Brachial plexus ‘rewiring’ restores teen’s paralyzed wrist, fingers after ATV crash
June 16, 2026
Kevin Briseno never saw the pothole that threw him off his new all-terrain vehicle (ATV). He slammed into a tree, landing hard on his back with his right arm pinned grotesquely behind him. His hand was smashed between his shoulder blades.
“I remember hitting the steering wheel and flying through the air,” Kevin said of that summer day just a few weeks after his 16th birthday in 2023. “I was gasping for air and trying to get up.”
A neighbor who heard the crash called 911. As Kevin was being loaded into the ambulance, he realized his arm was totally numb. He thought he’d broken it. “I couldn’t feel it at all,” he said. “I couldn’t lift my wrist. I couldn’t lift my fingers. It was just … dead.”
In an instant, Kevin went from being amped up about his new wheels to facing a total power outage in his arm. He’d suffered a severe brachial plexus injury – trauma to the network of nerves that sends signals from the spinal cord to the shoulder, arm, and hand. Kevin’s entire right arm was paralyzed.
What followed was a complex rewiring project, guided by an expert team of nerve and hand surgeons at UT Southwestern Medical Center and pediatric occupational therapists at Children’s Health.
A routine ride on an all-terrain vehicle took a terrifying turn, sending Kevin Briseno on a long road to recovery from a severe brachial plexus injury. Discover how UT Southwestern surgeons Jonathan Cheng, M.D., FACS, and Jennifer Kargel, M.D., performed a meticulous nerve transfer and tendon transfer to restore his finger mobility. Working closely with Children’s Health occupational therapists, the expert team also restored the teen's hope for a bright future.
How the upper extremity nerves are wired
The brachial plexus is a network of nerves that function like an electrical panel for the upper extremity from shoulder to fingertips. When it’s damaged, messages from the brain can’t reach the muscles they’re meant to control.
These nerves are composed of several protective layers, like the coatings of an electrical cable:
- Epineurium: A dense outer layer that protects the nerve from mechanical stress.
- Endoneurium: The delicate inner matrix surrounding individual nerve cells.
- Perineurium: A sheath that encloses bundles of nerve cells.
The brachial plexus provides sensation and movement. When the complex network of nerves is injured, the brain can no longer command the shoulder, arm, and hand to feel or move. Patients might feel numbness and weakness as well as painful sensations of burning, stinging, or electrical shocks.
Short circuit sets the clock ticking
Nerve injuries occur in about 2.6% of patients with upper limb trauma and are often caused by high-impact accidents such as falls or vehicle crashes. Overextension injuries like Kevin’s are common.
“Normally the arm is extremely mobile, but that also makes it vulnerable to instability and injury,” said Jonathan Cheng, M.D., FACS, Chief of Pediatric Hand, Peripheral Nerve, and Microvascular Surgery in the Department of Plastic Surgery at UT Southwestern and one of Kevin’s surgeons. “If your arm gets pulled one way and your head goes the other, it can tear the nerves away from the spinal cord. That’s why brachial plexus injuries often don’t get better on their own after a severe injury.”
Kevin’s doctors explained that the nerves might just be “stunned” from the trauma and could potentially recover with time. Careful monitoring allows them to see what function returns naturally and to plan surgery only where and when it’s truly needed.
“The clock starts ticking immediately after a severe nerve injury,” Dr. Cheng said. “There’s an optimal window for surgical intervention, typically between three and nine months after the trauma. After that, the likelihood of meaningful recovery drops.”
Rather than sending him straight to surgery, the team referred Kevin to intensive physical therapy and occupational therapy (OT) at Children’s Health.
Working the remaining circuits
From the first day of therapy, Kevin and his mom, Marina Melo, formed a close bond with Debbie Tilton Rains, his primary occupational therapist. They dutifully attended sessions multiple times each week to maintain Kevin’s remaining muscle strength, preserve his joint mobility, and retrain his brain to move the arm as much as possible. Electrical stimulation, resistance bands, and swimming became part of the routine to optimize functionality.
“At first, we had to help him slow down with verbal cueing,” Ms. Tilton Rains said. “He had to stop and think about every motion to relearn how to activate the tendon and nerve transfers.”
She also encouraged Kevin to plan short- and long-term goals.
“Kevin’s not the average patient,” she said. “He knew his limitations and what he wanted to accomplish. While some teens are not motivated to work hard, Kevin valued the challenge and intensely worked on his arm exercises consistently.”
Jessica Johnson, OTR, CHT, another occupational therapist and member of Kevin’s therapy team, said it’s important for patients to have ownership over their decisions and outcomes.
“Families want to jump in and help, but the patient needs to do the work and feel the progress,” she said. “He was able to be creative and active, and he could tolerate trying new things.”
As the months passed, Kevin regained some movement at his shoulder, elbow, and forearm. However, he still had very limited range of motion at his wrist and hand. His fingers wouldn’t extend, his thumb wouldn’t lift or extend, and he couldn’t efficiently grasp and release objects.
For a teen who loved drawing, styling and cutting hair, and cooking with his family, the deficit was devastating. Simple movements like opening a water bottle became daily reminders of the functionality he’d lost.
“I couldn’t just tell my wrist to move,” Kevin recalled. “I couldn’t even hold a fork or brush my teeth with my right hand. It was tough.”
Nerves in the human body regenerate at about 1 millimeter per day – roughly the width of the metal wire in a paperclip. For injuries high in the arm, that’s a long distance to travel before reaching the hand. Over time, muscles that lose their nerve supply begin to atrophy. If they remain denervated too long, they may not recover.
