{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T00:48:45Z","timestamp":1783730925274,"version":"3.55.0"},"reference-count":41,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T00:00:00Z","timestamp":1664409600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Science and Technology","award":["MoST 108-2314-B-650-006"],"award-info":[{"award-number":["MoST 108-2314-B-650-006"]}]},{"name":"Ministry of Science and Technology","award":["EDPJ-108074"],"award-info":[{"award-number":["EDPJ-108074"]}]},{"name":"E-Da Hospital","award":["MoST 108-2314-B-650-006"],"award-info":[{"award-number":["MoST 108-2314-B-650-006"]}]},{"name":"E-Da Hospital","award":["EDPJ-108074"],"award-info":[{"award-number":["EDPJ-108074"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Surgical reconstruction and postoperative rehabilitation are both important for restoring function in patients with traumatic brachial plexus injuries (BPIs). The current study aimed to understand variations in recovery progression among patients with different injury levels after receiving the nerve transfer methods. A total of 26 patients with BPIs participated in a rehabilitation training program over 6 months after nerve reconstruction. The differences between the first and second evaluations and between C5\u2013C6 and C5\u2013C7 BPIs were compared. Results showed significant improvements in elbow flexion range (p = 0.001), British Medical Research Council\u2019s score of shoulder flexion (p = 0.046), shoulder abduction (p = 0.013), shoulder external rotation (p = 0.020), quantitative muscle strength, and grip strength at the second evaluation for both groups. C5\u2013C6 BPIs patients showed a larger shoulder flexion range (p = 0.022) and greater strength of the shoulder rotator (p = 0.004), elbow flexor (p = 0.028), elbow extensor (p = 0.041), wrist extensor (p = 0.001), and grip force (p = 0.045) than C5\u2013C7 BPIs patients at the second evaluation. Our results indicated different improvements among patients according to injury levels, with quantitative values assisting in establishing goals for interventions.<\/jats:p>","DOI":"10.3390\/ijerph191912416","type":"journal-article","created":{"date-parts":[[2022,9,29]],"date-time":"2022-09-29T21:03:10Z","timestamp":1664485390000},"page":"12416","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Clinical Assessment of Functional Recovery Following Nerve Transfer for Traumatic Brachial Plexus Injuries"],"prefix":"10.3390","volume":"19","author":[{"given":"Yi-Jung","family":"Tsai","sequence":"first","affiliation":[{"name":"Department of Medical Research, E-Da Hospital, Kaohsiung 82445, Taiwan"},{"name":"Medical College, I-Shou University, Kaohsiung 82445, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chih-Kun","family":"Hsiao","sequence":"additional","affiliation":[{"name":"Department of Medical Research, E-Da Hospital, Kaohsiung 82445, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fong-Chin","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, National Cheng Kung University, Tainan 70101, Taiwan"},{"name":"Medical Device Innovation Center, National Cheng Kung University, Tainan 70101, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan-Kun","family":"Tu","sequence":"additional","affiliation":[{"name":"Medical College, I-Shou University, Kaohsiung 82445, Taiwan"},{"name":"Department of Orthopedics, E-Da Hospital, Kaohsiung 82445, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1097\/PRS.0b013e3181f95be7","article-title":"Comparison of single versus double nerve transfers for elbow flexion after brachial plexus injury","volume":"127","author":"Carlsen","year":"2011","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1016\/j.injury.2020.02.076","article-title":"Surgical reconstructions for adult brachial plexus injuries. Part I: Treatments for combined C5 and C6 injuries, with or without C7 injuries","volume":"51","author":"Hsueh","year":"2020","journal-title":"Injury"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"614","DOI":"10.3171\/jns.2005.103.4.0614","article-title":"Surgical interventions for traumatic lesions of the brachial plexus: A retrospective study of 134 cases","volume":"103","author":"Kandenwein","year":"2005","journal-title":"J. Neurosurg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.3171\/jns.2003.98.5.1005","article-title":"Outcomes of surgery in 1019 brachial plexus lesions treated at Louisiana State University Health Sciences Center","volume":"98","author":"Kim","year":"2003","journal-title":"J. Neurosurg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"382","DOI":"10.5435\/00124635-200510000-00003","article-title":"Adult traumatic brachial plexus injuries","volume":"13","author":"Shin","year":"2005","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1097\/01.prs.0000203410.35395.fa","article-title":"Suprascapular nerve reconstruction in 118 cases of adult posttraumatic brachial plexus","volume":"117","author":"Terzis","year":"2006","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1016\/S0363-5023(03)00199-0","article-title":"Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part II: A report of 7 cases","volume":"28","author":"Leechavengvongs","year":"2003","journal-title":"J. Hand Surg. Am."