{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T09:01:28Z","timestamp":1780736488230,"version":"3.54.1"},"reference-count":60,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Patients with complete traumatic brachial plexus injuries often require nerve transfers to restore lost function. Phrenic nerve (PN)\u2013musculocutaneous nerve (MCN) transfer can be used to restore elbow flexion. The degree to which reinnervated muscles achieve independent control requires central plastic changes. The central program of the PN donor nerve needs to disconnect and establish connections with that of the recipient MCN. This study aimed to improve understanding of the brain\u2019s changes after PN-MCN transfer by correlating electromyography (EMG) findings with clinical plasticity grading scale (PGS) scores.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n A prospective study was conducted on patients who underwent PN-MCN transfer after brachial plexus injury. EMG assessments were systematically performed under 3 distinct conditions: 1) normal respiration with the arm at rest, 2) deep respiration with the arm at rest, and 3) voluntary elbow flexion performed without inspiration. Motor unit potentials (MUPs) detected within a 150-msec interval were systematically categorized using a 5-point scale. Brain plasticity was clinically evaluated using the 4-point PGS.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n Twelve patients with a mean age of 21.8 years were included in the study. A significant negative correlation was found between EMG activity during deep breathing and PGS outcomes (correlation coefficient [CC] \u22120.623, p = 0.031). Likewise, EMG activity during deep breathing showed a negative correlation with EMG activity during voluntary elbow flexion (CC \u22120.811, p = 0.002). Only 1 patient (8%) demonstrated complete disconnection between the donor and recipient neural pathways.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n The authors\u2019 findings indicate a significant correlation between clinical measures of brain plasticity and EMG outcomes. Additionally, complete cerebral disconnection was rarely attained, with most patients retaining residual influence from the original donor function.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.1.focus24866","type":"journal-article","created":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T04:34:03Z","timestamp":1743654843000},"page":"E2","source":"Crossref","is-referenced-by-count":1,"title":["Correlation between electromyography findings and plasticity grading score after long-term phrenic nerve to musculocutaneous nerve transfer in brachial plexus injuries"],"prefix":"10.3171","volume":"58","author":[{"given":"Simon","family":"Miedema","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francisco","family":"Vargas","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Hospital de Cl\u00ednicas, Buenos Aires, Argentina; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugenia","family":"Conti","sequence":"additional","affiliation":[{"name":"Division of Neurology, Hospital de Cl\u00ednicas, Buenos Aires, Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Bourguet","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Hospital de Cl\u00ednicas, Buenos Aires, Argentina; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martijn","family":"Malessy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariano","family":"Socolovsky","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, Hospital de Cl\u00ednicas, Buenos Aires, Argentina; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"6","key":"b1","series-title":"Plast Reconstr Surg Glob Open","first-page":"e2290","article-title":"Nerve transfers\u2014a paradigm shift in the reconstructive ladder","volume":"7","author":"Domeshek LF","year":"2019","unstructured":"Domeshek LF, Novak CB, Patterson JMM, Nerve transfers\u2014a paradigm shift in the reconstructive ladder. Plast Reconstr Surg Glob Open. 2019;7(6):e2290."