Investigating the Effectiveness of Graded Motor Imagery Training in Children With Obstetric Brachial Plexus Injury

The modified Mallet classification is one of the valid and reliable scales frequently used in the literature to determine the functional status of the extremity in cases with brachial plexus lesions. This classification system aims to evaluate the global characteristics of the extremity rather than evaluating the functions of individual muscles. In this system, the extremity's global abduction, global external rotation, and the adequacy of the hand reaching the neck, mouth and back to the spine are evaluated. A score between 0 and 5 is made according to the position and degree of strain during each movement. The maximum score that can be obtained is 25, and the score obtained gives an idea about the functional status of the extremity.

Prepared by the Brachial Plexus Clinic of The Hospital for Sick Children (Toronto). In the OBPY group, the affected upper extremity was evaluated with 15 joint movements (from the shoulder to the fingers) specified on the scale. The movement is first examined in the position where gravity is eliminated, and if a full score is obtained, it is evaluated in the position against gravity and a score between (0-7) is given.

QUEST is a test that evaluates the child's manual skills and the quality of movement. It was developed by Prof. Dr. Carol De MATTEO for use in the 18-month-8 age group. Later, the validity and reliability study of this test was conducted for 4-12 age groups. There are studies in the literature regarding its use in children between the ages of 2-15. The sections of QUEST are as follows: A. Independent movements B. Grasping C. Weight bearing D. Protective extension E. Hand function rate F. Cooperation rates.

Range of motion will be assessed by measuring the range of motion of the shoulder, elbow and wrist joints with a universal goniometer. Active joint movements of the patients will be measured with a universal goniometer before and after treatment and recorded as degrees.

The Box and Block Test is a test developed to measure gross manual dexterity. It is a good indicator of the severity of upper extremity involvement in OBPY. In the study, the number of blocks collected in 60 seconds is calculated as in the original procedure of the test.

For proprioceptive sense evaluation, joint position sense evaluation (angle reconstruction test) is used in shoulder and elbow joints. The joint to be measured is ensured to be seen clearly. Digital inclinometer is used to evaluate poprioceptive sense. Shoulder joint proprioceptive sense is performed three times at 60, 90 and 120 degree angles using active reposition test. Eyes are covered with a tape. It is brought from 0 degree starting position to target angles of and waited for 5 seconds for the individual to learn this position and placed back to the starting position. The individual is then asked to actively bring his arm to the previously taught target angle and this test is repeated 3 times for each target angle. After the test, the average of the three angles is taken for each target angle. Elbow joint flexion is evaluated as specified at 30, 60, 90° angles.

The Timed Up and Go Test is a simple, practical and rapid test used to assess functional mobility and dynamic balance. Children are asked to get up from a standard chair with back and arm support, walk a predetermined distance of 3 meters as fast as possible without running, return without touching anything, walk back to the chair and return to a sitting position. The time taken is recorded in seconds (sec).

The Timed Stair Climbing and Descending Test is another test that has been proven to be valid and reliable in the assessment of functional mobility and dynamic balance. The test begins with the child standing 30 cm away from the bottom rung of a 10-step staircase and climbing the steps with the command. The individual is asked to climb the steps safely but as quickly as possible and then turn and descend without waiting after climbing the last step, and the test is completed when the individual descends the last step with both feet touching the ground. The test score is recorded as time (sec).

This test was developed to assess stability. The functional reach test is an easily applicable, performance-based assessment method. It is defined as the maximum distance that an individual can reach forward in the horizontal plane while maintaining stability on the support surface in a standing position. The person holds the shoulder parallel to the surface being measured while in 90-degree flexion. The distance between the shoulder and the tip of the 3rd finger is measured. Then, patients are asked to reach the farthest distance possible without moving their feet, and the point where the tip of the 3rd finger reaches is marked on the surface.

The pediatric quality of life scale (PedsQL 4.0) will be used to assess health-related quality of life. The scale was developed to assess the health-related quality of life of children and adolescents aged 2-18 and consists of 5 main headings. These are; physical functioning (8 items), emotional functioning (5 items), social functioning (5 items), and school functioning.