The collapse of building at Savar that killed several hundred workers and left several thousands injured is the worst industrial disaster in Bangladesh. Many of those who survived have lost their limbs, many have become paralysed. Ironically, all those people are in their productive age and most of them are the only earning member of their family. With disability and deformity, it has become extremely difficult for them to get back to work again. But with long term rehabilitation support, they can lead a better life with acquiring productivity and mobility.
The rehabilitation process varies according to the nature of injury. Some of them have lost both legs, either hand or one leg and/hand. So, the rehabilitation programme should be individualised. The core team should include orthopaedic surgeon, physical therapist and occupational and vocational trainer.
The large numbers of people who sustain limb amputations are in need of prosthetic devices and should be aware of rehabilitation techniques. We should start preparation for artificial limb or prosthesis now.
Post-operative management should be aimed at controlling pain and protection of the residual limb from trauma, swelling and other complications and make it fit for prosthesis.
To prevent contractures, joints must be moved through the full range of motion either actively or passively three times, at least twice a day. Attention must be directed toward preventing bed sore formation by changing position at regular interval. Emotional support and reassurance should be given to allow the patient to accept the loss.
Early prosthetic fitting, before the wound is completely healed is common in the management of the traumatic amputee. It has been shown that early fitting and mobilisation of the lower limb amputee has the advantage of decreasing the risk of muscle atrophy and joint contracture.
The amputee should be trained to use the prosthesis, how to care for the residual limb and maintain the prosthetic device. The amputee should also need to learn to recognise problems with the fit of the prosthesis and how to make adjustments.
Finally, rehabilitation should be completed with vocational rehabilitation where there will be functional improvement and recommencement the productive life.
We have to ensue that the injured people can receive immediate and long term rehabilitative care. Ironically, we do not have any public full fledged and independent rehabilitation centre to provide such large scale care. It is high time to establish this care facility to tackle any future disaster.
The writer is the Head, Department of Physiotherapy and Rehabilitation. Uttara Adhunik Medical College Hospital. Email: [email protected]