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Muhlestein WE, Smith BW, Chang KWC, Justice D, Nelson VS, Brown SH, Yang LJS. Early referral to multidisciplinary specialty centers to optimize outcomes in children with neonatal brachial plexus palsy. Dev Med Child Neurol 2024; 66:117-124. [PMID: 37246332 DOI: 10.1111/dmcn.15658] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/30/2023]
Abstract
AIM To demonstrate the trajectory of long-term recovery of upper-extremity movement and determine optimal timing of evaluation at multidisciplinary specialty centers in children with neonatal brachial plexus palsy (NBPP). METHOD All children with conservatively managed NBPP seen at one institution from 2005 to 2020 were considered for inclusion. The cohort was divided according to age at formal evaluation (≤30 or > 30 days). Active range of motion (AROM) for shoulder and elbow movements collected at each appointment were compared in local age windows between early and late cohorts. Locally estimated scatterplot smoothing was used to demonstrate the trajectory of recovery for the overall cohort. RESULTS More than 13 000 prospectively collected data points for 429 children (220 males, 209 females) were analysed. Elbow flexion improved to nearly full AROM for both groups over the course of the study. Shoulder abduction, forward flexion and external rotation, and forearm supination improved for the entire cohort, although greater absolute improvement, particularly at the shoulder, was seen in the early cohort (age at formal evaluation ≤30 days). AROM for elbow extension remained roughly stable for the early cohort but decreased for the late cohort (age at formal evaluation >30 days). AROM for forearm pronation decreased over time for both cohorts. INTERPRETATION Our data demonstrate good long-term functional recovery for children with conservatively managed NBPP. However, early referral to multispecialty brachial plexus centers may optimize outcomes. WHAT THIS PAPER ADDS Many children with conservatively managed neonatal brachial plexus palsy have good long-term shoulder and elbow outcomes. Early referral to multidisciplinary clinics may maximize long-term shoulder and elbow recovery and optimize outcomes.
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Affiliation(s)
| | - Brandon W Smith
- Department of Neurologic Surgery, Duke University, Raleigh, NC, USA
| | | | - Denise Justice
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Virginia S Nelson
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Susan H Brown
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
| | - Lynda J-S Yang
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
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Wingrat J, Berger C, Bauer L. Passive Range of Motion for Conservative Management of Brachial Plexus Birth Injury: A Survey of Expert Therapists. Occup Ther Health Care 2023:1-10. [PMID: 38019167 DOI: 10.1080/07380577.2023.2288205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/22/2023] [Indexed: 11/30/2023]
Abstract
Brachial plexus birth injury (BPBI) occurs in almost 1/1000 live births potentially resulting in lifelong upper extremity weakness and joint contracture. Early referral and initiation of passive range of motion (PROM) are recommended but there is no standard of care to guide treatment. A descriptive survey study design was used to target occupational and physical therapists who work in brachial plexus clinics to identify current practices for early therapeutic intervention. With 26 respondents, therapists recommend initiating PROM by 4 wks of life performed at every diaper change. Seventy-four percent of therapists report differences in outcomes for children whose caregivers are more adherent, however, there was no significant relationship between frequency of PROM and outcomes. More outcome research is needed to identify an optimal frequency and duration, examine the efficacy of methods for parent education, and identify training methods to facilitate adherence.
