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

## TL;DR

A coordinated rehabilitation network with surgeons and therapists improves recovery after nerve transfer for brachial plexus birth injury in infants.

## Contribution

A surgeon-directed, expert-guided therapy model significantly enhances functional outcomes after nerve transfer for BPBI.

## Key findings

- Institution A had 72.7% functional recovery versus 14.3% at Institution B.
- On-site therapy at Institution B produced better outcomes than off-site therapy.
- Patients at Institution A had 11.8-fold greater odds of achieving higher AMS scores.

## Abstract

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.