Injury to the anterior interosseous nerve (AIN) leads to loss of pinch strength due to lack of thumb IP joint flexion and index finger joint flexion. Given the lengthy regenerative distance from the brachial plexus to the forearm, restoration of distal hand function in lower plexus injuries where radial and ulnar function is limited has historically been unattainable via nerve transfer. The brachialis-to-AIN nerve transfer is a reliable option to restore thumb and index finger flexion in lower plexus injuries. Postoperative rehabilitation includes three phases based on the donor activation focused rehabilitation approach (DAFRA). Therapy progresses based on results of monthly manual muscle testing of the recipients: flexor pollicis longus and index finger flexor digitorum profundus muscles. Frequent donor activation with active elbow flexion (in pronation) is encouraged throughout the first two phases. Exercise and functional activities that combine elbow flexion in pronation (donor) with active-assisted and active recipient function (thumb and index finger pinch) are included in the motor re-education program.