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Affiliation(s)
- Jennifer Wingrat
- Department of Occupational Therapy and Occupational Science, Towson University, Towson, MD, USA
| | - Caitlin Berger
- Department of Occupational Therapy and Occupational Science, Towson University, Towson, MD, USA
| | - Lauren Bauer
- Department of Occupational Therapy and Occupational Science, Towson University, Towson, MD, USA
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Singh A, Orozco V, Balasubramanian S. In vivo biomechanical responses of neonatal brachial plexus when subjected to stretch. PLoS One 2023; 18:e0290718. [PMID: 37647327 PMCID: PMC10468090 DOI: 10.1371/journal.pone.0290718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/11/2023] [Indexed: 09/01/2023] Open
Abstract
Neonatal brachial plexus palsy (NBPP) results from over-stretching of the neonatal brachial plexus during complicated birthing scenarios. The lack of information on the biomechanical response of the neonatal brachial plexus complex when subjected to stretch limits our understanding of the NBPP injury mechanism. This study aims to fill that critical gap by using a neonatal piglet animal model and providing the in vivo biomechanical properties of the neonatal brachial plexus complex when subjected to stretch. Forty-seven brachial plexus levels (identified by the four brachial plexus terminal nerve branches namely musculocutaneous, median, ulnar, and radial), obtained from 16 neonatal Yorkshire piglets (3-5 days old), were subjected to stretch-induced failure. The average maximum load and corresponding strain were reported to be 16.6 ± 1.3 N and 36.1 ± 1.6%, respectively. Maximum loads reported at the musculocutaneous level were significantly lower than the median and radial levels. No differences in strains at failure were reported at all four tested levels. Proximal or distal failure locations were reported in 83% of the tests with 17% mid-length ruptures that were primarily reported at the bifurcation of the median and ulnar brachial plexus levels. Histological studies reported an overall loss of wavy pattern of the nerve fibers, an increase in nerve spacing, fiber disruptions, and blood vessel ruptures in the stretched tissue. This in vivo piglet animal study offers insight into the NBPP mechanism by reporting biomechanical, injury location, and structural damage responses in neonatal brachial plexus when subjected to stretch.
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Affiliation(s)
- Anita Singh
- Bioengineering Department, Temple University, Philadelphia, Pennsylvania, United States of America
| | - Virginia Orozco
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Sriram Balasubramanian
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania, United States of America
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Wingrat J, Elrick MJ. Frequency, facilitators, and barriers for range of motion to prevent shoulder contracture in brachial plexus birth injury: A pilot study. J Pediatr Rehabil Med 2023; 16:331-336. [PMID: 37005904 PMCID: PMC10895927 DOI: 10.3233/prm-220090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
PURPOSE This pilot study investigated the efficacy of passive range of motion (PROM) during the first year of life to prevent development of shoulder contractures in children with brachial plexus birth injury (BPBI) and identified facilitators and barriers to caregiver adherence with daily PROM. METHODS Five caregivers of children with upper trunk BPBI participated in retrospective interviews about the frequency with which they performed PROM during their child's first year of life including facilitators and barriers to daily adherence. Medical records were reviewed for documentation of caregiver-reported adherence and documented evidence of shoulder contracture by age one. RESULTS Three of the five children had documented shoulder contractures; all three had delayed initiation or inconsistent PROM in the first year of life. Two without shoulder contractures received consistent PROM throughout the first year of life. Making PROM part of the daily routine was a facilitator to adherence while family contextual factors were barriers. CONCLUSION Absence of shoulder contracture may be related to consistent PROM throughout the first year of life; decreased frequency of PROM after the first month of life did not increase the risk of shoulder contracture. Consideration of family routines and context may facilitate adherence with PROM.
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Affiliation(s)
- Jennifer Wingrat
- Department of Occupational Therapy and Occupational Science, Towson University, Towson, MD, USA
- Department of Occupational Therapy, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Matthew J Elrick
- Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
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Heise CO, Zaccariotto M, Martins RS, Sterman-Neto H, Siqueira MG. Self-biting behavior in patients with neonatal brachial plexus palsy. Childs Nerv Syst 2022; 38:1773-1776. [PMID: 35723725 DOI: 10.1007/s00381-022-05574-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/01/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Self-biting behavior in patients with neonatal brachial plexus palsy (NBPP) has been associated with finger amputation. Our objective is to describe the incidence of this complication, risk factors, and clinical management. METHODS We retrospectively analyzed 612 patients with NBPP. There were 303 males and 309 females. 51.8% of patients had C5-C6 lesions, 28.9% had C5-C7, 18.9% had C5-T1, and 0.3 had C7-T1 involvement. RESULTS We identified 15 patients with self-biting behavior (2.5%). Ten patients had C5-T1 lesions, and five had C5-C7 lesions. Eight patents were submitted to brachial plexus surgery and seven were not. This behavior appeared between 8 and 46 months of life (mean 23.5), and it was always temporary. There was no difference between operated and non-operated patients (p > 0.05), and no correlation between age at surgery and age of appearance of self-biting behavior (p > 0.05). Physical restriction was effective in treating this complication and we had no case of finger amputation. CONCLUSION Self-biting behavior is a rare complication of NBPP, and it is usually associated with severe motor involvement. The behavior duration is limited to a few months. This condition can be effectively treated with physical restriction to prevent hand biting.
