Rehabilitation after brachial plexus nerve transfer surgery: a case series

Theresa J. E. Hallenen

doi:10.17918/00001880

Background: Traumatic brachial plexus injury results in devastating functional loss to the affected arm. Motor and sensory changes vary based on the location and severity of nerve injury. Nerve transfer surgery is an effective intervention that improves functional outcomes following these injuries. Despite what we know about nerve transfer surgery, little evidence exists that examines rehabilitation for this patient population. Purpose: The aim of this descriptive study is to identify current occupational therapy and/or physical therapy methods for assessment, intervention, and functional outcomes of adults following traumatic brachial plexus injury and nerve transfer surgery. Methods: A search was conducted of 4 million electronic records treated within a 10-year period at the Duke University Health System. Eight-four potential cases were identified using diagnosis (ICD-10) and procedure (CPT(r)) codes specific to brachial plexus injury and nerve transfer surgery. The dataset was reduced to 20 cases based on inclusion criteria of completing three or more occupational therapy or physical therapy treatment sessions. The final four cases were determined based on medical records including sufficient documentation to adequately evaluate and describe the cases and rehabilitation treatment. Case report guidelines (CARE) guidelines were used to analyze the four cases. Results: The four cases selected highlight the complexity and unique rehabilitation needs of this patient population. The therapists for each case used assessments that targeted general arm function, range of motion, and strength deficits. Rehabilitation interventions addressing passive and active range of motion, strengthening, and neuromuscular re-education were consistent across all four cases. Variations in therapy assessment and intervention were identified. Conclusions: This case series provides meaningful insight into the current status of occupational and physical therapy evaluation, treatment, and rehabilitation reporting in patients undergoing nerve transfer surgery for brachial plexus injuries. Approaches to improve the rehabilitation treatment of this important population are discussed. Further research is necessary to make recommendations on how therapists assess and provide intervention for both physical and psychosocial changes as well as how to dose rehabilitation interventions after nerve transfer surgery

Rehabilitation after brachial plexus nerve transfer surgery: a case series

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Rehabilitation after brachial plexus nerve transfer surgery: a case series

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