Axonal injury to the spinal accessory nerve (SAN) leads to loss of arm elevation and function. The C7/pectoralis nerve to the SAN transfer is one surgical option that is described in the literature as having the potential to provide recovery of trapezius function and overhead shoulder activity. Following surgery, rehabilitation begins once the surgeon determines that the protective period is complete. Three phases of motor reeducation are used based on the donor activation focused rehabilitation approach (DAFRA). Phase 1 involves patient education, donor activation exercises, and exercises that combine donor/pectoralis muscle action with passive trapezius function. Manual muscle testing is performed monthly and guides the advancement to the next phase. During phase 2, exercises are advanced as trapezius muscle recovery improves. Beginning with donor activation combined with assisted trapezius exercises in gravity-lessened planes, phase 2 ends as the individual demonstrates active trapezius function against gravity. If the individual achieves this, phase 3 commences with the addition of resistance exercises to further strengthen the trapezius function.