Every landmine injury creates a demand for a host of services, including operative and postoperative care, the provision of mobility aids, physical therapy, vocational training, physiological counseling, and pain management. The vast majority of landmine injuries occur in low-income countries, where such services are not available. The World Health Organization estimates that approximately 80% of the world's disabled population lives in low-income countries and that less than 2% ever receive rehabilitation services. The continuing number of landmine casualties, about 26,000 per year, creates an enormous demand for rehabilitation services in societies that are often ill-equipped to provide them. The challenge of providing rehabilitation to survivors of landmine injuries lies in developing strategies for service delivery that can be sustained, over the lifetime of the survivors, within the community in which they reside. The majority of nonfatal, landmine injuries result in transtibial (below-knee) amputations, but transfemoral (above-knee) amputations are also common. Landmine survivors may also suffer damage to the upper extremities, vision, and hearing. The incidence of acute and chronic pain among landmine survivors during recovery has not been quantified. In this chapter, pain management issues are discussed as they arise during the course of treatment and recovery after blast injury. The key to effective rehabilitation lies in the effective coordination of operative, postoperative, prosthetic, therapeutic, and family services. This coordination can best be accomplished through application of the “team approach” to rehabilitation, which includes the patient, family, physician, prosthetist, therapist, and others in the rehabilitation process. At present, the team approach to rehabilitation has not been systematically implemented in many low-income, mine-affected countries. This is unfortunate because its absence almost certainly reduces the efficacy of available services. The provision of prosthesis without proper training from a therapist, for example, may result in poor utilization. Proper communication and training during rehabilitation …
Read full abstract