Brain Plasticity in Neonatal Brachial Plexus Palsies: Quantification and Comparison with Adults Brachial Plexus Injuries

doi:10.21203/rs.3.rs-3106823/v1

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Research Article

Brain Plasticity in Neonatal Brachial Plexus Palsies: Quantification and Comparison with Adults Brachial Plexus Injuries

https://doi.org/10.21203/rs.3.rs-3106823/v1

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Journal Publication

published 11 Jul, 2023

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Purpose

to compare two populations of brachial plexus palsies, one neonatal (NBPP) and the other traumatic (NNBPP) who underwent different nerve transfers, using the Plasticity Grading Scale (PGS) for detecting differences in brain plasticity between both groups.

Methods

To be included, all patients had to have undergone a nerve transfer as the unique procedure to recover one lost function. The primary outcome was the PGS score. We also assessed patient compliance to rehabilitation using the Rehabilitation Quality Scale (RQS). Statistical analysis of all variables was performed. A p ≤ 0.050 set as criterion for statistical significance.

Results

a total of 153 NNBPP patients and 35 NBPP babies (with 38 nerve transfers) met the inclusion criteria. The mean age at surgery of the NBPP group was 9 months (SD 5.42, range 4 to 23 months. The mean age of NNBPP patients was 22 years (SD 12 years, range 3 to 69). They were operated around sixth months after the trauma. All transfers performed in NBPP patients had a maximum PGS score of 4. This was not the case for the NNBPP population, that reached a PGS score of 4 in approximately 20% of the cases. This difference was statistically significant (p < 0.001). The RQS was not significantly different between groups

Conclusion

We found that babies with NBPP have a significantly greater capacity for plastic rewiring than adults with NNBPP. The brain in the very young patient can process the changes induced by the peripheral nerve transfer better than in adults.

Plasticity Grading Scale

Neuroplasticity Score

Neonatal Brachial Plexus Palsy

Brachial Plexus Injury

Nerve Transfer

Brain Plasticity

Neonatal Brachial Plexus Injuries (NBPP) occur during birth due to traction on the nerves running from the neck to the arm. Immediately after birth, patients have motor and sensory deficits of the upper limb. Spontaneously recovery takes place in around 70% of the babies [1]. In severe cases, functional deficits remain throughout their entire lifespan. Functional improvement can be obtained with reconstructive nerve surgery and or secondary surgery in a selective group of NBPP patients [2, 3]. Nerve surgery entails reconstruction of spinal roots with autologous nerve grafts, nerve transfers or a combination of both [2–4]. In a nerve transfer, a normal functioning nerve (donor) is cut and connected to the distal end of a non-functioning, but more important nerve (acceptor). Following a nerve transfer, the control over the reinnervated function is initially by the donor nerve command. The regain of volitional control, i.e. a functional response following the acceptor nerve command, requires central neural plasticity. This is the inherent capacity of the brain and spinal cord to adapt to changes in external or internal stimuli. Neural plasticity is a process that helps in learning, develop motor skills to execute new tasks and minimize deficits [5–8]. The capacity of the nervous system for central plastic changes is of great importance because it determines the final functional result of the applied nerve transfer [3, 9].

Recently, we developed the Plasticity Grading Score (PGS) to objectify the level of volitional control after nerve transfer [3]. In adults or children sustaining a traumatic brachial plexus injury after a motorcycle or car accident (NNBPP), independent control over the reinnervated function can be reached. However, in more than three quarter of the cases complete independence was never attained [3]. For instance, when a phrenic nerve transfer for elbow flexion was done, complete inspiration by firing the phrenic nerve increased the strength of the reinnervated biceps in up to 10% even years after the surgery [10, 11]. We concluded therefore that these lack of complete independence of voluntary control observed between donor and acceptor motor programs were due lo limitations on plasticity observed in the analyzed population, comprised mostly of adult patients. Furthermore, we compared the PGS score of adults with NNBPP and NBPP patients in which one specific nerve transfer was performed, namely the Ulnar or Median branches to Musculocutaneous nerve transfer. We found that the capacity for plastic changes was much bigger in the infant than in the adult [12]. Whether this difference only accounts for this specific transfer, or for nerve transfers in general is still unknown.

