Upper extremity function in the free living environment of adults with traumatic brachial plexus injuries

Quantifying Patient-Initiated Upper Extremity Movement After Surgical Reconstruction for Adult Pan-Brachial Plexus Injury

BACKGROUND AND OBJECTIVES

Determining functional recovery in adult patients with traumatic pan-brachial plexus injury (pBPI) is hampered by the fact that most outcome measures are collected in the clinical setting and may not reflect arm use in the real world. This study's objectives were to demonstrate the feasibility of using wearable motion sensor technology to quantify spontaneous arm movement in adult patients with pBPI after surgical reconstruction and report the time and intensity with which the affected arm was used.

METHODS

Twenty-nine patients with pBPI who underwent surgical reconstruction at least 2 years prior were included in this study. Study participants wore an accelerometer on bilateral arms for 7 days. The vector time (VT) and magnitude with which each arm moved were collected and divided by the same values collected from the uninjured arm to generate a ratio (VT and vector magnitude [VM], respectively) to quantify differences between the arms. Correlations between VT, VM, and patient demographic and physician-elicited clinical measures were calculated. Patients were enrolled at Chang Gung Memorial Hospital, Linkou Medical Center, Taiwan, and data analysis was performed at the University of Michigan.

RESULTS

Twelve patients had pan-avulsion injuries, and 17 patients had C5 rupture with C6-T1 avulsion injuries. All underwent nerve reconstruction with contralateral C7 or ipsilateral C5 nerve roots as donors. At mean 7.3 years after surgery, the mean VT ratio was 0.54 ± 0.13 and the mean VM ratio was 0.30 ± 0.13. Both VT and VM ratios were significantly correlated with patient employment and movements at the elbow and forearm.

CONCLUSION

Wearable motion detection technology can capture spontaneous, real-world movements of the arm in patients who have undergone surgical reconstruction for pBPI. Despite severe injuries, these patients are able to use their affected arm 50% of the time and with 30% of the intensity of their unaffected arm, which is positively correlated with return to work after injury. These data support the use of surgical reconstruction for pBPI.

Upper extremity asymmetry due to nerve injuries or central neurologic conditions: a scoping review

BACKGROUND

Peripheral nerve injuries and central neurologic conditions can result in extensive disabilities. In cases with unilateral impairment, assessing the asymmetry between the upper extremity has been used to assess outcomes of treatment and severity of injury. A wide variety of validated and novel tests and sensors have been utilized to determine the upper extremity asymmetry. The purpose of this article is to review the literature and define the current state of the art for describing upper extremity asymmetry in patients with peripheral nerve injuries or central neurologic conditions.

METHOD

An electronic literature search of PubMed, Scopus, Web of Science, OVID was performed for publications between 2000 to 2022. Eligibility criteria were subjects with neurological conditions/injuries who were analyzed for dissimilarities in use between the upper extremities. Data related to study population, target condition/injury, types of tests performed, sensors used, real-world data collection, outcome measures of interest, and results of the study were extracted. Sackett's Level of Evidence was used to judge the quality of the articles.

RESULTS

Of the 7281 unique articles, 112 articles met the inclusion criteria for the review. Eight target conditions/injuries were identified (Brachial Plexus Injury, Cerebral Palsy, Multiple Sclerosis, Parkinson's Disease, Peripheral Nerve Injury, Spinal Cord Injury, Schizophrenia, and stroke). The tests performed were classified into thirteen categories based on the nature of the test and data collected. The general results related to upper extremity asymmetry were listed for all the reviewed articles. Stroke was the most studied condition, followed by cerebral palsy, with kinematics and strength measurement tests being the most frequently used tests. Studies with a level of evidence level II and III increased between 2000 and 2021. The use of real-world evidence-based data, and objective data collection tests also increased in the same period.

CONCLUSION

Adequately powered randomized controlled trials should be used to study upper extremity asymmetry. Neurological conditions other than stroke should be studied further. Upper extremity asymmetry should be measured using objective outcome measures like motion tracking and activity monitoring in the patient's daily living environment.

A multidisciplinary approach to the management of brachial plexus injuries: experience from the Mayo Clinic over 100 years

A multidisciplinary brachial plexus clinic has been a relatively new concept, offering different surgical speciality perspectives on the treatment of brachial plexus injuries. The resulting collaborative effort has proven to be greater than the sum of its parts. In this review, the history, philosophy of care, development/implementation and impact of a creation of a multidisciplinary brachial plexus team at the Mayo Clinic are detailed.

Trends and advancements in shoulder biomechanics research

The 12th International Shoulder Group (ISG) Conference was held at Mayo Clinic in Rochester, Minnesota, USA, from August 12-13, 2018, and was hosted by Dr. Melissa (Missy) Morrow of Mayo Clinic and Dr. Meghan Vidt of Pennsylvania State University. This conference was held as a satellite conference to the annual 2018 American Society of Biomechanics Conference. This Editorial accompanies the Special Issue of the Journal of Electromyography and Kinesiology, and contains a selection of the work presented during the 12th Meeting of the ISG. Fourteen full-length articles describe advancements in shoulder research relevant to both basic science and clinical outlets. The work presented herein spans the research areas of methodology, mechanistic understanding, and clinical management. These areas are synergistic and equally important to propel the field forward and enhance impact. These manuscripts reinforce the dedication of the ISG and its members and showcase the ongoing drive toward translational application of these concepts across the common themes of rotator cuff, muscle, wheelchair & ergonomics, and methods & modeling. Highlights of each of the special issue publications are described within the context of the current trends in shoulder research and areas for further advancement.

A novel instrumented shoulder functional test using wearable sensors in patients with brachial plexus injury

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.

Effects of elbow immobilization on upper extremity activity

BACKGROUND

It has been dogma that handedness greatly impacts daily activities. Interruptions in the ability to utilize the dominant arm due to neuromusculoskeletal injuries could negatively impact performance of activities of daily living. Daily activity can be measured using activity monitors. This study aimed to examine how arm dominance impacts function by immobilizing the arms of healthy individuals.

METHODS

Ten individuals wore four upper extremity activity monitors for three days-one day without immobilization, one day with their dominant arm immobilized, and one day with their non-dominant arm immobilized. Triaxial acceleration data was used to calculate average daily activity and an asymmetry index. Between-condition differences were examined.

FINDINGS

During dominant arm immobilization, the dominant forearm had significantly less average daily activity when compared to the no immobilization day (p = .0001) and the non-dominant immobilized day (p < .0001). A similar trend was observed at the non-dominant forearm when the non-dominant arm was immobilized. Immobilization of an arm increased asymmetry index and reliance on the non-immobilized arm. Significant differences in asymmetry index were not observed between the two casted conditions.

INTERPRETATION

When an upper extremity was casted, immobilized forearm and upper arm average daily activity was comparable. Dominance did not have an effect on asymmetry index. Immobilization affected asymmetry index compared to no immobilization. This study has demonstrated that regardless of arm immobilized, there will be a reliance on the contralateral limb about twice as much as the immobilized limb. This could prove problematic if the contralateral limb is restricted or injured, limiting independent.