The stages of rehabilitation following motor nerve transfer surgery

Abstract

Nerve transfer surgery is a reliable technique for restoration of motor function for paralysis resulting from peripheral nerve injury. The donor motor branch or fascicle is selected in proximity to the denervated target, and a tension-free end-to-end nerve coaptation is performed allowing rapid neurotisation and functional restoration. To date, a standardised rehabilitation protocol does not exist. The Birmingham Protocol was developed to enhance communication between surgeons and physiotherapists and to improve patients understanding of the recovery process. It is a six-phase continuous rehabilitation programme designed to improve the outcomes following motor nerve transfer surgery. The programme was developed in a regional peripheral nerve injury service and has been evaluated over 10 years in >500 motor nerve transfer procedures. The programme is simple to understand and implement, allowing patient engagement and standardisation of treatment by non-specialist physiotherapists in rehabilitation units remote from the regional centre. The phases are described with expected timelines for progression for motor nerve transfers at different sites. Core outcome measures are defined to facilitate multicentre research. It is hoped that this protocol will serve as a framework that can be applied in other centres both in the UK and the international community.