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

Effect of Muscle Strength on Functionality after Shoulder Tendon Transfer in Brachial Plexus Birth Injury: Is There a Relationship between Them?

BACKGROUND/OBJECTIVES

Secondary problems in BPBI occur due to decreased muscle strength in the upper extremities. Comprehensive assessment methods are necessary to understand structural problems and to plan appropriate interventions in children with BPBI. We investigated the relationship between distal muscle strength, range of motion (ROM), and functionality by comparing distal muscle strength on the affected and unaffected sides in patients with BPBI who underwent shoulder tendon transfer.

METHODS

A total of 25 children with BPBI, 13 (52%) girls and 12 (48%) boys, aged 4-7 years (mean age: 5.98 ± 1.27 years), who had undergone shoulder tendon transfer surgery at least one year prior to the study were included. The muscle strength of the elbow, forearm, and wrist were assessed using the MicroFET®2 Digital Hand Dynamometer. The ROM of the elbow, forearm, and wrist were measured using the universal goniometer. The Pediatric Evaluation of Disability Inventory (PEDI) was used for functionality assessment.

RESULTS

The strength of the elbow flexor-extensor, forearm pronator-supinator, and wrist extensor muscles on the affected side was greater than on the unaffected side in all children (p < 0.001). No correlation was found between muscle strength, ROM, and functionality in the affected extremity (p > 0.005).

CONCLUSIONS

Although children with BPBI have good shoulder function after shoulder tendon transfer, structural problems in the distal joints may affect their functionality during daily life. Distal joint strengthening and ROM exercises, as well as bimanual functional activities, should be included in the rehabilitation programs of children with BPBI after shoulder tendon transfer.

Impact of brachial plexus birth injury on health-related quality of life in adulthood: a mixed methods survey study

PURPOSE

To describe the scope and nature of health concerns, functional impairments, and quality of life issues among adults with brachial plexus birth injury (BPBI).

METHODS

A mixed methods study was conducted by surveying two social media networks of adults with BPBI using a combination of closed-ended and open-ended questions regarding the role of BPBI on ones' health, function, and quality of life. Closed-ended responses were compared across ages and genders. Open-ended responses were qualitatively analyzed to expand upon the close-ended responses.

RESULTS

Surveys were completed by 183 respondents (83% female, age range 20-87 years). BPBI was reported to impact hand and arm use in 80% of participants (including affected and unaffected limbs and bimanual tasks), overall health in 60% (predominantly pain), activity participation in 79% (predominantly activities of daily living and leisure), life roles in 76% (predominantly occupation and parenting), and overall quality of life in 73% (predominantly self-esteem, relationships, and appearance). Significantly more females than males reported other medical conditions and an impact on hand and arm use and life roles. No other responses varied by age or gender.

CONCLUSIONS

BPBI affects many facets of health related quality of life in adulthood with variability among affected individuals.

Mental health risk and protective factors associated with brachial plexus birth injuries: a scoping review

PURPOSE

The purpose of this scoping review is to synthesize the current evidence on the risk and protective factors associated with mental health in children with brachial plexus birth injury (BPBI) and associated interventions.

MATERIALS AND METHODS

MEDLINE, EMBASE, and Cochrane databases were searched for reports on mental health in children with BPBI between 10 and 18 years. Risk and protective factors were charted using the VicHealth review and the Person-Environment-Occupation model.

RESULTS

Of 732 records found, 133 full text reports were reviewed and 16 reports were included. Multiple mental health risks associated with BPBI were identified, while protective factors were largely unexplored. Person-related risks were most common including negative coping strategies (n = 8, 50%) and pain (n = 6, 38%). Most frequently reported environment and occupation risk factors were social difficulties (n = 9, 56%) and challenges with upper limb function and daily activities (n = 6, 38%). Good self-determination and/or self-concept (n = 5, 30%) was the most common protective factor.

CONCLUSIONS

Research using a strengths-based approach is needed to elucidate protective factors and further understanding of the intersection of person and socio-cultural risk factors of mental health in children with BPBI.

Quality of upper extremity skills and disability inventory via manual ability classification in children with neonatal brachial plexus palsy

PURPOSE

The aim of study was to investigate the relationship between upper extremity skill quality and disability inventory according to manual ability classification system in children with neonatal brachial plexus palsy (NBPP).