},{"issue":"4)(suppl","key":"b2","series-title":"Neurosurgery","first-page":"A125","article-title":"Phrenic nerve transfer in the restoration of elbow flexion in brachial plexus avulsion injuries: how effective and safe is it?","volume":"65","author":"Siqueira MG","year":"2009","unstructured":"Siqueira MG, Martins RS. Phrenic nerve transfer in the restoration of elbow flexion in brachial plexus avulsion injuries: how effective and safe is it? Neurosurgery. 2009;65(4)(suppl):A125-A131."},{"issue":"4","key":"b3","series-title":"Microsurgery","first-page":"287","article-title":"Phrenic nerve transfer for brachial plexus motor neurotization","volume":"10","author":"Gu YD","year":"1989","unstructured":"Gu YD, Wu MM, Zhen YL, Phrenic nerve transfer for brachial plexus motor neurotization. Microsurgery. 1989;10(4):287\u2013289."},{"issue":"9","key":"b4","series-title":"Acta Neurochir (Wien)","first-page":"1793","article-title":"Outcome following phrenic nerve transfer to musculocutaneous nerve in patients with traumatic brachial palsy: a qualitative systematic review","volume":"158","author":"de Mendon\u00e7a Cardoso M","year":"2016","unstructured":"de Mendon\u00e7a Cardoso M, Gepp R, Correa JF. Outcome following phrenic nerve transfer to musculocutaneous nerve in patients with traumatic brachial palsy: a qualitative systematic review. Acta Neurochir (Wien). 2016;158(9):1793\u20131800."},{"issue":"6","key":"b5","series-title":"Acta Neurochir (Wien)","first-page":"1077","article-title":"The phrenic nerve as a donor for brachial plexus injuries: is it safe and effective? Case series and literature analysis","volume":"157","author":"Socolovsky M","year":"2015","unstructured":"Socolovsky M, di Masi G, Bonilla G, Dom\u00ednguez Paez M, Robla J, Calvache Cabrera C. The phrenic nerve as a donor for brachial plexus injuries: is it safe and effective? Case series and literature analysis. Acta Neurochir (Wien). 2015;157(6):1077\u20131086."},{"issue":"suppl","key":"b6","series-title":"Clin Neurol Neurosurg","first-page":"S95","article-title":"Respiration-related activity in the biceps brachii muscle after intercostal-musculocutaneous nerve transfer","volume":"95","author":"Malessy MJ","year":"1993","unstructured":"Malessy MJ, van Dijk JG, Thomeer RT. Respiration-related activity in the biceps brachii muscle after intercostal-musculocutaneous nerve transfer. Clin Neurol Neurosurg. 1993;95(suppl):S95-S102."},{"issue":"5","key":"b7","series-title":"J Neurosurg","first-page":"1419","article-title":"Nerve transfers for brachial plexus injuries: grading of volitional control","volume":"138","author":"Socolovsky M","year":"2022","unstructured":"Socolovsky M, Barillaro K, Bonilla G, Masi GD, Malessy M. Nerve transfers for brachial plexus injuries: grading of volitional control. J Neurosurg. 2022;138(5):1419\u20131425."},{"key":"b8","series-title":"Exp Neurol","first-page":"113426","article-title":"The evolution of nerve transfers for spinal cord injury","volume":"333","author":"Bazarek S","year":"2020","unstructured":"Bazarek S, Brown JM. The evolution of nerve transfers for spinal cord injury. Exp Neurol. 2020;333:113426."},{"key":"b9","series-title":"Neural Plast","first-page":"2952386","article-title":"The extracellular environment of the CNS: influence on plasticity, sprouting, and axonal regeneration after spinal cord injury","volume":"2018","author":"Quraishe S","year":"2018","unstructured":"Quraishe S, Forbes LH, Andrews MR. The extracellular environment of the CNS: influence on plasticity, sprouting, and axonal regeneration after spinal cord injury. Neural Plast. 2018;2018:2952386."