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  • Geoff Watson

Rehabilitation Starts at Time Zero

Updated: Jun 10

The war in Ukraine has created an urgent need to find better ways to manage mass casualties, using the knowledge gained from conflict around the world. There is a need for reimagined pathways that create a more streamlined rehabilitation journey and results in better outcomes for the injured in a more cost-effective, resource and time-efficient way. At a time when Ukraine is stretched beyond limits and is dependent on external generosity, ways of enhancing the journey need to be sought.

Recovery has to start from the moment a person is injured. Getting it Right First Time means resuscitation, life-saving interventions and early surgery have to be coordinated and planned before the trauma occurs; from the frontline to distant rehabilitation centres.

The rehabilitation journey can start as soon as the patient is stabilised, offering an opportunity to take the first step on that long journey to independence. Early interventions impact the pathway and can dramatically shorten the journey as well as improve the final outcome. These interventions may be as simple as where the tourniquet is placed on the limb, to the nutritional status of the individual. Simple, good primary care and an integrated, joined-up approach to managing the care pathway, can make all the difference in reducing the number of complicated cases that then require much more complex reconstruction and rehabilitation. Cases that can only be managed at the most well-resourced tertiary care centres or at centres of excellence abroad.

However, this requires a multidisciplinary team with a more holistic view of how to support the patient and ensure an integrated approach to future care.

Building independence early is crucial in the rehabilitation journey of an amputee; leading to enhanced quality of life, increased self-esteem, smoother reintegration into society and a reduced burden on caregivers.

Modern thinking and emerging systems are transforming the role of assistive technology in the day to day lives of those living with disability. New ideas in prosthetics have the potential to improve functionality and daily comfort so users are more likely to make best use of their aids

One example of a new technology offering the potential of enhanced rehabilitation is the Koalaa specialist post-op prosthetic. This can be used from as early as 48 hours post-surgery. Fitting within days rather than months can be transformational. A design so simple to fit can make a huge difference to resource efficiency, especially where there may be constraints in terms of a prosthetist's time and expertise as in the case of Ukraine. Fitting a good prosthetic this early in the rehabilitation journey of someone who has lost a limb can have a significant positive impact on their overall well-being and improve the physical and mental health of the patient. A well fitted prosthetic greatly reduces abandonment rates.

Learning to use a soft prosthetic such as this can occur while physical recovery from the injuries is ongoing. By giving something positive to focus on the individual may be more able to adjust to their new normal and engage more in physical and mental rehabilitation.

The human body has a remarkable ability to adapt and providing a well-fitted prosthetic limb early in the rehabilitation process allows individuals to begin adapting to their new circumstances sooner. Early use of a prosthetic can help retrain the brain, improve muscle strength and coordination, and facilitate the development of new movement patterns. This early adaptation can lead to faster achievement of improved final outcomes.

Following the loss of a limb or part of it the body undergoes significant adaptive changes with loss of muscle bulk and bone density where they are not being called on to function. Early use of a prosthetic limb can minimise these changes and help retain muscle and bone strength resulting in improved function with later prosthetics. The benefits are healthier limbs that retain as much function as possible to make use of aids in later years easier and more effective. Put simply, prevention (of muscle wasting) is better than cure (long term attempts at retraining).

A well-fitted prosthetic can enable individuals to participate in a wide range of activities they enjoyed before limb loss. Whether it's sports, hobbies, or work-related tasks, having an early prosthetic intervention can help individuals resume their previous activities or explore new ones, leading to a more fulfilling and inclusive lifestyle.

Key benefits of a well-fitted prosthetic limb:

Improved physical function:

• Improved retention of muscle bulk and movement, avoiding the atrophy caused by under use of muscles.

• Enhanced ability to perform daily activities such as grasping objects and performing tasks like eating, drinking or making phone calls.

• Faster adaptation and rehabilitation

• Preservation of musculoskeletal health

Psychological well-being:

• Reduced psychological impact of limb loss. By providing a functional and aesthetically pleasing prosthetic limb early on, individuals can regain a sense of normalcy and improve their self-image.

• This can boost self-confidence, reduce feelings of loss or stigmatisation, and contribute to better long-term mental health.

• Increased participation in daily activities

It is important to note that the specific impact of any intervention is individual specific and dependent on many factors including the limb affected, level of amputation, physical and mental condition before the injury and the sum of other injuries sustained.

The impact of an integrated recovery and rehabilitation programme is optimal only if it involves a multidisciplinary team including doctors, nurses, prosthetists, physical therapists, occupational therapists, and psychologists. Engaging friends and family early and integration of the pathway with joined-up thinking is key.

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