Donor Activation-focused Rehabilitation Approach: Maximizing Outcomes After Lower Extremity Nerve Transfers

Nerve transfers have become a mainstay in the surgical management of peripheral nerve injuries. Following surgical repair, a donor activation-focused rehabilitation approach (DAFRA) has been shown to significantly improve patient outcomes compared with nonspecific physical therapy approaches. Focused rehabilitation is critical following nerve transfers in the lower extremity due to the significant demands of weight-bearing and ambulation, both of which greatly impact a patient's quality of life.

DAFRA is formatted to strengthen the altered neural pathways created by nerve transfers by respecting the patient's new anatomy, encouraging cortical plasticity, and thoroughly educating the patient. This article outlined the early, middle, and late phases of therapy for patients with lower extremity nerve injuries who undergo nerve transfers to restore function.

There is no predetermined timeline of progression through the DAFRA program. The 3 phases of recovery are adapted to the individual and their personal needs and recovery.

The purpose of this article was to present the optimal DAFRA protocols for common nerve transfers in the lower extremity to reestablish hip stability, knee extension, and ankle mobility.