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Affiliation(s)
- Carlos Otto Heise
- Peripheral Nerve Surgery Unit, Department of Neurosurgery, University of São Paulo Medical School, São Paulo, SP, Brazil. .,Clinical Neurophysiology, Department of Neurology, University of São Paulo Medical School, São Paulo, SP, Brazil.
| | - Monise Zaccariotto
- Peripheral Nerve Surgery Unit, Department of Neurosurgery, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Roberto S Martins
- Peripheral Nerve Surgery Unit, Department of Neurosurgery, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Hugo Sterman-Neto
- Peripheral Nerve Surgery Unit, Department of Neurosurgery, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Mário G Siqueira
- Peripheral Nerve Surgery Unit, Department of Neurosurgery, University of São Paulo Medical School, São Paulo, SP, Brazil
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Frade F, Neves L, Florindo-Silva F, Gómez-Salgado J, Jacobsohn L, Frade J. Rehabilitation of a Child with Neonatal Brachial Plexus Palsy: Case Report Described by Parents. CHILDREN 2022; 9:children9091298. [PMID: 36138605 PMCID: PMC9497214 DOI: 10.3390/children9091298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/12/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022]
Abstract
This paper presents a case report of a child with Neonatal Brachial Plexus Palsy on the right arm, with C5, C6, and C7 nerve injuries. The symptoms presented at birth and at the time of diagnosis were absence of movement in the right arm but with mobility of the fingers; internal rotation of the injured limb with elbow extension; active flexion of the wrist and fingers; and ulnar deviation of the hand. The rehabilitation plan followed the conservative approach and included different intervention strategies (passive and active mobilisation, kinesio tape, use of splints, bimanual stimulation, etc.) carried out by the occupational therapist and the physical therapist. The rehabilitation allowed the child to have a functional limb for daily activities, with bimanual motor integration and coordination; passive and active range of motion in the different joints except for pronation, sensibility, and maintained strength. In conclusion, it can be said that this case report describes a set of rehabilitation strategies that were used in the conservative treatment of a child with NBPP and the functional gains they allowed. Early intervention, parental involvement in the rehabilitation process, and continuous follow-up of the child favoured the prognosis and allowed the prevention of functional sequelae of the limb.
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Affiliation(s)
- Fátima Frade
- Departamento de Enfermagem da Criança e do Jovem, Escola Superior de Enfermagem de Lisboa, Avenida Professor Egas Moniz, 1600-190 Lisboa, Portugal
- Centro de Administração e Políticas Públicas (CAPP), Instituto Superior de Ciências Sociais e Políticas da Universidade de Lisboa, Rua Almerindo Lessa, 1300-663 Lisbon, Portugal
| | - Lurdes Neves
- Escolher Brincar Terapia Ocupacional, Rua Professor Barbosa Soeiro 6, 4º Dto, 1600-598 Lisboa, Portugal
| | - Fátima Florindo-Silva
- Physiotherapy and Osteopathy Departments, Atlântica Health School, Universidade Atlantica, 2730-036 Barcarena, Portugal
- Serviço de Medicina Física e Reabilitação, Hospital Dona Estefânia-Centro Hospitalar Universitário Lisboa Central, 1169-045 Lisboa, Portugal
| | - Juan Gómez-Salgado
- Department of Sociology, Social Work and Public Health, Faculty of Labour Sciences, University of Huelva, 21007 Huelva, Spain
- Safety and Health Postgraduate Programme, Universidad Espíritu Santo, Guayaquil 092301, Ecuador
- Correspondence: ; Tel.: +34-959219700
| | - Lia Jacobsohn
- Physiotherapy and Osteopathy Departments, Atlântica Health School, Universidade Atlantica, 2730-036 Barcarena, Portugal
- Centro de Medicina de Reabilitação do Alcoitão, 2649-506 Alcabideche, Portugal
| | - João Frade
- Centre for Innovative Care and Health Technology (ciTechcare), Escola Superior de Saúde, Instituto Politécnico de Leiria, 2411-901 Leiria, Portugal
