A systematic review of evaluation methods for neonatal brachial plexus palsy

A review

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Neonatal brachial plexus palsy (NBPP) affects 0.4–2.6 newborns per 1000 live births in the US. Many infants recover spontaneously, but for those without spontaneous recovery, nerve and/or secondary musculoskeletal reconstruction can restore function to the affected arm. This condition not only manifests in a paretic/paralyzed arm, but also affects the overall health and psychosocial condition of the children and their parents. Currently, measurement instruments for NBPP focus primarily on physical ability, with limited information regarding the effect of the disablement on activities of daily living and the child's psychosocial well-being. It is also difficult to assess and compare overall treatment efficacy among medical (conservative) or surgical management strategies without consistent use of evaluation instruments. The purpose of this study is to review the reported measurement evaluation methods for NBPP in an attempt to provide recommendations for future measurement usage and development.


The authors systematically reviewed the literature published between January 1980 and February 2012 using multiple databases to search the keywords “brachial plexus” and “obstetric” or “pediatrics” or “neonatal” or “congenital.” Original articles with primary patient outcomes were included in the data summary. Four types of evaluation methods (classification, diagnostics, physical assessment, and functional outcome) were distinguished among treatment management groups. Descriptive statistics and 1-way ANOVA were applied to compare the data summaries among specific groups.


Of 2836 articles initially identified, 307 were included in the analysis, with 198 articles (9646 patients) reporting results after surgical treatment, 70 articles (4434 patients) reporting results after medical treatment, and 39 articles (4247 patients) reporting results after combined surgical and medical treatment. Among medical practitioners who treat NBPP, there was equivalence in usage of classification, diagnostic, and physical assessment tools (that focused on the Body Function and Structures measure of the International Classification of Functioning, Disability, and Health [ICF]). However, there was discordance in the functional outcome measures that focus on ICF levels of Activity and Participation. Of the 126 reported evaluation methods, only a few (the Active Movement Scale, Toronto Scale Score, Mallet Scale, Assisting Hand Assessment, and Pediatric Outcomes Data Collection Instrument) are specifically validated for evaluating the NBPP population.


In this review, the authors demonstrate disparities in the use of NBPP evaluation instruments in the current literature. Additionally, valid and reliable evaluation instruments specifically for the NBPP population are significantly lacking, manifesting in difficulties with evaluating the overall impact and effectiveness of clinical treatments in a consistent and comparative manner, extending across the various subspecialties that are involved in the treatment of patients with NBPP. The authors suggest that all ICF domains should be considered, and future efforts should include consideration of spontaneous (not practitioner-elicited) use of the affected arm in activities of daily living with attention to the psychosocial impact of the disablement.

Abbreviations used in this paper:ADLs = activities of daily living; EMG = electromyography; ICF = International Classification of Functioning, Disability, and Health; MRC = Medical Research Council; NBPP = neonatal brachial plexus palsy; ROM = range of motion; WeeFIM = Functional Independence Measure for Children.

Article Information

* Ms. Chang and Ms. Justice contributed equally to this work.

Address correspondence to: Lynda J. S. Yang, M.D., Ph.D., Department of Neurosurgery, University of Michigan, 1500 E. Medical Center Dr., Rm. 3552 TC, Ann Arbor, MI 48109-5338. email: ljsyang@med.umich.edu.

Please include this information when citing this paper: published online August 9, 2013; DOI: 10.3171/2013.6.PEDS12630.

© AANS, except where prohibited by US copyright law.



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    Flowchart of primary database search including number of articles retrieved and excluded from review.

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    Flowchart illustrating interaction of the ICF domains.



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