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

Assessment of spinal alignment in children with unilateral cerebral palsy

BACKGROUND

Children/youths with unilateral cerebral palsy are at high risk for the development of scoliosis and other postural deformities. The purpose of this study was to perform spinal assessment in the frontal and sagittal plane using Spinal Mouse® in children/youths with unilateral cerebral palsy and to compare their spinal shape and angles with typically developing children/youths.

METHODS

25 children/youths with unilateral cerebral palsy and 25 typical children/youths, aged 6-18 years, were included. The subject's frontal (scoliosis) and sagittal plane (kyphosis and lordosis) spinal curvatures were compared by assessing them with Spinal Mouse®.

FINDINGS

Scoliosis was detected in 40% of subjects in the unilateral cerebral palsy group and this rate was considerably higher than that in typical subjects (12%). The median angle of scoliosis was 8° in subjects with unilateral cerebral palsy and 5.3° in typical subjects. While the median angle of scoliosis was higher in subjects with unilateral cerebral palsy than typical subjects (p < 0.001), there was no significant difference in the angles of lordosis and kyphosis between both groups (p > 0.05). Curvature patterns of subjects with unilateral cerebral palsy differed from typical subjects.

INTERPRETATION

Our findings will allow children/youths with unilateral cerebral palsy, who are at risk of developing spinal deformity, to be identified earliest possible and included in the intervention. Children/youths with unilateral cerebral palsy have to be assessed in detail from the earliest period, especially when the possibility of an age-related increase in scoliosis is considered.

Discussions About Obstetric Brachial Plexus Injuries

Although patients with obstetric brachial plexus injuries (OBPI) have been recognized and treated for greater than 100 years there is much that is not understood or is mis-understood. I address 6 areas for discussion: the cause of OBPI and whether it matters to nerve surgeons; the value of the Narakas grading; whether surgeons should perform primary nerve surgery, especially in patients with incomplete OBPI; the cause and treatment of shoulder tightness; the cause and treatment of elbow contracture; and whether patients with OBPI need surgery in adulthood.

How brachial plexus birth palsy affects motor development and upper extremity skill quality?

PURPOSE

This study aimed to investigate the gross motor functions including head control, midline crossing, and rolling, and the relationship between these developmental skills and upper extremity skill quality in children with neonatal brachial plexus palsy (NBPP).

METHODS

A total of 106 children with NBPP, aged 10-18 months, were included in this study. Injury severity was determined with the Narakas Classification. The gross motor function measurement lying and rolling sub-scale was used to evaluate gross motor functions including head control, midline crossing, and rolling, while the Quality of Upper Extremity Skills Test was applied to assess the upper extremity skill quality. The assessments were performed only once during routine physiotherapy controls.

RESULTS

As the severity of injury increased, developmental skill capacity decreased and upper extremity skill quality deteriorated (ps = 0.0001). There was a strong positive correlation between these developmental skills and upper extremity skill quality (ps = 0.0001).

CONCLUSION

Developmental skills are affected by NBPP. Rehabilitation programs aimed at increasing the quality of upper extremity skills should be included in neurodevelopmental treatment approaches.