Relative importance of factors affecting activity and upper extremity function in children with Narakas Group 2
Kıvanç Delioğlu1, Akin Uzumcugil2, Ebru Öztürk3
1Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
Insights
Children with Narakas Group 2a obstetric brachial plexus injury show better upper limb function than Group 2b. Shoulder internal rotation is key for improving function in these pediatric patients.
Area of Science:
- Pediatric Orthopedics
- Neurology
- Rehabilitation Medicine
Background:
- Obstetric brachial plexus injury (OBPI) affects pediatric upper limb function.
- Narakas classification groups OBPI severity.
- Understanding functional differences in OBPI groups is crucial for targeted interventions.
Purpose of the Study:
- Compare upper limb function and activity/participation in preschool children with Narakas Groups 2a and 2b OBPI.
- Identify factors significantly impacting upper limb function in pediatric OBPI.
Main Methods:
- Evaluated 67 non-surgically treated children (3-7 years) with OBPI.
- Assessed joint movements, Mallet, Raimondi, Brachial Plexus Outcome Measure, PODCI, and stereognosis.
- Compared functional outcomes between Narakas Group 2a and 2b.
Main Results:
- Significant functional differences favored Narakas Group 2a.
- Hand-to-spine, global abduction, and hand-to-mouth movements were most significant for overall function (p < 0.001).
- Passive internal rotation was the most critical passive shoulder movement (p < 0.001).
Conclusions:
- Children in Narakas Group 2a demonstrate superior upper limb function compared to Group 2b.
- Treatment strategies for OBPI should prioritize improving shoulder internal rotation.
- Targeted interventions focusing on specific movements can enhance functional outcomes in pediatric OBPI.
Abstract:
The aim of the study was to determine the differences in upper limb function and activity/participation levels between preschool children with Narakas Groups 2a and 2b obstetric brachial plexus injury; and to determine the significance level of the factors affecting upper limb functions in these patients. Sixty-seven children, aged 3 to 7, who had not had surgical intervention, were evaluated in terms of joint movements, modified Mallet classification, Raimondi hand classification, brachial plexus outcome measure, paediatric outcome data collection instrument and stereognosis. There were significant functional differences between the groups, in favour of Group 2a. The movements affecting total function of the upper limb were: hand to spine (p < 0.001), global abduction (p < 0.001) and hand to mouth (p < 0.001), in descending order of significance. Passive internal rotation was the most important passive joint movement affecting shoulder function (p < 0.001). The results of this study suggest that more emphasis should be placed on the shoulder internal rotation in treatment strategies.Level of evidence: III.
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