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ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018;  ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: 
https://doi.org/10.33137/cpoj.v1i2.32047                                                                            

 

1 

 
OPEN  ACCESS 

 

AOPA’S 101 ST NATIONAL ASSEMBLY ABSTRACTS, SEPTEMBER 26-29, VANCOUVER, CANADA, 2018 
 

ABSTRACT (ORAL PRESENTATION) 

USE OF EXTERNALLY-POWERED ORTHOSIS TO ADDRESS COMPLEXITIES 

ASSOCIATED WITH BILATERAL BRACHIAL PLEXOPATHY 

Cassandra Delgado, Debra Latour,  

Handspring Clinical Services, Middletown, NY, USA.  

Email: cassandra@poaprosthetics.com 

DOI: https://doi.org/10.33137/cpoj.v1i2.32047  

 

INTRODUCTION 

Brachial plexus injuries are often caused by trauma, 

tumors or inflammation. The severity of the injury may 

vary, however in most traumatic cases, the 

supraclavicular region is impacted. Depending on the 

severity of the injury, surgery is often indicated early due 

to the likelihood of nerve regeneration. Surgical 

procedures include neurolysis, nerve grafting and 

neurotisation; where approximately 45% will regain 

adequate function to perform activities of daily living 

(ADLs) and return to work. According to current data, 

approximately 9,700 individuals per year will remain 

disabled due to the injury. 

For individuals where surgical intervention has not 

provided improvement in function, alternative solutions 

must be investigated. Particularly for those with bilateral 

involvement, potential solutions include orthotic 

technology. Like users of prosthetic technology, there is 

a wide array of technology available, intended to meet 

the diverse needs experienced by the population of 

individual who have lost function of the upper limbs. 

This paper describes the challenges experienced by an 

individual with bilateral brachial plexus injuries and 

addresses the case solutions using collaborative inter-

professional practice.1-4 

METHODS 

The subject of this reflective case study is a 45-year-old 

female who presents with bilateral brachial plexus 

injuries due to complications from a bilateral 

mastectomy. She experienced complete loss of function 

of both upper extremities when she awoke from the 

surgery. She was discharged from the hospital without 

return of bilateral upper limb function. After 2 years of 

PT and OT, she regained ~80% function in her non-

dominate left arm, however she fatigues quickly. She has 

some wrist and elbow flexion/extension range of motion 

return in her right upper extremity, however her strength 

is minimal and fatigue is apparent. The subject was 

employed as a family physician and has not been able to 

return to work, as she cannot carry her tablet or other 

equipment, is not able to type to chart on patients, cannot 

hold a scalpel to perform office procedures, and is not 

able to raise her arms to perform assessments. evaluation. 

It appeared that the subject would be a candidate for an 

externally-powered device. 

Measures: A full evaluation was completed by both an 

OT and orthotist. The Quick DASH was administered 

with an initial General Disability Index of 88.6. In 

addition, the subject completed the McGann Client 

Feedback form. The subject received initial training in 

the device that included application to functional skills, 

in particular, tasks that involve reaching, lifting, pushing 

and bringing the hand to the head, such as to self-feed or 

to groom hair. 

RESULTS 

Subsequent testing reveals continued functional 

improvement, orthosis satisfaction and decreased 

perceptions of disability. These factors appear to align 

with the client-centered goals to return to work in any 

capacity as a physician, continue to provide for her two 

daughters. 

 

 
Figure 1: Externally-powered technology for individual with 

bilateral brachial plexus injury. 

 

DISCUSSION 

The externally-powered elbow-wrist-hand orthosis can 

provide significant benefit to the individual with bilateral 

involvement. The client with brachial plexus injury can 

mailto:cassandra@poaprosthetics.com
https://doi.org/10.33137/cpoj.v1i2.32047


 

 

Delgado C, Latour D.  USE OF EXTERNALLY-POWERED ORTHOSIS TO ADDRESS COMPLEXITIES ASSOCIATED WITH BILATERAL BRACHIAL PLEXOPATHY. CANADIAN PROSTHETICS & 
ORTHOTICS JOURNAL, VOLUME 1, ISSUE 2, 2018;  ABSTRACT, ORAL PRESENTATION AT THE AOPA’S 101ST NATIONAL ASSEMBLY, SEPT. 26-29, VANCOUVER, CANADA, 2018. DOI: 
https://doi.org/10.33137/cpoj.v1i2.32047                                                                            

 

2 

 
OPEN  ACCESS 

 

AOPA’S 101 ST NATIONAL ASSEMBLY ABSTRACTS, SEPTEMBER 26-29, VANCOUVER, CANADA, 2018 
 

ABSTRACT (ORAL PRESENTATION) 

perform functional tasks and engage in meaningful 

activities that other interventions cannot fully address. 

REFERENCES 

1. Michael, J.W, Nunley J.A. Special Considerations: Brachial 

Plexus Injuries: Surgical Advances and Orthotic/Prosthetic 

Management. Atlas of Limb Prosthetics: Surgical, Prosthetic, 

and Rehabilitation Principles; 12A, 2016. 

(http://www.oandplibrary.org/alp/chap12-01.asp). 

2. Page S.J, Hill V, White S. Portable upper extremity robotics 

is as efficacious as upper extremity rehabilitative therapy: a 

randomized controlled pilot trial. Clinical rehab: 6,494-503, 

2012. https://doi.org/10.1177/0269215512464795. 

3. Sakellariou, et al. Treatment Options for Brachial Plexus 

Injuries. ISRN Orthopedics; 3,3, 2014. 

http://dx.doi.org/10.1155/2014/314137. 

4. Mendal S, David B. A Myoelectrically Controlled Wrist-

Hand Orthosis for Brachial Plexus Injury: A Case Study. J of 

Prost Ortho, 4,171-175, 1992.  

DISCLOSURE 

None.  

 

 

http://www.oandplibrary.org/alp/chap12-01.asp
https://doi.org/10.1177/0269215512464795
http://dx.doi.org/10.1155/2014/314137