MATERIALS AND METHODS

Children with NBPP were included between the ages of 4-7.5 years. Children were classified in Manual Ability Classification System (MACS). Upper extremity skill quality was evaluated with Quality of Upper Extremity Skills Test (QUEST), disability status was assessed with Pediatric Evaluation of Disability Inventory (PEDI).

RESULTS

Total of 63 children (girls:31/boys:32), and mean age was 6.32 ± 1.73 years. 37 (58.73%) of children were at MACS Level-2. According to MACS classification, significant differences were noted in PEDI scores (p = 0.001), dissociated movements (p = 0.016) and grasp (p = 0.002) domains of QUEST. However, no significant differences between QUEST total scores (p = 0.079). PEDI (ROC; AuC = 0.762) and QUEST total score (ROC; AuC = 0.714) were sensitive to difference between groups across MACS in children with NBPP.

CONCLUSION

The PEDI and QUEST are sensitive in distinguishing the disability of children with NBPP at different MACS levels. Assessment of children with NBPP is not limited to functionality, disability, and quality of movement, it is multidimensional. Outcomes measures studies of movement's quality in children with NBPP are needed.

Intersection of physical and mental health of youth with brachial plexus birth injuries: A qualitative study

Introduction

Youth with brachial plexus birth injuries (BPBI) have an increased risk of mental health issues such as depression, anxiety, and diminished self-confidence. Despite this evidence, current standards of care focus on physical interventions. Evaluation of psychological and emotional concerns is rarely prioritized in clinical settings. Therefore, mental health needs are unmet and poorly understood.

Methods

An interpretivist qualitative approach was used to understand the perspectives of youth with BPBI and their caregivers on the barriers and facilitators of addressing mental health concerns, to inform practice guidelines, and promote meaningful participation within this population.

Results

A purposeful sample of nine youth with BPBI between 10 to 20 years and eight caregivers participated in in-depth interviews. The interviews were semi-structured and an average of 60 min (35-85 min) long. Three themes emerged from these data: (i) physical disability identity and mental health; (ii) pursuit of "normal" body image; and (iii) paradox of advocacy. Findings illuminated the intersection of physical and mental health in these youth and provides actionable practice recommendations. Areas of need were identified including mental health support around the challenges of advocacy, body image, surgery, and preparation for the 'aging out' process for youth and their families.

Conclusions

The well-being of youth with BPBI is a result of the intersection between their physical and mental health. Further research on optimizing mental health resources within physical health settings is needed to better support the holistic needs of these youth and their families.

Recent Advances in the Treatment of Brachial Plexus Birth Injury

LEARNING OBJECTIVES

After studying this article, the participant should be able to: 1. Describe methods of clinical evaluation for neurologic recovery in brachial plexus birth injury. 2. Understand the role of different diagnostic imaging modalities to evaluate the upper limb. 3. List nonsurgical strategies and surgical procedures to manage shoulder abnormality. 4. Explain the advantages and disadvantages of microsurgical nerve reconstruction and distal nerve transfers in brachial plexus birth injury. 5. Recognize the prevalence of pain in this population and the need for greater sensory outcomes evaluation.

SUMMARY

Brachial plexus birth injury (BPBI) results from closed traction injury to the brachial plexus in the neck during an infant's vertex passage through the birth canal. Although spontaneous upper limb recovery occurs in most instances of BPBI, some infants do not demonstrate adequate motor recovery within an acceptable timeline and require surgical intervention to restore upper limb function. This article reviews major advances in the management of BPBI in the past decade that include improved understanding of shoulder pathology and its impact on observed motor recovery, novel surgical techniques, new insights in sensory function and pain, and global efforts to develop standardized outcomes assessment scales.

Systematic Review of Visual Motor Integration in Children with Developmental Disabilities

Original research articles regarding visual motor integration skills in children with developmental disabilities and the impact of occupational therapy were identified, appraised, and synthesized. Twenty-four articles were chosen for this review. Themes were noted during the critique of articles. Three themes emerged: "age," "gender," and "diagnosis." Regarding the impact on visual motor integration, there was strong evidence for age, moderate evidence for gender, and strong evidence for diagnosis. Future research investigating visual motor integration in children should control for age and diagnosis.