“If the nerve is going to regenerate spontaneously, that’s usually best,” explained Jennifer Kargel, M.D., a hand surgery and nerve reconstruction expert at the Department of Plastic Surgery and a member of Kevin’s surgical team. “But when it doesn’t recover within that optimal window of time, we can intervene with surgery when appropriate.”
Six months after his injury, he was referred to the UT Southwestern Peripheral Nerve and Brachial Plexus Multidisciplinary Team Clinic, where his care providers included specialists in plastic surgery and hand surgery.
Master plan: Peripheral nerve transfer
After extensive testing, including electromyography to identify which nerve circuits were still active, Dr. Cheng and Dr. Kargel mapped out a plan. A tendon transfer would support more immediate wrist extension and a peripheral nerve transfer would start the process of rewiring and regenerating Kevin’s damaged brachial plexus nerves, millimeter by millimeter.
The doctors described the procedure in terms that truly connected with Kevin: Imagine it's like an electrician facing a damaged circuit, they said. If a primary wire is beyond repair, the electrician could pull power from a nearby, less-essential circuit to restore the main lights.
In a peripheral nerve transfer, the surgeon takes a healthy, expendable nerve and reroutes it to a muscle that has lost its nerve connection.
The goal is to perform reconstruction within 3-9 months. Beyond that window, the muscle receptors, which are like the electrical outlets of the body, may disappear, making it impossible to ever turn the power back on.
As the surgery drew closer, Ms. Tilton Rains customized a wrist splint that supported Kevin’s hand so he could grasp objects while waiting for the nerve transfer to fully activate the extensor muscles of the fingers and thumb.
“He automatically wanted to wear it because the splint allowed for dynamic assistance for digit and thumb extension movement," she said. "It helped Kevin use his hand and strengthen the finger flexors to prepare for his pre- and post-operative phases.”
Related: Read “How hand surgery restores dexterity for adults and children”
Inside the operating room
Working in tandem, Dr. Cheng and Dr. Kargel carefully identified which nerves could be moved without compromising existing function. They used nerve stimulators during the 2.5-hour surgery to confirm which branches were active and which were not.
“We borrowed from nerves that flex the wrist and fingers and redirected them to help extend the wrist and fingers,” Dr. Kargel said. “We were careful to avoid shutting off a circuit that’s still functional.”
While tendon and nerve transfers have become more widely available in the past few decades, restoring lost motion in the hand after a traumatic injury like Kevin’s is a distinct specialty. UT Southwestern treats patients from across the U.S. due to that unique expertise.
“It can take another 9 to 12 months to know whether a procedure has worked, which requires a long feedback loop to understand what innovations to offer,” Dr. Cheng said. “That kind of knowledge requires a long-term commitment from a multidisciplinary team.”
Retraining Kevin’s brain for its new wiring
Recovery from peripheral nerve transfer surgery takes patience and persistence. Kevin’s brain would need to relearn how to move his hand, and it would take months for the cells to regenerate and create new connections to reach the muscles.
He again teamed up with the occupational therapists at Children’s Health for pre- and post-surgery occupational therapy. That continuity of treatment made a difference. They understood where Kevin had started, how far he’d come, and what still lay ahead. They reminded him that the challenge was difficult and it was OK to be frustrated. His brain was telling him the movements should be easy, but his body wasn’t responding.
“A lot of rehab is recognizing that a different way isn’t the wrong way. It’s just learning it in a new manner,” Mrs. Johnson said. “Our job is to help patients know that repetition is the key to relearning, and we’re going to be there along the way.”
Some days were discouraging. But his mom never let him quit. Marina encouraged him to keep working hard at home, which the OT team said was a key factor in his recovery. Slowly, the successes started coming. Kevin learned to activate new movements by thinking about motions that instinctively felt unrelated. To lift his fingers, for example, he imagined bending his wrist.
Marina recorded every milestone – the first time he opened a water bottle, lifted his wrist without support, held a pencil. She cried with joy when he was able to cut paper with scissors again for the first time.
“The whole family was trying our best to help him, but sometimes he got so frustrated,” Marina recalled. “Then he started saying, ‘Mom, look, I can do this!’ and I said, ‘See? I told you so!’”
Each accomplishment sparked Kevin’s confidence along with his nerves. By the time he completed rehab in May 2025 – just shy of two years after the accident – Kevin had regained nearly all the mobility in his right hand.
New nerve – and new career – pathways
Kevin also rewired his career interests during his recovery. He’s now working as an apprentice electrician, a job that requires intense manual dexterity, technical knowledge, and precise control.
Alongside his father, Guillermo, Kevin pulls wire, bends conduit, and grips 4-pound pliers – tasks he couldn’t have done without the surgery and his hard work in rehab.
Kevin still has some numbness in his hand, and certain movements will never fully return. He continues to practice with therapeutic hand putty every day to build strength.
But he can do what matters most: live independently, pursue a great career, enjoy his favorite activities, and continue riding ATVs with his family.
“We are so grateful that the outcome turned out so well for him,” Mrs. Johnson said. “He put in the work, and the consistency shows.”
Kevin went from having a total power outage to working as an electrician – something he says would never have been possible without the caring experts at UT Southwestern and Children’s Health.
“The surgery and therapy teams were genius,” he said. “They took what worked and used it to fix what didn’t. My future is finally looking bright.”
To talk with an expert about brachial nerve injuries or peripheral nerve surgery, make an appointment by calling 214-645-2353 or request an appointment online.
