INTRODUCTION TO POLYTRAUMA
REHABILITATION OF POLYTRAUMA PATIENTS REQUIRES a thorough understanding of how these injuries occur, which is important for appropriate and timely management. Polytrauma is defined as injury to at least two or more body regions that lead to “physical, cognitive, psychological, or psychosocial impairments and functional disability.”1 Polytrauma typically affects the young and middle-age groups or service members in the military. The combination of multiple injuries occurring as a result of the same traumatic event often lead to other disabling medical and psychological conditions including, most commonly, traumatic brain injury (TBI), amputation, orthopedic injuries, spinal cord injury, post-traumatic stress disorder, or other mental health impairments. Management of polytrauma patients is challenging and requires utmost utilization of resources for their care. Specialized coordinated care from multiple sources working together is needed. A comprehensive interdisciplinary team is often assembled in executing patients’ transition from acute hospitalization to acute rehabilitation and finally to help integrate them into the outpatient setting.
Literature regarding the topic of polytrauma is overtly expansive and spans decades. When narrowing the review parameters, it is noted that there are over 2,000 articles published within the last 5 years and another 400 plus written within the last 12 months. Publications include (but are not limited to) meta-analysis, case reports, and funded studies. Within the subset of publications evaluated, a variety of treatment methods have been implemented and outcomes measured. The overarching focus of the literature underlines the definition and recognition of polytrauma/TBI as a “chronic health condition with residual medical, functional, and psychosocial issues.”2
Since the early twentieth century, medical practitioners have recognized the need for comprehensive treatment plans geared toward maximizing function in individuals who have endured an appreciable decline in overall quality of life due to polytrauma. Those returning from combat were the most affected. Many soldiers died from their wounds while those who survived endured lifelong complications. During World War I, “clusters of physical and psychological symptoms that occurred as a result of exposure to intense combat [were] labeled in various ways, from ‘hysteria’ to ‘shell shock’ to ‘polytrauma’.”3 During World War II, “terms such as battle fatigue, combat stress, combat exhaustion, and war neuroses emerged to describe similar symptoms, which became a significant concern to military command of the U.S. Armed Forces.”3 Given the substantial morbidity and mortality, it was obvious that a standardized methodology for management of these conditions and their sequela needed to be developed; however, the ability to share information including research and clinical practices was severely limited.
Rehabilitation as a medical practice remained a relatively foreign concept despite the promotional efforts of doctors, nurses, and therapists caring for these polytrauma patients. It was not until the 1970s that perceptions and access to rehabilitative care began to emerge due to a noticeable number of patients surviving their injuries following advances in emergency and acute care medicine. ...