During military mission in Afghanistan injured Estonian soldiers rehabilitation

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1 During military mission in Afghanistan injured Estonian soldiers rehabilitation Annelii Nikitina (Physiatrist) Triin Rohumäe (Physiotherapist) East-Tallinn Central Hospital

2 Birth of military rehab in Estonia participating in international military operations since 1995 Estonian Infantry Company is directly involved in NATO operation in Afghanistan

3 Since 2003, we have lost 9 soldiers in international military operations, about 100 injured NEED FOR ON-GOING TREATMENT AND REHABILITATION

4 since 2008 East-Tallinn Central Hospital provides in- and out-patient rehab program for injured soldiers

5 A new kind of patient More and more soldiers are now surviving their injuries thanks to protective gear and improvements in field medicine But they live with the effects of severe burns, brain injuries, blindness, spinal damage, severe wounds, often requiring amputation. = military polytrauma patient with high expectations for return to the highest possible level of function

6 Military polytrauma patient each patient has his own unique combination of injuries brain injuries severe wounds, often requiring amputation associated injuries are remarkably frequent, complicating treatment and potentially delaying rehabilitation

7 Patient`s profile 2/3 of soldiers have severe polytrauma, some brain damage and these consequences, 1/3 of treated patients have had lower limb amputations, two of them have lost both of legs Almost 50% of injured soldiers have posttraumatic stress reaction. Many of patients had lost hearing due to blast wave.

8 Multidisciplinary medical approach comperhensive program for putting the pieces of the person`s life back together Military polytrauma patient needs multidisciplinary medical approach, it`s not unusual for 12 specialist to deal with a single case the patient will transition between specialists and services depending on each individual patient`s specific needs

9 Rehabilitation team PRM physician Other physicians: neurologist, orthopaedic surgeon etc Physiotherapist Occupational therapist Psychologist Speech patologist Prosthesist Social worker if it needed we co-operate with required specialist in other hospitals.

10 War injuries rehabilitation in Estonia We have experiences in this rehabilitation field about 2 years Challenge to provide medical rehabilitation to Estonian soldiers at home about 30 injuried soldiers are treated in our hospital

11 War injuries rehabilitation in Estonia Most of them were referred to East-Tallinn Central Hospital for on-going treatment, after being discharged from acute care at Selly Oak in Birmingham or Headley Court /England/. Recent we had 2 injured soldiers who are referred directly from Camp Bastion in Afghanistan.

12 War injuries rehabilitation in Estonia treatment at home from beginning of traumas. absent of own-language speech therapist or psychologist in early stage of rehabilitation time can delay the result of treatment all patients are initially seen by a team of experts from different medical fields

13 War injuries rehabilitation in Estonia better result we achieve if military patient get his/her treatment in a small group (10-15 in-patient on same time). there is a sense of military order with emphasis on the patient`s role as an active participant in the rehabilitation process. All patients are assessed by psychologist and get a professional psychological support.

14 Occupational therapy The primary goal of occupational therapy is to enable people to participate in the activities of everyday life. Occupational therapists use careful analysis of physical, environmental, psychosocial, mental, spiritual, political and cultural factors to identify barriers to occupation.

15 Assessment

16 Occupational therapy Occupational therapists help clients to perform all types of activities, from using a computer to caring for daily needs such as dressing, cooking, and eating. therapists demonstrate the use of adaptive equipment, including wheelchairs, orthoses, eating aids, and dressing aids

17 Amputations A core competency in military medicine and rehabilitation War injuries are often accompanied by more soft tissue damage and may take longer to heal Our amputees have had prosthesis in England more than one prosthetic limb, each one designed for a particular activity, such as walking, bathing, running or skiing

18 Prosthetic manufacturing 3 prosthetic manufacturers in Estonia Gadox running prosthesis Mechanical/electrical prosthesis C-leg As soon as possible after amputation Cast positsioning Scanning on to computer screen Technology is basicly the same Prosthesis for higher activity

19 Teamwork Rehabilitation Pre-, postoperative physiotherapy Individual therapy Group therapy Swimming pool Aquatherapy Gym training Massage, electrical therapy Warm-, coldtherapy

20

21

22

23 Cooperation GBR/USA Ancillary equipment Computer games Prosthetic manufacturer together with physiotherapy Prosthetics in accordance with sports Simulation programs Clinical gait analysis Experienced

24 To conclusion A new kind of patient: young, severely wounded war-polytrauma patient, but strongly motivated Military polytrauma patient needs multidisciplinary medical approach Need for consulting by many specialist of different medical branches, taking account patient`s shifting needs

25 To conclusion Suitable rehab program for military patient is comprehensive care in a small groups of military patients Psychological assessment ja support during rehab program are essential Need for high-tech prosthetic factory lab, gait-lab and for experienced stuff in Estonia

26 Thanks for attention!

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