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Peripheral nerve transfer techniques were examined with emphasis on adaptive changes within the central nervous system. Key clinical and experimental evidence was synthesized to highlight the mechanisms, advantages, and limitations of neuroplasticity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Functional recovery following nerve transfer depends not only on peripheral reconstruction but also on central adaptations. Although outcomes are often reported using muscle strength grading, this approach neglects critical aspects of coordination, selective control, and integration into complex motor tasks. Neuroplasticity facilitates meaningful function by enabling cortical and subcortical reorganization, but it also presents limitations related to variability, incomplete adaptation, and dependence on donor motor programmes. Review of the available evidence indicates that while neuroplasticity is indispensable to successful nerve transfer outcomes, it cannot fully overcome the intrinsic constraints of the donor\u2013recipient mismatch.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Peripheral nerve transfers must be assessed within the broader framework of neuroplasticity. A balanced understanding of this mechanism \u2013 its reliability, benefits, and inherent limitations \u2013 provides an up-to-date perspective for clinicians and researchers. Such knowledge is essential to refine reconstructive strategies, optimize rehabilitation and align patient expectations with achievable functional outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of evidence:<\/jats:title>\n                    <jats:p>IV<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/17531934251398407","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T12:17:45Z","timestamp":1768565865000},"page":"768-777","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Nerve transfers and central nervous system control in brachial plexus and peripheral nerve injuries: towards a balanced reconstructive strategy"],"prefix":"10.1177","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7512-5973","authenticated-orcid":false,"given":"G\u00fcrsel","family":"Leblebicio\u011flu","sequence":"first","affiliation":[{"name":"The Hand Clinic, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0667-3463","authenticated-orcid":false,"given":"Mariano","family":"Socolovsky","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital de Cl\u00ednicas, University of Buenos Aires School of Medicine, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7676-2819","authenticated-orcid":false,"given":"Tim","family":"Hems","sequence":"additional","affiliation":[{"name":"Scottish National Brachial Plexus Injury Service, Queen Elizabeth University Hospital, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4555-4563","authenticated-orcid":false,"given":"\u00c7i\u011fdem Ayhan","family":"Kuru","sequence":"additional","affiliation":[{"name":"Department of Musculoskeletal Physiotherapy and Rehabilitation, Hacettepe University, Faculty of Physical Therapy and Rehabilitation Hand Rehabilitation Unit, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5139-2401","authenticated-orcid":false,"given":"Zeynep Tuna","family":"Emir","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5471-8275","authenticated-orcid":false,"given":"Ufuk","family":"\u00d6zcan","sequence":"additional","affiliation":[{"name":"Therapy Pedia, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,1,16]]},"reference":[{"key":"e_1_3_2_2_1","doi-asserted-by":"publisher","DOI":"10.23736\/S0022-4707.23.14996-6"},{"key":"e_1_3_2_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2022.04.022"},{"key":"e_1_3_2_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroscience.2018.07.008"},{"key":"e_1_3_2_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2014.10.060"},{"key":"e_1_3_2_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e31826d16cf"},{"key":"e_1_3_2_7_1","doi-asserted-by":"publisher","DOI":"10.1142\/S2424835523300025"},{"key":"e_1_3_2_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2014.08.024"},{"key":"e_1_3_2_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroscience.2017.02.018"},{"key":"e_1_3_2_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2023.e15600"},{"key":"e_1_3_2_11_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.56.4.576-a"},{"key":"e_1_3_2_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/0363-5023(93)90328-Z"},{"key":"e_1_3_2_13_1","doi-asserted-by":"publisher","DOI":"10.3340\/jkns.2009.46.1.1"},{"key":"e_1_3_2_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2013.09.038"},{"key":"e_1_3_2_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroscience.2021.11.048"},{"key":"e_1_3_2_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/1753193420922184"},{"key":"e_1_3_2_17_1","doi-asserted-by":"publisher","DOI":"10.3171\/2014.9.PEDS14245"},{"key":"e_1_3_2_18_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2024.1486959"},{"key":"e_1_3_2_19_1","article-title":"Influence of purposeful activities on upper extremity motor performance: a systematic review","volume":"40","author":"Collis JM","year":"2020","unstructured":"Collis JM, Signal N, Mayland E, Wright-St Clair VA. 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