Prevalence and etiology of elbow flexion contractures in brachial plexus birth injury: A scoping review

Ho, Emily S.; Kim, Dorothy; Klar, Karen; Anthony, Alison; Davidge, Kristen M.; Borschel, Gregory H.; Hopyan, Sevan; Clarke, Howard M.; Wright, F. Virginia

doi:10.3233/prm-180535

Cited by 10 publications

(28 citation statements)

References 55 publications

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“…[12] [27]. Also, although our sample is relatively small and includes infants, our results are comparable to those of the literature and have the merit of proposing an alternative to all parents living in precariousness, at a distance from care structures but also to all health systems where qualified human resources would be deficient.…”

Section: Therapeutic Datasupporting

confidence: 73%

Obstetric Brachial Plexus Palsy of Newborns and Infants: Functional Outcomes after Rehabilitation by Their Own Parents

Marie-Ange¹,

Alexandre²,

Kennedy³

et al. 2022

OJO

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Section: Therapeutic Datasupporting

confidence: 73%

Obstetric Brachial Plexus Palsy of Newborns and Infants: Functional Outcomes after Rehabilitation by Their Own Parents

Marie-Ange¹,

Alexandre²,

Kennedy³

et al. 2022

OJO

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“…However, a recent review illustrated that multiple factors influence their occurrence, with reduced growth of the affected flexor muscles caused by denervation most likely playing the greatest role. 4 Since most daily living activities are performed in 30°-150°of elbow flexion, 6,7 the inability to extend the elbow to more than 30°of flexion results in functional limitations during daily activities, such as reaching out in front of and above the body. Treatment is therefore considered to be important and can be nonsurgical or surgical.…”

Section: Introductionmentioning

confidence: 99%

Elbow flexion contractures in neonatal brachial plexus palsy: A one-year comparison of dynamic orthosis and serial casting

Coul

Bleeker²,

Groot

et al. 2022

Clin Rehabil

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Objective Elbow flexion contractures are common complications of neonatal brachial plexus palsy, but evidence on how to treat these contractures is weak. This study compared the treatment of elbow flexion contractures using a dynamic orthosis or serial circular casting. Methods A randomized controlled trial was conducted with one-year follow-up. Children with an elbow flexion contracture of ≥30° were treated with either a night-worn dynamic orthosis for one year or serial casting for four weeks followed by night splinting. For pragmatic reasons, some participants were included in an open part of this study, this group was also analyzed separately. Degree of contracture and goal attainment scaling was evaluated at baseline and after 8, 20 and 54 weeks. Results 55 patients were analyzed in this trial, 32 of whom were randomized to treatment. At one-year follow-up of the randomized group, both dynamic splinting (median −8.5°, interquartile range [IQR] −13.5, −5) and serial casting (median −11.0°, IQR −16, −5) resulted in significant reduction of contracture ( P < 0 .001). The reduction was significantly greater with serial casting in the first 20 weeks, but not at one-year follow-up ( P = 0.683). In the entire cohort, the individual functional goals had been reached in 24 out of 32 cases (80%) of dynamic splinting and 18 out of 23 cases (82%) of serial casting, respectively. Conclusion The dynamic night orthosis is comparable to serial casting for treating elbow flexion contractures in children with brachial plexus birth injury. We recommend selecting one of these treatment modalities in close consultation with parents and patients.

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“…4 The majority of these contractures are not present at birth, instead developing gradually after infancy with a variable rate of progression. 4 The reported magnitude of contractures is from 5 to 90 , with severe restriction (>30 ) in 21% to 36% of children who have a contracture. 4 The functional and psychosocial impacts of these contractures may include difficulties with reaching and negative attention drawn by the apparent fixed posture of the elbow.…”

Section: Introductionmentioning

confidence: 99%

“…4 The reported magnitude of contractures is from 5 to 90 , with severe restriction (>30 ) in 21% to 36% of children who have a contracture. 4 The functional and psychosocial impacts of these contractures may include difficulties with reaching and negative attention drawn by the apparent fixed posture of the elbow. However, the manifestation of such concerns is not only related to the severity of the contracture but also dependent on the youth's and family's unique life situation.…”

Section: Introductionmentioning

confidence: 99%

“…Although most infants with BPBI have full spontaneous recovery, 20% to 30% have residual impairments in their affected limb owing to incomplete neurological recovery 3 . One common sequela is a persistent elbow flexion contracture, which has a reported median prevalence of 48% in BPBI populations 4 . The majority of these contractures are not present at birth, instead developing gradually after infancy with a variable rate of progression 4 .…”

Section: Introductionmentioning

confidence: 99%

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Developing a decision aid for youth with brachial plexus birth injuries facing treatment decisions for an elbow flexion contracture

Parsons

Davidge

et al. 2021

PM&R

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Background A common sequela of brachial plexus birth injury (BPBI) is an elbow flexion contracture. Youth with BPBI and their families face rehabilitation or surgical decisions that ideally entail careful deliberation of the risks and benefits of treatment within the context of the child's and family's functional and appearance‐related goals. Objective To develop a patient decision aid (PtDA) following International Patient Decision Aid Standards to help these youth and their families make treatment decisions. Design Mixed‐methods study. Setting Brachial plexus clinic in a pediatric tertiary care center. Participants Five young adults (21–24 years), 14 youth (8–19 years) and their parents, 15 families (children 2–16 years), and 19 clinicians from a brachial plexus clinic participated in the PtDA development. Seventeen other youth (8–18 years) facing treatment decisions regarding their elbow contracture field tested the PtDA prototype. Interventions Not applicable. Main Outcome Measures In‐depth interviews and participant observation to conduct a decisional needs assessment of young adults, youth, parents, and health care professionals involved in these shared decisions. Cognitive interviews to field test the PtDA prototype. Results Evidence from previously conducted knowledge synthesis and the youth‐focused decisional needs assessment qualitative data informed the development of new PtDA prototype, which included a questionnaire‐based values clarification method for youth to rate what matters most to them regarding their elbow function, appearance, psychosocial impact, and treatment options. The majority (90%) of youth >11 years who field tested the PtDA prototype understood its content, whereas only 29% of those between 8 and 11 years demonstrated independent comprehension. The majority (69%) responded that they would prefer to use the PtDA on their own either at home or in the clinic waiting room. Conclusions This new PtDA can be used to help youth with BPBI and their families to make a personal value‐based informed decision regarding treatment options for their elbow flexion contracture.

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Prevalence and etiology of elbow flexion contractures in brachial plexus birth injury: A scoping review

Cited by 10 publications

References 55 publications

Obstetric Brachial Plexus Palsy of Newborns and Infants: Functional Outcomes after Rehabilitation by Their Own Parents

Obstetric Brachial Plexus Palsy of Newborns and Infants: Functional Outcomes after Rehabilitation by Their Own Parents

Elbow flexion contractures in neonatal brachial plexus palsy: A one-year comparison of dynamic orthosis and serial casting

Developing a decision aid for youth with brachial plexus birth injuries facing treatment decisions for an elbow flexion contracture

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