Narakas classified babies with obstetric palsy into four groups: upper Erb's, extended Erb's, total palsy, and total palsy with a Horner. Over the last 15 years, it was noted at our obstetric palsy clinic that good spontaneous recovery in newborns with extended Erb's palsy (C5, C6, C7 injury) was more likely if they recovered active wrist extension against gravity before 2 months of age. A hypothesis was made that newborns with extended Erb's palsy (Narakas Group II) may be subclassified into two groups according to this 'early recovery of wrist extension.' In a retrospective study of 581 cases with strict inclusion criteria, the hypothesis was found to be true: patients with extended Erb's and 'early recovery of wrist extension' have significantly higher percentages of good spontaneous recovery of limb function than those with extended Erb's and 'no early recovery of wrist extension' (P<0.0001 by chi-squared test).

BackgroundBrain training games (BTG) are believed to play a major role in improving cognitive functions. The current study evaluated if BTG showed positive impact on attention and memory functions compared with baseline visit in healthy subjects.Material/MethodsThe study was carried out from October 2015 until April 2016 in the Department of Physiology, College of Medicine, King Saud University and in King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia.We enrolled 51 normal healthy subjects to use a computerized cognitive training game (Lumosity) for exercises that target a range of cognitive functions, including attention, processing speed, visual memory, and executive functions for about 15 min per day, at least 7 days per week, for 3 weeks. The control (n=21) group did not perform the training. Both groups took the CANTAB test before and 3 weeks after training for various cognitive functions (flexibility, memory, attention, speed, and problem solving). Serum samples were used to study the brain-derived growth factor (BDNF) and apolipoprotein (Apo) E (APOE) levels.ResultsA significant improvement in Lumosity performance index was observed in the active group compared to the control group by the end of training (p-value 0.001). After the training, a statistically significant difference in most of the CANTAB measures, such as attention-switching task (AST), mean correct latency, AST switching cost, AST mean correct latency (congruent), AST mean correct latency (incongruent), AST mean correct latency (blocks 3 and 5) [non-switching blocks], AST mean correct latency (block 7) [switching block], and MOT mean correct latency (all P=0.000). However, in the control group, significant improvements were not observed. A positive correlation between pattern recognition memory (PRM) and APOE was found and people who had higher ApoE levels had faster response.ConclusionsAn improvement in different cognitive domains was noted, including attention and motor speed. However, this study warrants further research to determine the long-term effect on other cognitive functions and in different groups (e.g., elderly vs. adults).

Compared to non-diabetic mothers, diabetic mothers are known to deliver larger babies who are at higher risk for shoulder dystocia and obstetric brachial plexus palsy. The intrapartum forces applied during delivery of larger babies are expected to be higher. Hence, the chances of these babies for good spontaneous recovery are expected to be lower; and this is a generally believed hypothesis. The objective of this retrospective study was to compare obstetric brachial plexus palsy in newborn babies of diabetic and non-diabetic mothers. There were a total of 655 cases of obstetric palsy: 253 cases with diabetic mothers and 402 with non-diabetic mothers. The former were more likely to develop total palsy while the latter were more likely to develop extended Erb's palsy. Newborn babies of diabetic mothers had significantly larger birth weights than those of non-diabetic mothers regardless of the type of palsy. The rate of good spontaneous recovery of the motor power of the limb in the two groups was not significantly different except in total palsy cases for shoulder external rotation and elbow flexion where the recovery was significantly better in the diabetic group. It was concluded that the generally believed hypothesis is not correct if one compares the outcome in the diabetic and non-diabetic groups for each type of palsy.

Flexor profundus lacerations in the distal part of zone I are usually treated by tendon reinsertion into bone. We present a modified technique in which three 'figure of eight' sutures include the palmar plate in the distal purchase. Inclusion of the palmar plate significantly strengthens the tensile strength of the repair and this was confirmed biomechanically in an experimental study. In a prospective clinical study, 15 patients with clean-cut complete lacerations of the profundus tendon in the distal part of zone I underwent the modified repair technique of three separate 'figure of eight' sutures with the palmar plate included in the suture distally and 7 mm suture purchase proximally, with postoperative immediate active motion that ensured full active extension of the interphalangeal joints. There were no ruptures or infections. At final follow-up 12-25 weeks after surgery, the mean range of motion at the distal, proximal, and combined interphalangeal joints was 66 degrees, 100 degrees and 166 degrees respectively. All patients achieved an excellent or good outcome.

In this retrospective study we compared obstetric brachial plexus palsy (OBPP) in two non-operated groups of newborn babies delivered vaginally by breech or cephalic presentation. There were 35 cases of OBPP in the breech group and 663 cases in the cephalic group. The former group was more likely to develop upper Erb's palsy while the latter group was more likely to develop total palsy. The breech group also had a significantly lower mean birth weight, a significantly higher percentage of bilateral OBPP palsies and concurrent phrenic nerve palsy. Spontaneous recovery of shoulder abduction and elbow flexion in newborn babies with upper Erb's palsy was significantly worse in the breech compared with the cephalic group. It was concluded that OBPP following vaginal breech delivery has several unique demographic features and breech babies with upper Erb's palsy have a worse prognosis for spontaneous recovery than those in the cephalic group.