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Active Range of Motion Over Time in Patients With Obstetrical Brachial Plexus Palsy: A 10-Year Analysis
Robert Bains1, Abdullah Kattan2, Christine G Curtis3
1Division of Plastic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Insights
Children with obstetrical brachial plexus palsy did not show a loss of active range of motion over time. This study found no diminished active movement scores at 10-year follow-up in operated and non-surgical patients.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Rehabilitation Medicine
Background:
- Obstetrical brachial plexus palsy (OBPP) can impact a child's motor function.
- Previous observations suggested a potential decline in active range of motion (AROM) over time in OBPP patients.
- The long-term trajectory of AROM in OBPP patients requires further investigation.
Purpose of the Study:
- To investigate whether a loss of active range of motion occurs over time in children with obstetrical brachial plexus palsy.
- To evaluate the long-term functional outcomes in both surgical and non-surgical OBPP cohorts.
- To determine if initial recovery of AROM is sustained throughout childhood.
Main Methods:
- Retrospective analysis of 139 OBPP patients from a specialized clinic (1991-2000).
- Patients were categorized into non-surgical (n=42) and surgical (n=97) groups.
- Active Movement Scale assessed 15 joint movements at multiple time points (2, 4-6, 9-11 years, and final follow-up) with 10-year minimum follow-up.
Main Results:
- Active movement scores remained stable and were not diminished at the 10-year follow-up visit.
- No significant difference in the change of AROM over time was observed between surgical and non-surgical groups.
- The study did not find evidence supporting a progressive loss of active motion in OBPP patients up to 10 years of age.
Conclusions:
- The anticipated decline in active range of motion over time in obstetrical brachial plexus palsy patients is not supported by 10-year follow-up data.
- Active movement capabilities appear to be maintained in the long term for children with OBPP.
- This finding suggests a favorable long-term prognosis regarding active motion in this patient population.
Purpose:
In our experience, and from the personal report of others, children with obstetrical brachial plexus palsy appear to lose some of their initially recovered active range of motion over the time in both operated and nonsurgical patients. This study investigates whether such a diminution of active movement occurs over time.
Methods:
We performed a retrospective analysis of data from our obstetrical brachial plexus clinic. Between 1991 and 2000, 139 patients with a minimum follow-up of 10 years were included in the study. Patients were divided into a nonsurgical group (n = 42) and a group who underwent either primary or secondary brachial plexus reconstruction or both (n = 97). Fifteen joint movements were assessed at 2, 4 to 6, and 9 to 11 years of age and at later final follow-up using the Active Movement Scale. Repeated measures analysis using age at each visit as the repeated measures covariate was undertaken.
Results:
Active movement scores were not diminished when patients were evaluated at the 10-year follow-up visit.
Conclusions:
The suggested loss of active range of motion over time is not demonstrated at 10-year follow-up.
Type Of Study/Level Of Evidence:
Prognostic III.
