OBSTETRİK BRAKİYAL PLEKSUS YARALANMASI OLAN ÇOCUKLARDA ÖLÇÜLEN POSTURAL SALINIM TİPİK GELİŞİM GÖSTEREN ÇOCUKLARDAN FARKLI MIDIR?

Year 2023, Volume: 34 Issue: 2, 235 - 240, 31.08.2023

Azize Reda Tunç , Tüzün Fırat , Akmer Mutlu , Semra Topuz

https://doi.org/10.21653/tjpr.1142578

Abstract

Amaç: Obstetrik Brakial Pleksus Yaralanması (OBPY) olan çocuklarda yaralanma sonucu üst ekstremitede gelişen asimetrik kullanım postural kontrol gelişimini ve postural salınım değerlerini etkilemektedir. Bu çalışmada OBPY’li çocuklarda postural salınım değerlerindeki değişimi incelemek sağlıklı kontrol olgularıyla karşılaştırmak amaçlandı.
Yöntem: Çalışmaya, yaşları ortalama 6,35±1,40 yıl olan OBPY tanılı 55 çocuk ve yaşları ortalama 6,09±0,76 yıl olan 45 tipik gelişim gösteren sağlıklı olgu dahil edildi. Her iki grubun demografik bilgileri ve OBPY'li çocukların ayrıca Narakas Sınıflandırma Sistemine göre yaralanma dereceleri kaydedildi. Çalışmada grupların postural kontrol parametrelerine ait postural salınım değerleri Balance Check Screener kuvvet platformu (Model BP5050; Bertec, Columbus, OH, ABD) ile elde edildi.
Sonuçlar: Yapılan istatistiksel analizde gruplar arası demografik özellikler benzer bulundu (p˃0,05). OBPY olgularında, tipik gelişim gösteren sağlıklı olgulara göre, anterio-posterior salınım değerlerinin istatistiksel olarak anlamlı düzeyde artmış olduğu saptandı (p<0,05). OBPY olgularında gözler kapalı medio-lateral yönünde salınım miktarının daha yüksek olduğu ve farkın istatistiksel olarak anlamlı olduğu belirlendi (p<0,05). Sert ve yumuşak zeminde gözler açık olarak elde edilen medio-lateral salınım değerleri açısından gruplar arası karşılaştırma sonuçları arasında fark olmadığı görüldü (p˃0,05).
Tartışma: Çalışmamızın sonuçları, OBPY'li çocukların sağlıklı yaşıtları ile karşılaştırıldığında, postural salınımlarının arttığını göstermiştir. OBPY'li çocuklarda yaralanma sonucu üst ekstremitelerin asimetrik gelişimi ve buna bağlı olarak kompansasyonların açığa çıkmasının, postural kontrol gelişimini de olumsuz etkilediği düşünülmektedir. Bu kapsamda, OBPY'li bireylerde sadece etkilenen ekstremiteyi içeren tedavi yaklaşımları yerine, bütüncül bir bakış açısıyla gövde asimetrisi, postural kontrol ve denge kayıplarının değerlendirilmesi ve bunlara yönelik tedavi stratejilerinin en erken dönemde oluşturularak tedavi programlarına dahil edilmesi önerilmektedir.

Keywords

Obstetrik Brakiyal Pleksus Yaralanması, Postural Kontrol, Postural Salınım

Project Number

-

Thanks

Desteği için Yasin Tunç'a teşekkürü bir borç bilirim.

IS POSTURAL SWAY MEASURED IN CHILDREN WITH OBSTETRIC BRACHIAL PLEXUS INJURY DIFFERENT FROM TYPICALLY DEVELOPING CHILDREN?

Abstract

Purpose: Asymmetric use of the upper extremity as a result of injury in children with Obstetric Brachial Plexus Injury (OBPI) affects the development of postural control and postural sway values. The objective of the present study was to investigate the changes in postural sway values in children with OBPI and to compare them with healthy controls.
Methods: Fifty-five children with OBPI with a mean age of 6.35±1.40 years and 45 healthy subjects with typical development, with a mean age of 6.09±0.76 years were included in the study. Demographic information of both groups and the degree of injury of children with OBPI according to the Narakas Classification System were recorded. The postural sway values of the postural control parameters of the groups were obtained with the Balance Check Screener force platform (Model BP5050; Bertec, Columbus, OH, USA).
Results: In the statistical analysis, demographic characteristics between the groups were found to be similar. The statistics related to anteroposterior oscillation values were found to be significantly increased in patients with OBPI compared to healthy patients with typical development (p<0.05). It was observed that the amount of oscillation in the medio-lateral direction was higher in OBPY cases with eyes closed and the difference was statistically significant (p<0.05). No difference was observed between the results of the groups in terms of medio-lateral oscillation values obtained with eyes open on hard and soft ground (p ˃0.05).
Conclusion: The results of our study showed that the postural sway of children with OBPI increased when compared to their healthy peers. It is assumed that the asymmetric development of the upper extremities and the emergence of compensations as a result of injury in children with OBPI negatively affect the development of postural control. In this context, it is recommended to evaluate the effects of trunk asymmetry, postural control and balance losses from a holistic perspective, instead of treatment approaches involving only the affected extremity in individuals with OBPI, and to create treatment strategies for them in the earliest period and include them in treatment programs.

