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首页> 外文期刊>Journal of Brachial Plexus and Peripheral Nerve Injury >Comparison of visual and objective quantification of elbow and shoulder movement in children with obstetric brachial plexus palsy
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Comparison of visual and objective quantification of elbow and shoulder movement in children with obstetric brachial plexus palsy

机译：小儿臂丛神经麻痹患儿肘关节和肩膀运动的视觉和客观定量比较

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BackgroundThe Active Movement Scale is a frequently used outcome measure for children with obstetric brachial plexus palsy (OBPP). Clinicians observe upper limb movements while the child is playing and quantify them on an 8 point scale. This scale has acceptable reliability however it is not known whether it accurately depicts the movements observed. In this study, therapist-rated Active Movement Scale grades were compared with objectively-quantified range of elbow flexion and extension and shoulder abduction and flexion in children with OBPP. These movements were chosen as they primarily assess the C5, C6 and C7 nerve roots, the most frequently involved in OBPP. Objective quantification of elbow and shoulder movements was undertaken by two-dimensional motion analysis, using the v-scope.MethodsYoung children diagnosed with OBPP were recruited from the Royal Children's Hospital (Melbourne, Australia) Brachial Plexus registry. They participated in one measurement session where an experienced paediatric physiotherapist facilitated maximal elbow flexion and extension, shoulder abduction and extension through play, and quantified them on the Active Movement Scale. Two-dimensional motion analysis captured the same movements in degrees, which were then converted into Active Movement Score grades using normative reference data. The agreement between the objectively-quantified and therapist-rated grades was determined using percentage agreement and Kappa statistics.ResultsThirty children with OBPP participated in the study. All were able to perform elbow and shoulder movements against gravity. Active Movement Score grades ranged from 5 to 7. Two-dimensional motion analysis revealed that full range of movement at the elbow and shoulder was rarely achieved. There was moderate percentage agreement between the objectively-quantified and therapist-rated methods of movement assessment however the therapist frequently over-estimated the range of movement, particularly at the elbow. When adjusted for chance, agreement was equal to chance.ConclusionVisual estimates of elbow and shoulder movement in children with OBPP may not provide true estimates of motion. Future work is required to develop accurate, clinically-acceptable methods of quantifying upper limb active movements. Since few children attained full range of motion, elbow and shoulder movement should be monitored and maintained over time to reduce disability later in life.
机译：背景主动运动量表是儿童产科臂丛神经麻痹（OBPP）常用的结局指标。临床医生观察孩子玩耍时的上肢运动，并以8分制进行量化。该标尺具有可接受的可靠性，但是尚不清楚它是否能准确地描述观察到的运动。在这项研究中，对OBPP儿童的治疗师评定的主动运动量表等级与客观量化的肘屈伸范围以及肩外展屈曲范围进行了比较。选择这些运动是因为它们主要评估OBPP中最常见的C5，C6和C7神经根。方法使用v形镜通过二维运动分析对肘部和肩膀的运动进行客观量化。方法从澳大利亚皇家儿童医院（澳大利亚墨尔本）臂丛神经登记处招募被诊断为OBPP的幼儿。他们参加了一次测量会议，其中一位经验丰富的儿科理疗师通过游戏促进了最大的肘关节屈伸，肩外展和伸展，并在主动运动量表上对其进行了量化。二维运动分析捕获了相同的度数运动，然后使用规范性参考数据将其转换为“主动运动得分”等级。使用百分比一致性和Kappa统计量确定客观量化级和治疗师级之间的一致性。结果30例OBPP儿童参加了这项研究。所有人都能够克服重力进行肘部和肩膀运动。主动运动评分等级介于5到7之间。二维运动分析显示，几乎无法实现肘部和肩膀的全部运动。在客观量化和治疗师评估的运动评估方法之间存在适度的百分比一致性，但是治疗师经常高估了运动幅度，尤其是在肘部。调整机会后，一致就等于机会。结论视觉估计OBPP儿童的肘部和肩膀运动可能无法提供运动的真实估计。需要进一步的工作来开发量化上肢活动运动的准确的，临床上可接受的方法。由于很少有儿童能完全运动，因此应及时监测并保持肘部和肩膀的运动，以减少以后的残疾。

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