Here, instead of comparing both populations analyzing only one transfer, we studied the differences in PGS scores between NBPP and NBPP patients after those different nerve transfers which are most frequently used, namely the Ulnar and or Median nerve fascicles to Musculocutaneous nerve, Spinal accessory nerve to nerves for elbow flexion, Spinal accessory to suprascapular nerve, Intercostal to Musculocutaneous nerve, Triceps branches to Axillary nerve, and Phrenic nerve to nerves for elbow flexion.

Inclusion criteria

We retrospectively reviewed infants with NBPP and adults with NNBPI for which a nerve transfer was performed. All patients were operated upon consecutively in the Peripheral Nerve Unit within the Department of Neurosurgery, University of Buenos Aires School of Medicine between January 1^st, 2002 and December 31^st, 2018. To be included in the study, both NBPP and NNBPP had to have undergone an extra or intra-plexal nerve transfer to regain a lost neurological function, but not nerve grafting for the same function. Therefore, in all included cases the specific nerve transfer was the only nerve surgical technique used. The patients who underwent grafting were excluded because if a nerve root was reconstructed with grafts and subsequently a nerve transfer was performed to recover the same or a similar function, it is not possible to determine if the recovery was either due to the root repair or to the nerve transfer.

The primary outcome was the PGS score, ranging from 1 to 4 (Table 1)[3]. Briefly, PGS score 1 represented the lowest independent volitional control, with British Medical research Council (MRC) grade 4 obtained in response to the donor command and MRC grade 0 in response to the acceptor command (minimum brain plasticity), whereas PGS score 4 was no noticeable contraction in response to the donor command and MRC score 4 in response to the acceptor command (maximum brain plasticity). Each muscle reinnervated following the transfer was tested three times in.

We also assessed patient compliance with the rehabilitation therapy using the 4-point Rehabilitation Quality Scale (RQS) [3, 14-16]. An RQS score of 1 represents patients who failed to attend any rehabilitation therapy or attended less than once weekly. Patients who had rehabilitation therapy at a regular center more than once weekly were classified as RQS of 2, and a score of 3 was attained when patients exhibited good adherence to a rehabilitation program at a nonspecialized neurorehabilitation center with periodic assessments at a specialized neuro-rehabilitation center. Patients who exhibited good adherence to a rehabilitation program at our specialized institution were assigned an RSQ score of 4 (Table 2).

Exclusion criteria were: 1/ patients who were lost to follow up; 2/ a clinical final result of the nerve transfer of MRC grade < 4; 3/ surgical repair more than 12 months after the trauma; 4/ NNBPP patients who had a concurrent brain contusion which might have affected their potential for brain plasticity, or 5/ follow-up of less than 12 months. Finally, we studied the influence of the compliance of each patient to the rehabilitation plan (table 2), the time from trauma to surgery and the time of follow-up, in order to determine whether these independent factors predict a response in the PGS score.

The study was performed in full accordance with the Declaration of Helsinki II and our institution´s ethics committee. All eligible patients -or responsible parents in children or NNBPP cases) were asked to participate in our study protocol, which included a throughout clinical examination. Written informed consent was obtained from each patient prior to study participation. Patient demographic characteristics — like gender, age, time from trauma to surgery, and the duration of follow-up — were recorded at the time of assessment.

Surgical strategies and techniques

General descriptions of the brachial plexus surgery and also of our rehabilitation program have recently been published [16-18]. All nerve transfers included a complete or a partial nerve section of the donor nerve and a direct coaptation with the recipient nerve. Nerve transfers only were used when proximal roots for grafting were unavailable as assessed by preoperative MRI and intraoperative inspection. Post-operative evaluations were performed every six months by at least two of the authors.

Post-operative clinical evaluation

Post-operative evaluations were performed every six months on a regular basis by at least two of the authors to reduce ascertainment bias. After a general clinical evaluation, we determined the PGS score. Postoperative evaluations were performed every 6 months

by at least two of the authors.

