Activity-based hand-function profile in preschool children with obstetric brachial plexus palsy

Area of Science:

• Pediatric Orthopedics
• Neurology
• Rehabilitation Medicine

Background:

• Obstetric brachial plexus palsy (OBPP) can cause significant hand-function disorders in children.
• Existing literature suggests hand function is often preserved in upper-root brachial plexus injuries, questioning the need for detailed hand function evaluation.
• Understanding activity-based hand function profiles across different OBPP severity levels is crucial for targeted interventions.

Purpose of the Study:

• To determine activity-based hand function profiles in preschool children diagnosed with varying functional levels of obstetric brachial plexus palsy (OBPP).
• To compare hand function outcomes based on the Narakas classification system.
• To identify specific activity restrictions in children with OBPP and assess the utility of activity-based assessments.

Main Methods:

• 112 preschool children (44-77 months) with OBPP were classified into Narakas groups 1 (type 1), 2 (type 2), and 3 (types 3+4).
• Hand function was evaluated using the Raimondi scale, stereognosis testing, and the Brachial Plexus Outcome Measure (BPOM) focusing on hand, elbow/forearm, and wrist/finger/thumb activities.
• Statistical analysis was performed to compare outcomes between the Narakas groups.

Main Results:

• Children in Narakas groups 1 and 2 demonstrated comparable completion of BPOM hand activities, but Group 1 excelled in BPOM elbow/forearm activities.
• Group 2 exhibited difficulties with elbow flexion, supination, and pronation, while Group 1 struggled mainly with supination.
• Group 3 showed significantly lower scores across all evaluated measures, including the Raimondi scale, BPOM-hand, BPOM-elbow/forearm, and stereognosis, indicating severe functional deficits. Grasp was absent and thumb function deficient in total plexus injury.
• Activity restrictions related to forearm rotation were observed even in cases where literature suggests preserved hand function.

Conclusions:

• Activity-based assessments are essential for identifying nuanced hand function restrictions in children with OBPP, including limitations in forearm rotation.
• The findings challenge the assumption that hand function is always conserved in milder OBPP, emphasizing the need for specific evaluations.
• Population-specific activity-based assessments effectively identify functional deficits in children with OBPP, from mild to total plexus injuries.