Life After Injury

Life After Injury is a practical handbook for people who wish to help those injured as a result of accidents, landmines or armed conflict. It is written from extensive experience infolving work with village health workers, injured and disabled people, their families and communities. The aim is to build sustainable local capacity for rehabilitation at the village level in the poorest communities in the world.

The book contains far more than physical therapy and and rehabilitation. It discusses the full range of understanding and help that severely injured people need to overcome trauma and go on to rebuild their lives with their families and communities. The down-to-earth approach covers a wide range of relat3ed problems and needs. These extend from the event of the injury, through emergency care, hospitalization (when possible), learning too do daily activities and finally reintegration into the community. The book also promotes the use of low-cost appropriate technology, splints and aids, training, teamwork and community education.

Life After Injury is remarkably broad in scope. It uses numerous illustrations and photos and its clear and simple style of writing can be understood by the community-level rehabilitation worker or village health worker. At the same time, the book provides sufficient detail and depth that fully trained physio and occupational therapists, doctors and nurses will also benefit greaterly from it.

Forward by David Werner

As the title of this very practical hand-book implies, “Life After Injury” is about far more than physiotherapy and rehabilitation in the more limited sense. It covers the full range of the understanding and assistance that severely injured persons need to overcome both physical and psycho-social trauma, so that they can return to the fullest possible participation with their families and communities. While the central focus of this manual is on physical (and to some extent occupational) therapy in difficult circumstances, the comprehensive, down-to-earth approach covers a wide range of related problems and needs. These extend from the event of the injury, through emergency care, hospitalization (when possible), and finally integration back into the community.

The book is remarkably broad in scope. And it is written with a clarity and simplicity of language that can be understood by the community-level rehabilitation worker or village health worker. Yet at the same time, the book provides sufficient detail and depth so that fully trained physiotherapists, doctors, and nurses will learn an enormous amount from it.

An outstanding feature of this book is its thoughtful, problem-solving approach. The authors methodically guide the reader in figuring out the unique combination of needs and possibilities for each person. And they do this in ways that include the injured person, family and friends in the therapeutic process.

One reason this book is so down-to-earth and practical in terms of rehabilitation in difficult settings, is the authors' wealth of experience, both in the Australian “Out Back” and in a number of developing countries. I first met Liz Hobbs when—as a volunteer physiotherapist— she visited PROJIMO, a community-based rehabilitation program run by disabled villagers in the mountains of Western Mexico. Liz came to learn and to teach rather than to provide direct services. In the process she helped the team of disabled rehab workers gain a deeper and broader understanding of physical therapy, and how to adapt it to a community-based context. In the process, Liz learned about low-cost approaches and innovative technologies. Subsequently, Liz built on this experience by facilitating informal training courses at Mas Validos, an urban community rehabilitation program in western Mexico, started by disabled graduates of PROJIMO.

For me it has been a delight to help the authors in a small way with this book, by reviewing and making suggestions concerning the text and illustrations. This is because “Life after Injury” responds to an enormous and still widely unmet need. Let me explain:

Over the last two decades or so I have visited dozens of rehabilitation programs—both institutional and “community-based,” in many countries, but especially in the South. Repeatedly I have been struck by methodological shortcomings, and sometimes counterproductive aspects, of rehabilitation services in general and physiotherapy in particular. Too often physical therapy has become a kind of thoughtless mechanical ritual. In center after center, the same sort of rote “water pump” exercises are applied to virtually everyone, irrespective of the specific injuries or needs. Added to this, there is often a tendency by therapy workers to look at their client as a “patient” rather than a person, as an object to be manipulated and repaired, rather than as a partner in an open-ended, caring, problem-solving process.)

The beauty of “Life After Injury” is that the authors encourage rehab workers and therapists— in partnership with the injured person and relatives—to sensitively yet systematically evaluate the person’s full range of needs, fears, hopes, and possibilities. Family and community understanding and support—along with consideration of local and cultural factors—are celebrated as integral to this process.

Often physiotherapists and rehab workers find themselves in daunting situations of poverty or war, sometimes with dozens of injured persons to deal with, as well as a shortage of staff and equipment. They are at a loss regarding how to make the best use of their time, energy and skills. This manual provides many suggestions for coping in such difficult circumstances. These include teaching and working with family members, with care providers, and with the disabled persons themselves—so that they gain the necessary understanding and hands-on skills to help one another with therapy, rehab, and meeting of basic needs.

For such demanding situations, the authors include all kinds of suggestions for “appropriate technology” rather than high-tech assistive devices. In this way they help to spark the imaginations of rehab and therapy workers to seek low-cost, innovative solutions.

What makes this book such an enormously useful tool for rehabilitation workers and therapists at every level is its wealth of precise, useful, very detailed information presented in a well-organized and accessible way. Hundreds of instructive line drawings, integrated into the text, add greatly to communication of methods and techniques.

In sum, “Life After Injury” is a goldmine of comprehensive information for assessing needs and carrying out a plan of therapeutic action in difficult circumstances … in a way that preserves the dignity and caring human touch of all concerned.

Parts of the Book

• Part 1: Introduction
  • What is rehabilitation?
  • Families and Friends
  • Bringing rehabilitation to the people
  • Working out what to do
• Part 2: Healing
  • Section 1 – Early rehabilitation
  • Section 2 – More problems after injury
  • Section 3 – Rehabilitation of specific injuries
  • Section 4 – Healing and rehabilitation of fractures
• Part 3: Becoming Able
  • Section 5 – Solving problems with moving and doing activities
    • How to find solutions
    • Finding the causes of a movement problem
    • Weakness
    • Stiffness
  • Secction 6 – Splints
    • Introduction to splints
    • Choosing which arm splints to use
    • Choosing which leg splints to use
    • Using splinting materials
    • Instructions for making splints
• Part 4: Joining In
  • Returning to work
  • Encouraging positive community attitudes
• Part 5: Getting Organized
  • Setting up a rehabilitation programme
  • Your work as a rehabilitation worker
  • Sharing rehabilitation skills
  • Advice for expatriate trainers
• Part 6: Appendices
  • Record forms
  • Normal movement
  • References
  • Special or difficult words
  • Index

About the Authors

The authors—Liz Hobbs, Sue McDonough and Ann O’Callaghan—are Australian physio and occupational therapists. Between them they have visited or worked in rehabilitation programmes in Cambodia, Ethiopia, Sudan, India, Pakistan, Mexico, Thailand, Papua New Guinea and Malaysia, as well as in Australia with both indigenous and non-indigenous people. Their combined experience includes community-based rehabilitation models, cross-cultural training in acute care, medium and long-term rehabilitation, vocational training, low-cost appropriate technology, research and community development.

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  • Buy: Third World Network ($10 in developing countries; $30 elsewhere)
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