PD-3-01-01
PERSIAN GULF WAR AMPUTEES: INJURIES AND REHABILITATIVE NEEDS
P.V. Belandres (U. S. Army Medical Research & Materiel Command, Ft. Detrick, Maryland, U.S.A.); T.R. Dillingham (Johns Hopkins University, MD); S.E. Braverman (Walter Reed AMC, Washington, DC)
Purpose: This study describes the injuries, functional deficits, and rehabilitation needs of amputees managed at Walter Reed Army Medical center (WRAMC) during the Persian Gulf conflict (1991).
Methods: Prior to the beginning of Operation Desert Storm (1991) and during Operation Desert Shield (1990-91), the Physical Medicine and Rehabilitation Department established a prospective study to record injuries, functional limitations, and secondary complications sustained in casualties referred to WRAMC (Washington, DC) for rehabilitation. Between November 1990 and July 1991, amputees managed by the PM&R Department were included in this study. Data regarding their injuries, complications, and rehabilitative needs were prospectively collected. A follow-up clinic evaluation or telephone interview was performed to determine medical and vocational status approximately 1 year after discharge from WRAMC. Results: Fourteen amputees were treated sustaining amputations. In six casualties there were multiple amputations with 18 lower-limb and 3 upper-limb amputations. In six casualties there were multiple amputations. Battle injuries were the cause in 79%. Nerve injuries occurred in 79%, phantom pain in 64%, and functional limitations (ambulation and activities of daily living [ADLs]) were present in all casualties. Contractures were noted in 86%. Skin traction for open wounds was lacking in all but one case. With comprehensive rehabilitation, all casualties achieved independent ambulation, and 93% were independent in all ADLs at discharge, with one below-knee amputee successfully returning to duty.
Conclusion: These findings highlight the need for education of military health care providers in skin traction techniques, and provision of multidisciplinary rehabilitative care for these casualties.
PD-3-01-02
Amputation Rehabilitation Following the War in Bosnia
Robert H. Meier, III (O' Hara Regional Center for Rehabilitation, Denver, Colorado)
During the four years of the war, over 7,000 persons in this Country of 3.8 million persons sustained amputations of their arms and legs. This toll of disability continues because there are over 1 million land mines remaining. The International Rescue Committee supported five rehabilitation professionals to travel to Tuzla, Bosnia in September, 1996 to train a team of Bosnian rehabilitation professionals in the evaluation, prescription, fabrication and training of arm amputees with body-powered prostheses. In Tuzla, Bosnia, all prosthetic fabrication equipment, componentry and laboratory space have been provided by international assistance begun by Handicap International in 1992. The professionals trained included orthopedic surgeons, physiatrists, nurses, physical therapists and prosthetic technicians. Thirteen arm amputees were fitted and trained in eight working days. The most frequently identified uses of the prosthesis were for improved cosmesis, activities of daily living, gardening, homemaking, carpentry and fishing. A smaller team returned to Bosnia in February, 1997 to follow-up on these amputees. 60% were wearing and using their prostheses functionally. The most frequently described problems were discomfort with harness fitting and the desire for better cosmesis than a hook terminal device provided. These problems were resolved and further prosthetic technician training was accomplished. The desired outcome is a better wearing and usage rate than 60%. More amputations will result as the Country is demined over the next five years. A prosthetic rehabilitation team is now in place to address the needs of these amputees. However, the need for prosthetic componentry and fabrication materials remains unmet.