},{"issue":"1","key":"b10","series-title":"Nat Commun","first-page":"5782","article-title":"Enhancing plasticity in central networks improves motor and sensory recovery after nerve damage","volume":"10","author":"Meyers EC","year":"2019","unstructured":"Meyers EC, Kasliwal N, Solorzano BR, Enhancing plasticity in central networks improves motor and sensory recovery after nerve damage. Nat Commun. 2019;10(1):5782."},{"issue":"2","key":"b11","series-title":"J Hand Microsurg","first-page":"100029","article-title":"Functional outcome following phrenic nerve transfer in brachial plexus injury","volume":"16","author":"Vyas AK","year":"2024","unstructured":"Vyas AK, Gupta A, Dhanjani B, Batajoo S, Misra S. Functional outcome following phrenic nerve transfer in brachial plexus injury. J Hand Microsurg. 2024;16(2):100029."},{"issue":"7","key":"b12","series-title":"J Reconstr Microsurg","first-page":"546","article-title":"Phrenic nerve transfer for reconstruction of elbow extension in severe brachial plexus injuries","volume":"32","author":"Flores LP","year":"2016","unstructured":"Flores LP, Socolovsky M. Phrenic nerve transfer for reconstruction of elbow extension in severe brachial plexus injuries. J Reconstr Microsurg. 2016;32(7):546\u2013550."},{"issue":"4","key":"b13","series-title":"Hand (N Y)","first-page":"206","article-title":"Restoration of elbow flexion by transfer of the phrenic nerve to musculocutaneous nerve after brachial plexus injuries","volume":"2","author":"Monreal R","year":"2007","unstructured":"Monreal R. Restoration of elbow flexion by transfer of the phrenic nerve to musculocutaneous nerve after brachial plexus injuries. Hand (N Y). 2007;2(4):206-211."},{"issue":"3","key":"b14","series-title":"Neurosurg Focus","first-page":"E13","article-title":"Current concepts in plasticity and nerve transfers: relationship between surgical techniques and outcomes","volume":"42","author":"Socolovsky M","year":"2017","unstructured":"Socolovsky M, Malessy M, Lopez D, Guedes F, Flores L. Current concepts in plasticity and nerve transfers: relationship between surgical techniques and outcomes. Neurosurg Focus. 2017;42(3):E13."},{"issue":"1","key":"b15","series-title":"Injury","first-page":"227","article-title":"Comparative study of phrenic nerve transfers with and without nerve graft for elbow flexion after global brachial plexus injury","volume":"45","author":"Liu Y","year":"2014","unstructured":"Liu Y, Lao J, Gao K, Gu Y, Zhao X. Comparative study of phrenic nerve transfers with and without nerve graft for elbow flexion after global brachial plexus injury. Injury. 2014;45(1):227-231."},{"issue":"11","key":"b16","series-title":"Arch Neurol","first-page":"1467","article-title":"New type of cortical neuroplasticity after nerve repair in brachial plexus lesions","volume":"68","author":"Beisteiner R","year":"2011","unstructured":"Beisteiner R, H\u00f6llinger I, Rath J, New type of cortical neuroplasticity after nerve repair in brachial plexus lesions. Arch Neurol. 2011;68(11):1467\u20131470."},{"issue":"1","key":"b17","series-title":"J Neurosurg","first-page":"165","article-title":"Phrenic to musculocutaneous nerve transfer for traumatic brachial plexus injuries: analyzing respiratory effects on elbow flexion control","volume":"131","author":"Socolovsky M","year":"2019","unstructured":"Socolovsky M, Malessy M, Bonilla G, Di Masi G, Conti ME, Lovaglio A. Phrenic to musculocutaneous nerve transfer for traumatic brachial plexus injuries: analyzing respiratory effects on elbow flexion control. J Neurosurg. 2019;131(1):165-174."},{"issue":"5","key":"b18","series-title":"Neurosurgery","first-page":"1305","article-title":"Cortical reorganization following neurotization: a diffusion tensor imaging and functional magnetic resonance imaging study","volume":"70","author":"Sokki AM","year":"2012","unstructured":"Sokki AM, Bhat DI, Devi BI. Cortical reorganization following neurotization: a diffusion tensor imaging and functional magnetic resonance imaging study. Neurosurgery. 