Sensory function is impaired in adults with conservatively treated OBPL. There is widespread motor misrouting together with motor functional impairment in conservatively treated OBPL, not... Show moreSensory function is impaired in adults with conservatively treated OBPL. There is widespread motor misrouting together with motor functional impairment in conservatively treated OBPL, not explained by muscle weakness. There were no differences in the degree of cocontraction between OBPL patients and healthy subjects for either the triceps or deltoid muscles during supramaximal biceps stimulation. However, elbow stiffness was approximately 1.7 times higher in OBPL patients than in control subjects during voluntary levels of contraction, suggesting a significant effect of misrouting in the patients. In children with OBPL the deficit during automatic arm abduction was not observed during voluntary movements and therefore cannot be explained by a peripheral deficit, suggesting a central component. In adults OBPL affected imagined but not actual elbow flexion suggested an impairment of motor planning. Show less
An obstetric brachial plexus lesion (OBPL) is a traction injury of a peripheral nerve network resulting in function loss of the upper limb __ which may be permanent. The aim of this thesis is to... Show moreAn obstetric brachial plexus lesion (OBPL) is a traction injury of a peripheral nerve network resulting in function loss of the upper limb __ which may be permanent. The aim of this thesis is to provide a conceptual framework for treatment of infants with an OBPL. The research is largely based on our own patient cohort of the LUMC Department of Neurosurgery, which serves as a tertiary referral center in the Netherlands. Each year, 25-35 infants are treated with nerve surgery. Part 1 consists of a general introduction, a historical overview, and a critical analysis of selection criteria for surgery advocated by different surgeons. Part 2 describes obstetric factors related to the severity of OBPL in our own patient cohort. In addition, a systematic literature review of the natural history is presented. Part 3 evaluates the use of electrodiagnostic studies (EMG, NAP, CMAP) in the preoperative and intra-operative assessment of lesion severity. Part 4 consists of four outcome studies of nerve surgery. Three chapters describe results of the LUMC patient cohort, and one chapter presents the results of an innovative technique performed by Prof Gilbert, one of the OBPL pioneers. Part 5 consists of a summary and discussion of all chapters. Show less