- Unit for Multidisciplinary Research in Biomedicine (UMIB), University of Porto, 4099-002 Porto, Portugal
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Validation and Cultural Adaptation of the Serbian Version of the Pediatric Outcome Data Collection Instrument (PODCI) in Children with Obstetrical Brachial Plexus Lesion. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060807. [PMID: 35744070 PMCID: PMC9227359 DOI: 10.3390/medicina58060807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 11/25/2022]
Abstract
Background and objectives: Pediatric Outcome Data Collection Instrument (PODCI) is among the most described scales developed to evaluate the physical status of children and adolescents with various musculoskeletal disorders. We aimed to translate PODCI from English to Serbian, culturally adopt items and domains, evaluate the temporal stability, internal consistency and the test−retest reliability of PODCISR in children with obstetrical brachial plexus lesion (OBPL), and finally, to test the construct validity of PODCISR against muscular manual test (MMT) Materials and Methods: The study included 48 eligible participants aged between 2 and 10 years with OBPL. The MMT was used to test the construct validity. Results: There were no significant differences (p > 0.05) between test and retest for all PODCISR domains. Correlations for all tested domains with MMT were statistically significant except for biceps muscle and domains II and IV. Cronbach’s alpha value of the Global Functioning Scale was good and equaled 0.838 for test and 0.832 for retest session. Cronbach’s α was more than 0.600 for all PODCISR domains except for Domain II and for Domain IV. The observed Test−Retest ICC for all PODCISR domains scores ranged from 0.899 to 0.996. Conclusion: The Serbian version of PODCI (PODCISR) was successfully translated and transculturally adopted. It has satisfactory temporal stability, construct validity and test−retest reliability as well as relevant internal consistency.
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Cui Z, Liu L, Chen X, Zeng H, Zheng S, Wu D. Single Blind Randomized Controlled Trial of Modified Constraint-Induced Movement Therapy in Infants With the Sequelas of Unilateral Brachial Plexus Injury. Front Hum Neurosci 2022; 16:900214. [PMID: 35706479 PMCID: PMC9189277 DOI: 10.3389/fnhum.2022.900214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo explore the effect of modified constraint-induced movement therapy (mCIMT) on upper limbs residual dysfunction for infancy with the sequelas of unilateral brachial plexus injury (uBPI).MethodsSingle blind randomized controlled trial of mCIMT vs. standard care. An enrolling 31 infants with a uBPI exhibiting residual dysfunction of the affected upper limb for over 6 months was conducted. And functional outcomes pertaining to the affected upper limb were assessed via AMS, GRES, RHS, and MSS at 0, 3, and 6 months after treatment.ResultsNo differences were found in baseline (acquisition phase) AMS, MSS, GRES, or RHS between the control and mCIMT groups [F(1, 14) = 0.062, P = 0.086; F(1, 14) = 0.483, P = 0.499; F(1, 14) = 0.272, P = 0.610; Z = −0.336, P = 7.373]. At the 3- and 6-month follow-up time points, AMS, MSS, and GRES scores were significantly improved over baseline in both groups [mCIMT: F(2, 30) = 183.750, 128.614, 110.085, P < 0.05; Control: F(2, 28) = 204.007, 75.246, 51.070, P < 0.05]. No significant differences were found between two treatment groups at the 3-month follow-up time point [F(1, 14) = 0.565, P = 0.465; F(1, 14) = 0.228, P = 0.641; F(1, 14) = 0.713, P = 0.413; Z = −0.666, P = 0.505]. However, at the 6-month follow-up time point, AMS and MSS scores were significantly improved in the mCIMT group relative to the control group [F(1, 14) = 8.077, P = 0.013; F(1, 14) = 18.692, P = 0.001].ConclusionmCIMT may benefit the rehabilitation of residual upper limb dysfunction associated with a uBPI in infants.Clinical Trial Registration[www.chictr.org.cn], identifier [ChiCTR1900022119].
