ACTIVITY AND PARTICIPATION IN PRESCHOOL CHILDREN WITH DIFFERENT INJURY TYPES OF OBSTETRIC BRACHIAL PLEXUS PARALYSIS

Purpose: Obstetric brachial plexus palsy (OBPP) causes various disorders in the musculoskeletal system. Studies investigating activity and participation in different types of injury are limited. This study aimed to determine the activity and participation levels of preschool children with different injury types of OBPP. Methods: The 112 children with OBPP, aged between 44 and 77 months, were included. The children were grouped according to the Narakas Classification System: Type 1 (n=7), Type 2 (n=91), Type 3 (n=2), and Type 4 (n=12). Both Type 3 and Type 4 represented a total brachial plexus injury. The Pediatric Outcome Data Collection Instrument (PODCI) was used to evaluate activity and participation. Results: Narakas Type 1 and Type 2 had similarly high scores in PODCI Global (p<0.001), and PODCI Upper Extremity (p<0.001), Pain/Comfort (p<0.001), and Sport (p<0.001) subscales as compared with Narakas Type 3/4. In the PODCI Happiness subscale, Narakas Type 1 had the highest score, followed by lower scores of Narakas Type 2 and Type 3/4 (p<0.001). Conclusion: Preschool children with total OBPP had lower levels of activity and participation, less use of their arm in daily living activities, and express a lower level of sport participation compared to those with upper plexus injuries (Narakas Type 1 and Type 2). As activity and participation problems persist or even got worse as the children grow, it is essential to evaluate both activity and participation, particularly in those with total plexus injuries, in preschool age and preferably earlier.