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How brachial plexus birth palsy affects motor development and upper extremity skill quality?

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This study aimed to investigate the gross motor functions including head control, midline crossing, and rolling, and the relationship between these developmental skills and upper extremity skill quality in children with neonatal brachial plexus palsy (NBPP).


A total of 106 children with NBPP, aged 10–18 months, were included in this study. Injury severity was determined with the Narakas Classification. The gross motor function measurement lying and rolling sub-scale was used to evaluate gross motor functions including head control, midline crossing, and rolling, while the Quality of Upper Extremity Skills Test was applied to assess the upper extremity skill quality. The assessments were performed only once during routine physiotherapy controls.


As the severity of injury increased, developmental skill capacity decreased and upper extremity skill quality deteriorated (ps = 0.0001). There was a strong positive correlation between these developmental skills and upper extremity skill quality (ps = 0.0001).


Developmental skills are affected by NBPP. Rehabilitation programs aimed at increasing the quality of upper extremity skills should be included in neurodevelopmental treatment approaches.

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  1. Abid A (2016) Brachial plexus birth palsy: Management during the first year of life. Orthop Traumatol Surg Res 102:S125-132.

    Article  CAS  Google Scholar 

  2. Russo SA, Loeffler BJ, Zlotolow DA, Kozin SH, Richards JG, Ashworth S (2015) Limited glenohumeral cross-body adduction in children with brachial plexus birth palsy: a contributor to scapular winging. J Pediatr Orthop 35:240–245.

    Article  PubMed  Google Scholar 

  3. Ismaeel MMI, El-Saeed TM, Hafez EA (2014) Spinal deviations in relation to arm functions in obstetrical brachial plexus injuries. Life Science Journal 11

  4. Candan SA, Firat T, Livanelioglu A (2019) Assessment of spinal curvatures in children with upper trunk obstetrical brachial plexus palsy. Pediatr Phys Ther 31:149–154.

    Article  Google Scholar 

  5. Bain JR, DeMatteo C, Gjertsen D, Packham T, Galea V, Harper JA (2012) Limb length differences after obstetrical brachial plexus injury: a growing concern. Plast Reconstr Surg 130:558e–571e.

    Article  CAS  PubMed  Google Scholar 

  6. Buitenhuis S, van Wijlen-Hempel RS, Pondaag W, Malessy MJ (2012) Obstetric brachial plexus lesions and central developmental disability. Early Human Dev 88:731–734.

    Article  Google Scholar 

  7. Kahraman A, Mutlu A, Livanelioğlu A (2020) Assessment of motor repertoire in 3- to 5-month-old infants with obstetric brachial plexus lesion. Pediatr Phys Ther 32:114–119.

    Article  PubMed  Google Scholar 

  8. Çelik G, Delioğlu K, Fırat T (2021) The relationship between trunk control and upper extremity function in children with obstetric brachial plexus palsy. Dev Neurorehabil 24:150–158.

    Article  PubMed  Google Scholar 

  9. Capute AJ, Accardo PJ (1996) The infant neurodevelopmental assessment: a clinical interpretive manual for CAT-CLAMS in the first two years of life, Part 2. Curr Probl Pediatr 26:279–306.

    Article  CAS  PubMed  Google Scholar 

  10. Provine RR, Westerman JA (1979) Crossing the midline: limits of early eye-hand behavior. Child Dev 50:437–441

    Article  CAS  Google Scholar 

  11. van Hof R, van der Kamp J, Savelsbergh GJ (2002) The relation of unimanual and bimanual reaching to crossing the midline. Child Dev 73:1353–1362.

    Article  PubMed  Google Scholar 

  12. Russell D, Palisano R, Walter S, Rosenbaum P, Gemus M, Gowland C, Galuppi B, Lane M (1998) Evaluating motor function in children with Down syndrome: validity of the GMFM. Dev Med Child Neurol 40:693–701.

    Article  CAS  PubMed  Google Scholar 

  13. Linder-Lucht M, Othmer V, Walther M, Vry J, Michaelis U, Stein S, Weissenmayer H, Korinthenberg R, Mall V (2007) Validation of the gross motor function measure for use in children and adolescents with traumatic brain injuries. Pediatrics 120:e880-886.

    Article  PubMed  Google Scholar 

  14. Ruck-Gibis J, Plotkin H, Hanley J, Wood-Dauphinee S (2001) Reliability of the gross motor function measure for children with osteogenesis imperfecta. Pediatr Phys Ther 13:10–17.

    Article  CAS  PubMed  Google Scholar 

  15. Palisano RJ, Hanna SE, Rosenbaum PL, Russell DJ, Walter SD, Wood EP, Raina PS, Galuppi BE (2000) Validation of a model of gross motor function for children with cerebral palsy. Phys Ther 80:974–985.