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Affiliation(s)
- Zhenzhen Cui
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Le Liu
- Department of Pediatric, Anhui Province Maternity and Child Health Hospital, Hefei, China
| | - Xi Chen
- Pediatric Neurorehabilitation Center, Hefei Changxing Rehabilitation Hospital, Hefei, China
| | - Haiyan Zeng
- Pediatric Neurorehabilitation Center, Hefei Changxing Rehabilitation Hospital, Hefei, China
| | - Shizhu Zheng
- Pediatric Neurorehabilitation Center, Lu’an Rehabilitation Hospital, Lu’an, China
| | - De Wu
- Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Pediatric Neurorehabilitation Center, Hefei Changxing Rehabilitation Hospital, Hefei, China
- *Correspondence: De Wu,
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Orozco V, Magee R, Balasubramanian S, Singh A. A Systematic Review of the Tensile Biomechanical Properties of the Neonatal Brachial Plexus. J Biomech Eng 2021; 143:110802. [PMID: 34091659 PMCID: PMC8299814 DOI: 10.1115/1.4051399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/30/2021] [Indexed: 11/08/2022]
Abstract
Brachial plexus (BP) birth injury has a reported incidence of 1 to 4 per 1000 live births. During complicated deliveries, neonatal, maternal, and other birth-related factors can cause over-stretching or avulsion of the neonatal brachial plexus leading to injury. Understanding biomechanical responses of the neonate brachial plexus when subjected to stretch can offer insight into the injury outcomes while guiding the development of preventative maneuvers that can help reduce the occurrence of neonatal brachial plexus injuries. This review article aims to offer a comprehensive overview of existing literature reporting biomechanical responses of the brachial plexus, in both adults and neonates, when subjected to stretch. Despite the discrepancies in the reported biomechanical properties of the brachial plexus, available studies confirm the loading rate and loading direction dependency of the brachial plexus tissue. Future studies, possibly in vivo, that utilize clinically relevant neonatal large animal models can provide translational failure values of the biomechanical parameters for the neonatal brachial plexus when subjected to stretch.
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Affiliation(s)
- Virginia Orozco
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3140 Market St., BOSSONE 718, Philadelphia, PA 19104
| | - Rachel Magee
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3140 Market St., BOSSONE 718, Philadelphia, PA 19104
| | - Sriram Balasubramanian
- School of Biomedical Engineering, Science and Health Systems, Drexel University, 3140 Market St., BOSSONE 718, Philadelphia, PA 19104
| | - Anita Singh
- Department of Biomedical Engineering, Widener University, One University Place, Chester, PA 19013
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Lee JA, Smith BT, Egro FM, Stanger M, Koster W, Grunwaldt LJ. Timing of Nerve Recovery After Nerve Grafting in Obstetrical Brachial Plexus Palsy Patients With Isolated Upper Trunk Neuromas. Ann Plast Surg 2021; 87:446-450. [PMID: 34559713 DOI: 10.1097/sap.0000000000002939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The timing of nerve recovery after nerve grafting in obstetrical brachial plexus palsy patients has not been well reported. One prior study reported a return to baseline function at 3 to 6 months postoperatively. However, there is a paucity of studies to corroborate this timing, and there have been no studies delineating the timeline to obtain clinically meaningful function. METHODS OBPP patients with upper trunk neuromas-in-continuity who were treated with resection and sural nerve grafting at a single institution were studied. Time to return to baseline function was assessed by Active Movement Scale (AMS) scores preoperatively and postoperatively. Time to clinically meaningful function, defined as an AMS score of ≥6, was also assessed. RESULTS Eleven patients with isolated upper trunk neuromas-in-continuity underwent excision and reversed sural nerve grafting. Three of 11 patients also underwent spinal accessory to suprascapular nerve transfers. Average age at surgery was 9.8 ± 1.9 months. One patient did not have follow-up data and was excluded. Average follow-up was 37.1 ± 16.8 months. Average return to baseline AMS score was approximately 4 to 8 months for shoulder abduction, shoulder flexion, shoulder external rotation, elbow flexion, and forearm supination. Clinically meaningful function was obtained in most patients between 9 and 15 months. The remaining patients who did not achieve clinically meaningful function had all obtained scores of 5, which reflects less than one half normal range of motion against gravity. CONCLUSIONS Nerve recovery after surgical intervention in OBPP patients who undergo resection of an upper trunk neuroma-in-continuity and nerve grafting is more rapid than in adults but longer than previously reported in OBPP literature. This study provides an important data point in delineating the timeline of nerve recovery.
