Investigating the cortical changes in patients with obstetrical brachial plexus injury

Thesis Type: Doctorate

Institution Of The Thesis: Gazi Üniversitesi, Sağlık Bilimleri Enstitüsü, Turkey

Approval Date: 2017


Supervisor: DERAN OSKAY


Obstetric Brachial Plexus Injury (OBPI) may cause permanent disability in adulthood. Persistent disability is thought to result from central problems rather than peripheral ones. However, studies investigating the cortical changes after OBPI are very poor. Therefore, aim of this study was to investigate the cortical activity during impaired movements by functional magnetic resonance imaging. Five adult patients with right upper trunk (C5 and C6) involvement and 5 age-matched healthy volunteers participated in the study. Participants watched videos of 2 movements (hand to mouth and neck) of either side inside the scanner via integrated eyeglasses. MATLAB and SPM were used for statistical analysis. The cortical activity level during action observation in the patient group was significantly lower than in the control group (p <0,05). Areas of difference were middle temporal gyrus, premotor area and inferior parietal lobule. Region of Interest analysis also showed that the signal change in these areas was significantly lower in the patient group than in the control group (p <0.05). Observing right and left hand movements resulted in similar activity in the cortex in patient group (p> 0,05). In conclusion, OBPI causes neuroplastic changes in the cortex, although it is a birth injury involving peripheral structures. The motor memory of some movements does not appropriately develop as those patients cannot perform them properly in the time period critical for motor programming after birth. Therefore, it may be concluded that, even if the patients observe the correct pattern of movements, mirroring of deficient movements is also impaired.