Background Birth-related brachial plexus injury (BRBPI) occurs in 1.2/1,000 births in British Columbia. Even in children with "good" recovery, external rotation (ER) and supination (Sup) are often weaker, and permanent skeletal imbalance ensues. A preventive early infant shoulder passive repositioning program was created using primarily a novel custom splint holding the affected arm in full ER and Sup: the Sup-ER splint. The details of the splint and the shoulder repositioning program evolved with experience over several years. This study reviews the first 4 years. Methods A retrospective review of BCCH patients managed with the Sup-ER protocol from 2008 to 2011 compared their recovery scores to matched historical controls selected from our database by two independent reviewers. Results The protocol was initiated in 18 children during the study period. Six were excluded due to the following: insufficient data points, non-compliance, late splint initiation, and loss to follow-up. Of the 12 matches, the Sup-ER group final score at 2 years was better than controls by 1.18 active movement scale (AMS) points (p=0.036) in Sup and 0.96 AMS points in ER (but not statistically significant (p=0.13)). Unexpectedly, but importantly, during the study period, zero subjects were assessed to have the active functional criteria to indicate brachial plexus reconstruction, where previously we operated on 13 %. Conclusions Early application of passive shoulder repositioning into Sup and ER may improve outcomes in function of the arm in infants with BRBPI. A North American multisite randomized control trial has been approved and has started recruitment.

Background: Our group previously developed an upper extremity repositioning (Sup-ER) protocol for brachial plexus birth injuries (BPBIs) that may improve supination and external rotation (ER) at 2 years of age. Questions were raised about the potential for the protocol to cause internal rotation (IR) deficits. The goal of this study was to explore the longer-term outcomes of the Sup-ER protocol and investigate IR/ER function. Methods: This prospective cross-sectional cohort study examined 16 children older than 4 years of age with significant enough BPBI to be treated with the Sup-ER protocol. Total shoulder and elbow function were assessed, including passive and active ranges of motion and strength of IR and ER. Results: Range of motion (ROM) for most active movements was decreased in the affected compared to unaffected arm. Notably, IR passive ROM was similar in the affected (78.7°) and unaffected arm (82.8°). External rotation strength of the affected arm was weaker (42.8 N) compared to the unaffected arm (57.9 N). IR strength had a greater deficit in the affected (43.2 N) arm compared to the unaffected arm (72.2 N), but both ER and IR showed less deficit than described in the literature. Conclusions: Despite differences in ranges of motion between the affected and unaffected arms, ROMs for the affected arm were comparable to the functional limits as reported in the literature. The Sup-ER protocol shows potential to optimize long-term shoulder rotation function in children with BPBI without compromising IR.

Purpose: Most children with severe birth-related brachial plexus injury (BRBPI) have some functional impairment, but information on the impact of BRBPI on coordination and balance is limited. The study's purpose was to determine whether children with BRBPI exhibit deficits in body coordination and balance. Method: A prospective cohort study involving 39 children with BRBPI aged 5-15 years was conducted. Range of motion, strength, active movement, and balance and coordination motor skills were assessed using the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2), and the Movement Assessment Battery for Children-Second Edition (MABC-2). A self-report measure of physical disability, the Activities Scale for Kids-Performance Version (ASKp), was also administered. Results: Participants scored a mean of 44.72 on the BOT-2 Body Coordination composite subtest; scores can range from 20 to 80. Eleven participants (28.2%) scored below average on this test. Participants scored a mean of 7.3 on the Balance subtest of the MABC-2; scores can range from 1 to 19. Twenty-six participants (66.7%) scored below average on this test. Of 38 participants, 25 (65.8%) had an ASKp score indicating some level of disability (<95/100); we found a statistically significant difference in balance (p ¼ 0.007) between these 25 participants and those without disability (ASKp score 95-100). Conclusions: The majority of our study population scored in the categories of at risk or significant difficulty for balance on the MABC-2. Balance rehabilitation may be a valuable treatment adjunct for children with BRBPI.Key Words: birth injuries; brachial plexus; ataxia; paralysis, obstetric; postural balance. RÉ SUMÉObjet : La plupart des enfants qui ont une grave lé sion du plexus brachial relié e à la naissance (LPBRN) ont une dé ficience fonctionnelle, mais l'information au sujet de l'effet de la LPBRN sur la coordination et l'é quilibre est toutefois limité e. L'é tude visait à dé terminer si les enfants qui ont une LPBRN montrent des dé ficiences de la coordination et de l'é quilibre. Mé thode : On a procé dé à une é tude de cohorte prospective portant sur 39 enfants ayant subi une LPBRN â gé s de 5 à 15 ans. On a é valué l'amplitude du mouvement, la force, le mouvement actif, l'é quilibre et la coordination de la motricité au moyen du test de Bruininks-Oseretsky de la maîtrise de la motricité (BOT-2) et du test d'é valuation du mouvement chez les enfants (MABC-2). On a aussi administré une mesure autodé claré e de l'incapacité physique, la version de l'é chelle des activité s pour la performance des enfants (ASKp). Ré sultats : Les participants ont obtenu une moyenne de 44,72 comme score composite de la coordination du corps BOT-2, qui peut varier de 20 à 80. Onze participants (28,2%) ont obtenu un ré sultat infé rieur à la moyenne. Les participants ont obtenu un ré sultat moyen de 7,3 au sous-test de l'é quilibre du test MABC-2, ré sultat qui peut varier de 1 à 19; 26 participants (66,7%) ont obtenu un ré sultat infé rieur à ...

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