scholarly journals Case Report: Bionic Reconstruction in an Adult With Obstetric Brachial Plexus Injury

2022 ◽  
Vol 2 ◽  
Author(s):  
Anna Boesendorfer ◽  
Agnes Sturma ◽  
Clemens Gstoettner ◽  
Anna Pittermann ◽  
Gregor Laengle ◽  
...  

Introduction: Many adults who had a severe Narakas IV obstetric brachial plexus injury (OBPI) suffer from extensive impairments in daily living due to limited hand-arm function. The dramatic loss of axonal support at this very early age of development often render the entire extremity a biologic wasteland and reconstructive methods and therapies often fail to recover any functional hand use. In this scenario bionic reconstruction, including an elective amputation and a subsequent prosthetic fitting, may enable functional improvement in adults suffering from the consequences of such severe brachial plexus injuries. We here describe our experience in treating such patients and lay out the surgical rational and rehabilitation protocol exemplified in one patient.Case Presentation/Methods: A 27-year-old adult with a unilateral OBPI contacted our center. He presented with globally diminished function of the affected upper extremity with minimal hand activity, resulting in an inability to perform various tasks of daily living. No biological reconstructive efforts were available to restore meaningful hand function. An interdisciplinary evaluation, including a psychosocial assessment, was used to assess eligibility for bionic reconstruction. Before the amputation and after the prosthetic fitting functional assessments and self-reported questionnaires were performed.Results: One month after the amputation and de-rotation osteotomy of the humerus the patient was fitted with a myoelectric prosthesis. At the 1.5 year-follow-up assessment, the patient presented with a distinct improvement of function: the ARAT improved from 12 to 20 points, SHAP score improved from 8 to 29, and the DASH value improved from 50 to 11.7. The average wearing times of the prosthesis were 5 to 6 h per day (on 4–5 days a week).Discussion: The options for adults suffering from the consequences of severe OBPIs to improve function are limited. In selected patients in whom the neurological deficit is so severe that biologic hand function is unsatisfactory, an elective amputation and subsequent restoration of the hand with mechatronic means may be an option. The follow-up results indicate that this concept can indeed lead to solid hand function and independence in daily activities after amputation, subsequent prosthetic fitting, and rehabilitation.

2017 ◽  
Vol 140 (4) ◽  
pp. 747-756 ◽  
Author(s):  
Kathleen M. O’Grady ◽  
Hollie A. Power ◽  
Jaret L. Olson ◽  
Michael J. Morhart ◽  
A. Robertson Harrop ◽  
...  

Author(s):  
Havva Ezgi Karas ◽  
Emine Atıcı ◽  
Gamze Aydın ◽  
Mert Demirsöz

AbstractThe present study aimed to examine the effects of playing Nintendo Wii games on upper extremity functions compared with conventional physiotherapy, in children with obstetric brachial plexus injury (OBPI). Twenty-two patients with brachial plexus injuries were enrolled. The patients were divided into two groups by simple randomization. The control group (conventional physiotherapy group [CTG]: n = 11) received conventional physiotherapy for 6 weeks (40 minutes per day, for 4 days per week). The study group, called Nintendo Wii group (NWG; n = 11), received conventional physiotherapy as well as tennis, baseball, and boxing games with Nintendo Wii on days when there was no physical therapy. The upper extremity range of motion (ROM) was evaluated using a digital goniometer, motor function was assessed using the Active Movement Scale (AMS), and shoulder functions were assessed with the Mallet Scoring System (MSS). Virtual reality treatment had a positive effect on shoulder flexion, forearm pronation, wrist flexion, ROM, and functionality (p < 0.05). There was a significant improvement in shoulder abduction and shoulder external rotation in the CTG (p < 0.05). There was no significant difference in the MSS values of either groups (p > 0.05). As per the AMS, in the NWG, the shoulder internal rotation increased significantly (p < 0.05). Nintendo Wii treatment used in addition to conventional physiotherapy may be effective in increasing upper extremity functions in children with OBPI. Clinical Trials Number NCT04605601.


2013 ◽  
Vol 88 (3) ◽  
pp. 267-272
Author(s):  
Kamila Okulczyk ◽  
Bożena Okurowska-Zawada ◽  
Janusz Wojtkowski ◽  
Anna Kalinowska ◽  
Anna Mirska ◽  
...  

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