Evaluation of Upper Extremity Reachable Workspace in Children With Brachial Plexus Birth Injury
Robert T Richardson1, Stephanie A Russo2, Ross S Chafetz3
1Pennsylvania State University at Harrisburg, Middletown, PA.
Insights
Brachial plexus birth injury (BPBI) causes upper extremity (UE) movement limitations. A reachable workspace tool effectively quantifies these UE impairments in children with BPBI, offering a more sensitive assessment.
Area of Science:
- Pediatric Orthopedics
- Rehabilitation Medicine
- Movement Science
Background:
- Brachial plexus birth injury (BPBI) leads to significant upper extremity (UE) functional limitations.
- Existing UE assessments for BPBI are often insensitive to subtle yet meaningful functional differences.
- Objective, quantitative measures are needed to accurately assess UE function in BPBI.
Purpose of the Study:
- To evaluate the efficacy of a real-time feedback reachable workspace tool for assessing UE movement in children with BPBI.
- To determine if this tool can detect and quantify functional deficits caused by BPBI.
Main Methods:
- Twenty-two children with BPBI underwent UE functional assessment using a 3D motion capture system.
- Real-time visual feedback guided participants to reach maximally in all body regions.
- Reachable workspace data (percentage and reach distance) were analyzed for interlimb differences across six regions.
Main Results:
- Children with BPBI demonstrated significantly reduced percentage workspace and median reach distance in all six assessed regions on the affected limb compared to the unaffected limb.
- Deficits ranged from 5.7% to 38.6% in workspace percentage and 3.1% to 36.8% in median reach distance across regions.
Conclusions:
- The reachable workspace approach successfully detected and quantified UE movement impairments in the affected limb of children with BPBI.
- These findings correlate with known BPBI-related movement limitations, such as restricted shoulder and elbow motion.
- The real-time feedback reachable workspace tool is a robust and sensitive method for assessing UE function in pediatric BPBI.
Purpose:
Brachial plexus birth injury (BPBI) results in upper extremity (UE) movement limitations. Current assessments of UE function used to inform clinical decision-making only evaluate a limited set of static postures and/or movements and have been criticized for being insensitive to certain meaningful differences in function. Reachable workspace provides a numeric and visual assessment of global UE movement ability by quantifying the regions in space that patients can reach with their hands, and it can be collected using real-time feedback to elicit a best-effort acquisition of function. This study evaluated the ability of a real-time feedback reachable workspace tool to assess UE movement in BPBI.
Methods:
Twenty-two children with BPBI participated. Reachable workspace data were collected with three-dimensional motion capture using real-time visual feedback to measure UE reaching ability in all regions surrounding the body. All outer, far-from-body points reached by the hand were recorded and analyzed by region. A two-way, within-subjects analysis of variance was used to assess interlimb differences in percentage workspace reached and median reach distance for each of the six regions.
Results:
The affected limb had significantly less percentage workspace reached than the unaffected limb for all six regions (mean interlimb differences by region, 5.7%-38.6%). The affected limb had significantly less median reach distance than the unaffected limb for all six regions (mean interlimb differences by region, 3.1%-36.8%).
Conclusions:
The workspace approach was capable of detecting UE movement impairments of the BPBI-affected limb. The reported deficits in workspace on the affected limb correspond to common movement impairments in BPBI, such as limitations in shoulder elevation, external rotation, extension, and elbow extension.
Clinical Relevance:
The real-time feedback reachable workspace tool is sufficiently robust for assessing UE movement impairments in children with BPBI.
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