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Updated: Jul 2, 2025
Structured Motor Rehabilitation After Selective Nerve Transfers
Published on: August 15, 2019
Rehabilitation protocols in neonates undergoing primary nerve surgery for upper brachial plexus palsy: A scoping
Dhruv Mendiratta1, Michael F Levidy1, Alice Chu1
1Department of Orthopaedics, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
Insights
Rehabilitation after neonatal brachial plexus palsy (NBPP) surgery is underexplored. Therapies vary based on surgical approach, with active treatments more common after nerve transfers than exploration.
Area of Science:
- Pediatric Surgery
- Neurorehabilitation
- Microsurgery
Background:
- Severe neonatal brachial plexus palsy (NBPP) requires surgical management within the first six months for optimal function.
- Post-surgical rehabilitation protocols for NBPP remain an under-researched area.
Purpose of the Study:
- To conduct a scoping review of existing rehabilitation modalities for NBPP following microsurgery.
- To analyze variations in rehabilitation approaches based on different microsurgical techniques.
Main Methods:
- Systematic search of articles on upper trunk obstetric brachial plexus nerve microsurgery in pediatric patients mentioning rehabilitation.
- Categorization of rehabilitation aims (passive, active, initial motor recovery) and surgical approaches (exploration of the brachial plexus - EBP, nerve transfer without root exploration - NTwoRE).
Main Results:
- Thirty-six articles were included, with rehabilitation initiated an average of 22.26 days post-surgery.
- Active therapy was more frequently reported in NTwoRE (75.0%) compared to EBP (27.7%) studies.
- Specific nerve transfers showed varied rehabilitation focus, e.g., spinal accessory to suprascapular transfers favored active shoulder exercises, while contralateral C7 transfers often used electrostimulation for initial motor recovery.
Conclusions:
- Rehabilitation information post-NBPP nerve surgery is limited.
- Rehabilitation aims and modalities are influenced by surgical approach and technique.
- Therapy selection should consider patient age, initial deformity, and care team goals.
Introduction:
Surgical management is recommended in patients with severe neonatal brachial plexus palsy (NBPP) within the first 6 months of age to regain best possible function. Rehabilitation post-surgery remains relatively unexplored. This is a scoping review that explores, which rehabilitation modalities exist and how they vary for different microsurgical approaches in NBPP.
Materials And Methods:
A systematic search was conducted to include articles about upper trunk obstetric brachial plexus nerve microsurgery in pediatric patients that made mention of rehabilitation protocols. The aims of rehabilitation modalities varied and were grouped: "passive" movement to prevent joint contracture or stiffness, "active" or task-oriented movement to improve motor function, or "providing initial motor recovery". Surgical approach was described as either exploration of the brachial plexus (EBP) or nerve transfer without root exploration (NTwoRE). Technique was categorized into transfers and non-transfers.
Results:
Thirty-six full-text articles were included. Initiation of rehabilitation was 22.26 days post-surgery. Twenty-eight studies were EBP, and six were NTwoRE. Of studies classifiable by aims, nine were "passive", nine were "active", and five were "providing initial motor recovery". Only 27.7% of EBP studies mentioned active therapy, while 75.0% of NTwoRE studies mentioned active therapy. The average age of patients in the EBP procedure category was 7.70 months, and NTwoRE was 17.76 months. Within transfers, the spinal accessory to suprascapular group was more likely to describe an active shoulder exercise therapy, whereas contralateral C7 group was more likely to describe "initial motor recovery", especially through the use of electrostimulation. All articles on electrostimulation recommended 15-20-minute daily treatment.
Conclusion:
Information on rehabilitation is limited post-nerve surgery in NBPP. However, when mentioned, the aims of these therapies vary with respect to surgical approach and technique. The type of therapy to employ may be a multifaceted decision, involving factors such as patient age, initial deformity, and goals of the care team.
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