2012;70(5):1305-1311."},{"issue":"3","key":"b19","series-title":"Orthop Rev (Pavia)","first-page":"37578","article-title":"Assessment of motor function in peripheral nerve injury and recovery","volume":"14","author":"John A","year":"2022","unstructured":"John A, Rossettie S, Rafael J, Cox C, Ducic I, Mackay B. Assessment of motor function in peripheral nerve injury and recovery. Orthop Rev (Pavia). 2022;14(3):37578."},{"key":"b20","series-title":"Front Neurol","first-page":"72","article-title":"Rehabilitation, using guided cerebral plasticity, of a brachial plexus injury treated with intercostal and phrenic nerve transfers","volume":"8","author":"Dahlin LB","year":"2017","unstructured":"Dahlin LB, Andersson G, Backman C, Svensson H, Bj\u00f6rkman A. Rehabilitation, using guided cerebral plasticity, of a brachial plexus injury treated with intercostal and phrenic nerve transfers. Front Neurol. 2017;8:72."},{"issue":"2","key":"b21","series-title":"Neural Regen Res","first-page":"328","article-title":"Phrenic nerve transfer to the musculocutaneous nerve for the repair of brachial plexus injury: electrophysiological characteristics","volume":"10","author":"Liu Y","year":"2015","unstructured":"Liu Y, Xu XC, Zou Y, Li SR, Zhang B, Wang Y. Phrenic nerve transfer to the musculocutaneous nerve for the repair of brachial plexus injury: electrophysiological characteristics. Neural Regen Res. 2015;10(2):328\u2013333."},{"issue":"1","key":"b22","series-title":"Neurol Int","first-page":"239","article-title":"Mapping motor neuroplasticity after successful surgical brachial plexus reconstruction using navigated transcranial magnetic stimulation (nTMS)","volume":"16","author":"Durner G","year":"2024","unstructured":"Durner G, Ulrich I, Gerst A, Mapping motor neuroplasticity after successful surgical brachial plexus reconstruction using navigated transcranial magnetic stimulation (nTMS). Neurol Int. 2024;16(1):239\u2013252."},{"key":"b23","series-title":"Front Neurol","first-page":"1116","article-title":"Peripheral nervous system reconstruction reroutes cortical motor output-brain reorganization uncovered by effective connectivity","volume":"9","author":"Amini A","year":"2018","unstructured":"Amini A, Fischmeister FPS, Matt E, Schmidhammer R, Rattay F, Beisteiner R. Peripheral nervous system reconstruction reroutes cortical motor output-brain reorganization uncovered by effective connectivity. Front Neurol. 2018;9:1116."},{"issue":"3","key":"b24","series-title":"Neurosurg Focus","first-page":"E14","article-title":"Cortical plasticity after brachial plexus injury and repair: a resting-state functional MRI study","volume":"42","author":"Bhat DI","year":"2017","unstructured":"Bhat DI, Indira Devi B, Bharti K, Panda R. Cortical plasticity after brachial plexus injury and repair: a resting-state functional MRI study. Neurosurg Focus. 2017;42(3):E14."},{"key":"b25","series-title":"Neuroimage Clin","first-page":"277","article-title":"Reduced functional connectivity within the primary motor cortex of patients with brachial plexus injury","volume":"12","author":"Fraiman D","year":"2016","unstructured":"Fraiman D, Miranda MF, Erthal F, Reduced functional connectivity within the primary motor cortex of patients with brachial plexus injury. Neuroimage Clin. 2016;12:277\u2013284."},{"key":"b26","series-title":"J Clin Neurosci","first-page":"95","article-title":"Cerebral plasticity after contralateral cervical nerve transfer in human by longitudinal PET evaluation","volume":"48","author":"Ma H","year":"2018","unstructured":"Ma H, Zheng M, Lu Y, Hua X, Xu W. Cerebral plasticity after contralateral cervical nerve transfer in human by longitudinal PET evaluation. J Clin Neurosci. 2018;48:95\u201399."