Quantifying long-term upper-limb activity using wearable motion sensors after nerve reconstruction for neonatal brachial plexus palsy

View More View Less
  • 1 Department of Neurosurgery, and
  • | 2 School of Kinesiology, University of Michigan, Ann Arbor, Michigan; and
  • | 3 Department of Neurosurgery, Duke University, Durham, North Carolina
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $45.00
USD  $515.00
USD  $612.00
Print or Print + Online Sign in

OBJECTIVE

Standard, physician-elicited clinical assessment tools for the evaluation of function after nerve reconstruction for neonatal brachial plexus palsy (NBPP) do not accurately reflect real-world arm function. Wearable activity monitors allow for the evaluation of patient-initiated, spontaneous arm movement during activities of daily living. In this pilot study, the authors demonstrate the feasibility of using body-worn sensor technology to quantify spontaneous arm movement in children with NBPP 10 years after nerve reconstruction and report the timing and magnitude of recovered arm movement.

METHODS

Eight children with NBPP who underwent brachial plexus reconstruction approximately 10 years prior were recruited to take part in this single-institution prospective pilot study. Per the treatment protocol of the authors’ institution, operated patients had severe, nonrecovering nerve function at the time of surgery. The patients were fitted with an activity monitoring device on each of the affected and unaffected arms, which were worn for 7 consecutive days. The duration (VT) and power (VM) with which each arm moved during the patient’s normal daily activities were extracted from the accelerometry data and ratios comparing the affected and unaffected arms were calculated. Demographic data and standard physician-elicited clinical measures of upper-extremity function were also collected.

RESULTS

Three children underwent nerve grafting and transfer and 5 children underwent graft repair only. The mean (± SD) active range of motion was 98° ± 53° for shoulder abduction, 130° ± 24° for elbow flexion, and 39° ± 34° for shoulder external rotation. The median Medical Research Council grade was at least 2.5 for all muscle groups. The median Mallet grade was at least 2 for all categories, and 13.5 total. The VT ratio was 0.82 ± 0.08 and the VM ratio was 0.53 ± 0.12.

CONCLUSIONS

Wearable activity monitors such as accelerometers can be used to quantify spontaneous arm movement in children who underwent nerve reconstruction for NBPP at long-term follow-up. These data more accurately reflect complex, goal-oriented movement needed to perform activities of daily living. Notably, despite severe, nonrecovering nerve function early in life, postsurgical NBPP patients use their affected arms more than 80% of the time that they use their unaffected arms, paralleling results in patients with NBPP who recovered spontaneously. These data represent the first long-term, real-world evidence to support brachial plexus reconstruction for patients with NBPP.

ABBREVIATIONS

AROM = active range of motion; ICF = International Classification of Functioning, Disability and Health; MRC = Medical Research Council; NBPP = neonatal brachial plexus palsy; PROM = passive range of motion; VM = intensity of movement; VT = amount of time per day that the monitor measured movement.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
USD  $515.00
USD  $612.00
  • 1

    Malessy MJ, Pondaag W. Nerve surgery for neonatal brachial plexus palsy. J Pediatr Rehabil Med. 2011;4(2):141148.

  • 2

    Pondaag W, Malessy MJ, van Dijk JG, Thomeer RT. Natural history of obstetric brachial plexus palsy: a systematic review. Dev Med Child Neurol. 2004;46(2):138144.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3

    Smith BW, Daunter AK, Yang LJ, Wilson TJ. An update on the management of neonatal brachial plexus palsy-replacing old paradigms: a review. JAMA Pediatr. 2018;172(6):585591.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    World Health Organization. International Classification of Functioning, Disability and Health: ICF. 2001.Accessed February 17, 2022. http://whqlibdoc.who.int/publications/2001/9241545429.pdf

    • Search Google Scholar
    • Export Citation
  • 5

    Birch R, Bonney G, Wynn Parry CB. Surgical Disorders of the Peripheral Nerves. Churchill Livingstone;1998.

  • 6

    Haerle M, Gilbert A. Management of complete obstetric brachial plexus lesions. J Pediatr Orthop. 2004;24(2):194200.

  • 7

    Mallet J. Obstetrical paralysis of the brachial plexus. Etiopathogenesis. Article in French. Rev Chir Orthop Reparatrice Appar Mot. 1972;58(suppl 1):119123.

    • Search Google Scholar
    • Export Citation
  • 8

    Tassin GA. Obstetrical palsy: a clinical, pathological and surgical review. Terzis J, ed. Microreconstruction of Nerve Injuries. Saunders;1987:529533.

    • Search Google Scholar
    • Export Citation
  • 9

    Hill B, Williams G, Olver JH, Bialocerkowski A. Do existing patient-report activity outcome measures accurately reflect day-to-day arm use following adult traumatic brachial plexus injury?. J Rehabil Med. 2015;47(5):438444.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Chang KW, Austin A, Yeaman J, et al. Health-related quality of life components in children with neonatal brachial plexus palsy: a qualitative study. PM R. 2017;9(4):383391.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Lang CE, Waddell KJ, Klaesner JW, Bland MD. A method for quantifying upper limb performance in daily life using accelerometers. J Vis Exp. 2017;(122):55673.