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1016\/0363-5023(94)90011-6","article-title":"Nerve transfer to biceps muscle using a part of ulnar nerve for C5-C6 avulsion of the brachial plexus: Anatomical study and report of four cases","volume":"19","author":"Oberlin","year":"1994","journal-title":"J. Hand Surg. Am."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1097\/01.prs.0000200628.15546.06","article-title":"Preliminary results of double nerve transfer to restore elbow flexion in upper type brachial plexus palsies","volume":"117","author":"Liverneaux","year":"2006","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1016\/S0363-5023(98)80059-2","article-title":"Nerve transfer to biceps muscle using a part of the ulnar nerve in brachial plexus injury (upper arm type): A report of 32 cases","volume":"23","author":"Leechavengvongs","year":"1998","journal-title":"J. Hand Surg. Am."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1016\/j.jhsa.2005.09.019","article-title":"Combined nerve transfers for C5 and C6 brachial plexus avulsion injury","volume":"31","author":"Leechavengvongs","year":"2006","journal-title":"J. Hand Surg. Am."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.jhsa.2003.10.013","article-title":"Reconstruction of C5 and C6 brachial plexus avulsion injury by multiple nerve transfers: Spinal accessory to suprascapular, ulnar fascicles to biceps branch, and triceps long or lateral head branch to axillary nerve","volume":"29","author":"Bertelli","year":"2004","journal-title":"J. Hand Surg. Am."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1097\/00130911-200206000-00007","article-title":"Restoration of elbow flexion in brachial plexus injury by transfer of ulnar nerve fascicles to the nerve to the biceps muscle","volume":"6","author":"Oberlin","year":"2002","journal-title":"Tech. Hand Up. Extrem. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1227\/NEU.0b013e31822848eb","article-title":"Outcome after delayed Oberlin transfer in brachial plexus injury","volume":"69","author":"Sedain","year":"2011","journal-title":"Neurosurgery"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"113","DOI":"10.3233\/NRE-172220","article-title":"A comparative study of rehabilitation therapy in traumatic upper limb peripheral nerve injuries","volume":"42","author":"Milicin","year":"2018","journal-title":"NeuroRehabilitation"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/j.hcl.2008.06.001","article-title":"Rehabilitation following motor nerve transfers","volume":"24","author":"Novak","year":"2008","journal-title":"Hand Clin."},{"key":"ref_17","unstructured":"O\u2019Brien, M. (2010). Aids to the Examination of the Peripheral Nervous System, Saunders. [4th ed.]."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1123\/jsr.20.3.367","article-title":"Reliability of isokinetic assessment of shoulder-rotator strength: A systematic review of the effect of position","volume":"20","author":"Edouard","year":"2011","journal-title":"J. Sport Rehabil."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3758\/BF03193146","article-title":"G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences","volume":"39","author":"Faul","year":"2007","journal-title":"Behav. Res. Methods"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"17","DOI":"10.3352\/jeehp.2021.18.17","article-title":"Sample size determination and power analysis using the G* Power software","volume":"18","author":"Kang","year":"2021","journal-title":"J. Educ. Eval. Health Prof."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"819","DOI":"10.2106\/JBJS.I.01602","article-title":"Comparison of nerve transfers and nerve grafting for traumatic upper plexus palsy: A systematic review and analysis","volume":"93","author":"Garg","year":"2011","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1016\/S0266-7681(05)80133-0","article-title":"The effect of unilateral intercostal nerve transfer upon lung function","volume":"20","author":"Giddins","year":"1995","journal-title":"J. Hand Surg. Br."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1097\/00006534-199709001-00011","article-title":"Experimental study on donor nerves for brachial plexus injury: Comparison between the spinal accessory nerve and the intercostal nerve","volume":"100","author":"Hattori","year":"1997","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1053\/jhsu.2001.28762","article-title":"Surgical approach to the spinal accessory nerve for brachial plexus reconstruction","volume":"26","author":"Hattori","year":"2001","journal-title":"J. Hand Surg. Am."