Rehabilitation outcome of a severe combat blast injury: a case report

Annique Priesterbach, Indy Smits, Souline Heil, Erik van de Krol, Michael Edwards, Vincent Stirler, Niek Koenders
Purpose:

This case report describes the multidisciplinary approach and physiotherapy treatment of a 38-year-old Ukrainian man sustained blast injuries who was treated at a European level one trauma center and a military rehabilitation center.

Methods:

Outcomes that were recorded include range of motion of the joints, strength (Medical Research Council Scale (MRC)), use of walking aids and supportive materials, functional transfers, and independence in daily activities.

Results:

The patient presented with severe soft tissue injuries to his back, as well as damage to multiple organs, including the sciatic nerve and sacrum. Due to these injuries, he was initially restricted to lying in a prone position. The patient was unable to actively move his right hip, knee, and ankle. Passive flexion of the right knee was 50 degrees. Leg movements were only sustainable for a short duration due to polyneuropathy and a significant increase in leg pain (numeric pain rating scale (NPRS) 10). The strength in both arms was MRC 5. 

Verticalization was initiated in a prone position on a tilt table. It was necessary to gradually build up the verticalization due to orthostatic hypotension. Once the patient was able to stand, walking was started with a scale walker and eventually with crutches. At the military rehabilitation center, there has also been a focus on strengthening the back muscles, abdominal muscles, and the muscles around the right hip and leg through targeted exercises and hydrotherapy.

Thirteen months after the accident, the patient is almost fully independent in the activities of daily living. He can safely climb stairs with the support of a railing. Right hip flexion showed an improvement in strength (MRC 4). Passive flexion of the right knee has improved to 90 degrees with little pain (NPRS 2). The patient uses a foot-up device to assist right foot lifting. The patient walks with a slightly adapted gait pattern and modified walking speed; during the six-minute walk test, he covers 250 meters.

Conclusion(s):

This case report presents the challenging yet successful multidisciplinary approach and physiotherapeutic treatment of a soldier who suffered a blast injury. A dedicated multidisciplinary treatment team, progressive mobilisation with walking aids, targeted exercises, and the creative use of supportive materials contributed to the patient’s recovery to independent daily functioning.

Implications:

This case report demonstrates the importance of specialized physiotherapy and provides physiotherapists with various interventions for the treatment of individuals recovering from a blast injury.

Funding acknowledgements:
This work was partly funded by an incentive grant for research & innovation from the Dutch Association for Hospital Physiotherapy (NVZF)
Keywords:
Polytrauma combat injuries
Interdisciplinary rehabilitation approach
Ukraine
Primary topic:
Disability and rehabilitation
Second topic:
Musculoskeletal
Third topic:
Humanitarian response and management
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
This study was approved by the Ethics Committee of the Radboud University Medical Center.
Provide the ethics approval number:
(registration number 2023-16525)
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
Yes

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