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Use of Wearable Sensors to Measure Improvements in Real-World Upper Extremity Activity after Brachial Plexus Reconstruction
Arakua N Welbeck, MD1; Catherine E Lang, PhD1; Yosita P Beamer, MBS1; David M Brogan, MD, MSc2; Christopher J Dy, MD1
1Washington University in St. Louis, St. Louis, MO; 2Washington University School of Medicine, St. Louis, MO

Introduction: Traumatic brachial plexus injuries (BPI) are devastating events that dramatically alter patients' lives. Reconstructive surgery aims to offer pain relief and optimize chances of functional improvement. Nevertheless, current tools available to assess function are riddled with shortcomings. Surgeon-graded active range-of-motion and strength scores are inconsistent and test joints in isolation, while patient-reported outcomes (PRO) are burdened with subjectivity, biases, and questionable psychometric properties. This study aims to explore the feasibility of using wearable sensors to objectively quantify trends in recovery and outcomes in persons with BPI.
Materials/Methods: BPI patients wore bilateral wrist-worn movement sensors (accelerometers) for 7-day periods at 6-month intervals. We calculated the ratio of magnitude (VM) and duration (VT) of use of the injured upper extremity (UE) relative to the uninjured UE. Elbow/shoulder manual muscle testing, DASH, Impact of BPI Questionnaire, PROMIS and SF-36 surveys were collected. Correlational analyses were used to assess the relationship between function(VT, VM) and PROs.
Results: We collected baseline pilot data from 1 pre-operative and 5 post-operative participants (average 22.5 months post-operative; 1 upper trunk; 2 cord level, 2 pan-plexus injuries), and 6-month test data for 3 participants (Figure). BPI participants (blue) had lower activity magnitudes (VM - panel A) and less activity time (VT - panel B) compared to controls (black, n=74), with interval increases in mean values at 6-month testing. Differences were most pronounced when expressed relative to unaffected side (panel C, time use ratio [time using affected limb relative to unaffected limb]). Lower magnitude ratios were associated with greater disability on DASH (r=-0.81) and Impact of BPI (r=-0.89). Patients with highest duration and magnitude of activity both had M4-M5 shoulder abduction and elbow flexion, while those with lowest time and magnitude had M0-M2 scores.
Conclusion: As expected, indices of real-world UE movement in BPI patients are modest compared to controls. In preliminary work, we have shown that increases in use can be tracked over time after BPI surgery. Future work will include an increased sample size and continued repeat testing over time, allowing greater characterization of trends in recovery after BPI.


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