Close-to-body Reachable Workspace in Children with Brachial Plexus Birth Injuries
Madison M Lovette, MS1, R. Tyler Richardson, PhD2, Stephanie A Russo, MD, PhD1, Emily Nice, BS3, Ross S Chafetz, DPT, PhD4, Dan A Zlotolow, MD3 and Scott H Kozin, MD3, 1Akron Children's Hospital, Akron, OH, 2Penn State University - Harrisburg, Middletown, PA, 3Shriners Hospitals for Children, Philadelphia, PA, 4Department of Orthopaedic Surgery, Shriners Hospitals for Children, Philadelphia, PA
Introduction
Brachial plexus birth injuries (BPBI) occur in about 1 of every 1000 live births. Reachable workspace analysis provides an assessment of global upper extremity function by measuring the regions in space that a patient can reach with their hand. Typical assessments only include outer, far-from-body measurements. Prior studies have demonstrated decreased outer reachable workspace for the affected limb of children with BPBI. The purpose of this pilot study was to assess inner (close-to-body) reachable workspace using real-time feedback in children with BPBI.
Methods
A total of 10 subjects (average age 7.3 years) with unilateral BPBI and no prior shoulder surgery participated in data collection. Real-time feedback was utilized to measure each participant's workspace on the affected and unaffected limbs. Targets surrounding an avatar representing the participant were displayed on a screen and disappeared as the participant reached them. The percent of theoretically available workspace reached was computed for each region and each limb. A series of paired t-tests were used to determine if within-subjects interlimb differences reached statistical significance for each region analyzed and Bonferroni corrections were used to account for multiple comparisons.
Results
The affected limb had significantly less percent workspace for 6 of 9 inner workspace regions (Figure 1). All three regions of the head had significant differences between the affected and unaffected limbs. The anterior ipsilateral thoracic region and the anterior/posterior ipsilateral abdominal regions showed significant differences between the affected and unaffected limbs.
Conclusions
The regions that showed significant differences often correspond with common deficits that are found in BPBI patients. All three head regions showed significant differences, which all require shoulder elevation to complete. The anterior ipsilateral thoracic region requires shoulder external rotation and/or extension. The anterior and posterior ipsilateral abdominal regions also require shoulder external rotation and/or extension. Overall, the results show that the affected limbs had significantly less inner reachable workspace than the unaffected limbs in children with BPBI. A combination of inner and outer reachable workspace would be informative for future clinical assessments and research projects related to children with BPBI.
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