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Affiliation(s)
- Jessica A Lee
- From the Department of Plastic Surgery, University of Pittsburgh Medical Center
| | - Brandon T Smith
- From the Department of Plastic Surgery, University of Pittsburgh Medical Center
| | - Francesco M Egro
- From the Department of Plastic Surgery, University of Pittsburgh Medical Center
| | - Meg Stanger
- Division of Pediatric Plastic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Wendy Koster
- Division of Pediatric Plastic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Lorelei J Grunwaldt
- Division of Pediatric Plastic Surgery, Children's Hospital of Pittsburgh, Pittsburgh, PA
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Gkiatas I, Kostas-Agnantis I, Batistatou A, Kosmas D, Korompilia M, Gelalis I, Pakos E, Vekris M, Korompilias A. Neonatal brachial plexus injuries and their impact on growing bone. An experimental study. Injury 2020; 51:2851-2854. [PMID: 32122625 DOI: 10.1016/j.injury.2020.02.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/17/2020] [Accepted: 02/21/2020] [Indexed: 02/02/2023]
Abstract
Neonatal brachial plexus palsy remains a problem, even in light of current advances in perinatal care. While many cases resolve spontaneously, the concern remains on the best means of surgical management for restoration of elbow flexion and shoulder reanimation. The present experimental study in an animal model examines the evidence that supports that neonatal brachial plexus injuries result in structural changes in the affected bone. The study suggests that if the microsurgical reinnervation takes place early enough, these changes may be diminished. On the other hand there is no way to identify at birth, which injuries will be permanent and will need surgical repair and which will spontaneously improve.
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Affiliation(s)
- Ioannis Gkiatas
- Department of Orthopaedic Surgery, University of Ioannina, School of Medicine, Ioannina, Greece.
| | - Ioannis Kostas-Agnantis
- Department of Orthopaedic Surgery, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Anna Batistatou
- Department of Pathology, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Dimitrios Kosmas
- Department of Orthopaedic Surgery, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Maria Korompilia
- Department of Orthopaedic Surgery, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Ioannis Gelalis
- Department of Orthopaedic Surgery, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Emilios Pakos
- Department of Orthopaedic Surgery, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Marios Vekris
- Department of Orthopaedic Surgery, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Anastasios Korompilias
- Department of Orthopaedic Surgery, University of Ioannina, School of Medicine, Ioannina, Greece
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Orozco V, Balasubramanian S, Singh A. A Systematic Review of the Electrodiagnostic Assessment of Neonatal Brachial Plexus. NEUROLOGY AND NEUROBIOLOGY (TALLINN, ESTONIA) 2020; 3. [PMID: 33043293 PMCID: PMC7546533 DOI: 10.31487/j.nnb.2020.02.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Despite improvements in obstetric care, neonatal brachial plexus palsy continues to significantly impact infants’ lives worldwide, with an incidence of 1 to 4 per 1000 live births. While a majority of affected infants recover spontaneously by three months, 20-30% suffer permanent functional deficits that significantly impair their quality of life. Anatomical complexity of the brachial plexus results in varying degrees of injury and pathological changes at multiple levels within the plexus. Current clinical diagnosis relies on electrodiagnostic techniques such as nerve conduction (i.e., motor and sensory) and electromyography studies. These techniques not only aid clinicians to differentiate between axonal and demyelinating lesions, evident by changes in signal shape and conduction, but also provide prognostic information in cases of brachial plexus injuries. The presented study offers a comprehensive review of existing literature on electrodiagnostic techniques employed for assessing neonatal brachial plexus injuries.
