Constraint Therapy for Brachial Plexus Birth Injury

Mini-Assisting Hand Assessment

The primary outcome will be spontaneous bimanual upper-extremity function as measured by the Mini-Assisting Hand Assessment (Mini-AHA). The Mini-Assisting Hand Assessment (Mini-AHA) will be used as a standardized observational assessment for patients 8-12 months old. The Mini-AHA is an adaptation of the Assisting Hand Assessment (AHA) specifically designed for children approximately 8-18 months of age who have unilateral upper limb impairment. The Mini-AHA uses a structured play session lasting 10-15 minutes during which the child interacts with a standardized set of age-appropriate toys designed to elicit a range of bimanual actions (e.g., grasping, stabilizing, manipulating). Sessions are video-recorded and later scored by certified Mini-AHA/AHA raters using a detailed scoring manual on a scale from 0 to 100, with a higher score indicating more function of the limb.

Active Movement Scale

The Active Movement Scale (AMS) is an ordinal clinical scale used to quantify active joint motion in infants and children with brachial plexus birth injury. The scale evaluates active movement across several joints of the upper extremity including shoulder abduction, shoulder external rotation, elbow flexion, elbow extension, wrist extension, and finger movements. Movements are scored on an 8-point scale (0-7) based on the presence and range of active motion both with gravity eliminated and against gravity. A higher score indicates more function of the affected limb. Scores are assigned through standardized clinical examination performed by trained clinicians. The AMS has been widely used in BPBI populations and demonstrates strong inter-rater reliability and validity for assessing motor recovery following brachial plexus injury.

Toronto Score

The Toronto Test Score is a standardized clinical assessment used to evaluate motor recovery in infants with brachial plexus birth injury. The instrument evaluates muscle function across multiple upper extremity muscle groups using standardized manual muscle testing and movement observation. Individual muscle group scores from 0 to 2 are combined to generate domain-specific and total scores ranging from 0 to 10, which reflects overall upper extremity motor function. A higher score indicates more function of the affected limb The Toronto Score has been used extensively in BPBI clinical research and longitudinal outcome studies and provides a complementary measure of motor recovery alongside the AMS.

Goniometric Range of Motion (AROM)

Active range of motion of the affected upper extremity will be assessed using standard goniometric measurement techniques performed by trained clinicians. Joints assessed will include: * Shoulder abduction * Shoulder external rotation * Elbow flexion * Elbow extension * Wrist extension Goniometric measurements provide quantitative assessment of joint mobility and are commonly used in clinical evaluation of children with BPBI to monitor recovery of joint-specific motor function.

Wearable Activity Monitoring

Spontaneous upper extremity movement will also be evaluated using wearable activity sensors (Fibion accelerometer). Sensors will be placed on both upper extremities to capture continuous movement data during daily activities. The Fibion sensor provides objective quantification of limb activity through accelerometry-based motion detection. Metrics derived from the device will include: o Acceleration X, Y, and Z axis in m/s2 These measures will provide a continuous, objective estimate of spontaneous upper extremity use over 2-3 day data collection periods, complementing observational and clinical assessment measures.