Researchers at the KITE Research Institute have developed an interprofessional care map that outlines key steps and roles involved in delivering peripheral nerve transfer (PNT) surgery—a promising procedure that helps people with spinal cord injuries regain arm and hand function, supporting greater independence.
Spinal cord injuries affect thousands of people each year and can lead to tetraplegia—which is the partial or complete loss of movement and sensation in all four limbs. For the individuals affected, regaining the use of their arms and hands can improve both independence and quality of life. Despite advances in spinal cord injury care, restoring upper limb function remains challenging due to the complexity of nerve damage and the precise coordination required for hand and arm movements.
PNT is an innovative surgical technique that reroutes healthy nerves to muscles that have lost function. It can lead to faster recovery and fewer physical limitations compared to traditional surgical methods, such as tendon transfer. However, access to this approach is limited, as there are no standardized guidelines for effective PNT care delivery.
To address this gap, a research team led by Dr. Catharine Craven, Senior Scientist at the KITE Research Institute, developed a structured care program for delivering PNT. The team brought together surgeons, neurophysiologists, rehabilitation specialists, and other experts from three hospitals to coordinate PNT care—from early screening and surgical planning to long-term rehabilitation and follow-up.
Through structured virtual meetings, the group identified critical points of care, key stages in the recovery process, tools to measure patient progress, and strategies to deliver care across hospital and community settings. The result was a detailed care map outlining how to provide safe, timely, effective, and patient-centred PNT care throughout the recovery journey.
Evaluation of the clinical program is ongoing, but early findings show improved access to surgery, better recovery outcomes, and reduced need for long-term caregiver support. The team hopes this model will serve as a guide for other health centres looking to adopt PNT, offering renewed hope for restored independence after spinal cord injury.
The lead author of the paper is Dr. Catharine Craven, Senior Scientist at the KITE Research Institute. At the University of Toronto, Dr. Craven is also a Professor in the Department of Medicine, an Associate Professor at the Institute for Health Policy, Management and Evaluation, and a Faculty Member at the Rehabilitation Sciences Institute.
The collaboration of co-authors, Dr. Parvin Eftekhar, Affiliate Scientist at the KITE Research Institute, and Dr. Jana Dengler, Staff Surgeon in the Division of Plastic and Reconstructive Surgery at Sunnybrook Health Sciences Centre, have contributed to the success of patient outcomes and driven the innovations in rehabilitation service delivery in this study.
This work was supported by UHN Foundation, KITE – Toronto Rehabilitation Institute, and the University of Toronto/University Health Network Cope Family Chair in Spinal Cord Injury Rehabilitation Health Systems Innovation.
Craven BC, Dengler J, Rybkina J, Gulasingam S, Bishop K, Eftekhar P, Kalsi-Ryan S, Furlan JC, Silverman J, Guy K, Robinson L. A quality improvement initiative to develop an interprofessional peripheral nerve transfer clinic for individuals with traumatic cervical spinal cord injury. Disabil Rehabil. 2025 Mar 20. doi: 10.1080/09638288.2025.2461267.