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Affiliation(s)
- Virginia Orozco
- Drexel University, School of Biomedical Engineering, Science and Health Systems, Philadelphia, Pennsylvania, USA
| | - Sriram Balasubramanian
- Drexel University, School of Biomedical Engineering, Science and Health Systems, Philadelphia, Pennsylvania, USA
| | - Anita Singh
- Widener University, School of Engineering, Chester, Pennsylvania, USA
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Cunha MRD, Dias AAM, Brito JMD, Cruz CDS, Silva SK. Anatomical study of the brachial plexus in human fetuses and its relation with neonatal upper limb paralysis. EINSTEIN-SAO PAULO 2020; 18:eAO5051. [PMID: 31994607 PMCID: PMC6980293 DOI: 10.31744/einstein_journal/2020ao5051] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 09/11/2019] [Indexed: 11/13/2022] Open
Abstract
Objective To study the anatomy of the brachial plexus in fetuses and to evaluate differences in morphology during evolution, or to find anatomical situations that can be identified as the cause of obstetric paralysis. Methods Nine fetuses (12 to 30 weeks of gestation) stored in formalin were used. The supraclavicular and infraclavicular parts of the brachial plexus were dissected. Results In its early course, the brachial plexus had a cord-like shape when it passed through the scalene hiatus. Origin of the phrenic nerve in the brachial plexus was observed in only one fetus. In the deep infraclavicular and retropectoralis minor spaces, the nerve fibers of the brachial plexus were distributed in the axilla and medial bicipital groove, where they formed the nerve endings. Conclusion The brachial plexus of human fetuses presents variations and relations with anatomical structures that must be considered during clinical and surgical procedures for neonatal paralysis of the upper limbs.
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Rehabilitation of Neonatal Brachial Plexus Palsy: Integrative Literature Review. J Clin Med 2019; 8:jcm8070980. [PMID: 31284431 PMCID: PMC6679188 DOI: 10.3390/jcm8070980] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/01/2019] [Accepted: 07/02/2019] [Indexed: 11/24/2022] Open
Abstract
This integrative literature review has been carried out with the aim of analyzing the scientific literature aimed at identifying and describing existing rehabilitation treatments/therapies for neonatal brachial plexus palsy (NBPP). NBPP is a frequent consequence of difficult birthing, and it impairs the function of the brachial plexus in newborns. This is why knowledge on rehabilitation strategies deserves special attention. The data collection was carried out in January 2019, in the EBSCOhost and BVS (Biblioteca Virtual em Saúde) platforms, in the CINAHL Complete, MEDLINE Complete, LILACS and PubMed databases. Thirteen articles were included in this integrative literature review, based on a literature search spanning title, abstract and full text, and considering the inclusion criteria. Two main treatments/therapies for NBPP rehabilitation were identified: conservative treatment and surgical treatment. Conservative treatment includes teamwork done by physiatrists, physiotherapists and occupational therapists. These professionals use rehabilitation techniques and resources in a complementary way, such as electrostimulation, botulinum toxin injection, immobilizing splints, and constraint induced movement therapy of the non-injured limb. Professionals and family members work jointly. Surgical treatment includes primary surgeries, indicated for children who do not present any type of spontaneous rehabilitation in the first three months of life; and secondary surgeries, recommended in children who after primary surgery have some limitation of injured limb function, or in children who have had some spontaneous recovery, yet still have significant functional deficits. Treatment options for NBPP are defined by clinical evaluation/type of injury, but regardless of the type of injury, it is unanimous that conservative treatment is always started as early as possible. It should be noted that there was no evidence in the literature of other types of rehabilitation and techniques used in clinical practice, such as preventive positioning of contractures and deformities, hydrotherapy/aquatic therapy, among others, so we consider there is a need for further studies at this level in this area.
