Association between upper extremity muscle function and perfusion in children for predicting the effectiveness of rehabilitation in the post-traumatic period

Abstract

Background. The adverse social situation in Ukraine and an increase in the number of injured children lead to a burden on trauma departments and rehabilitation centers. Looking for simple methods to help detect violations of compensatory mechanisms, one of which is the centralization of blood circulation, and impaired perfusion at the microcirculatory periphery level is of great current relevance. Materials and methods. A comprehensive clinical and functional examinations were applied to 44 children aged 10–15 years, 21 of them had home-related upper extremity fractures (main group), 23 otherwise healthy children served as the control group. All the children underwent the Box and Block Test (BBT), and the perfusion index (PI) from the extremities was recorded. Results. The BBT performance was characterized by a 1.6-fold decrease (p < 0.05) in the affected extremity of children aged 10–15 years under the rehabilitation treatment compared to that of the non-dominant extremity in healthy children and a 1.3-fold decrease (p < 0.05) in the healthy extremity compared to the dominant one. PI decreased to 2.52 ± 0.58 at rest in the main group children who underwent upper extremity rehabilitation treatment for injuries compared to 3.49 ± 0.34 (p < 0.05) in healthy children. PI reduced to 1.57 ± 0.56 in injured children at exercise loads versus 2.93 ± 0.91 (p < 0.05) in healthy children. The dynamics of recovery also differed and amounted to 2.82 ± 0.45 in the main group versus 4.00 ± 0.64 in the control group. Children with PI up to 1.5 ± 0.4 had significantly lower BBT scores at the beginning of exercise training. PI reduction to less than 1.5 allowed predicting a decrease in muscle functions, delayed wound healing, and the need for analgesia. With an increase in PI to 2.40 ± 0.54 during exercise training, children performed BBT better, while those who had a decrease in perfusion up to 0.98 ± 0.20 performed it twice as slowly (p < 0.05). As a study result, an association between the physical exercise load, changes in PI and BBT has been revealed. Conclusions. BBT scores were characterized by a 1.6-, 2.0- and 1.8-fold (p < 0.05) reduction during the first, second and third measurements, respectively, compared to those of healthy children. Characteristic feature of perfusion index was a statistically significant decrease before and during exercise training as well as slow dynamics of recovery. The correlations between perfusion index and BBT have proven the association of the rehabilitation processes and blood flow restoration.