Synopsis: 21

RECENT ADVANCES IN THE MANAGEMENT OF BRACHIAL PLEXUS INJURIES (BPI)

Nerve transfer and muscle transfer are the reliable restorative options for the avulsed brachial plexus injuries (BPI). Nerve transfer can be broadly classified into three categories: extraplexus e.g. SSN-SAN, CC7 transfer, phrenic nerve transfer etc, intraplexus e.g. C5 fibers transferred to C6 and close-target nerve transfers e.g. Oberlin I &II. As a physiotherapist rehabilitating these surgical procedures, one needs to have a thorough understanding of the anatomical aspects of the surgery and how to go about the rehabilitation of the same. The aim of this workshop is to illustrate various techniques followed by us over five years at a government medical college hospital leading to successful rehabilitation of traumatic brachial plexus injury patients.

In Induction technique, muscle action from the donor nerve is achieved prior in order to induce the action in the recipient muscle. For e.g. in Oberlin-I transfer where ulnar nerve fascicle was transferred to biceps muscle, subject was asked to do flexion with ulnar deviation of wrist 30 times hourly. Kahn et al referred this exercise as Donor activated focused rehabilitation approach (DAFRA). Later we modified this protocol and divided into several stages. In the stage 1 subject was asked to perform passive range of motion of recipient muscle along with resisted movement of muscles supplied by the donor nerve and later progressed to other stages. Various case studies published by us on these techniques have shown that individually these techniques have a successful outcome in the management of traumatic brachial plexus injury.