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Conclusion.– Cette étude randomisée et contrôlée en simple insu offre lespremières preuves d’efficacité de la TAR chez l’enfant PC. D’autres étudesdevront investiguer son intérêt à long terme.Référence[1] Krebs. et al. Dev Med Child Neurol 2009;51:140–5.
http://dx.doi.org/10.1016/j.rehab.2013.07.748
Oral communicationsEnglish version
CO33-001-e
Multidisciplinary management in children withobstetric brachial plexus injury (OBPI)N. Quintero Prigent a,*, C. Romana b
a Service de rééducation orthopédique pôle Enfant, Hôpitaux de SaintMaurice, 14, rue du Val d’Osné, 94410 Saint Maurice, Franceb Hôpital Armand-Trousseau, France*Corresponding author.E-mail address: [email protected]
Keywords: Obstetric brachial plexus injury; Sequelae; TreatmentsDespite advances in obstetrics, the incidence of obstetric brachial plexus injury(OBPI) does not appear to have decreased significantly (3-4 per 1000 newbirths).During the first weeks of life, classic care of children with brachial plexus relieson preventing muscle contractures and joint deformities.Once about three months old, depending on the recovery of their elbow flexion,children will benefit from microsurgery and then, continue rehabilitation work.Depending on the plexus injury, sequelae may appear. Most common are co-contractions, resulting from the reorganization of nerve fibers and of musclehypertonia, for which we detail our experience with botulinum toxin. Commonexamples of muscle deficits are lack of external rotation of the shoulder, andlack of wrist extension and flexion of the elbow because of a triceps deficit. Wealso highlight current treatments of joint sequelae, such as ankylosis of theelbow or subluxation of the humeral head.Motor impairment and loss of functional movements are common consequencesof OBPI that compromise the quality of life of our patients. The improvement ofthe efficiency of treatment of our patients can only be reached through theharmonization of our practices.Further ReadingN. Quintero, F. Guillou, M. Alkandari, A.G. Py, D. Pilliard, C. Romana.Traitement du déséquilibre musculaire du plexus brachial. Plexus brachial.Actualités et perspectives. Springer-Verlag Paris 2012;77-85.Saleh M. Shenaq and all. Current Management of Obstetrical Brachial PlexusInjuries at Texas Children’s Hospital Brachial Plexus Center and BaylorCollege of Medicine. Semin Plast Surg 2005;19:42-55.LC. Sheffler, Lisa Lattanza, Yolanda Hagar, Anita Bagley, Michelle A. James.The Prevalence, Rate of Progression, and Treatment of Elbow FlexionContracture in Children with Brachial Plexus Birth Palsy. J Bone Joint SurgAm 2012;94;403-409.Gobets D, Beckerman H, de Groot V, Van Doorn-Loogman MH, BecherJG.Indications and effects of botulinum toxin A for obstetric brachial plexusinjury: a systematic literature review. Dev Med Child Neurol 2010;52;517-28.Forin V, Romana C. Paralysie obstétricale du plexus brachial. In: Elsevier(ed) Kinésitherapie-Rééducation Fonctionelle. Encycl Méd Chir 1996;p.462-473.
http://dx.doi.org/10.1016/j.rehab.2013.07.749
CO33-002-e
Three-dimensional characterization of muscularatrophy and its consequences on the strengthgenerated by the shoulder of brachial plexus birthpalsy childrenC. Pons a,*, F. Sheehan b, K. Alter b, H.S. Im b, S. Brochard c
a CHU de Brest, service de rééducation fonctionnelle,2, avenue Foch, 29200Brest, Franceb Functional and Applied Biomechanics section, département de‘‘Rehabilitation Medicine’’, NIH, Bethesda, Maryland, USAc LaTIM, Inserm U1101, Brest, France*Corresponding author.E-mail address: [email protected]
Keywords: Obstetrical brachial plexus palsy; Shoulder; Strength; Musclevolume; ImbalanceIntroduction.– In children with obstetrical brachial plexus palsy (OBPP),prevention and treatment of the glenohumeral deformities caused by a strengthimbalance is a main therapeutic goal. However, the most affected muscles andimbalance are scarcely identified. The objective of this work was to determinein 3D the muscles involved in the strength loss and to investigate therelationship between muscle volume and maximal isometric strength producedby the shoulder.Methodology.– Twelve children with unilateral OBPP were included. A MRI ofboth shoulders was carried out, the healthy shoulder serving as a control.Segmentation and 3D reconstruction of the shoulder muscles were made,enabling calculation of the muscle volumes. Maximal isometric strength wasmeasured using a hand-held dynamometer in flexion/extension, abduction/adduction, internal and external rotations.Results.– The total muscle volume was significantly decreased in the injuredside (65.4% on average compared to the healthy side). Most atrophic muscleswere: teres major (43.2%), subscapularis (52.2%), supraspinatus (53%),infraspinatus (62.1%), deltoid (62.3%) and pectoral major (84.3%). Thedistribution of muscle volumes was different between the two sides withsignificant differences for muscles pectoralis major (injured side 31.9% of thetotal volume vs 2.3%), teres major (9.6% vs 13.9%), subscapularis (12.3% vs14.5%) and supraspinatus (3.8 vs 4.5%). A linear relationship existed betweenmuscle volumes and maximal isometric strength in injured and healthy sides(r = 0.91 and 0.95). Maximal isometric strength were also significantlydecreased (0.001 < p < 0.01).Discussion.– For the first time, these original data characterize in 3D the atrophyof the muscles implicated in OBPP. They show that muscular atrophy is highlycorrelated with strength and that it exists a morphological and functionalimbalance around the gleno-humeral joint. Further studies may be conducted tostudy the relationship between muscular parameters and gleno-humeraldeformity, which will help with muscle selection during focal treatments likebotulinum toxin injections or rebalancing surgeries.
http://dx.doi.org/10.1016/j.rehab.2013.07.750
CO33-003-e
Three dimensional gleno-humeral deformities inobstetric brachial plexus palsyS. Brochard a,*, B. Borotikar b, J. Mozingo c, K. Alter b, F. Sheehan b
a CHRU de Brest, 5, Avenue Foch, 29200 Brest, Franceb Functional and Applied Biomechanics Section, Rehabilitation MedicineDepartment, National Institutes of Health, Bethesda, MD, USAc University of Rochester Hajim School of Engineering and Applied Sciences,USA*Corresponding author.E-mail address: [email protected]
Keywords: Obstetric brachial plexus palsy; Gleno-humeral deformityIntroduction.– Three-dimensional (3D) quantification of skeletal changesassociated with obstetrical brachial plexus palsy (OBPP) will enable cliniciansand surgeons to make more informed interventional decisions. The aims of thisstudy were to quantify the 3D glenoid version and humeral head migration(HHM) in children with OBPP and to evaluate the reliability of the typicallyused 2D and the newly developed 3D measures.Methods.– Thirteen children (4F/9 M, age = 11.8 � 3.3years, Mal-let_score = 15.1 � 3.0) participated in this IRB-approved study. AT1-weightedgradient-recalled-echo axial image set (resolution = 0.55–0.63mm2, sli-ce_thickness = 1.2 mm) was acquired for the impaired and non-impairedshoulders using a 3 T MRI. 2D measures of the glenoid anterior-posterior (AP)version and humeral head migration (HHM) were determined in the axial slice
Pédiatrie (2) – membre supérieur / Annals of Physical and Rehabilitation Medicine 56S (2013) e288–e294 e291