},{"issue":"5","key":"b27","series-title":"Ann Neurol","first-page":"1053","article-title":"Biceps activity synchronous with inspiration after phrenic nerve transfer","volume":"89","author":"Rebello A","year":"2021","unstructured":"Rebello A, Balaini N, Gaba S, Mahesh KV. Biceps activity synchronous with inspiration after phrenic nerve transfer. Ann Neurol. 2021;89(5):1053\u20131054."},{"issue":"4","key":"b28","series-title":"Hand Clin","first-page":"425","article-title":"Cortical plasticity following nerve transfer in the upper extremity","volume":"24","author":"Anastakis DJ","year":"2008","unstructured":"Anastakis DJ, Malessy MJ, Chen R, Davis KD, Mikulis D. Cortical plasticity following nerve transfer in the upper extremity. Hand Clin. 2008;24(4):425-444,vi-vii."},{"issue":"6577","key":"b29","series-title":"Nature","first-page":"69","article-title":"Central reorganization of sensory pathways following peripheral nerve regeneration in fetal monkeys","volume":"381","author":"Florence SL","year":"1996","unstructured":"Florence SL, Jain N, Pospichal MW, Beck PD, Sly DL, Kaas JH. Central reorganization of sensory pathways following peripheral nerve regeneration in fetal monkeys. Nature. 1996;381(6577):69\u201371."},{"key":"b30","series-title":"Prog Brain Res","first-page":"379","article-title":"Extensive cortical reorganization following sciatic nerve injury in adult rats versus restricted reorganization after neonatal injury: implications for spatial and temporal limits on somatosensory plasticity","volume":"108","author":"Cusick CG","year":"1996","unstructured":"Cusick CG. Extensive cortical reorganization following sciatic nerve injury in adult rats versus restricted reorganization after neonatal injury: implications for spatial and temporal limits on somatosensory plasticity. Prog Brain Res. 1996;108:379\u2013390."},{"issue":"6","key":"b1","series-title":"Plast Reconstr Surg Glob Open","first-page":"e2290","article-title":"Nerve transfers\u2014a paradigm shift in the reconstructive ladder","volume":"7","author":"Domeshek LF","year":"2019","unstructured":"Domeshek LF, Novak CB, Patterson JMM, Nerve transfers\u2014a paradigm shift in the reconstructive ladder. Plast Reconstr Surg Glob Open. 2019;7(6):e2290."},{"issue":"4)(suppl","key":"b2","series-title":"Neurosurgery","first-page":"A125","article-title":"Phrenic nerve transfer in the restoration of elbow flexion in brachial plexus avulsion injuries: how effective and safe is it?","volume":"65","author":"Siqueira MG","year":"2009","unstructured":"Siqueira MG, Martins RS. Phrenic nerve transfer in the restoration of elbow flexion in brachial plexus avulsion injuries: how effective and safe is it? Neurosurgery. 2009;65(4)(suppl):A125-A131."},{"issue":"4","key":"b3","series-title":"Microsurgery","first-page":"287","article-title":"Phrenic nerve transfer for brachial plexus motor neurotization","volume":"10","author":"Gu YD","year":"1989","unstructured":"Gu YD, Wu MM, Zhen YL, Phrenic nerve transfer for brachial plexus motor neurotization. Microsurgery. 1989;10(4):287\u2013289."},{"issue":"9","key":"b4","series-title":"Acta Neurochir (Wien)","first-page":"1793","article-title":"Outcome following phrenic nerve transfer to musculocutaneous nerve in patients with traumatic brachial palsy: a qualitative systematic review","volume":"158","author":"de Mendon\u00e7a Cardoso M","year":"2016","unstructured":"de Mendon\u00e7a Cardoso M, Gepp R, Correa JF. Outcome following phrenic nerve transfer to musculocutaneous nerve in patients with traumatic brachial palsy: a qualitative systematic review. Acta Neurochir (Wien). 2016;158(9):1793\u20131800."},{"issue":"6","key":"b5","series-title":"Acta Neurochir (Wien)","first-page":"1077","article-title":"The phrenic nerve as a donor for brachial plexus injuries: is it safe and effective? Case series and literature analysis","volume":"157","author":"Socolovsky M","year":"2015","unstructured":"Socolovsky M, di Masi G, Bonilla G, Dom\u00ednguez Paez M, Robla J, Calvache Cabrera C. The phrenic nerve as a donor for brachial plexus injuries: is it safe and effective? Case series and literature analysis. Acta Neurochir (Wien). 