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"523","DOI":"10.3171\/jns.2002.96.3.0523","article-title":"Brachial plexus neurotization with donor phrenic nerves and its effect on pulmonary function","volume":"96","author":"Luedemann","year":"2002","journal-title":"J. Neurosurg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"266","DOI":"10.3171\/jns.1998.88.2.0266","article-title":"Evaluation of intercostal to musculocutaneous nerve transfer in reconstructive brachial plexus surgery","volume":"88","author":"Malessy","year":"1998","journal-title":"J. Neurosurg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1097\/PRS.0000000000003668","article-title":"Comparing the efficacy of triple nerve transfers with nerve graft reconstruction in upper trunk obstetric brachial plexus injury","volume":"140","author":"Power","year":"2017","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/S0363-5023(96)80349-2","article-title":"Spinal accessory neurotization for restoration of elbow flexion in avulsion injuries of the brachial plexus","volume":"21","author":"Songcharoen","year":"1996","journal-title":"J. Hand Surg. Am."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1053\/jhsu.1999.0571","article-title":"Restoration of elbow flexion in brachial plexus avulsion injury: Comparing spinal accessory nerve transfer with intercostal nerve transfer","volume":"24","author":"Waikakul","year":"1999","journal-title":"J. Hand Surg. Am."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"195","DOI":"10.3171\/2014.9.JNS132823","article-title":"Upper brachial plexus injury in adults: Comparative effectiveness of different repair techniques","volume":"122","author":"Ali","year":"2015","journal-title":"J. Neurosurg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1097\/00003086-198812000-00011","article-title":"Neurotization via the spinal accessory nerve in complete paralysis due to multiple avulsion injuries of the brachial plexus","volume":"237","author":"Allieu","year":"1988","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1053\/jhsu.2001.21518","article-title":"Results of nerve transfer techniques for restoration of shoulder and elbow function in the context of a meta-analysis of the English literature","volume":"26","author":"Merrell","year":"2001","journal-title":"J. Hand Surg. Am."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"135e","DOI":"10.1097\/PRS.0000000000000795","article-title":"Optimal axon counts for brachial plexus nerve transfers to restore elbow flexion","volume":"135","author":"Schreiber","year":"2015","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.2106\/00004623-200407000-00018","article-title":"Transfer of fascicles from the ulnar nerve to the nerve to the biceps in the treatment of upper brachial plexus palsy","volume":"86","author":"Teboul","year":"2004","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1054\/jhsb.2000.0367","article-title":"Transfer of a single fascicle from the ulnar nerve to the biceps muscle after avulsions of upper roots of the brachial plexus","volume":"25","author":"Sungpet","year":"2000","journal-title":"J. Hand. Surg. Br."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.hcl.2015.12.005","article-title":"Nerve transfers to restore elbow function","volume":"32","author":"Bulstra","year":"2016","journal-title":"Hand Clin."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1302\/0301-620X.88B5.17360","article-title":"Electromyographic comparison of various exercises to improve elbow flexion following intercostal nerve transfer","volume":"88","author":"Chalidapong","year":"2006","journal-title":"J. Bone Jt. Surg. Br."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.hcl.2015.12.014","article-title":"Donor activation focused rehabilitation approach: Maximizing outcomes after nerve transfers","volume":"32","author":"Kahn","year":"2016","journal-title":"Hand Clin."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1302\/0301-620X.98B11.36113","article-title":"A quantitative assessment of the functional recovery of flexion of the elbow after nerve transfer in patients with a brachial plexus injury","volume":"98-B","author":"Quick","year":"2016","journal-title":"Bone Jt. J."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/j.jhsa.2014.10.033","article-title":"A systematic review of outcomes reporting for brachial plexus reconstruction","volume":"40","author":"Dy","year":"2015","journal-title":"J. Hand Surg. Am."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"438","DOI":"10.2340\/16501977-1950","article-title":"Do existing patient-report activity outcome measures accurately reflect day-to-day arm use following adult traumatic brachial plexus injury?","volume":"47","author":"Hill","year":"2015","journal-title":"J. Rehabil. Med."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/19\/12416\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:41:49Z","timestamp":1760143309000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/19\/12416"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,29]]},"references-count":41,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["ijerph191912416"],"URL":"https:\/\/doi.org\/10.3390\/ijerph191912416","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,29]]}}}