Statistical analysis

Continuous variables (age at surgery in months, time of follow-up in months, compliance to rehabilitation scale and plasticity scale) were summarized as means with standard deviations (SD) and minimum to maximum ranges, then tested for normality of distribution using the Shapiro-Wilk’s test. Since all four continuous variables were non-normally distributed and were being compared between subject groups (NBPP versus NNBPP), Kruskal-Wallis one-way analysis of variance (KW-ANOVA) was used to compare Medians and distributions. Distributions for both PGS scores and compliance were further compared using Pearson χ2 analysis or Fisher’s Exact test, as indicated. Within each subject group, the degree and significance of correlations between the four continuous variables were calculated using Pearson correlation coefficients, with r values < 0.30 considered weak, from 0.30-0.69 moderate, and ≥ 0.70 strong correlations. To identify predictors of the final neuroplasticity score, simple linear regression analysis was performed with the four independent variables — subject group, time to surgery, length of follow-up, and compliance score entered by forward entry. All tests were two-tailed, with p ≤ 0.050 set as the a-priori criterion for statistical significance.

Comparing two series

A total of 153 NNBPP patients and 35 NBPP babies met the inclusion criteria. The demographic characteristics of the NBPP and NNBPP patients are shown in Table 3. The mean age at surgery of the NBPP group was 9 months (SD 5.42, range 4 to 23 months) and approximately half of them were male. The duration of follow-up and the compliance with the rehabilitation scale were not very different than NNBPP patients (Table 3). The mean age of NNBPP patients was 22 years (SD 12 years, range 3 to 69). They were operated around sixth months after the trauma and more than 90% were male. In Tables 4 and 5, a description of the surgical techniques used in each group (NBPP and NNBPP) are described, as well as the number of individuals sustaining each technique. All NNBPP patients underwent one nerve transfer, whereas in the NBPP group some had two transfers for different functions resulting in a total of 38 nerve transfers.

All transfers performed in NBPP patients had a PGS score of 4 while as all nerve transfers in NBPP group scored the maximum. This was not the case for the NNBPP population, that reached a PGS score of 4 in less than one quarter of the cases (Figure 1).

The difference in PGS scores of infants with NBPP and patients with NNBPP was statistically significant (p < 0.001, Table 6). Furthermore, time to surgery differed significantly between both groups (p < 0.001, Table 3).

The PGS score of the total group of NNBPP patients was 3.05. The PGS score in this group was better following an intra-plexal transfer (Triceps to Axillary PGS score 3.15, Ulnar and/or median fascicle to musculocutaneous PGS score 3.27) than following an extra plexal transfer (Phrenic nerve for elbow flexion PGS score 2.57, spinal accessory nerve for elbow flexion PGS score 2.95) (Table 7). No statistical difference in the PGS scores of the different nerve transfer techniques was found.

The compliance to Rehabilitation measured employing the RQS was not significantly (Table 6) different when comparing NBPP and NNBPP groups. (2.76 versus 3.04, respectively, Table 3)

Differences in plasticity between NBPP babies and NNBPP patients

Nerve transfers are frequently used to reanimate function lost due to root avulsions both in NBPP and [2–4, 14, 19–22]. Functional outcome following brachial plexus repair is in part determined by the level of volitional control over the reinnervated muscle. This is not so obvious after a nerve transfer. After all, brain programs for control of function of the donor nerve are different from those of the acceptor nerve. The recovery of volitional control depends on the degree of plasticity. The degree of plasticity can be expressed using the PGS [3]. Similar nerve transfers are used in both NBPP and NNBPP injuries. It is important to know in both groups what can be expected with regard to regaining volitional control after the operation. The fact that the surgical transfer technique is similar in both groups does not automatically imply that the level of cerebral control after reinnervation also becomes the same. Therefore, we investigated whether there is a difference in the level of volitional control achieved after nerve transfers in NBPP in babies as compared to NNBPP in adults. The main finding of this study was that there was a statistically significant difference between the PGS scores of babies with NBPP and adults with NNBPP. Nerve surgeons should be aware of this difference while informing their patients.

