Browsing by Author "Logue, Rachel N."

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Impact of Unilateral Neonatal Brachial Plexus Palsy on Dynamic Balance Control in Children and Adolescents
(Saudi Digital Library, 2022) Bin Mulayh, Ejlal A.; Logue, Rachel N.; Yang, Lynda J-S.; Brown, Susan H.; Brown, Susan H
Introduction: Unilateral birth-related damage to the brachial plexus - a complex network of nerves innervating the shoulder and upper limb - is associated with muscle weakness and altered somatosensation that often persists despite conservative or neurosurgical treatment. To what extent such asymmetric arm deficits impact postural control in this population is not well understood. Methods: Twelve participants with neonatal brachial plexus palsy (NBPP) who were conservatively treated (mean age: 11.6 ± 3.2y) and 10 who underwent surgical reconstruction of the brachial plexus (mean age: 10 ± 1.1y) stood on a force plate and traced a maze using their outstretched arm. The maze display was mounted at chest height and the task was performed with the unaffected and the affected arm. Dependent measures were center of pressure (COP) displacement and smoothness. Sixteen age-matched controls (mean age: 11.5 ± 2.4y) were included for comparison purposes. Assessments were followed by one week of wrist accelerometry to capture self-initiated arm movement. Relative movement of the two arms was expressed as symmetry ratios. Results: When performing the task with their affected arm, total COP displacement was greater in the surgical NBPP group compared to the nonsurgical and control groups (p<0.001). COP displacement in the surgical group was 69% greater (p< 0.001) and more irregular (p< 0.05) when the task was performed by the affected compared to the unaffected hand. Lastly, COP sway area was predictive of accelerometry-based movement magnitude but only in the surgical NBPP group (p<0.05). Conclusions: These findings demonstrate that long term impairment due to NBPP is associated with greater postural sway during the performance of goal-directed arm movements, particularly in cases where nerve reconstruction as occurred. In such cases, impaired postural control may contribute to a reduction in arm use in real world settings and underscores the importance of whole-body assessment when considering rehabilitation strategies.
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