Balance Impairments after Brachial Plexus Injury as Assessed through Clinical and Posturographic Evaluation.

Lidiane Souza,José M De Oliveira,José F Guedes Corrêa,Paulo L Tavares,Thiago Lemos,Laura A Oliveira,Débora C Silva,Erika C Rodrigues,Claudia D Vargas

doi:10.3389/fnhum.2015.00715

Abstract

Objective: To investigate whether a sensorimotor deficit of the upper limb following a brachial plexus injury (BPI) affects the upright balance.Design: Eleven patients with a unilateral BPI and 11 healthy subjects were recruited. The balance assessment included the Berg Balance Scale (BBS), the number of feet touches on the ground while performing a 60 s single-leg stance and posturographic assessment (eyes open and feet placed hip-width apart during a single 60 s trial). The body weight distribution (BWD) between the legs was estimated from the center of pressure (COP) lateral position. The COP variability was quantified in the anterior-posterior and lateral directions.Results: BPI patients presented lower BBS scores (p = 0.048) and a higher frequency of feet touches during the single-leg stance (p = 0.042) compared with those of the healthy subjects. An asymmetric BWD toward the side opposite the affected arm was shown by 73% of BPI patients. Finally, higher COP variability was observed in BPI patients compared with healthy subjects for anterior-posterior (p = 0.020), but not for lateral direction (p = 0.818).Conclusions: This study demonstrates that upper limb sensorimotor deficits following BPI affect body balance, serving as a warning for the clinical community about the need to prevent and treat the secondary outcomes of this condition.

Highlights

The brachial plexus is formed by the spinal nerves C5 to T1 and is responsible for both motor and sensory innervation of the upper limb (Resnick, 1995)
Clinical balance assessment was made through Berg Balance Scale (BBS) and single-leg stance performance, and the results of both tests indicate that brachial plexus injury (BPI) individuals performed poorly under static and dynamic conditions compared with their healthy counterparts
Clinical balance assessment and posturographic analysis in the BPI group indicate that these individuals exhibit postural control and balance impairments

Summary

Introduction

The brachial plexus is formed by the spinal nerves C5 to T1 and is responsible for both motor and sensory innervation of the upper limb (Resnick, 1995). Clinical surveys indicate that 10–20% of peripheral nervous system lesions involve the brachial plexus (Narakas, 1985) Among this subset, 70% are due to auto/motorcycle traumas that generate traction forces on the neck and shoulder. BPI compromises the entire brachial plexus (complete injury) or the upper trunk only (a particular case of incomplete injury; Dubuissson and Kilne, 2002; Moran et al, 2005). This pattern of injury makes the proximal shoulder and elbow flexors muscle groups more prone to paralysis and sensory losses, as their innervation comes from the C5-C6 (upper trunk) nerve roots (Özkan and Aydin, 2001)

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Conclusion