The mechanisms underlying brain plasticity after a nerve transfer have been extensively studied [6–9, 23–25]. In view of the relatively short time in which the control over the reinnervated muscle shifts from the donor program to the acceptor program and the cortical distance between both programs the mechanism underlying plasticity is the increase of the efficiency of signaling in pre-existing pathways between donor and acceptor programs. This occurs by unmasking of previously silent synaptic connections rather than arborization of dendrites.

It is a well determined phenomenon that newborns and children in general have a more plastic brain than adults, as plasticity decreases with age [12, 27, 28]. In confirmation of these fact, all babies with NBPP had the maximal PGS score of 4, regardless of the applied nerve transfer. Apparently, the process of re-wiring in the motor cortex is going very well at early age when the brain is in a developing stage. Theoretically, this may imply that NBPP patients may potentially be good candidates for the contralateral C7 root transfer for hand or elbow flexion. This transfer is not widely accepted in the nerve surgical community for use in adults patients because of the lack of volitional control. This assumption, however, needs to be studied. Other studies point in the same direction as the current one. NBPP patients with a right palsy usually change their language-dominant hemisphere from left to right [29] as a result of plastic changes occurring at early stages of development. Similarly, fMRI studies showed that the increased use of the left hand (forced at early ages due to a right NBPP) induces primary and secondary cortical changes -called hand knob-enlargements of the left hand area, similarly to what occurs in natural left-handed dominant [30–33]. Lastly, it has been reported that children below six years old that started learning English as a foreign language in Saudi Arabia before they reach 6 years of age, learn the language much easier, faster, and mostly as a native language [28].

It has been hypothesized that plastic changes are more successful if the donor and acceptor cortical motor programs are located close rather than with a distance [2, 6, 7, 9, 11, 13]. In babies with NBPP this difference could not be observed.

In adults with NNBPP, extra-plexual nerve transfers had worse PGS scores when compared to intra-plexual ones, but as described, the differences were not significant.

We found that in a group of patients with NNBPP a trace of movement related to donor nerve program was present in more than 80% [12]. We interpreted this finding as a limitation of brain plasticity in already developed brains. These findings where present even after more than 10 years [12, 34].

Demographic results: comparison between NBPP and NNBPP patients

Both groups of patients showed some differences. NBPP patients were in the vast majority male who suffered a motorcycle accident [35], while the sex distribution was similar in NBPP. (Table 3 and) So far, there are no studies that have analyzed potential differences in the capacity for plastic rewiring between male and female.

Additionally, the time between trauma and surgery differed for reasons related to the different management of each type of trauma. Generally, prolonged denervation is related to worse outcome of reconstruction [36] Therefore, early surgery is frequently advised [4, 5, 13, 14]. However, babies who have a NBPP may recover spontaneously in around 70–80% [37] probably due to the relatively low amount of kinetic energy involved which is exerted over a period of minutes. Thus, unless a severe injury is diagnosed (i.e. a complete palsy with accompanying Horner sign or root avulsions determined by MRI), later surgeries are not uncommon. In addition, late referrals to our center are not uncommon. Notably, the statistically significant difference in interval between trauma and surgery, being longer in babies, did not affected the plasticity after a nerve transfer, a fact that again remarks the elevated plasticity shown by the NBPP group.

The compliance to rehabilitation (as we scored, using RQS) [3, 11–14] showed some differences between groups although they were not statistically significant. Nevertheless, and similarly to what was observed regarding the difference in timing for surgery, the aforementioned difference in compliance to the rehabilitation did not implied a worst result in terms of plasticity, probably being the latter stronger than the former.

Limitations and originality of our study

This study was retrospective of nature and included a relatively limited number of patients, especially those with NBPP. We included different types of nerve transfers and grouped the PGS scores. The differences in nerve transfers were not evenly distributed in both groups. Differences in plasticity per type of transfer may exist, which may affect the outcome. Noteworthy, this is the first report of a comparison between adults and babies regarding brain plasticity measured using the PGS that included different types of nerve transfers for brachial plexus injuries.