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Outcomes from primary surgical reconstruction of neonatal brachial plexus palsy in 104 children. Childs Nerv Syst 2019; 35:349-354. [PMID: 30610478 DOI: 10.1007/s00381-018-04036-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE The outcome from microsurgical reconstruction of neonatal brachial plexus palsy (NBPP) varies, and comparison between different series is difficult, given the differences in preoperative evaluation, surgical strategies, and outcome analysis. To evaluate our results, we reviewed a series of children who underwent surgical treatment in a period of 14 years. METHODS We made a retrospective review of 104 cases in which microsurgical repair of the brachial plexus was performed. Strength was graded using the Active Movement Scale. Whenever possible, upper palsies underwent surgery 4 to 6 months after birth and total lesions around 3 months. The lesions were repaired, according to the type of injury: neurolysis, nerve grafting, nerve transfer, or a combination of techniques. The children were followed for at least 24 months. RESULTS The majority of cases were complete lesions (56/53.8%). Erb's palsy was present in 10 cases (9.6%), and 39 infants (37.5%) presented an extended Erb's palsy. The surgical techniques applied were neurolysis (10.5%), nerve grafts (25.9%), nerve transfers (34.6%), and a combination of grafts and transfers (30.7%). The final outcome was considered poor in 41.3% of the cases, good in 34.3%, and excellent in 24%. A functional result (good plus excellent) was achieved in 58.3% of the cases. CONCLUSIONS There is no consensus regarding strategies for treatment of NBPP. Our surgical outcomes indicated a good general result comparing with the literature. However, our results were lower than the best results reported. Maybe the explanation is our much higher number of total palsy cases (53.8% vs. 25% in the literature).
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Secondary procedures for restoration of upper limb function in late cases of neonatal brachial plexus palsy. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:329-336. [DOI: 10.1007/s00590-019-02362-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 01/02/2019] [Indexed: 12/17/2022]
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Yilmaz V, Umay E, Tezel N, Gundogdu I. Timing of rehabilitation in children with obstetric upper trunk brachial plexus palsy. Childs Nerv Syst 2018; 34:1153-1160. [PMID: 29623411 DOI: 10.1007/s00381-018-3790-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/28/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The initiation timing of rehabilitation in children with obstetric brachial plexus palsy is controversial. The aim of the present study is to evaluate the effectiveness of rehabilitation timing to the functional outcomes of patients with obstetric upper trunk brachial plexus palsy. MATERIAL AND METHODS Twenty-nine patients, who did not previously received any rehabilitation programme but attended our outpatient clinic, were included for the study. The electrophysiological findings, obstetric characteristics, and demographic features of the patients were recorded. The range of motion (ROM) of shoulders, elbows, and wrists and the strength of the muscles associated with these joints were evaluated. Modified Mallet Scale (MMS) was used for functional evaluation. A 4-week rehabilitation programme was performed twice at 2-month intervals. Patients were divided into three groups according to their ages as follows: 1-3 years old (group 1), 3-5 years old (group 2), and 5-7 years old (group 3). The ROMs, muscle strengths, and MMS scores of the patients were all evaluated. RESULTS Two out of 29 patients were female (6.9%) and 27 were male (93.1%). All 29 patients had right upper extremity palsy (100%). The MMS scores, ROMs, and muscle strength of the upper extremities had improved in all the groups following the standardized rehabilitation programme. CONCLUSIONS A rehabilitation programme is the best choice of treatment before surgical procedures in patients with mild to moderate obstetric upper trunk brachial plexus palsy regardless of age and the initiation time.
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Affiliation(s)
- Volkan Yilmaz
- Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Physical Rehabilitation Medicine Clinic, Irfan Bastug Street, Altindag, Ankara, Turkey.
| | - Ebru Umay
- Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Physical Rehabilitation Medicine Clinic, Irfan Bastug Street, Altindag, Ankara, Turkey
| | - Nihal Tezel
- Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Physical Rehabilitation Medicine Clinic, Irfan Bastug Street, Altindag, Ankara, Turkey
| | - Ibrahim Gundogdu
- Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Physical Rehabilitation Medicine Clinic, Irfan Bastug Street, Altindag, Ankara, Turkey
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