Rehabilitation for free functional muscle transfers following complete brachial plexus injury: A case report
Macyn M Stonner1, Ellen T King1, Christopher J Dy2
1Milliken Hand Rehabilitation Center, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA.
Background:
Free functional muscle transfer surgery requires supervised rehabilitation to optimize motor re-education, yet guidelines regarding orthotic use and therapeutic exercises are lacking.
Purpose:
To present an overview of the rehabilitation protocol for a patient who underwent free functional muscle transfer after brachial plexus injury.
Study Design:
Case report.
Methods:
A 49-year-old male with complete brachial plexus injury began outpatient hand therapy 2 weeks after free functional muscle transfer. Rehabilitation included a dedicated orthosis program and exercises based off the Donor Activation Focused Rehabilitation Approach. Donor muscle activation is first coupled with passive elbow and finger flexion, followed by active-assisted, antigravity, and then resisted motion.
Results:
The case obtained a 4 cm distal palmar crease distance, an elbow arc of 30-100 degrees, and the elbow could withstand moderate (4/5) resistance. Elbow and finger flexion strength was greater with co-contraction of the donor trapezius muscle.
Conclusions:
Good strength and range-of-motion outcomes were obtained using Donor Activation Focused Rehabilitation Approach as a framework to model free functional muscle transfer rehabilitation.
