The Use of Dynamic Assist Orthosis for Muscle Reeducation following Brachial Plexus Injury and Reconstruction

Abstract

Therapeutic management of brachial plexus injuries remains complex. The impact of brachial plexus injuries on everyday human functioning should not be underestimated. Early active-assisted range of motion following such injuries may prevent myostatic contractures, minimize muscle atrophy, facilitate muscle fiber recruitment, and enable a faster return to baseline strength levels. The dynamic assist elbow flexion orthosis proposed is designed to provide patients with a graded system for muscle reeducation and function. No clinical data are currently available on the use of this orthosis design; however, this article presents a treatment option based on sound clinical reasoning to facilitate rehabilitation following this devastating injury.

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

“…Prior reports in the literature document various forms of elbow flexion orthoses that have been indicated to assist with rehabilitation after insufficient recovery from a BPI. [3][4][5] These studies typically focused on the rehabilitative potential of the device and were oftentimes case studies in laboratory settings instead of determining the impact of the device on a patient's daily life. Although recent case studies indicate the potential for improvement in clinical outcomes using an MEO after BPI, the patients' perspectives on such use are still unknown.…”

Review of rehabilitation protocols for brachial plexus injury

“…Virtual reality and robotics combined to facilitate upper extremity pain management and sensory recovery after brachial plexus injury ( 44 ). The very first mention of dynamic orthoses as having a role in motor re-education came in 2018 ( 37 ), but more recent research has revealed that dynamic nocturnal orthoses are equally effective as continuous cast immobilization in treating elbow flexion contractures in kids with brachial plexus nerve birth injuries ( 45 ). As children’s upper extremities move less than those of adults, dynamic orthoses may only serve as a fixation device in children with brachial plexus injuries while offering more motor support in adults.…”

“…Treatment methods may rely on the expertise of experienced physicians and therapists. Power-assisted orthoses can offer a functional replacement in the end phase and have some effectiveness in motor re-education when the surgical benefit is not preferably factored in ( 37 ). Rehabilitation of brachial plexus injuries in the sequela period seems to be a neglected area that needs further development.…”

Rehabilitation Following Nerve Transfer Surgery

“…As muscle function and motor control improve, the assistance of dynamic orthosis and support systems, such as suspension slings, are gradually decreased, and patients will progressively perform exercises against gravity. Furthermore, as quality of motion improves, the concept of donor activation is slowly reduced, and the concept of selective activation, or “donor deactivation,” is initiated to free the patient from the requirement for donor nerve/muscle function to produce useful motion 13,14,27. That is, by the end of their rehabilitation process, patients should have achieved sufficient cortical reorganization to be able to perform receptor muscle action “unconsciously” and without the need to “first think” of the donor nerve/muscle function (donor activation).…”

“…Furthermore, as quality of motion improves, the concept of donor activation is slowly reduced, and the concept of selective activation, or "donor deactivation," is initiated to free the patient from the requirement for donor nerve/muscle function to produce useful motion. 13,14,27 That is, by the end of their rehabilitation process, patients should have achieved sufficient cortical reorganization to be able to perform receptor muscle action "unconsciously" and without the need to "first think" of the donor nerve/muscle function (donor activation). The importance of donor deactivation, and cortical plasticity in our opinion is important to long term success and improved outcomes.…”