## 4 Discussion
These MUAP became independent from breathing throughout the following 2 to 3 years and, at that point, the TMS suggested a transition of the representation of the reinnervated biceps brachii from the intercostal muscle towards the arm's cortical area, as a post-surgical reorganization behavior [13]. PT neurorehabilitation plays a major role in the patient's outcomes [1; 14]. Neuromuscular electrical stimulation (NEMS) and proprioceptive neuromuscular facilitation (PNF) can not only improve peripherally, but we also consider that the rehabilitation intervention can sustain cortical reorganization patterns that can allow better amelioration of active voluntary elbow flexion [1; 14]. Therefore, we align our research with the correspondent available body of data and sustain that EMG and TMS may provide a useful assessment of the rehabilitation outcomes in tBPIs [4]. [PERSON] et al., in a case study with bilateral tBPIs, showed that an intensive PT rehabilitation program that was composed of electrostimulation and finger movement amplitude exercises achieved promising results [15]. At 3 months, the patient's muscle movement against gravity without any resistance in both upper limbs was 3/5 on the MRC scale; at 4 months the score was 4/5 and at 12 months, unrestricted range of motion was present with a score of 5/5 on the MRC scale [15]. [PERSON], [PERSON], and [PERSON] in a review published in 2019 have shown that the rehabilitative potential of electrical stimulation can range from modulating motor function to reducing symptom severity in clinical cohorts [16]. NEMS currents can increase muscle strength in targeted muscles, but spectacularly these currents have the ability to increase strength in muscles that are not directly targeted as well as in contralateral muscles [16]. NMES works by creating a strong electric field near the motor axons of peripheral nerves, which manages to depolarize the axonal membranes causing action potentials, which in turn will cause muscle contractions. However, for NMES to be effective, the peripheral nerves to the target muscles must be intact and the muscles must be normally vascularized, which is why they are recommended in central nervous system disorders. [17]. Proprioceptive neuromuscular facilitation (PNF) is a PT technique for the development of muscle strength that is based on the application of mechanical resistance to muscle contraction, thereby facilitating the contractile strength of the muscle. PNF is suitable for patients with partial peripheral nerve damage involving significant muscle weakness [18]. [PERSON] et al. tested a protocol developed specifically for tBPIs in which PNF exercises were chosen according to the deficits presented by the patients aiming to recover limb function with minimal compensation from increased blood flow [19]. The selected PNF exercises represent different graded combinations of resistance application on diagonal movement patterns in the three planes to achieve high neural recruitment. Agonistic techniques, among which rhythmic-initiation and combination of isotones are considered to be the first choice in rehabilitation programs, aim to give the patient a first explanation of the movement. Antagonistic techniques, including stabilizing inversion and dynamic inversion, have been used to promote functional and task-oriented movement aimed at improving motor learning [19]. In our case, in the five non-compliant patients, the amelioration of TMS parameters in bicipital and cervical measurements can be attributed directly to nerve regeneration following the surgical procedure alone (more or less related to initial rehabilitation), especially in terms of restoring nervous continuity of the plexus. These results correlate less with signs of ongoing brain plasticity, as compared to the other six patients, when related to MEP latency measured at the cerebral magnetic stimulation. Also, SNAP amplitude alone does not provide information other than a favorable background to continue physical treatment or, if necessary, complementary surgical procedures.