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Case Studies for the Master Clinician: Brachial Plexus Birth Injury

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1.  What is the primary risk factor for a brachial plexus birth injury?
  1. Maternal obesity
  2. Shoulder dystocia
  3. Low birth weight
  4. Jaundice
2.  What is the prevalence of sustaining a brachial plexus injury at birth?
  1. 1.5 per 1,000 live births
  2. 5 per 1,000 live births
  3. 15 per 1,000 live births
  4. 150 per 1,000 live births
3.  In the United States, what percent of children with a brachial plexus birth injury have permanent impairments?
  1. 1-2%
  2. 5-7%
  3. 7-12%
  4. 10-18%
4.  Which brachial plexus assessment quantifies upper extremity function and predicts recovery based on movement achieved by certain ages?
  1. Toronto Test Score
  2. Active Movement Scale
  3. Mallet/Nath Modification to Mallet
  4. Narakas Classification
5.  Which brachial plexus assessment classifies active, functional shoulder movements, with modifications to additionally assess the elbow and forearm?
  1. Toronto Test Score
  2. Active Movement Scale
  3. Mallet/Nath Modification to Mallet
  4. Narakas Classification
6.  What is an indicator for surgical nerve repair or nerve transfer?
  1. Waiter's tip sign at birth
  2. No biceps function against gravity by 3 months of age
  3. Limited active forearm pronation by 9 months of age
  4. Shoulder abduction limited to 90 degrees by 1 year of age
7.  Which of the following therapeutic interventions is well-supported by evidence?
  1. Serial casting to increase active elbow flexion
  2. Neuromuscular Electrical Stimulation (NMES) to lengthen tightened unaffected musculature in the affected arm
  3. Therapeutic taping after Botulinum Toxin A injections to increase strength in the affected arm
  4. Constraint Induced Movement Therapy (CIMT) to increase awareness and functional use of the affected arm
8.  Evidence from treatment of what condition has been used to theorize and explore treatment for brachial plexus birth injury?
  1. Paraplegic Spinal Cord Injury
  2. Spina Bifida
  3. Hemiplegic Cerebral Palsy
  4. Rasmussen's Encephalopathy
9.  Isolated nerve transfers can be completed until __________; if done later, muscles will have atrophied to the point that nerve innervation will not impact active motor function.
  1. ~18 months
  2. ~24 months
  3. ~2 1/2 years
  4. ~3 years
10.  For children with brachial plexus birth injuries, what should remain the priority of OT intervention?
  1. Affected arm strength
  2. Affected arm range of motion
  3. Functional activities and participation that demands BUE use
  4. Focus on range of motion for the joint that is most affected