Okul Öncesi Yaş Grubu Obstetrik Brakiyal Pleksus Paralizili Çocuklarda Vücut Yapı ve Fonksiyonların Aktivite ve Katılım Üzerine Etkisinin İncelenmesi

Abstract

Obstetric brachial plexus palsy (OBPP) is a clinical condition that occurs as a result of an injury to the nerves and/or roots of the brachial plexus (BP) during delivery. Although there are lots of studies investigating body structures and function, such as muscle strength and range of motion, there are few studies investigating activity and participation restrictions in different types of OBPP. The aim of the study was to investigate body structure, function, activity and participation domains according to International Classification of Functioning, Disability and Health in preschool aged children with different types of OBPP, and also determine significance level of impact of the body structure and function on activity and participation levels. One hundred twelve OBPP children aged between 44-77 months and their parents were included in this study. The children were investigated based on their Narakas types: Group 1, Narakas type 1 (n=7); Group 2, Narakas type 2a (n=45); Group 3, Narakas Type 2b (n=46); Group 4, Narakas Type 3 and 4, representing total plexus palsy, (n=14). Mallet classification, Raimondi hand classification were used; shoulder and elbow active and passive joint movements and stereognosis were evaluated, brachial plexus outcome measure (BPOM), and paediatric outcome data collection instrument (PODCI) were used. As a result, Type 1 and 2a were similar, total palsy group being the worst; both Narakas type 1 and 2a children had better outcomes than type 2b and total plexus palsy group in body structure and function, and activity and participation levels (p<0.001). Body structure and functions ranking based on their effects on activity and participants levels from high to low are hand functions, hand to mouth, hand to back, global abduction, global external rotation and stereognozis respectively (p<0.001). We found that these evaluations could explain 92% of changes in activity and participant levels. Identifying body structure and function disorders and activity/participation restrictions, and prioritizing body structure and function components, effecting activity and participation levels, are crucial for physical therapy and rehabilitation intervention strategies in preschool children. In conclusion, to develop rehabilitation programs for treatment and long term follow up of OBPP that aims body structure and functional impairment, which effects activity and participation restrictions, would result with more beneficial effects on the children’s activity and participation levels.