Activity Loss and Retention Patterns Following Unilateral Peripheral Nerve Injury: Implications for Rehabilitation

Importance: Peripheral nerve injury (PNI) in the upper extremity can significantly affect the ability of patients to participate in preferred activities, yet measuring this effect is challenging because of limited suitable tools. Objective: To understand the impact of PNI on activity participation on basis of the activities’ motor demands (fine motor, gross motor, and/or bimanual). We hypothesized that fine motor activities would show lower retention than gross motor or nonmotor activities, that hand dexterity would correlate with fine motor retention, and that unimanual activities would be retained more than bimanual activities. Design: Cross-sectional observational study. Setting: Two upper extremity rehabilitation clinics. Participants: Forty-eight patients with unilateral PNI in the upper extremity. Outcomes and Measures: Primary outcome was participation retention rates in five activity dimensions, as assessed with the Activity Card Sort. Results: Participants retained fewer gross motor activities than fine motor activities. Pain and health-related quality of life were the only patient factors significantly associated with participation. Hand dexterity did not correlate with fine motor retention, and unimanual activities showed higher retention than bimanual activities, regardless of the injured side. Conclusions and Relevance: Patterns of activity loss after PNI cannot be fully explained by motor demands alone. Although addressing specific motor skills remains important, participation is shaped by a complex interplay of physical, personal, and contextual factors as well as compensation and difficulties with bimanual tasks, even in unilateral injuries. Rehabilitation should incorporate activity-based assessments that capture real-world challenges and support individualized intervention planning. Plain-Language Summary: Nerve injuries in the upper extremity can significantly affect the ability to engage in essential activities. This study aimed to enhance the assessment of activity participation for people with upper extremity nerve injuries. We found that focusing on specific motor skills, such as fine and gross motor skills, gives a better understanding of how nerve injuries affect engagement in important activities. Hand dexterity, as measured using standard tools, was not linked to the ability to retain fine motor activities. These findings suggest that, to tailor interventions to enhance overall recovery, rehabilitation should include an individualized assessment (in addition to standard scales) to identify the activities that depend on the patient’s specific motor skills impairments.