skip to main content
US FlagAn official website of the United States government
dot gov icon
Official websites use .gov
A .gov website belongs to an official government organization in the United States.
https lock icon
Secure .gov websites use HTTPS
A lock ( lock ) or https:// means you've safely connected to the .gov website. Share sensitive information only on official, secure websites.

Explore Research Products in the PAR
It may take a few hours for recently added research products to appear in PAR search results.


  • NSF Public Access
  • Search Results
  • Available Computational and Physical Models to Understand the Mechanisms of Neonatal Brachial Plexus Injury During Shoulder Dystocia
Title: Available Computational and Physical Models to Understand the Mechanisms of Neonatal Brachial Plexus Injury During Shoulder Dystocia
Neonatal brachial plexus palsy is a devastating complication occurring during complicated birthing scenarios including shoulder dystocia. To understand the effects of maneuvers that reduce forces required for delivery following shoulder dystocia, tools that simulate the birthing scenarios are needed. Incorporation of brachial plexus responses is further required to help understand the mechanism of neonatal brachial plexus palsy and devise strategies that can help prevent them. Given the inability to measure forces and tissue strains during actual birthing process, computer and physical models serve as optimal tools with its known limitations. This mini-review highlights and summaries available computational and physical models that can help understand brachial plexus injury mechanisms in neonates following complicated delivery including shoulder dystocia.  more » « less
Award ID(s):
1752513
PAR ID:
10168628
Author(s) / Creator(s):
Date Published:
Journal Name:
Open access journal of neurology neurosurgery
ISSN:
2476-0501
Format(s):
Medium: X
Sponsoring Org:
National Science Foundation
More Like this
  1. ; ; ; ; (, Journal of Biomechanical Engineering)
    Abstract The purpose of this computational study was to investigate the effects of neonate-focused clinical delivery maneuvers on brachial plexus (BP) during shoulder dystocia. During shoulder dystocia, the anterior shoulder of the neonate is obstructed behind the symphysis pubis of the maternal pelvis, postdelivery of the neonate's head. This is managed by a series of clinical delivery maneuvers. The goal of this study was to simulate these delivery maneuvers and study their effects on neonatal BP strain. Using madymo models of a maternal pelvis and a 90th-percentile neonate, various delivery maneuvers and positions were simulated including the lithotomy position alone of the maternal pelvis, delivery with the application of various suprapubic pressures (SPPs), neonate in an oblique position, and during posterior arm delivery maneuver. The resulting BP strain (%) along with the required maternal delivery force was reported in these independently simulated scenarios. The lithotomy position alone served as the baseline. Each of the successive maneuvers reported a decrease in the required delivery force and resulting neonatal BP strain. As the applied SPP force increased (three scenarios simulated), the required maternal delivery force and neonatal BP strain decreased. A further decrease in both delivery force and neonatal BP strain was observed in the oblique position, with the lowest delivery force and neonatal BP strain reported during the posterior arm delivery maneuver. Data obtained from the improved computational models in this study enhance our understanding of the effects of clinical maneuvers on neonatal BP strain during complicated birthing scenarios such as shoulder dystocia. 
    more » « less
  2. ; (, PLOS ONE)
    Chaudhary, Priti (Ed.)
    The brachial plexus is a set of nerves that innervate the upper extremity and may become injured during the birthing process through an injury known as Neonatal Brachial Plexus Palsy. Studying the mechanisms of these injuries on infant cadavers is challenging due to the justifiable sensitivity surrounding testing. Thus, these specimens are generally unavailable to be used to investigate variations in brachial plexus injury mechanisms. Finite Element Models are an alternative way to investigate the response of the neonatal brachial plexus to loading. Finite Element Models allow a virtual representation of the neonatal brachial plexus to be developed and analyzed with dimensions and mechanical properties determined from experimental studies. Using ABAQUS software, a two-dimensional brachial plexus model was created to analyze how stresses and strains develop within the brachial plexus. The main objectives of this study were (1) to develop a model of the brachial plexus and validate it against previous literature, and (2) to analyze the effect of stress on the nerve roots based on variations in the angles between the nerve roots and the spinal cord. The predicted stress for C5 and C6 was calculated as 0.246 MPa and 0.250 MPa, respectively. C5 and C6 nerve roots experience the highest stress and the largest displacement in comparison to the lower nerve roots, which correlates with clinical patterns of injury. Even small (+/- 3 and 6 degrees) variations in nerve root angle significantly impacted the stress at the proximal nerve root. This model is the first step towards developing a complete three-dimensional model of the neonatal brachial plexus to provide the opportunity to more accurately assess the effect of the birth process on the stretch within the brachial plexus and the impact of biological variations in structure and properties on the risk of Neonatal Brachial Plexus Palsy. 
