Cargando…

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

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 was...

Descripción completa

Detalles Bibliográficos
Autores principales: Boesendorfer, Anna, Sturma, Agnes, Gstoettner, Clemens, Pittermann, Anna, Laengle, Gregor, Aszmann, Oskar C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9397750/
https://www.ncbi.nlm.nih.gov/pubmed/36188841
http://dx.doi.org/10.3389/fresc.2021.804376
_version_ 1784772187719204864
author Boesendorfer, Anna
Sturma, Agnes
Gstoettner, Clemens
Pittermann, Anna
Laengle, Gregor
Aszmann, Oskar C.
author_facet Boesendorfer, Anna
Sturma, Agnes
Gstoettner, Clemens
Pittermann, Anna
Laengle, Gregor
Aszmann, Oskar C.
author_sort Boesendorfer, Anna
collection PubMed
description 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.
format Online
Article
Text
id pubmed-9397750
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-93977502022-09-29 Case Report: Bionic Reconstruction in an Adult With Obstetric Brachial Plexus Injury Boesendorfer, Anna Sturma, Agnes Gstoettner, Clemens Pittermann, Anna Laengle, Gregor Aszmann, Oskar C. Front Rehabil Sci Rehabilitation Sciences 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. Frontiers Media S.A. 2022-01-05 /pmc/articles/PMC9397750/ /pubmed/36188841 http://dx.doi.org/10.3389/fresc.2021.804376 Text en Copyright © 2022 Boesendorfer, Sturma, Gstoettner, Pittermann, Laengle and Aszmann. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Rehabilitation Sciences
Boesendorfer, Anna
Sturma, Agnes
Gstoettner, Clemens
Pittermann, Anna
Laengle, Gregor
Aszmann, Oskar C.
Case Report: Bionic Reconstruction in an Adult With Obstetric Brachial Plexus Injury
title Case Report: Bionic Reconstruction in an Adult With Obstetric Brachial Plexus Injury
title_full Case Report: Bionic Reconstruction in an Adult With Obstetric Brachial Plexus Injury
title_fullStr Case Report: Bionic Reconstruction in an Adult With Obstetric Brachial Plexus Injury
title_full_unstemmed Case Report: Bionic Reconstruction in an Adult With Obstetric Brachial Plexus Injury
title_short Case Report: Bionic Reconstruction in an Adult With Obstetric Brachial Plexus Injury
title_sort case report: bionic reconstruction in an adult with obstetric brachial plexus injury
topic Rehabilitation Sciences
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9397750/
https://www.ncbi.nlm.nih.gov/pubmed/36188841
http://dx.doi.org/10.3389/fresc.2021.804376
work_keys_str_mv AT boesendorferanna casereportbionicreconstructioninanadultwithobstetricbrachialplexusinjury
AT sturmaagnes casereportbionicreconstructioninanadultwithobstetricbrachialplexusinjury
AT gstoettnerclemens casereportbionicreconstructioninanadultwithobstetricbrachialplexusinjury
AT pittermannanna casereportbionicreconstructioninanadultwithobstetricbrachialplexusinjury
AT laenglegregor casereportbionicreconstructioninanadultwithobstetricbrachialplexusinjury
AT aszmannoskarc casereportbionicreconstructioninanadultwithobstetricbrachialplexusinjury