Application of a myoelectric elbow flexion assist orthosis in adult traumatic brachial plexus injury: patient perspectives

Abstract

Background: Individuals with brachial plexus injuries (BPIs) can be prescribed assistive devices, including myoelectric elbow orthoses (MEOs), for rehabilitation or functional use after failed treatment for elbow flexion restoration. Although recent case studies indicate potential for clinical improvements after using an MEO after BPI, the patients' perspectives on such use are still unknown.Objective: To explore patient perspectives on the use of an MEO after surgical treatment for a traumatic BPI. Study design: Qualitative using both a focus group and semistructured interviews. Methods: Patients with BPI that used an MEO were recruited. Five patients participated in an in-person focus group, whereas three patients participated in individual phone interviews. Themes that emerged from the focus group were compared against those that emerged from the personal interviews. Results: Feedback was grouped into three themes: device usage, hardware performance, and device design. Within each theme, positive elements, areas for improvement, and additional considerations emerged. Patients indicated a positive attitude toward using an MEO as a rehabilitation tool. They desired a streamlined, stronger device to support them and assist during activities of daily living. Conclusions: For patients with BPI, a well-designed MEO that meets their needs could assist with rehabilitation and increase independence in daily activities. Continued patient engagement in the evaluation and development of both medical devices and treatment plans offers the best opportunity for improved outcomes that are important to the patient.

Application of myoelectric elbow flexion assist orthosis in adult traumatic brachial plexus injury: a retrospective clinical study

“…The results reported in this study differ starkly from the “Patient Perspectives” study performed by Webber et al 17 This qualitative focus group of patients studied in this report was informative by the fact that the patients reported that the MEO did not meet their expectations. They reported that the MEO had limited utility in activities of daily living because of unpredictable operation.…”

“…19,20 Second, several questions on the DASH ask about activities of daily living, which require only minimal or even no assistance from the contralateral limb. Thus, while the focus group interviews reported by Webber et al 17 highlight patient frustration with not returning to preinjury levels, their responses on surveys may in fact still demonstrate improvement in some activities of daily living. Finally, little has been written about the method of collecting these surveys and the timing at which they are obtained, but this is a potential source of bias when done in a postoperative setting with the surgical team.…”

“…This study has demonstrated that the use of an MEO has utility among patients who have shown some return of elbow flexion strength but have failed to regain meaningful use of their extremity. Not only does this orthosis allow for improved use of the arm while it is being worn, 17 but also 12 patients had an increase in elbow flexion strength after a mean of 13 months of use. Patients with a shorter duration to initiation of MEO and those treated with free-functioning muscles were more likely to show gains in muscle grading.…”

Mechatronic Design of a Prototype Orthosis to Support Elbow Joint Rehabilitation

“…The results suggest a tremor power reduction of 99% in an experimental setting, while it has not been validated in a natural environment. Other relevant perspectives in the area are [ 17 , 18 , 19 ], which show different efforts to help treat different conditions that can affect the elbow through technology, which speaks to the relevance of the topic in the research community. The studies described above are focused on helping to treat different elbow alterations many times without validation by professionals specialized in the area; in addition, as far as the authors know, the mechatronic design of a technological proposal (orthosis) that supports the recovery of mobility using flexion–extension and pronation–supination movements has not been described, so it is a gap in the literature that this research aims to solve.…”