2015;157(6):1077\u20131086."},{"issue":"suppl","key":"b6","series-title":"Clin Neurol Neurosurg","first-page":"S95","article-title":"Respiration-related activity in the biceps brachii muscle after intercostal-musculocutaneous nerve transfer","volume":"95","author":"Malessy MJ","year":"1993","unstructured":"Malessy MJ, van Dijk JG, Thomeer RT. Respiration-related activity in the biceps brachii muscle after intercostal-musculocutaneous nerve transfer. Clin Neurol Neurosurg. 1993;95(suppl):S95-S102."},{"issue":"5","key":"b7","series-title":"J Neurosurg","first-page":"1419","article-title":"Nerve transfers for brachial plexus injuries: grading of volitional control","volume":"138","author":"Socolovsky M","year":"2022","unstructured":"Socolovsky M, Barillaro K, Bonilla G, Masi GD, Malessy M. Nerve transfers for brachial plexus injuries: grading of volitional control. J Neurosurg. 2022;138(5):1419\u20131425."},{"key":"b8","series-title":"Exp Neurol","first-page":"113426","article-title":"The evolution of nerve transfers for spinal cord injury","volume":"333","author":"Bazarek S","year":"2020","unstructured":"Bazarek S, Brown JM. The evolution of nerve transfers for spinal cord injury. Exp Neurol. 2020;333:113426."},{"key":"b9","series-title":"Neural Plast","first-page":"2952386","article-title":"The extracellular environment of the CNS: influence on plasticity, sprouting, and axonal regeneration after spinal cord injury","volume":"2018","author":"Quraishe S","year":"2018","unstructured":"Quraishe S, Forbes LH, Andrews MR. The extracellular environment of the CNS: influence on plasticity, sprouting, and axonal regeneration after spinal cord injury. Neural Plast. 2018;2018:2952386."},{"issue":"1","key":"b10","series-title":"Nat Commun","first-page":"5782","article-title":"Enhancing plasticity in central networks improves motor and sensory recovery after nerve damage","volume":"10","author":"Meyers EC","year":"2019","unstructured":"Meyers EC, Kasliwal N, Solorzano BR, Enhancing plasticity in central networks improves motor and sensory recovery after nerve damage. Nat Commun. 2019;10(1):5782."},{"issue":"2","key":"b11","series-title":"J Hand Microsurg","first-page":"100029","article-title":"Functional outcome following phrenic nerve transfer in brachial plexus injury","volume":"16","author":"Vyas AK","year":"2024","unstructured":"Vyas AK, Gupta A, Dhanjani B, Batajoo S, Misra S. Functional outcome following phrenic nerve transfer in brachial plexus injury. J Hand Microsurg. 2024;16(2):100029."},{"issue":"7","key":"b12","series-title":"J Reconstr Microsurg","first-page":"546","article-title":"Phrenic nerve transfer for reconstruction of elbow extension in severe brachial plexus injuries","volume":"32","author":"Flores LP","year":"2016","unstructured":"Flores LP, Socolovsky M. Phrenic nerve transfer for reconstruction of elbow extension in severe brachial plexus injuries. J Reconstr Microsurg. 2016;32(7):546\u2013550."},{"issue":"4","key":"b13","series-title":"Hand (N Y)","first-page":"206","article-title":"Restoration of elbow flexion by transfer of the phrenic nerve to musculocutaneous nerve after brachial plexus injuries","volume":"2","author":"Monreal R","year":"2007","unstructured":"Monreal R. Restoration of elbow flexion by transfer of the phrenic nerve to musculocutaneous nerve after brachial plexus injuries. Hand (N Y). 2007;2(4):206-211."},{"issue":"3","key":"b14","series-title":"Neurosurg Focus","first-page":"E13","article-title":"Current concepts in plasticity and nerve transfers: relationship between surgical techniques and outcomes","volume":"42","author":"Socolovsky M","year":"2017","unstructured":"Socolovsky M, Malessy M, Lopez D, Guedes F, Flores L. Current concepts in plasticity and nerve transfers: relationship between surgical techniques and outcomes. Neurosurg Focus. 