Development and evaluation of 3D markerless protocols for clinical decision making in brachial plexus injuries for developing children

About the Project

The aim of this PhD will be to develop and evaluate a protocol which draws on 3D movement technology (marker based and markerless) for the assessment and management of children with perinatal brachial plexus injuries (PBPI).

This project will provide the student with skills in mixed-methods research and extensive experience in clinical biomechanics. This includes training in systematic literature reviews, co-design, 3D movement analysis, clinical service design and evaluation.

This project will involve collaborations with Liverpool John Moores University, industry and Alder hey Children’s NHS Hospital.

PBPI occurs during birth and usually results from the shoulder of the infant being caught on a bony part of the mother’s pelvis. The shoulder is pulled relative to the head in a traction injury and the nerves around the neck and shoulder (brachial plexus) get injured. The incidence of PPBI ranges between 0.38 to 4.6 per 1000 live births and approximately 40% of infants who suffer a traction injury do not fully recover [1, 2]. Multiple nerve roots can be affected with varying levels of motor and sensory deficits. For children who do not recover fully, they can have ongoing sensory-motor complications in the affected upper-limb including complete paralysis or weakness, asymmetrical bony deformities and postural changes, shoulder dislocations and contractures, all of which affect their levels of activity and participation [2].

The natural history regarding recover of brachial plexus injures is not well understood. This is due to the heterogeneity and complexity of the condition, limited scientific literature, variability and limited measurement ability of outcome measures used for informing decision making [3]. This makes treatment planning complex and outcomes associated with both surgical (e.g. tendon transfers) and conservative (e.g. occupational and physiotherapy involving exercises, stretches) are variable. Existing clinical methods used for informing decision making are unable to capture the complexity of the condition and identify changes over the time-course of the developing child [1]. 3D movement analysis may overcome these limitations and inform decision making but requires development of a protocol for assessing relevant impairments and selection of the most appropriate technology and clinical interventions [4, 5].

The aim of the PhD will be achieved by carrying out the following objectives

1. A systematic review of existing assessments used to inform decision making and treatment allocation (surgical and non-surgical) in PBPI
2. Co-design workshops for development of 3D assessment protocol. This will be informed but the systematic review and clinical questions from multidisciplinary teams involved in the management of PBPI.
3. A pilot longitudinal study of upper-limb function, using 3D movement technology of children > 8 years of age with brachial plexus injuries and age and sex matched controls (10 in each group). This objective will draw on the developed protocol and
   1. Evaluate the reliability of marker versus marker less methods of motion capture
   2. Identify differences in movements and muscle activity patterns PBPI and controls
   3. Identify longitudinal changes in movements and muscle activity patterns in PBPI and controls
   4. Evaluate the acceptability and feasibility of the protocol, including identification information for informing clinical decision making.

Training will be provided for systematic literature reviews, co-design methodologies, dedicated marker and marker less capture for human movement analysis, biomechanics, statistical and data analysis and critical writing.

This will be achieved using a combination of in house training, systematic review and co-production workshops/training to meet early PhD objectives, attendance at monthly departmental research meetings/ lab groups, journal clubs, writing and dissemination retreats, attendance at conferences. Additional training and support will be available through the respective institutions.

Supervisors:

• Dr Fraser Philp - f.philp@liverpool.ac.uk
• Dr Richard Foster - R.J.Foster@ljmu.ac.uk
• Henni Greaves - Henrike.Greaves@alderhey.nhs.uk

Applying:

Email your CV, cover letter, project title and reference number to Dr Fraser Philp (f.philp@liverpool.ac.uk) and the IPH PG admin team (iphpgradmin@liverpool.ac.uk)