Analysis of upper extremity motion in children after axillary burn scar contracture release.

Burns to the upper extremity and axilla frequently result in the formation of contractures that can impede shoulder range of motion. The purpose of this study was to determine the long-term effects of upper extremity burn scar contracture release on motion during activities of daily living in the first year postrelease. Upper extremity motion analysis was conducted on children aged 4 to 17 years before and 1, 3, 6, and 12 months after axillary contracture release surgery. Movements were analyzed during three functional tasks including high reach (reaching for an object), hand to head (combing hair), and hand to back pocket (toileting). A total of 23 subjects (34 axillary contractures; mean age 10+/-3 years; mean TBSA burn 40+/-6%) completed the study. Preoperatively, decreased shoulder mobility due to axillary contractures resulted in the use of compensatory motions to complete the tested activities. Surgical release of the contracture increased shoulder mobility and decreased compensatory movements. Improvements were maintained for 1 year after surgery with majority of the improvement involving shoulder flexion. Axillary contracture release surgery improves functional shoulder mobility and decreases compensatory motions used during activities of daily living in the first year postrelease. Additional follow-up is needed to evaluate the impact of growth on scar development.

The contralateral unimpaired arm as a control for upper extremity kinematic analysis in children with brachial plexus birth palsy.

BACKGROUND: Kinematic studies of abnormal upper extremity (UE) motion provide the unique and valuable perspective of motion analysis during simulated functional tasks. However, they require comparison with healthy control data. Obtaining this control data usually entails testing a healthy population, which can be costly and time consuming, requiring separate subject inclusion criteria, recruitment, and institutional review board approval. The kinematics of the unimpaired UE in people with unilateral impairment have not been analyzed and documented. The purpose of this study was to compare UE motion during activities of daily living in the contralateral unimpaired arm of subjects with brachial plexus birth palsy (BPBP) with an age-matched control population. METHODS: The contralateral arms of 40 subjects with unilateral BPBP were compared with the arms of 15 healthy subjects using an established 3-dimensional upper extremity motion analysis protocol. RESULTS: There were no significant differences between the 2 arms on 17 of 19 motion parameters. The 2 differences that were statistically significant (P < 0.05) were not clinically meaningful. CONCLUSIONS: The contralateral arms of children with unilateral BPBP can be used as controls for future upper extremity motion analysis studies of this population, and further recruitment of age-matched controls is not necessary for comparison with 5- to 8-year-old children with BPBP.

Upper extremity kinematics during functional activities: three-dimensional studies in a normal pediatric population.

Children with brachial plexus birth palsy, burns, cerebral palsy, spinal cord injury and upper limb malformations may have diminished ability to perform activities of daily living (ADLs) due to limited upper extremity (UE) motion. Three-dimensional (3D) imaging techniques provide a way to document multi-planar functional limitations in the UE. These techniques have not been routinely used for this purpose primarily due to a lack of standardized protocols stemming from the complex nature of UE motion. Before 3D techniques can be routinely used for quantitative analysis and determination of functional limitations, standard activities and nomenclature for UE motion must be determined, and normal arm motion defined. This study establishes a normative pediatric database of 3D kinematic values during selected ADLs, enabling future comparisons with pathologic movements. Regardless of their underlying condition, children with limited UE function and ADL performance can be studied using this protocol and compared with this age-matched normal population.

Kinematic assessment of the upper extremity in brachial plexus birth palsy.

Children with brachial plexus birth palsy (BPBP) may have shoulder external rotation and abduction weakness that can restrict activities of daily living (ADLs). Static range of motion measurements may not measure ADL restrictions. Motion analysis has been used to quantify gait limitations and measure changes associated with treatment. The purpose of this study was to determine whether upper extremity motion analysis (UEMA) can measure the differences in shoulder motion during ADLs between children with BPBP and normal children. Following a previously described UEMA protocol, 55 children with BPBP and 51 normal children (control group) were studied. Kinematic data of selected ADLs were collected before surgery. UEMA was used to measure statistically significant differences between children with BPBP and control subjects for all planes of shoulder motion in all activities tested. The authors conclude that UEMA can discriminate between children with BPBP and control subjects during selected ADLs, and suggest that UEMA can also be used to measure the effects of surgical interventions in children with BPBP.

Alterations in functional movement after axillary burn scar contracture: a motion analysis study.

Children with axillary burns often develop scar contractures that restrict shoulder movement. Objective data on functional movement patterns after contracture formation is sparse. The purpose of this study was to determine how axillary contractures affect shoulder movement during activities of daily living (ADLs). This was a prospective study of children with axillary contractures scheduled for surgical release. Three-dimensional upper extremity kinematic analysis was used to assess shoulder, elbow, and trunk motion during two ADLs: high reach and hand to back pocket. Results were compared with a pool of 49 normal age-matched controls. Eleven children with axillary contractures were compared with controls. During high reach, significant decreases in shoulder flexion, shoulder internal rotation, arm pronation, and trunk extension occurred. Elbow flexion increased significantly. In the hand to back pocket task, shoulder extension and elbow flexion decreased and shoulder abduction increased. Axillary contractures result in quantifiable movement changes during ADLs. Aggressive rehabilitation is required to prevent contracture formation. Three-dimensional motion analysis is a unique tool for the quantification of functional limitations and provides an objective method to evaluate treatment efficacy in patients with axillary contractures.

A method for determination of upper extremity kinematics.

Kinematic analysis of the upper extremity has been conducted using a wide variety of techniques, philosophies, and analytic methods. We describe a simple, marker-based three-dimensional video analytic technique that borrows concepts from lower extremity kinematic analysis. A sequential rotation order about orthogonal axes is described, although alternate methods are examined as well. The method has been verified by application to a mechanical model. In certain positions, gimbal lock may occur, and a different sequence of rotational decomposition may be required. Agreement on standardization of technique would assist in the dissemination of upper extremity scientific data.