Cognitive and Executive Function Profiles in School‑Age Children with Obstetric Brachial Plexus Injury

To evaluate cognitive and executive function (EF) in children with obstetric brachial plexus injury (OBPI), and the potential effects of injury severity and surgical intervention.

Fifty-two children aged 6-12 years were assessed: 30 with OBPI (Type IIa: n = 10, Type IIb: n = 11, Type III-IV: n = 9) and 22 children with typical development. Cognitive function was measured using the Dynamic Occupational Therapy Cognitive Assessment for Children (DOTCA-Ch), and EF was assessed via parent-reported Childhood Executive Functioning Inventory (CHEXI). Non-parametric tests and subgroup analyses were conducted, with false discovery rate (FDR) correction applied for multiple comparisons.

Children with OBPI scored significantly lower on total and domain-specific DOTCA-Ch measures (median [IQR]: 85 [72-95] vs. 125 [115-135]; q = 0.002), with large effect sizes (Cliff's δ = -0.82 to -0.90). No significant differences were found in CHEXI EF composites. Subgroup analyses showed no statistically significant effects of surgery or Narakas classification, although trends indicated potentially poorer cognitive outcomes in children with Narakas type III-IV.

Children with OBPI had lower cognitive function than children with typical development but there was no difference in EF. Findings support integrating cognitive assessments into management of children with OBPI.