    • Search Google Scholar
    • Export Citation
  • 12

    Rand D, Eng JJ. Predicting daily use of the affected upper extremity 1 year after stroke. J Stroke Cerebrovasc Dis. 2015;24(2):274283.

  • 13

    Thorp JE, Adamczyk PG, Ploeg HL, Pickett KA. Monitoring motor symptoms during activities of daily living in individuals with Parkinson’s disease. Front Neurol. 2018;9:1036.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    van Eijk RPA, Bakers JNE, Bunte TM, de Fockert AJ, Eijkemans MJC, van den Berg LH. Accelerometry for remote monitoring of physical activity in amyotrophic lateral sclerosis: a longitudinal cohort study. J Neurol. 2019;266(10):23872395.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    Coker-Bolt P, Downey RJ, Connolly J, Hoover R, Shelton D, Seo NJ. Exploring the feasibility and use of accelerometers before, during, and after a camp-based CIMT program for children with cerebral palsy. J Pediatr Rehabil Med. 2017;10(1):2736.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16

    Hoyt CR, Van AN, Ortega M, et al. Detection of pediatric upper extremity motor activity and deficits with accelerometry. JAMA Netw Open. 2019;2(4):e192970.

  • 17

    Smith BW, Chang KW, Saake SJ, Yang LJ, Chung KC, Brown SH. Quantifying real-world upper-limb activity via patient-initiated movement after nerve reconstruction for upper brachial plexus injury. Neurosurgery. 2019;85(3):369374.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Gatward ME, Logue RN, Yang LJS, Brown SH. Quantifying real-world upper limb activity via patient-initiated spontaneous movement in neonatal brachial plexus palsy. PM R. Published online January 30, 2022.doi: 10.1002/pmrj.12780

    • Search Google Scholar
    • Export Citation
  • 19

    Jan MM. Neurological examination of difficult and poorly cooperative children. J Child Neurol. 2007;22(10):12091213.

  • 20

    Bailey RR, Klaesner JW, Lang CE. An accelerometry-based methodology for assessment of real-world bilateral upper extremity activity. PLoS One. 2014;9(7):e103135.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21

    Medical Research Council War Memorandum No. 7: Aids to the Examination of the Peripheral Nervous System. Medical Research Council; 1941.

  • 22

    Smith BW, Sakamuri S, Flavin KE, et al. Assessment of variability in motor grading and patient-reported outcome reporting: a multi-specialty, multi-national survey. Acta Neurochir (Wien). 2021;163(7):20772087.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23

    Chang KW, Justice D, Chung KC, Yang LJ. A systematic review of evaluation methods for neonatal brachial plexus palsy: a review. J Neurosurg Pediatr. 2013;12(4):395405.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Waters PM. Comparison of the natural history, the outcome of microsurgical repair, and the outcome of operative reconstruction in brachial plexus birth palsy. J Bone Joint Surg Am. 1999;81(5):649659.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25

    Strömbeck C, Krumlinde-Sundholm L, Forssberg H. Functional outcome at 5 years in children with obstetrical brachial plexus palsy with and without microsurgical reconstruction. Dev Med Child Neurol. 2000;42(3):148157.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26

    Lin JC, Schwentker-Colizza A, Curtis CG, Clarke HM. Final results of grafting versus neurolysis in obstetrical brachial plexus palsy. Plast Reconstr Surg. 2009;123(3):939948.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27

    Ahmed-Labib M, Golan JD, Jacques L. Functional outcome of brachial plexus reconstruction after trauma. Neurosurgery. 2007;61(5):10161023.

  • 28

    Garg R, Merrell GA, Hillstrom HJ, Wolfe SW. Comparison of nerve transfers and nerve grafting for traumatic upper plexus palsy: a systematic review and analysis. J Bone Joint Surg Am. 2011;93(9):819829.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29

    Borisov AB, Carlson BM. Cell death in denervated skeletal muscle is distinct from classical apoptosis. Anat Rec. 2000;258(3):305318.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30

    Fu SY, Gordon T. Contributing factors to poor functional recovery after delayed nerve repair: prolonged axotomy. J Neurosci. 1995;15(5 Pt 2):38763885.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31

    Wilson TJ, Chang KWC, Yang LJS. Prediction algorithm for surgical intervention in neonatal brachial plexus palsy. Neurosurgery. 2018;82(3):335342.

  • 32

    Gilbert A. Long-term evaluation of brachial plexus surgery in obstetrical palsy. Hand Clin. 1995;11(4):583595.

  • 33

    Squitieri L, Steggerda J, Yang LJS, Kim HM, Chung KC. A national study to evaluate trends in the utilization of nerve reconstruction for treatment of neonatal brachial plexus palsy [outcomes article]. Plast Reconstr Surg. 2011;127(1):277283.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Birch R, Ahad N, Kono H, Smith S. Repair of obstetric brachial plexus palsy: results in 100 children. J Bone Joint Surg Br. 2005;87(8):10891095.

  • 35

    Hems T. Questions regarding natural history and management of obstetric brachial plexus injury. J Hand Surg Eur Vol. 2021;46(7):796799.

Metrics

All Time Past Year Past 30 Days
Abstract Views 713 713 173
Full Text Views 53 53 24
PDF Downloads 77 77 40
EPUB Downloads 0 0 0