In Brachail Plexus Birth Palsy (BPBI), fractures, glenohumeral joint dislocation, torticollis and plagiocephaly, facial nerve palsy, phrenic nerve palsy, obesity, speech delay, integumentary system problems, and central nervous system disorders are common comorbidities. Clinical assessments such as observation, palpation, and radiologic imaging are commonly used to identify early period comorbidities after delivery .Since fractures or joint deformities may occur in the affected upper extremity due to high-energy trauma at birth, pain assessment in the early postnatal period is recommended and several objective assessment methods have been proposed. Due to the difficulty of pain assessment in early childhood, the assessment is mostly performed by palpation. Pain is suspected if the baby grimaces with light palpation of the neck and upper shoulder area. Although some hospitals have adopted objective assessment of pain and objective assessment is recommended, the level of pain in early childhood has not been investigated. Therefore, the aim of our study was to determine the level of pain in BPBI in early childhood and to examine the relationship between pain and motor function. In addition, the second aim of the study is to determine the cut-off value of the pain level that may be a sign of fracture in patients with BPBI, in order to suspect a fracture in the shoulder region and request additional examinations. The diagnosis of BPBI, determination of Narakas classification and evaluation of comorbidities were performed by a senior orthopedic surgeon. After the initial doctor's examination, patients are routinely referred to the physiotherapy clinic for a physiotherapy evaluation.In the assessment, active joint movement and pain assessments of children were used, and all of these assessments were performed by a hand and pediatric physiotherapist.
Study Type
OBSERVATIONAL
Enrollment
59
There was no intervention in our study, only observational and quantitative clinical evaluations.
Hacettepe University, Faculty of Physical Therapy Rehabilitation
Ankara, Altındağ, Turkey (Türkiye)
Comorbidities
In BPBI, fractures, glenohumeral joint dislocation, torticollis and plagiocephaly, facial nerve palsy, phrenic nerve palsy, obesity, speech delay, integumentary system problems, and central nervous system disorders are common comorbidities. In our university hospital, humerus or scapula fracture, glenohumeral joint dislocation, torticollis and plagiocephaly, facial nerve palsy, phrenic nerve palsy, Horner's syndrome, and central nervous system disorders are checked with clinical examinations and X-ray to record as a comorbidities and additional problems.
Time frame: Baseline, initial examination of children with BPBI who applied for medical follow-up.
Active Movement Scale - Motor Function Assessment
The AMS is a standardized assessment of 15 active joint movements on the affected side using an eight-point scale. The 15 movements were assessed by the AMS include. For each movement, the range of 0-4 points is evaluated in gravity eliminated position, while the range of 5-7 represents movement against gravity. The AMS-Total score is the sum of the scores of all 15 movements and represents the total function of the affected upper extremity, therefore the score can range from 0 to 105 points, with 0 being poor and 105 being the best score.
Time frame: Baseline, initial examination of children with BPBI who applied for medical follow-up.
Flacc Pain Scale
The FLACC Pain Scale is an observational behavioral scale developed by Merkel et al. in 1997. It provides a simple and consistent method for the assessment of pain in early childhood, especially in the age group when the child cannot verbally express his pain. It is used to evaluate procedural and postoperative pain in children older than 1 month. The FLACC scale is used to assess pain at rest, during a medical procedure or during various environmental stimuli. It scores 5 behaviors of the infant, including facial expression, leg movements, activities, crying and consolability, between 0 and 2 points. The scale produces a total pain score between 0 and 10 points.
Time frame: Baseline, initial examination of children with BPBI who applied for medical follow-up.
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