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

Transition of data acquisition out of the laboratory, into the real world offers a previously inaccessible perspective of physical function. This proves to be beneficial when assessing surgical intervention, especially after a traumatic brachial plexus injury (BPI) causing loss of motor function in an upper extremity (UE). Moving towards the use of real world data in clinical practice as an outcome measure, this study developed a method to report bilateral UE activity in patients with BPI. Three groups of ten subjects each participated in this study-healthy controls, subjects with traumatic BPI prior to surgical treatment (pre-), and subjects who had surgical reconstruction to treat BPI (post-). Subjects wore four activity monitors on bilateral forearms and upper arms for four days. Tri-axial acceleration data were used to calculate asymmetry indices for forearm and upper arm usage. Analysis revealed a bimodal distribution in the post- group, prompting division of this group into two subgroups based on injury type: pan-plexus and upper trunk. While median asymmetry indices at the forearm and upper arm were decreased in the post- group when compared to the pre- group, these differences were not significant. Compared to controls, the pre-surgery group (p < 0.0001, p < 0.0001) and post-surgery group with pan-plexus injuries (p = 0.0074, p = 0.0242) both exhibited statistically significant differences in forearm and upper arm asymmetry, respectively. Further investigation to establish clinically significant differences in asymmetry index is warranted. Importantly, analyzing the activity of UEs following treatment of a BPI provides objective real world evidence of function.