Plastic changes in the brain determine volitional control over a reinnervated muscle following a nerve transfer. We found that babies with NBPP have a significantly greater capacity for plastic rewiring than adults with NNBPP. Surgeons use the same type of transfers in both populations. They must realize that although the nerve surgical repair technique is the same, the outcome regarding volitional control is not necessarily the same. The brain in the very young patient can process the changes induced by the peripheral nerve transfer better than in adults.

Author Contributions

Conception and design: MS, GdM, MM. Acquisition of data: DB, MS, AL, GdM, GB. Analysis and interpretation of data: all authors. Drafting the article: MS, MM, RR. Critically revising the article: MM, MS.

Funding: no funding was obtained for this study

Statements and Declarations

The authors report no conflicts of interest concerning the materials or methods used in this study or the findings reported in this paper. No funding, grants, financial or non-financial interests were involved directly or indirectly related to the work submitted for publication. All ethical standards than could be related during design, data collection, statistical analysis, writing and editing this paper were accomplished, as well as any treatment of personal data from the patients involved.

Malessy MJ, Pondaag W (2009) Obstetric brachial plexus injuries. Neurosurg Clin N Am 20(1):1–14. https://doi.org/10.1016/j.nec.2008.07.024
Socolovsky M, Martins RS, Di Masi G, Siqueira M (2012) Upper brachial plexus injuries: grafts vs ulnar fascicle transfer to restore biceps muscle function. Neurosurgery 71(2 Suppl Operative):ons 227–232. https://doi.org/10.1227/NEU.0b013e3182684b51
Socolovsky M, Barillaro K, Bonilla G, Di Masi G, Malessy M (2022) Nerve transfers for brachial plexus injuries: grading of volitional control. J Neurosurg 138(5):1419–1425. https://doi.org/10.3171/2022.7.JNS22887
Groen JL, Pondaag W, Malessy MJA (2023) Early grafting in severe adult traumatic brachial plexus injury. Neurosurg Focus Video 8(1):V13. https://doi.org/10.3171/2022.10.FOCVID2288
Khu KJ (2015) Neuroplasticity and Brachial Plexus Injury. World Neurosurg 84(6):1509–1510. https://doi.org/10.1016/j.wneu.2015.06.065
Tuna Z, Oskay D, Algin O, Koçak OM (2020) Cortical motor areas show different reorganizational changes in adult patients with brachial plexus birth injury (BPBI). Int J Dev Neurosci 118:419–422. https://doi.org/10.1002/jdn.10037
de Sousa AC, Guedes-Corrêa JF (2016) Post-Oberlin procedure cortical neuroplasticity in traumatic injury of the upper brachial plexus. Radiol Bras 49(3):201–202. https://doi.org/10.1590/0100-3984.2015.0082
Bhat DI, Indira Devi B, Bharti K, Panda R (2017) Cortical plasticity after brachial plexus injury and repair: a resting-state functional MRI study. Neurosurg Focus 42(3):E14. https://doi.org/10.3171/2016.12.FOCUS16430
Socolovsky M, Malessy M, Lopez D, Guedes F, Flores L (2017) Current concepts in plasticity and nerve transfers: relationship between surgical techniques and outcomes. Neurosurg Focus 42(3):E13. https://doi.org/10.3171/2016.12.FOCUS16431
Chuieng-Yi Lu J, An-Jou Lin J, Lee CS, Nai-Jen Chang T, Chwei-Chin Chuang D (2022) Phrenic nerve as an alternative donor for nerve transfer to restore shoulder abduction in severe multiple root injuries of the adult brachial plexus. J Hand Surg Am 21:S0363-5023(
22)00154
. https://doi.org/10.1016/j.jhsa.2022.03.004
