A systematic review of evaluation methods for neonatal brachial plexus palsy

Abstract

Object Neonatal brachial plexus palsy (NBPP) affects 0.4-2.6 newborns per 1000 live births in the US. Many infants recover spontaneously, but for those without spontaneous recovery, nerve and/or secondary musculoskeletal reconstruction can restore function to the affected arm. This condition not only manifests in a paretic/paralyzed arm, but also affects the overall health and psychosocial condition of the children and their parents. Currently, measurement instruments for NBPP focus primarily on physical ability, with limited information regarding the effect of the disablement on activities of daily living and the child's psychosocial well-being. It is also difficult to assess and compare overall treatment efficacy among medical (conservative) or surgical management strategies without consistent use of evaluation instruments. The purpose of this study is to review the reported measurement evaluation methods for NBPP in an attempt to provide recommendations for future measurement usage and development. Methods The authors systematically reviewed the literature published between January 1980 and February 2012 using multiple databases to search the keywords "brachial plexus" and "obstetric" or "pediatrics" or "neonatal" or "congenital." Original articles with primary patient outcomes were included in the data summary. Four types of evaluation methods (classification, diagnostics, physical assessment, and functional outcome) were distinguished among treatment management groups. Descriptive statistics and 1-way ANOVA were applied to compare the data summaries among specific groups. Results Of 2836 articles initially identified, 307 were included in the analysis, with 198 articles (9646 patients) reporting results after surgical treatment, 70 articles (4434 patients) reporting results after medical treatment, and 39 articles (4247 patients) reporting results after combined surgical and medical treatment. Among medical practitioners who treat NBPP, there was equivalence in usage of classification, diagnostic, and physical assessment tools (that focused on the Body Function and Structures measure of the International Classification of Functioning, Disability, and Health [ICF]). However, there was discordance in the functional outcome measures that focus on ICF levels of Activity and Participation. Of the 126 reported evaluation methods, only a few (the Active Movement Scale, Toronto Scale Score, Mallet Scale, Assisting Hand Assessment, and Pediatric Outcomes Data Collection Instrument) are specifically validated for evaluating the NBPP population. Conclusions In this review, the authors demonstrate disparities in the use of NBPP evaluation instruments in the current literature. Additionally, valid and reliable evaluation instruments specifically for the NBPP population are significantly lacking, manifesting in difficulties with evaluating the overall impact and effectiveness of clinical treatments in a consistent and comparative manner, extending across the various subspecialties that are involved in the treatment of pat...

Quality of Life and Upper Limb Function of Children With Neonatal Brachial Plexus Palsy

“…These behaviors could be related to feelings such as anger or irritation due to the differences in task performance when compared to that in other children. 9 In addition, NBPP children undergo several therapies without a guarantee of functional improvement, 30 and this uncertainty of outcomes could also trigger negative emotions, such as anxiety or fear, 13 which could influence these results. However, it was surprise in the self-esteem domain that parents of NPBB children reported scores similar to those of unaffected controls.…”

Relationships Between 3 Classification Systems in Brachial Plexus Birth Palsy

“…12 Several different scoring systems will be encountered within available studies that investigate BPBP. The modified Mallet, AMS, and Toronto Test are the only 3 physical evaluation methods validated for use in children with BPBP.…”

“…12 The 3 scoring systems validated by Bae et al 10 each possess distinct grading criteria. 12 The 3 scoring systems validated by Bae et al 10 each possess distinct grading criteria.…”

C8 cross transfer for the treatment of caudal brachial plexus avulsion in three dogs

“…In the dog and in people, the treatment of BPA is usually palliative. However, recent studies have reported that rootlet reimplantation into the spinal cord in people can promote motor reinnervation of denervated muscles . In the dog, this potential surgical therapy for brachial plexus injuries has unsatisfactory results because of the large distance of neurotization from the spinal cord to the muscular effector, and because of the low number of motor neurons that can regenerate through the reimplanted rootlets .…”