Review Article Evaluation of functional outcomes after brachial plexus injury Tom J. Quick 1,2,3 and Hazel Brown 1,2 Abstract Major nerve injuries such as those of the brachial plexus present a significant challenge for both rehabilitation and evaluation of outcome. With these often complex and multi-faceted injuries, correct selection of outcome measures is important. Healthy nerve function in humans heightens our interactions with the world, creating quality and enjoyment through our experiences of movement and touch. Therefore, assessments should be holistic and representative of all of these features. This article considers the assessment and evaluation of all of the features of nerve injury: sensorimotor, sensation (including that of pain), function and the psychosocial aspects. Current practice is described and combined with clinical experience and research findings to provide suggestions and recommendations for the selection of the most appropriate tools for use with this patient group. Keywords Brachial plexus injury, evaluation, assessment, nerve injury Date received: 23rd May 2019; revised: 5th September 2019; accepted: 10th September 2019 Introduction Peripheral nerve injury (PNI) can affect all aspects of nerve function and has a wider impact on personal and societal interaction (Choi et al., 1997). Brachial plexus injuries (BPI) are complicated through the involvement of many nerve territories. Under the correct condi- tions, peripheral nerves have the ability to regenerate unlike any other tissue (Cajal, 1928). The challenges for reconstruction are greater due to long regener- ation distances. Restoration of functional connections can occur but often take many years. Furthermore, central reorganization may be necessary to allow inte- gration into functional movement patterns (Rose ´n, 1996). The patients often feel that recovery has been painful, slow and incomplete (Brown et al., 2018). In a longitudinal cohort study by Choi et al. (1997), 50% of patients considered their function to plateau at 4 years post-injury. A further third reported continued recov- ery beyond the 4 years. Quality of life is significantly reduced in BPI (Gray, 2016; Verma et al., 2019; Wellington, 2010) with approximately 3%–50% of patients remaining out of employment at 1.5 years post-injury (Choi et al., 1997; Rasulic ¸ et al., 2017). Studies have also highlighted the importance of psychosocial factors within recovery. Body image, employment and hope/expectations are all key issues that can be overlooked during studies reliant on quantification of isolated physio- logical responses (Brown et al., 2018; McDonald and Pettigrew, 2014; Wellington, 2010). Following nerve injury, it is essential to serially monitor recovery over multiple intervals of time. The measurements and assessments deployed should be valid, reliable and both sensitive and respon- sive to change (Arezzo et al., 2013). The World Health Organization developed the International Classification of Functioning, Disability and Health (WHO-ICF) as a conceptual framework for measuring health and dis- ability at both an individual and population level (World Health Organization, 2001). This framework recognizes that a disease or injury has multimodal effects. 1 Peripheral Nerve Injury Unit, Royal National Orthopaedic Hospital, Stanmore, UK 2 Centre for Nerve Engineering, University College London, London, UK 3 Institute of Orthopaedics and Musculoskeletal Science, University College London, London UK Corresponding Author: Tom J. Quick, Peripheral Nerve Injury Unit, Royal National Orthopaedic Hospital, University College London, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK. Email: [email protected] Journal of Hand Surgery (European Volume) 2020, Vol. 45(1) 28–33 ! The Author(s) 2019 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/1753193419879645 journals.sagepub.com/home/jhs
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