Socolovsky M, Malessy M, Bonilla G, Di Masi G, Conti ME, Lovaglio A (2018) Phrenic to musculocutaneous nerve transfer for traumatic brachial plexus injuries: analyzing respiratory effects on elbow flexion control. J Neurosurg 131(1):165–174. https://doi.org/10.3171/2018.4.JNS173248
Socolovsky M, Lovaglio A, Bonilla G, Di Masi G, Barillaro K, Malessy M (2023) Brain plasticity and age after restoration of elbow flexion with distal nerve transfers in neonatal brachial plexus palsy and traumatic brachial plexus injury using the plasticity grading scale. J Neurosurg In press
Socolovsky M, Di Masi G, Battaglia D (2011) Use of long autologous nerve grafts in brachial plexus reconstruction: factors that affect the outcome. Acta Neurochir (Wien) 153(11):2231–2240. https://doi.org/10.1007/s00701-011-1131-1
Socolovsky M, Di Masi G, Bonilla G, Lovaglio A, Krishnan KG (2021) Nerve graft length and recovery of elbow flexion muscle strength in patients with traumatic brachial plexus injuries: case series. Oper Neurosurg (Hagerstown) 20(6):521–528. https://doi.org/10.1093/ons/opab007
Flores LP, Socolovsky M (2016) Phrenic nerve transfer for reconstruction of elbow extension in severe brachial plexus injuries. J Reconstr Microsurg 32(7):546–550. https://doi.org/10.1055/s-0036-1583302
Socolovsky M, Di Masi G, Bonilla G, Domínguez Paez M, Robla J, Calvache Cabrera C (2015) The phrenic nerve as a donor for brachial plexus injuries: is it safe and effective? Case series and literature analysis. Acta Neurochir 157(6):1077–1086. https://doi.org/10.1007/s00701-015-2387-7
Solanki C, Socolovsky M, Devi BI, Bhat DI (2019) Nerve repair: bridging the gap from "limp" to "limb". Neurol India 67(Supplement):S16-S19. https://doi.org/10.4103/0028-3886.250712
Kim D, Murovic J, Kline D (2004) Mechanisms of injury in operative brachial plexus lesions. Neurosurg Focus 16(5):E2-11
Estrella EP, Mina JE, Montales TD (2023) The outcome of single versus double nerve transfers in shoulder reconstruction of upper and extended upper-type brachial plexus injuries. J Hand Surg Glob Online 5(3):284–289. https://doi.org/10.1016/j.jhsg.2023.01.012
Javeed S, Greenberg JK, Zhang JK, Plog B, Dibble CF, Benedict B, Botterbush K, Khalifeh JM, Wen H, Chen Y, Park Y, Belzberg AJ, Tuffaha S, Burks SS, Levi AD, Zager EL, Faraji AH, Mahan MA, Midha R, Wilson TJ (2023) Association of upper-limb neurological recovery with functional outcomes in high cervical spinal cord injury. J Neurosurg Spine 1–8. https://doi.org/10.3171/2023.4.SPINE2382
Shin AY, Socolovsky M, Desai K, Fox M, Wang S, Spinner RJ (2022) Differences in management and treatment of traumatic adult pan brachial plexus injuries: a global perspective regarding continental variations. J Hand Surg Eur 47(1):40–51. https://doi.org/10.1177/17531934211039677
Socolovsky M, Costales JR, Paez MD, Nizzo G, Valbuena S, Varone E (2016) Obstetric brachial plexus palsy: reviewing the literature comparing the results of primary versus secondary surgery. Childs Nerv Syst 32(3):415–425. https://doi.org/10.1007/s00381-015-2971-4
Socolovsky M, Malessy M (2021) Brain changes after peripheral nerve repair: limitations of neuroplasticity. J Neurosurg Sci 65(4):421–430. https://doi.org/10.23736/S0390-5616.21.05298-X
Fraiman D, Miranda MF, Erthal F, Buur PF, Elschot M, Souza L, Rombouts SA, Schimmelpenninck CA, Norris DG, Malessy MJ, Galves A, Vargas CD (2016) Reduced functional connectivity within the primary motor cortex of patients with brachial plexus injury. Neuroimage Clin 12:277–284. https://doi.org/10.1016/j.nicl.2016.07.008
