A Comprehensive Description of Independent Function of Adults With Traumatic Brachial Plexus Injuries

Links

Abstract

Patients with brachial plexus injuries (BPI) have limited upper extremity function as a result of a traumatic episode damaging the nerves exiting the spinal cord that provide sensory and motor function to the arm. Current clinical outcome measures may not adequately describe a patient’s independent function during daily life after injury and subsequent treatment. Utilizing both established and emerging quantitative and qualitative methodologies, this dissertation produced a detailed description of independent daily function of individuals with BPI.

Activity monitoring in the free-living environment provided a measure of the asymmetrical upper extremity usage following a BPI. A difference in asymmetry index between BPI severities was discerned using an asymmetry index. Immobilizing the elbow and wrist in unimpaired individuals forced increased reliance upon the contralateral limb, quantified by increased asymmetry indices. Utilizing immobilization, it was demonstrated that regardless of the location on a rigid segment, activity monitors record the same accelerations, indicating that the arm primarily undergoes translation during daily activity.

Activities of daily living (ADLs) were difficult to accomplish for patients with BPI. Subjects were only able to complete feeding and dressing tasks in a controlled setting. Compensatory trunk motion and limited shoulder external rotation existed in subjects with BPI during laboratory testing using motion capture techniques, as demonstrated by conventional kinematic descriptors and an emerging analysis—Statistical Parametric Mapping (SPM).

To complete the description of daily independent function, a subset of patients with BPI who rely on the use of a myoelectric elbow orthosis (MEO) to assist with elbow flexion were consulted through a focus group and phone interviews. The use of an MEO was beneficial in a rehabilitation setting, but had limited utility in daily life. A streamlined device that provided shoulder and elbow support is desired by participants.

Activity monitoring, motion capture, and qualitative analysis of function in patients with a BPI has established a multidimensional framework that can serve as a baseline for future studies evaluating promising clinical treatments for BPI. Combining these methodologies with current clinical outcome measures offers the opportunity to identify areas of strength and potential targets for improvement in existing treatment paradigms.

Cited Works (6)

Year	Entry
2005	Wu G, van der Helm FCT, Veeger HEJ, Makhsous M, Van Roy P, Anglin C, Nagels J, Karduna AR, McQuade K, Wang X, Werner FW, Buchholz B. ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion, II: shoulder, elbow, wrist and hand. J Biomech. May 2005;38(5):981-992.
1983	Winter DA. Energy generation and absorption at the ankle and knee during fast, natural, and slow cadences. Clin Orthop Relat Res. August 1983;175:147-154.
1990	McMahon TA, Cheng GC. The mechanics of running: how does stiffness couple with speed? J Biomech. 1990;23(suppl 1):65-78.
2010	Pataky TC. Generalized n-dimensional biomechanical field analysis using statistical parametric mapping. J Biomech. July 20, 2010;43(10):1976-1982.
1986	Woltring HJ. A Fortran package for generalized, cross-validatory spline smoothing and differentiation. Adv Eng Softw. April 1986;8(2):104-113.
1996	Cappozzo A, Catani F, Leardini A, Benedetti M, Della Croce U. Position and orientation in space of bones during movement: experimental artefacts. Clin Biomech (Bristol, Avon). March 1996;11(2):90-100.