Developmental and biomechanical considerations in the provision of wrist orthoses in children with obstetrical brachial plexus palsy

Introduction. Children with obstetrical brachial plexus palsy may have motor deficits in wrist extension that impact optimal hand function. Wrist orthoses are recommended for such impairment to address biomechanical and functional needs. The functional need of the child should be considered within the context of their developmental expectation. Methods. A review of the literature pertaining to brachial plexus, wrist joint and injuries, orthotics devices and splints in children was conducted. The databases MEDLINE, AMED (Allied and Complementary Medicine) and CINAHL (Cumulative Index to Nursing and Allied Health Literature) were searched from 1950, 1985 and 1981, respectively, to July 2009 using the Medical Subject Headings (MeSH) brachial plexus, wrist joint and injuries, orthotics devices and splints under the limits of children aged 0-18 years. Results. There is a paucity of literature on the orthotic management for this impairment. Therefore, an evaluation of the literature on development and the biomechanics of the wrist joint is necessary to develop clinical guidelines for the provision of wrist orthoses in children with obstetrical brachial plexus palsy. An algorithm for providing wrist orthoses in this population is proposed. Discussion. A balance between biomechanical risks and functional needs at each developmental stage is needed to optimize hand function in the prescription of wrist orthoses.