    more » « less
  3. ; ; ; (, Journal of Biomechanical Engineering)
    null (Ed.)
    Abstract Brachial plexus birth injury has a reported incidence of 1 to 4 per 1000 live births. During complicated deliveries, neonatal, maternal, and other birth-related factors can cause over-stretching or avulsion of the neonatal brachial plexus leading to injury. Understanding biomechanical responses of the neonate brachial plexus when subjected to stretch can offer insight into the injury outcomes while guiding the development of preventative maneuvers that can help reduce the occurrence of neonatal brachial plexus injuries. This review article aims to offer a comprehensive overview of existing literature reporting biomechanical responses of the brachial plexus, in both adults and neonates, when subjected to stretch. Despite the discrepancies in the reported biomechanical properties of the brachial plexus, the studies confirm the loading rate and loading direction dependency of the brachial plexus tissue. Future studies, possibly in vivo, that utilize clinically-relevant neonatal large animal models can provide translational failure values of the biomechanical parameters for the neonatal brachial plexus when subjected to stretch. 
    more » « less
  4. ; ; (, Journal of Biomechanical Engineering)
    null (Ed.)
    Abstract Despite occurrence of neonatal hypoxia and peripheral nerve injuries in complicated birthing scenarios, the effect of hypoxia on the biomechanical responses of neonatal peripheral nerves is not studied. In this study, neonatal brachial plexus and tibial nerves, obtained from eight normal and eight hypoxic 3-5 days old piglets, were tested in uniaxial tension until failure at a rate of 0.01 mm/s or 10 mm/s. Failure load, stress, and modulus of elasticity were reported to be significantly lower in hypoxic neonatal brachial plexus (BP) and tibial nerves than respective normal tissue at both 0.01 and 10 mm/s rates. Failure strain was significantly lower in the hypoxic neonatal BP nerves only at 10 mm/s rate when compared to normal BP nerve. This is the first available data that indicates weaker mechanical behavior of hypoxic neonatal peripheral nerves as compared to normal tissue, and offers an understanding of the biomechanical responses of peripheral nerves of hypoxic neonatal piglets. 
    more » « less
  5. ; (, IntechOpen)
    Taiar, Redha (Ed.)
    Neonatal brachial plexus palsy is a birth process-related injury that affects 1–2/1000 infants, with about 10% of those having a permanent deficit that can affect the muscle strength, range of motion, and sensation of the upper extremity. While computational models make the most sense for investigation of injury mechanisms in the vulnerable infant population, the models remain very simplified – incorporating only a single indicator nerve that mimics the response of the C5 nerve root rather than taking into consideration the complex, 3D anatomy of the plexus. Two existing finite element models of the adult brachial plexus have been published – but neither attempts to model the complex anatomy of the plexus through the divisions, cords, and terminal nerves. This project involved the development of an anatomically appropriate 3D model of the infant brachial plexus. This is the first published finite element model of the full, complex anatomy of the brachial plexus and the first that includes an appropriate anatomy for an infant. The model was then used to better understand the pattern and progression of brachial plexus injury that has been observed clinically in neonates. The model was able to predict a stress distribution that aligns with the C5 nerve root being the location of initial injury. It also demonstrated how the stress in remaining, intact nerve roots will increase when rupture or avulsion of C5 and then C6 occurs – which matches the progression of the injury from the upper plexus (an Erb’s Palsy) to the middle and lower plexus. 
    more » « less
  • Citation Formats
  • MLA
  • APA
  • Chicago
  • BibTeX
  • Save / Share this Record
  • Send to Email