Multidisciplinary rehabilitation network enhances outcomes after nerve transfer in brachial plexus birth injury

Outcomes after brachial plexus birth injury (BPBI) vary widely, highlighting the need for rehabilitation strategies that reliably enhance functional recovery. We hypothesized that a coordinated, interdisciplinary rehabilitation network involving surgeons and occupational therapists improves functional outcomes after spinal accessory to suprascapular nerve (SAN-SSN) transfer. We compared outcomes from two academic centers with similar surgical indications and techniques but distinct rehabilitation models.

We reviewed 25 infants who underwent SAN-SSN transfer from 2022 to 2024. Institution A used a coordinated multidisciplinary rehabilitation model in which the surgeon partnered directly with specialized therapists. Patients at institution B self-selected therapy sites. Pre- and postoperative external rotation Active Movement Scale (AMS) scores were collected and analyzed.

Both cohorts showed significant improvement in external rotation (ER) (P < 0.05). Median postoperative AMS scores were higher at institution A (7; interquartile range [IQR] 5.5-7) than at institution B (4; IQR 3-5). Functional recovery (AMS ≥ 6) occurred in 72.7% of institution A patients versus 14.3% at institution B (P = 0.005). Within institution B, on-site therapy produced significantly better outcomes than off-site therapy. Patients at institution A had 11.8-fold greater odds of achieving higher AMS scores than patients at institution B (P = 0.018); these differences were not significant when comparing institution A to institution B's on-site subgroup.

Surgeon-directed, expert-guided therapy is associated with superior recovery after SAN-SSN transfer for BPBI. These findings support the impact of a scalable model which prioritizes timely, consistent, and coordinated postoperative rehabilitation.

III, retrospective cohort comparison.