Peripheral nerve injuries are common in younger population commonly due to road traffic accidents especially in two wheeler accidents. Traumatic brachial plexus injury is a devastating and common form of nerve injury usually result after RTA.
Nerve transfer is a common treatment of choice especially in upper plexus injury. This treatment idea works on the principle of neuroplasticity. It involves innervating the affected area with nerve that supply adjacent area. This procedure is commonly named as neurotization technique,
In Brachial plexus Injury nerve transfers are usually extraplexal where the nerves are transferred from outside the plexus (eg. spinal accessory nerves)
Donor Activation Focused Rehabilitation approach which are based on the anatomical aspect of the surgery. in this technique the action of the donor nerve is achieved first to activate the recipient nerve, for example if spinal accessory nerve supplying the trapezius muscle is transferred to suprascapular nerve supplying supraspinatus, the training begins with simultaneous abduction and external rotation of glenohumeral joint along with elevation of shoulder girdle and tucking of humeral head.
Idea Of Neuroplasticity And its application in DAFRA
The term plasticity refers the ability to change. In past brain is believed to be a rigid structure with limited ability to change and adapt according to the environmental situations. But in recent years modern neuroscience has proved this concept is wrong and brain can undergo changes through out lifespan.. Neuroplasticity occurs throughout the CNS. Changes in the somatosensory cortex has been identified following the transection and subsequent repair of peripheral nerve.
Neural plasticity can be divided in to two category
Structural Neuroplasticity :is often understood as the brains ability to change its neuronal connections. New neurons are always produced and integrated to CNS through out the lifespan based upon the idea of neuroplasticity.
Functional Neuroplasticity: Neuroplasticity that refers to brains ability to alter and adapt the functional properties of neuron.
The neuroplasticity traditionally thought to be occur in three stages.
A. First 48 hrs : On this stage brain attempt to use secondary neuronal networks to maintain functions.
B. Following week : Recruitment of support cells occurs in this period as the cortical pathways shift from inhibitory to excitatory.
C. Weeks to month afterward the brain continues to remodel itself via axonal sprouting and further reorganization around the damage.
Recent studies shown the effect of DAFRA in inducing neuroplasticity after nerve transfer.
REFERENCE
1. Thatte M, Babhulkar S, Hiremath A. Brachial plexus injury in adults: Diagnosis and surgical treatment strategies. Ann Indian Acad Neurol 2013;16(1):26–33. doi: 10.4103/0972- 2327.107686 2. Verma C, Yardi S, Puri V, Thosar J. Study of Incidence and Factors Associated with Traumatic Brachial Plexus Injury Patients Treated at Government Tertiary Care Hospital from Mumbai- A Retrospective Study. Int J Basic Appl Res 2019;9(2):103-10. 3. Jain D, Bharadwaj P, Venkatramani H. An epidemiological study of traumatic brachial plexus injury patients treated at an Indian centre. Indian J Plast Surg 2012;45(3):498-503. 4. Sakellariou V, Badilas N, Mazis G. Brachial Plexus Injuries in Adults: Evaluation and Diagnostic Approach. ISRN Orthop 2014;2014:9. 5. Bhandari P, Sadhotra L, Bharghava P, Bath A, Mukherjee M, Bhatti T, Maurya S. Surgical outcomes following nerve transfers in upper brachial plexus injuries. Indian J Plast Surg 2009;42(2):150-60. 6. Sun G, Wu Z, Wang X. Nerve transfers help repair brachial plexus injury by increasing cerebral cortical plasticity. Neural Regen Res 2014;9(23):2111-4.
Prepared By
Dr.Athul Chandran (PT)
BPT,MPT (Orthopedics)
chief & Specialist Orthopedic Physiotherapist, Rebounds Physiotherapy And Rehabilitation Center..
Special Thanks To Dr. Subin Solomaon (PT)
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