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Article Title

Life After Injury, A Book Review

This book is written by a physical therapist and two occupational therapists with extensive experience in community based rehabilitation in third world countries. The book is written for caregivers in third world countries, who have a desire to help injured persons. The authors wrote the book because they felt that injured persons have rehabilitation needs and the right to access rehabilitation workers who are knowledgeable. The book provides comprehensive information on carrying out rehabilitation in difficult circumstances while preserving patient dignity. The focus of the book is to provide practical training and advise to caregivers in third world counties who may be dealing with the after effects of war, poverty, landmines, and other devastating events in the absence of adequate resources. The text is written in lay language with extensive pictures so that both rehabilitation workers and village health / community workers can easily understand and carry out the techniques described.

The book takes a problem solving approach by presenting real patient cases from various countries and assisting the reader to work through the cases to determine the optimal solutions within the limited resources. According to the authors, rehabilitation encompasses the body, mind and spirit.

The book begins with four chapters devoted to defining rehabilitation and role of the caregiver, emphasizing the rehabilitation role that family and friends can play in an injured persons life and the importance of training people to do rehabilitation. The book is then divided into seven primary sections.

Section 1:

Addresses the acute phase of injury (defined in the book as the first 7 days after injury) and the techniques needed during that time period including emphasis on breathing exercises, assisted and independent mobility, positioning and turning, and bed exercises.

Section 2:

Addresses secondary problems associated with injury including pain assessment and treatment; emotional problems following trauma; pressure sore prevention and management; identification of infectious diseases and processes such as tuberculosis arthritis, rheumatoid arthritis, osteomyelitis; wound prevention and management; and prevention and management of swelling.

Section 3:

Addresses specific types of injuries including spinal cord injuries, burns, amputations, brain damage and other nerve injuries (upper and lower extremity peripheral nerve injuries) . Each chapter addresses the disabilities of the injuries, goals of rehabilitation, and techniques to achieve those goals.

Section 4:

Addresses fracture management including types of fractures and fracture healing, immobilization of fractures including traction, plaster casts, internal and external fixation devices and the use of slings. Extensive information is devoted to making plaster casts and managing individuals with plaster casts.

Section 5:

Addresses the planning stage of rehabilitation including assessing persons to determine causes of movement problems and developing treatment plans to address those problems. Specific problems addressed include spasticity, loss of sensation, leg length discrepancy, coordination problems, contractures, and muscle weakness. Appropriate exercises to address each of the above problems are included.

Section 6:

Addresses the use of splints including problems that can be addressed by splinting, choosing an appropriate splint, and making upper and lower extremity splints.

Section 7:

Addresses mobility issues including the use of adaptive devices. Walking aids are addressed including parallel bars, walking frames, crutches and canes. Wheeled mobility aids include wheelchairs, tricycles and gurneys. Activities of daily living such as showering and bathing, toilet use, dressing, eating and food preparation, writing and gardening are described, including the use of adaptive devices.

The final chapters in the book address issues of returning to work with a disability and adapting the work environment to meet the needs of the individual. Issues of community acceptance are addressed, as well as making the home environment and community accessible. The book concludes with steps for setting up a rehabilitation program.

Appendices include documentation forms and checklists and an analysis of the normal movement of the major joints of the body. The emphasis throughout the book is on prevention of secondary problems and early active mobility. Extensive pictures are used throughout the book to assist the reader in understanding the concepts, techniques and exercises presented.

This book could serve as a valuable resource for medical professionals serving on medical missions or working in third world countries. The information and concepts are important and are presented in a way the layperson can easily understand with the combination of lay terminology and pictures. This book would serve as an valuable resource for professionals not familiar with rehabilitation techniques who find themselves in the position of not having access to trained rehabilitation professionals.

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