2017;42(3):E13."},{"issue":"1","key":"b15","series-title":"Injury","first-page":"227","article-title":"Comparative study of phrenic nerve transfers with and without nerve graft for elbow flexion after global brachial plexus injury","volume":"45","author":"Liu Y","year":"2014","unstructured":"Liu Y, Lao J, Gao K, Gu Y, Zhao X. Comparative study of phrenic nerve transfers with and without nerve graft for elbow flexion after global brachial plexus injury. Injury. 2014;45(1):227-231."},{"issue":"11","key":"b16","series-title":"Arch Neurol","first-page":"1467","article-title":"New type of cortical neuroplasticity after nerve repair in brachial plexus lesions","volume":"68","author":"Beisteiner R","year":"2011","unstructured":"Beisteiner R, H\u00f6llinger I, Rath J, New type of cortical neuroplasticity after nerve repair in brachial plexus lesions. Arch Neurol. 2011;68(11):1467\u20131470."},{"issue":"1","key":"b17","series-title":"J Neurosurg","first-page":"165","article-title":"Phrenic to musculocutaneous nerve transfer for traumatic brachial plexus injuries: analyzing respiratory effects on elbow flexion control","volume":"131","author":"Socolovsky M","year":"2019","unstructured":"Socolovsky M, Malessy M, Bonilla G, Di Masi G, Conti ME, Lovaglio A. Phrenic to musculocutaneous nerve transfer for traumatic brachial plexus injuries: analyzing respiratory effects on elbow flexion control. J Neurosurg. 2019;131(1):165-174."},{"issue":"5","key":"b18","series-title":"Neurosurgery","first-page":"1305","article-title":"Cortical reorganization following neurotization: a diffusion tensor imaging and functional magnetic resonance imaging study","volume":"70","author":"Sokki AM","year":"2012","unstructured":"Sokki AM, Bhat DI, Devi BI. Cortical reorganization following neurotization: a diffusion tensor imaging and functional magnetic resonance imaging study. Neurosurgery. 2012;70(5):1305-1311."},{"issue":"3","key":"b19","series-title":"Orthop Rev (Pavia)","first-page":"37578","article-title":"Assessment of motor function in peripheral nerve injury and recovery","volume":"14","author":"John A","year":"2022","unstructured":"John A, Rossettie S, Rafael J, Cox C, Ducic I, Mackay B. Assessment of motor function in peripheral nerve injury and recovery. Orthop Rev (Pavia). 2022;14(3):37578."},{"key":"b20","series-title":"Front Neurol","first-page":"72","article-title":"Rehabilitation, using guided cerebral plasticity, of a brachial plexus injury treated with intercostal and phrenic nerve transfers","volume":"8","author":"Dahlin LB","year":"2017","unstructured":"Dahlin LB, Andersson G, Backman C, Svensson H, Bj\u00f6rkman A. Rehabilitation, using guided cerebral plasticity, of a brachial plexus injury treated with intercostal and phrenic nerve transfers. Front Neurol. 2017;8:72."},{"issue":"2","key":"b21","series-title":"Neural Regen Res","first-page":"328","article-title":"Phrenic nerve transfer to the musculocutaneous nerve for the repair of brachial plexus injury: electrophysiological characteristics","volume":"10","author":"Liu Y","year":"2015","unstructured":"Liu Y, Xu XC, Zou Y, Li SR, Zhang B, Wang Y. Phrenic nerve transfer to the musculocutaneous nerve for the repair of brachial plexus injury: electrophysiological characteristics. Neural Regen Res. 2015;10(2):328\u2013333."},{"issue":"1","key":"b22","series-title":"Neurol Int","first-page":"239","article-title":"Mapping motor neuroplasticity after successful surgical brachial plexus reconstruction using navigated transcranial magnetic stimulation (nTMS)","volume":"16","author":"Durner G","year":"2024","unstructured":"Durner G, Ulrich I, Gerst A, Mapping motor neuroplasticity after successful surgical brachial plexus reconstruction using navigated transcranial magnetic stimulation (nTMS). 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