Sensation in children with an Obstetric Brachial Plexus Palsy

The obstetric brachial plexus lesion (OBPL) is a traction injury that occurs
during birth. The most common type is a lesion of the two upper nerves of the
brachial plexus, which are C5 and C6. It is a clinical observation, that was
acknowledged in a number of clinical papers, that - despite a good motor
recovery of the C5 and C6 spinal nerves - a certain clumsiness of the hand was
noticed. This is remarkable, because motor innervation of the hand is
innervated by the three lower nerves of the brachial plexus, i.e C7, C8 en T1,
which should not be involved in a C5-C6 lesion.

One explanation for this observation is that hand function was diminished by
diminished sensation of the hand. The spinal nerve C6 serves the palmar surface
and finger tips of the thumb and index finger, and thus diminished sensation in
this area probably exists in C5-C6 lesions. The diminished sensation is the
subject of the current research proposition.

From a therapeutical point of view it is important to have proper knowledge of
the sensation function of children with an upper brachial plexus lesion, as
treatment regimes might be adapted to improve sensation. Current literature
does not contain a good description of sensation in children with an OBPL.

A first shortcoming is that a validated measurement tool for sensation in
children is lacking. We performed a literature research on existing measurement
tools to develop a method that is applicable in children. The set of found
methods or tools were adapted for the intended population to suit practicality
(smaller size of childrens fingers), understanding and concentration. These
modifications were tested as pilot in a a number of health children, which led
to further adaptations. The resulting measurement tool will be employed during
this study.

The main objective is to investigate if the sensation of children with an upper
OBPL is diminished. Both children that were treated conservatively as children
that were surgically treated with nerve surgery in early infancy.

The primary research question is:
1. Do children with an upper OBPL have a normal sensation of the hand ?
To answer this question sensation will be measured in a control group of
healthy children without nerve lesion.

Secondary research questions are:
2. What is a good measurement tool to assess sensation of the hand in children;
which parts of the measurement tool are sensitive clinical practice to diagnose
a diminished sensation.
3. Is there a correlation between sensation of the hand with clinical
parameters, like motor recovery of the limb, severity of the nerve lesion, and
hand function.

The hypothesis is, that sensation of the hand is diminished in children with an
upper OBPL, which could potentially explain clumsiness of the hand.

The study design is a cross sectional investigation of patients that are follow
in our patient clinic of the NerveCenter of the LUMC.

To answer the primary research question our measurement tool will be employed
to assess sensation in 50 children with an upper OBPL. Depending on the results
of the first 20 children, intra- and inter-observer variablility will be
investigated.

In a control group of 25 healthy children our measurement tool will be applied.

The secondary research questions will be investigated with the obtained
results.

The age of the population is 7 up to 12 years .
The investigation is not invasive or painful, but they demand attention and
cooperation.
The measurement of sensation shall be done by an experienced child
physiotherapist, on a child friendly way.