Brown Susan H, Wernimont Cory W, Phillips Lauren, Kern Kathy L, Nelson Virginia S, Yang Lynda J-S
Motor Control Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, Michigan.
Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, Michigan.
Pediatr Neurol. 2016 Mar;56:42-47. doi: 10.1016/j.pediatrneurol.2015.12.012. Epub 2015 Dec 24.
Routine sensory assessments in neonatal brachial plexus palsy are infrequently performed because it is generally assumed that sensory recovery exceeds motor recovery. However, studies examining sensory function in neonatal brachial plexus palsy have produced equivocal findings. The purpose of this study was to examine hand sensorimotor function in older children with neonatal brachial plexus palsy using standard clinical and research-based measures of tactile sensibility.
Seventeen children with neonatal brachial plexus palsy (mean age: 11.6 years) and 19 age-matched controls participated in the study. Functional assessments included grip force, monofilament testing, and hand dexterity (Nine-Hole Peg, Jebsen-Taylor Hand Function). Tactile spatial perception involving the discrimination of pin patterns and movement-enhanced object recognition (stereognosis) were also assessed.
In the neonatal brachial plexus palsy group, significant deficits in the affected hand motor function were observed compared with the unaffected hand. Median monofilament scores were considered normal for both hands. In contrast, tactile spatial perception was impaired in the neonatal brachial plexus palsy group. This impairment was seen as deficits in both pin pattern and object recognition accuracy as well as the amount of time required to identify patterns and objects. Tactile pattern discrimination time significantly correlated with performance on both functional assessment tests (P < 0.01).
This study provides evidence that tactile perception deficits may accompany motor deficits in neonatal brachial plexus palsy even when measures of tactile registration (i.e., monofilament testing) are normal. These results may reflect impaired processing of somatosensory feedback associated with reductions in goal-directed upper limb use and illustrate the importance of including a broader range of sensory assessments in neonatal brachial plexus palsy.
新生儿臂丛神经麻痹的常规感觉评估很少进行，因为通常认为感觉恢复超过运动恢复。然而，关于新生儿臂丛神经麻痹感觉功能的研究结果并不明确。本研究的目的是使用基于标准临床和研究的触觉敏感性测量方法，检查大龄儿童新生儿臂丛神经麻痹的手部感觉运动功能。
17名新生儿臂丛神经麻痹患儿（平均年龄：11.6岁）和19名年龄匹配的对照组儿童参与了本研究。功能评估包括握力、单丝测试和手部灵巧性（九孔插板测试、耶布森-泰勒手部功能测试）。还评估了涉及针模式辨别和运动增强物体识别（实体觉）的触觉空间感知。
在新生儿臂丛神经麻痹组中，与未受影响的手相比，受影响的手运动功能存在显著缺陷。双手的单丝测试中位数得分均被认为正常。相比之下，新生儿臂丛神经麻痹组的触觉空间感知受损。这种损害表现为针模式和物体识别准确性的缺陷，以及识别模式和物体所需的时间。触觉模式辨别时间与两项功能评估测试的表现均显著相关（P<0.01）。
本研究提供了证据，表明即使触觉登记测量（即单丝测试）正常，新生儿臂丛神经麻痹中触觉感知缺陷可能与运动缺陷同时存在。这些结果可能反映了与目标导向上肢使用减少相关的体感反馈处理受损，并说明了在新生儿臂丛神经麻痹中纳入更广泛感觉评估的重要性。