Eggers R, Tannemaat MR, De Winter F, Malessy MJ, Verhaagen J (2016) Clinical and neurobiological advances in promoting regeneration of the ventral root avulsion lesion. Eur J Neurosci 43(3):318–335. https://doi.org/10.1111/ejn.13089
Stroh AL, Grin K, Rösler F, Bottari D, Ossandón J, Rossion B, Röder B (2022) Developmental experiences alter the temporal processing characteristics of the visual cortex: evidence from deaf and hearing native signers. Eur J Neurosci 55(6):1629–1644. https://doi.org/10.1111/ejn.15629
Gawi EM (2011) The effects of age factor on learning english: a case study of learning english in saudi schools, Saudi Arabia. English Language Teaching 5:127–139. https://doi.org/10.5539/elt.v5n1p127
Van der Looven. Risk management, nerve regeneration and developing brain plasticity. Thesis submitted to fulfill the requirements for the degree of ‘Doctor in medical sciences’ Ghent University, Belgium Juni 2021
Auer T, Pinter S, Kovacs N, Kalmar Z, Nagy F, Horvath R, Koszo B, Kotek G, Perlaki G, Koves M, Kalman B, Komoly S, Schwarcz A, Woermann F (2009) Does obstetric brachial plexus injury influence speech dominance? Ann Neurol 65(1):57–66. https://doi.org/10.1002/ana.21538
Kolb B, Harker A, Gibb R (2017) Principles of plasticity in the developing brain. Dev Med Child Neurol 59(12):1218–1223. https://doi.org/10.1111/dmcn.13546
Siero JCW, Hermes D, Hoogduin H, Luijten PR, Ramsey NF, Petridou N (2014) BOLD matches neuronal activity at the mm scale: a combined 7 T fMRI and ECoG study in human sensorimotor cortex. Neuroimage 101:177–184. https://doi.org/10.1016/j.neuroimage.2014.07.002
Siebner HR, Rothwell J (2003) Transcranial magnetic stimulation: new insights into representational cortical plasticity. Exp Brain res 148(1):1–16. https://doi.org/10.1007/s00221-002-1234-2
Li S, HanY, Wang D, Yang H, Fan Y, Lv Y, Tang H, Gong Q, Zang Y, He Y (2010) Mapping surface variability of the central sulcus in musicians. Cereb cortex 20(1):25–33. https://doi.org/10.1093/cercor/bhp074
Estrada RG, Bacca J, Socolovsky M (2021) A novel dual nerve transfer for restoration of shoulder function and sensory recovery of the hand, in patients with C567 traumatic root avulsion of the brachial plexus. Clin Neurol Neurosurg 210:107005. https://doi.org/10.1016/j.clineuro.2021.107005
Faglioni W Jr, Siqueira MG, Martins RS, Heise CO, Foroni L (2014) The epidemiology of adult traumatic brachial plexus lesions in a large metropolis. Acta Neurochir (Wien) 156(5):1025–1028. https://doi.org/10.1007/s00701-013-1948-x
Fu SY, Gordon T (1995) Contributing factors to poor functional recovery after delayed nerve repair: prolonged axotomy. J Neurosci 15(5 Pt 2):3876–85. https://doi.org/10.1523/JNEUROSCI.15-05-03876.1995
Pondaag W, Malessy MJ (2014) The evidence for nerve repair in obstetric brachial plexus palsy revisited. Biomed Res Int 2014:434619. https://doi.org/10.1155/2014/434619

Tables 1-7 is available in the Supplementary Files section.

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Brain Plasticity in Neonatal Brachial Plexus Palsies: Quantification and Comparison with Adults Brachial Plexus Injuries

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Abstract

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Introduction

Materials and methods

Results

Discussion

Differences in plasticity between NBPP babies and NNBPP patients

Demographic results: comparison between NBPP and NNBPP patients

Limitations and originality of our study

Conclusions

Declarations

References

Tables

Additional Declarations

Supplementary Files

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