    Article  CAS  PubMed  Google Scholar 

  16. Bobath K, Bobath B (1964) The facilitation of normal postural reactions and movements in the treatment of cerebral palsy. Physiotherapy 50:246–262

    CAS  PubMed  Google Scholar 

  17. DeMatteo C, Law M, Russell D, Pollock N, Rosenbaum P, Walter S (1993) The reliability and validity of the Quality of Upper Extremity Skills Test. Phys Occup Ther Pediatr 13:1–18.

    Article  Google Scholar 

  18. Thorley M, Lannin N, Cusick A, Novak I, Boyd R (2012) Construct validity of the Quality of Upper Extremity Skills Test for children with cerebral palsy. Dev Med Child Neurol 54:1037–1043.

    Article  PubMed  Google Scholar 

  19. Fehlings D, Rang M, Glazier J, Steele C (2000) An evaluation of botulinum-A toxin injections to improve upper extremity function in children with hemiplegic cerebral palsy. J Pediatr 137:331–337.

    Article  CAS  PubMed  Google Scholar 

  20. Kawamura A, Campbell K, Lam-Damji S, Fehlings D (2007) A randomized controlled trial comparing botulinum toxin A dosage in the upper extremity of children with spasticity. Dev Med Child Neurol 49:331–337.

    Article  PubMed  Google Scholar 

  21. Duff SV, DeMatteo C (2015) Clinical assessment of the infant and child following perinatal brachial plexus injury. J Hand Ther 28: 126–133; quiz 134.

  22. Schober P, Boer C, Schwarte LA (2018) Correlation coefficients: appropriate use and interpretation. Anesth Analg 126:1763–1768.

    Article  PubMed  Google Scholar 

  23. Kislay K, Devi BI, Bhat DI, Shukla DP, Gupta AK, Panda R (2018) Novel findings in obstetric brachial plexus palsy: a study of corpus callosum volumetry and resting-state functional magnetic resonance imaging of sensorimotor network. Neurosurgery 83:905–914.

    Article  PubMed  Google Scholar 

  24. Longo E, Nishiyori R, Cruz T, Alter K, Damiano DL (2020) Obstetric brachial plexus palsy: can a unilateral birth onset peripheral injury significantly affect brain development? Dev Neurorehabil 23:375–382.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Brown T, Cupido C, Scarfone H, Pape K, Galea V, McComas A (2000) Developmental apraxia arising from neonatal brachial plexus palsy. Neurology 55:24–30.

    Article  CAS  PubMed  Google Scholar 

  26. Anguelova GV, Malessy MJ, Buitenhuis SM, van Zwet EW, van Dijk JG (2016) Impaired automatic arm movements in obstetric brachial plexus palsy suggest a central disorder. J Child Neurol 31:1005–1009.

    Article  PubMed  Google Scholar 

  27. Björkman A, Weibull A, Svensson H, Dahlin L (2016) Cerebral reorganization in patients with brachial plexus birth injury and residual shoulder problems. Front Neurol 7:240.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Tuna Z, Oskay D, Algin O, Koçak OM (2020) Cortical motor areas show different reorganizational changes in adult patients with brachial plexus birth injury (BPBI). Int J Dev Neurosci.

  29. Bruggink JL, Einspieler C, Butcher PR, Van Braeckel KN, Prechtl HF, Bos AF (2008) The quality of the early motor repertoire in preterm infants predicts minor neurologic dysfunction at school age. J Pediatr 153:32–39.

    Article  PubMed  Google Scholar 

  30. Hadders-Algra M, Brogren E, Forssberg H (1996) Training affects the development of postural adjustments in sitting infants. J Physiol 493(Pt 1):289–298.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Hadders-Algra M (2000) The neuronal group selection theory: a framework to explain variation in normal motor development. Dev Med Child Neurol 42:566–572.

    Article  CAS  PubMed  Google Scholar 

  32. Oskay D, Oksüz C, Akel S, Firat T, Leblebicioğlu G (2012) Quality of life in mothers of children with obstetrical brachial plexus palsy. Pediatr Int 54:117–122.

    Article  PubMed  Google Scholar 

  33. Lagerkvist AL, Johansson U, Johansson A, Bager B, Uvebrant P (2010) Obstetric brachial plexus palsy: a prospective, population-based study of incidence, recovery, and residual impairment at 18 months of age. Dev Med Child Neurol 52:529–534.

    Article  PubMed  Google Scholar 

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The authors would like to thank all the children and their families who participated in this study on a voluntary basis.

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Authors and Affiliations



All authors contributed to all studies. TF and GÇ designed the study, and GÇ acquired the data by performing assessments. TF performed statistical analyses. TF and GÇ drafted the manuscript.

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Correspondence to Tüzün Fırat.

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Ethical approval

This study was approved by the Hacettepe University Non-Interventional Clinical Research Ethics Committee (license number: GO 17/923), and all procedures carried out in the study involving human participants were in accordance with the 1964 Helsinki Declaration.

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Informed consent was obtained from all children’s parents.

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The authors declare that they have no conflict of interest.

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Çelik, G., Fırat, T. How brachial plexus birth palsy affects motor development and upper extremity skill quality?. Childs Nerv Syst 37, 2865–2871 (2021).

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