Concepts of functioning and health important to children with an obstetric brachial plexus injury: a qualitative study using focus groups

Purpose This study described physical and psychosocial limitations associated with adult brachial plexus injuries (BPI) and patients' expectations of BPI surgery. Methods During in-person interviews, preoperative patients were asked about expectations of surgery and preoperative and postoperative patients were asked about limitations due to BPI. Postoperative patients also rated improvement in condition after surgery. Data were analyzed with qualitative and quantitative techniques. Results Ten preoperative and 13 postoperative patients were interviewed; mean age was 37 years, 19 were men, all were employed/students, and most injuries were due to trauma. Preoperative patients cited several main expectations, including pain-related issues, and improvement in arm movement, self-care, family interactions, and global life function. Workrelated expectations were tailored to employment type. Preoperative and postoperative patients reported that pain, altered sensation, difficulty managing self-care, becoming physically and financially dependent, and disability in work/school were major issues. All patients reported making major compensations, particularly using the uninjured arm. Most reported multiple mental health effects, were distressed with long recovery times, were self-conscious about appearance, and avoided public situations. Additional stresses were finding and paying for BPI surgery. Some reported BPI impacted overall physical health, life priorities, and decision-making processes. Four postoperative patients reported hardly any improvement, four reported some/a good deal, and five reported a great deal of improvement. Conclusions BPI is a life-altering event affecting physical function, mental well-being, financial situation, relationships, self-image, and plans for the future. This study contributes to clinical practice by highlighting topics to address to provide comprehensive BPI patient-centered care.

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“…The mean age was 37±14 years (range 19-63), 19 were men, and all were working or were full-time students at the time of the injury.…”

Section: Resultsmentioning

confidence: 99%

Expectations and Limitations Due to Brachial Plexus Injury: A Qualitative Study

Mancuso

Lee

et al. 2015

Hand (New York, N,Y.)

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“…Both domains may be related to the limited ROM in these children, which is impaired by muscle weakness, simultaneous activation of antagonists, length difference in the affected limb, and contractures. 4 Then, NBPP children show restrictions in performance of functional tasks, 1 which are fundamental for independence in daily-life activities and QOL, 3 as well as for tasks that require fine motor skills (e.g. writing).…”

Section: Nbppg Mean±sdmentioning

confidence: 99%

“…The PODCI domain of sports and physical function was reduced in the NBPPG compared with the UCG, confirming other findings. 3,10,11 Sports and physical function domain cover tasks such as walking, running, climbing stairs, and cycling, as well as participation in non-competitive sports and games, in comparison to sports competitions with other children at the same age. 19 In the CHQ, differences in physical functioning were observed between groups; however, the effect size was small.…”

Section: Nbppg Mean±sdmentioning

confidence: 99%

“…When spontaneous recovery does not occur, the upper limb has deficits, such as muscle weakness, soft tissue contractures, limited range of motion (ROM), and shortened forearm and hand regardless of motor function. 3,4 Thus, NBPP children present reduced upper limb function compared with controls. 5 Performing simple daily tasks can be difficult for NBPP children.…”

Section: Introductionmentioning

confidence: 99%

“…5,[9][10][11] This is probably due to functional impairments, pain, psychosocial problems, 5,[9][10][11] and limitation in sports activities. 3,12,13 Personal and environmental factors can influence the QOL of children with NBPP with regard to coping mechanisms to psychological, financial, family, therapeutic, aesthetic, and body image issues. 5 Given the challenges faced by NBPP children, as well as relation between functional deficits of upper limb and their QOL, understanding how NBPP influences the QOL and upper limb function is essential.…”

Section: Introductionmentioning

confidence: 99%

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Quality of Life and Upper Limb Function of Children With Neonatal Brachial Plexus Palsy

Medeiros

Agostinho

Mochizuki

et al. 2020

Rev. paul. pediatr.

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Objective: To compare the upper limb function and quality of life between children with neonatal brachial plexus palsy and controls with unaffected brachial plexus (typical children). Methods: Twenty-four children with neonatal brachial plexus palsy and 24 typical ones were evaluated, both groups with 10±3 years of age. The upper limb function was assessed by the Modified Mallet Scale and the Active Movement Scale, whereas quality of life was analyzed by the Pediatric Outcome Data Collection Instrument and the Child Health Questionnaire. Mann-Whitney U tests investigated the differences between groups in such scales. Results: Children with neonatal brachial plexus palsy presented lower limb function compared to typical children in both scales. These children also presented lower scores for most of the Pediatric Outcome Data Collection Instrument domains, except for comfort/pain. In addition, they had lower scores in the following domains of the Child Health Questionnaire: physical functioning, pain, behavior, mental health, overall health perception, emotional impact on parents, and psychosocial summarized score. Conclusions: Neonatal brachial plexus palsy has a negative influence on upper limb function and quality of life, mainly considering overall health, basic mobility, physical and psychosocial functions, happiness, pain, behavior, mental health, upper limb function, and emotional impact on their parents. Objetivo: Comparar a função do membro superior e a qualidade de vida entre crianças com paralisia obstétrica do plexo braquial e aquelas sem paralisia do plexo braquial (crianças usuais). Métodos: Foram avaliadas 24 crianças com paralisia obstétrica do plexo braquial e 24 crianças usuais, ambos os grupos com 10±3 anos. A função do membro superior foi avaliada pela Escala Mallet Modificada e Active Movement Scale, já a qualidade de vida foi analisada por meio das escalas Pediatric Outcome Data Collection Instrument e Child Health Questionnaire. Foram realizados testes U de Mann-Whitney para investigar diferenças entre os grupos nas escalas. Resultados: Crianças com paralisia obstétrica do plexo braquial apresentaram menor função do membro superior quando comparadas às crianças usuais, em ambas as escalas utilizadas. Essas crianças também apresentaram menores pontuações para a maioria dos domínios do Pediatric Outcome Data Collection, exceto para conforto/dor. Além disso, apresentaram escores inferiores nos seguintes domínios do Child Health Questionnaire: função física, dor, comportamento, saúde mental, percepção da saúde em geral, impacto emocional nos pais e pontuação psicossocial resumida. Conclusões: A paralisia obstétrica do plexo braquial tem uma influência negativa na função do membro superior e na qualidade de vida, principalmente em relação à saúde geral, mobilidade básica, funções física e psicossocial, felicidade, dor, comportamento, saúde mental, funcionalidade do membro superior e impacto emocional nos pais. Palavras-chave: Criança; Qualidade de vida; Extremidade superior; Movimento; Plexo braqu...

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