS There was a significant difference (p = .0001) in the degree of upward scapular rotation between less affected and affected sides (-41.78 ± 4.87 and -26.42 ± 6.34, respectively). There was a significant difference (p = .0001) between the function of the upper extremity of the affected side and the less affected sides (48.15 ± 14.37, 62.1 ± 6.62, respectively). Pearson Correlation Coefficient (r) was calculated, and there was a strong negative significant correlation between the degree of scapular upward rotation of the affected side, a unilateral score of the affected side, and the total score of the Pediatric Arm Function Test (r = -0.976, p = .0001 and r = -0.973, p = .0001, respectively). The correlation between symmetry index and total score of the Pediatric Arm Function Test was a strong positive significant correlation (r = 0.946, p = .0001). CONCLUSION The degree of upward scapular rotation was less on the affected side. Scapular alignment and symmetry may contribute to upper extremity function in children with hemiplegic cerebral palsy. Clinically, correction of scapular deviations may be considered in the rehabilitation program for children with hemiplegic cerebral palsy. This study suggests further experimental studies to find the cause and effect.
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Affiliation(s)
- Mahmoud Mohammed Metwaly
- Department of Pediatric Physical Therapy, Faculty of Physical Therapy, Cairo University, Giza, Eygpt
| | - Elham Elsayed Salem
- Department of Pediatric Physical Therapy, Faculty of Physical Therapy, Cairo University, Giza, Eygpt
| | - Mai Elsayed Abbass
- Department of Pediatric Physical Therapy, Faculty of Physical Therapy, Cairo University, Giza, Eygpt
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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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Tanrıverdi M, Hoşbay Z, Aydın A. Upper-limb function in Brachial Plexus birth palsy: Does the Pediatric Outcomes Data Collection Instrument correlate with the Brachial Plexus Outcome Measure? HAND SURGERY & REHABILITATION 2021; 41:252-257. [PMID: 34864216 DOI: 10.1016/j.hansur.2021.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/23/2021] [Accepted: 11/23/2021] [Indexed: 11/28/2022]
Abstract
Functional outcome assessment for children with brachial plexus birth palsy (BPBP) is essential. We aimed to investigate the association between the Brachial Plexus Outcome Measure (BPOM) and the Pediatric Outcomes Data Collection Instrument (PODCI) in children with BPBP and healthy matched controls, and to explore upper-limb function and the discriminative properties of the two tests. Thirty children, aged 6-14 years, diagnosed with BPBP and undergoing shoulder tendon transfer and 20 age-matched healthy controls were included. In both groups, the Turkish version of the PODCI, used to evaluate daily living activities, was implemented. The Turkish version of the BPOM, specifically developed for BPBP, was applied in children with BPBP. Test results, demographic and clinical characteristics were recorded. The mean age of children with BPBP was 8.53 ± 2.53 years and their BPOM Activity scale score was 42.93 ± 8.28. The PODCI Upper Extremity Function score (74.97 ± 23.49 vs. 100) and the PODCI Global Functioning score (89.20 ± 7.73 vs. 99.36 ± 7.73) were significantly lower in the BPBP group (p < 0.01). While there was a significant and very strong relationship between the BPOM Activity and PODCI Global Functioning scores (r = 0.845; p = 0.037), no correlation was found between the BPOM Self-Evaluation scale and PODCI Global Functioning score (r = 0.456; p = -0.141). The PODCI correlated with the BPOM Activity scale, providing an appropriate alternative measurement for upper-limb function in children with BPBP after shoulder tendon transfer.
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Affiliation(s)
- M Tanrıverdi
- Bezmialem Vakıf University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Silahtarağa Street, No:189, 34060 İstanbul, Turkey.
| | - Z Hoşbay
- Biruni University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, 10.Yıl Street, No:45, 34025 İstanbul, Turkey
| | - A Aydın
- İstanbul University, Faculty of İstanbul Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Turgut Özal Millet Street, No:118, 34093 İstanbul, Turkey
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Nazarahari M, Chan KM, Rouhani H. A novel instrumented shoulder functional test using wearable sensors in patients with brachial plexus injury. J Shoulder Elbow Surg 2021; 30:e493-e502. [PMID: 33246080 DOI: 10.1016/j.jse.2020.10.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/14/2020] [Accepted: 10/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Because nerve injury of muscles around the shoulder can be easily disguised by "trick movements" of the trunk, shoulder dysfunction following brachial plexus injury is difficult to quantify with conventional clinical tools. Thus, to evaluate brachial plexus injury and quantify its biomechanical consequences, we used inertial measurement units, which offer the sensitivity required to measure the trunk's subtle movements. METHODS We calculated 6 kinematic scores using inertial measurement units placed on the upper arms and the trunk during 9 functional tasks. We used both statistical and machine learning techniques to compare the bilateral asymmetry of the kinematic scores of 15 affected and 15 able-bodied individuals (controls). RESULTS Asymmetry indexes from several kinematic scores of the upper arm and trunk showed a significant difference (P < .05) between the affected and control groups. A bagged ensemble of decision trees trained with trunk and upper arm kinematic scores correctly classified all controls. All but 2 patients were also correctly classified. Upper arm scores showed correlation coefficients ranging from 0.55-0.76 with conventional clinical scores. CONCLUSIONS The proposed wearable technology is a sensitive and reliable tool for objective outcome evaluation of brachial plexus injury and its biomechanical consequences. It may be useful in clinical research and practice, especially in large cohorts with multiple follow-ups.
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Affiliation(s)
- Milad Nazarahari
- Department of Mechanical Engineering, University of Alberta, Donadeo Innovation Centre for Engineering, Edmonton, AB, Canada
| | - Kam Ming Chan
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB, Canada
| | - Hossein Rouhani
- Department of Mechanical Engineering, University of Alberta, Donadeo Innovation Centre for Engineering, Edmonton, AB, Canada; Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, AB, Canada.
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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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Delioğlu K, Uzumcugil A, Öztürk E, Kerem Gunel M. Relative importance of factors affecting activity and upper extremity function in children with Narakas Group 2 brachial plexus birth palsy. J Hand Surg Eur Vol 2021; 46:239-246. [PMID: 33092449 DOI: 10.1177/1753193420964768] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of the study was to determine the differences in upper limb function and activity/participation levels between preschool children with Narakas Groups 2a and 2b obstetric brachial plexus injury; and to determine the significance level of the factors affecting upper limb functions in these patients. Sixty-seven children, aged 3 to 7, who had not had surgical intervention, were evaluated in terms of joint movements, modified Mallet classification, Raimondi hand classification, brachial plexus outcome measure, paediatric outcome data collection instrument and stereognosis. There were significant functional differences between the groups, in favour of Group 2a. The movements affecting total function of the upper limb were: hand to spine (p < 0.001), global abduction (p < 0.001) and hand to mouth (p < 0.001), in descending order of significance. Passive internal rotation was the most important passive joint movement affecting shoulder function (p < 0.001). The results of this study suggest that more emphasis should be placed on the shoulder internal rotation in treatment strategies.Level of evidence: III.
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Affiliation(s)
- Kıvanç Delioğlu
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
| | - Akin Uzumcugil
- Department of Orthopedics and Traumatology, Hacettepe University, Ankara, Turkey
| | - Ebru Öztürk
- Department of Biostatistics, Hacettepe University, Ankara, Turkey
| | - Mintaze Kerem Gunel
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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