Keywords

Obstetric Brachial Plexus Injury, Postural Control, Postural Sway

Project Number

-

References

• 1. Frade F, Gómez-Salgado J, Jacobsohn L, Florindo-Silva F. Rehabilitation of neonatal brachial plexus palsy: integrative literature review. J. Clin. Med. 2019;8(7):980.
• 2. Abid A. Brachial plexus birth palsy: management during the first year of life. OTSR. 2016;102(1):125-32.
• 3. Coroneos CJ, Voineskos SH, Coroneos MK, Alolabi N, Goekjian SR, Willoughby LI, et al. Primary nerve repair for obstetrical brachial plexus injury: a meta-analysis. Plast Reconstr Surg. 2015;136(4):765-79.
• 4. Yang LJ-S, editor Neonatal brachial plexus palsy—Management and prognostic factors. Seminars in perinatology; 2014: Elsevier.
• 5. Cornwall R. The Biology of Brachial Plexus Birth Injuries. Operative Brachial Plexus Surgery: Springer; 2021. p. 465-79.
• 6. Bellows D, Bucevska M, Verchere C. Coordination and balance in children with birth-related brachial plexus injury: a preliminary study. Physiother Can. 2015;67(2):105-12.
• 7. Souza L, Lemos T, Silva DC, De Oliveira JM, Guedes Correa JF, Tavares PL, et al. Balance impairments after brachial plexus injury as assessed through clinical and posturographic evaluation. Front Hum Neurosci. 2016;9:715.
• 8. Buterbaugh KL, Shah AS. The natural history and management of brachial plexus birth palsy. Curr. Rev. Musculoskelet. 2016;9(4):418-26.
• 9. Ridgway E, Valicenti-McDermott M, Kornhaber L, Kathirithamby DR, Wieder H. Effects from birth brachial plexus injury and postural control. J. Pediatr. 2013;162(5):1065-7.
• 10. Al-Qattan M, El-Sayed A, Al-Zahrani A, Al-Mutairi S, Al-Harbi M, Al-Mutairi A, et al. Narakas classification of obstetric brachial plexus palsy revisited. J Hand Surg Eur Vol. 2009;34(6):788-91.
• 11. Šarabon N. Development of software for comprehensive analyses of force plate measurements. Kinesiol. 2011;43(2.):204-12.
• 12. Ivanenko Y, Gurfinkel VS. Human postural control. Front. Neurosci. 2018;12:171.
• 13. Simsek D, Ertan H. Postural kontrol ve spor: spor branşlarına yönelik postural sensör-motor stratejiler ve postural salınım. Spormetre Beden Eğitimi ve Spor Bilimleri Dergisi. 2011;9(3):81-90.
• 14. Keklicek H, Kırdı E, Yalcin A, Yuce D, Topuz S. Learning effect of dynamic postural stability evaluation system. J Back Musculoskelet Rehabil. 2019;32(1):7-14.
• 15. Rosengren KS, Rajendran K, Contakos J, Chuang L-L, Peterson M, Doyle R, et al. Changing control strategies during standard assessment using computerized dynamic posturography with older women. Gait Posture 2007;25(2):215-21.
• 16. Roostaei M, Raji P, Kalantari KK, Faghihzadeh E, Fragala-Pinkham M. Effect of upper extremity constraints on functional and dynamic postural control in children with hemiplegic cerebral palsy. Dev. Neurorehabilit. 2022;25(4):281-8.
• 17. Giddins G, Giddins H. Wrist and hand postures when falling and description of the upper limb falling reflex. j.injury. 2021;52(4):869-76.
• 18. Anguelova GV, Malessy MJ, Buitenhuis SM, Zwet EWv, Dijk JGv. Impaired automatic arm movements in obstetric brachial plexus palsy suggest a central disorder. J. Child Neurol. 2016;31(8):1005-9.
• 19. Hill MW, Wdowski MM, Pennell A, Stodden DF, Duncan MJ. Dynamic postural control in children: do the arms lend the legs a helping hand? Front. Physio. 2019:1932.
• 20. Wdowski MM, Duncan MJ, Pennell A, Hill MW. Changes in joint kinematics and dynamic postural stability with free and restricted arm movements in children. Gait Posture. 2021;88:47-53.
• 21. Boström KJ, Dirksen T, Zentgraf K, Wagner H. The contribution of upper body movements to dynamic balance regulation during challenged locomotion. Front. Hum. Neurosci. 2018;12:8.
• 22. Bingham JT, Choi JT, Ting LH. Stability in a frontal plane model of balance requires coupled changes to postural configuration and neural feedback control. J. Neurophysiol.2011;106(1):437-48.
• 23. Hilliard MJ, Martinez KM, Janssen I, Edwards B, Mille M-L, Zhang Y, et al. Lateral balance factors predict future falls in community-living older adults. Arch Phys Med Rehabi. 2008;89(9):1708-13.