Abstract
Brachial plexus injuries with multiple-root involvement lead to severe and long-lasting impairments in the functionality and appearance of the affected upper extremity. In cases, where biologic reconstruction of hand and arm function is not possible, bionic reconstruction may be considered as a viable clinical option. Bionic reconstruction, through a careful combination of surgical augmentation, amputation, and prosthetic substitution of the functionless hand, has been shown to achieve substantial improvements in function and quality of life. However, it is known that long-term distortions in the body image are present in patients with severe nerve injury as well as in prosthetic users regardless of the level of function. To date, the body image of patients who voluntarily opted for elective amputation and prosthetic reconstruction has not been investigated. Moreover, the degree of embodiment of the prosthesis in these patients is unknown. We have conducted a longitudinal study evaluating changes of body image using the patient-reported Body Image Questionnaire 20 (BIQ-20) and a structured questionnaire about prosthetic embodiment. Six patients have been included. At follow up 2.5–5 years after intervention, a majority of patients reported better BIQ-20 scores including a less negative body evaluation (5 out of 6 patients) and higher vital body dynamics (4 out of 6 patients). Moreover, patients described a strong to moderate prosthesis embodiment. Interestingly, whether patients reported performing bimanual tasks together with the prosthetic hand or not, did not influence their perception of the prosthesis as a body part. In general, this group of patients undergoing prosthetic substitution after brachial plexus injury shows noticeable inter-individual differences. This indicates that the replacement of human anatomy with technology is not a straight-forward process perceived in the same way by everyone opting for it.
Highlights
Global brachial plexus injuries or lower root avulsions have a devastating impact on upper extremity function and quality of life of affected patients (Carlstedt, 2008; Franzblau and Chung, 2015), who are predominantly young male adults (Seddighi et al, 2016)
All patients involved in this study suffered a traumatic multi-level brachial plexus injury, meeting both of the following conditions: (1) damage to upper and lower brachial plexus roots with clinically evident impairment of shoulder, elbow and hand function as well as (2) avulsion of multiple roots confirmed via imaging and/or surgical exploration
The single item answers for every participant can be found in the Supplementary Material
Summary
Global brachial plexus injuries or lower root avulsions have a devastating impact on upper extremity function and quality of life of affected patients (Carlstedt, 2008; Franzblau and Chung, 2015), who are predominantly young male adults (Seddighi et al, 2016). Recent studies suggest that up to two third of all brachial plexus injury patients do not accept the appearance of their often motionless hand and arm, which can eventually become stiff, cold, and atrophic as shown in Figure 1 (Carlstedt, 2008; Franzblau et al, 2014) This aesthetic dissatisfaction and the distorted body image affect social life, resulting in the reduced willingness to participate in social activities, especially if these include meeting new people (Mancuso et al, 2015; Verma et al, 2019). For selected patients where the aesthetics of the functionless hand is a main concern, radiocarpal and finger joint arthrodeses are an option for improving function, appearance, and quality of life (Giuffre et al, 2012)
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