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Asymmetrical Arm Swing During Gait In Children With Brachial Plexus Birth Injury
Eliza Buttrick, BA
1, Apurva S. Shah, MD, MBA
1, Valentina Graci, PhD
1, Sayaka Mori, BA
1, Elliot M Greenberg, PT, DPT, PhD, OCS
1, Shaun D. Mendenhall, MD
2; Meagan Pehnke, MS, OTR/L, CHT, CLT
1(1)Children's Hospital of Philadelphia, Philadelphia, PA, (2)University of Utah, Salt Lake City, UT
Introduction: Children with brachial plexus birth injury (BPBI) often report notable differences in arm movement between the affected and unaffected arm during activity, though this has not been investigated. We characterized abnormalities in arm swing during gait in children with BPBI, exploring asymmetry in arm movement and asynchrony with the lower extremities.
Materials & Methods: Patients aged 5-17.99 years with BPBI at a single children's hospital were prospectively evaluated. We used an Inertial Measurements Unit system (XSENS, Movella Inc.) to collect bilateral shoulder and elbow 3D kinematics and toe velocity during a 60-feet sprint. A custom MATLAB program extracted toe strike (defining gait cycle start/end), peak shoulder and elbow flexion (positive)/extension (negative) angles, and the timing of these peaks relative to contralateral toe strike. Patient-reported outcomes included the Children's Hand-Use Experience Questionnaire (CHEQ) and PROMIS Anxiety and Peer Relations modules. Paired t-tests compared sides, and one-sample Mann-Whitney tests assessed CHEQ scores.
Results: Twenty-two patients were evaluated at an average age of 8.5 ± 3.2 years. On the affected side, patients achieved less maximum shoulder extension (-1.83º vs. -37.19º, p<0.01) and elbow flexion (58.4º vs. 79.1º, p<0.01) compared to the unaffected side (Figure 1). While peak shoulder extension occurred at a similar point in the gait cycle [mean 0.18 sec (affected) vs. 0.12 sec (unaffected), p=0.3], timing was less consistent on the affected side (SD 0.12 vs. 0.07, p=0.02), with similar findings for elbow extension (mean 0.14 sec (affected) vs. 0.09 sec (unaffected), p=0.50; SD 0.19 (affected) vs. 0.12 (unaffected), p=0.04). On the mini CHEQ (ages 5-7.99, normal=4) and CHEQ (age 8+, normal=100), patients reported lower hand capacity (mean 3.0, 58.9), longer task completion time (mean 2.9, 63.6), and were more bothered by their arm function (mean 3.2, 69.5) than normal (p<0.01 for all). PROMIS Peer Relations and Anxiety scores were within normal limits (means 53.4 ± 7.3 and 50.5 ± 8.9, respectively).
Conclusion: Children with BPBI demonstrate reduced shoulder extension and elbow flexion and decreased coordination with leg movements, ultimately limiting sprinting efficiency. Children also reported being bothered by their arm function.
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