Restoration of the functional state of military personnel after gunshot wounds to the upper limb using physical therapy measures based on the principles of neuroplasticity

Nataliia Shestopal; Helen Bismak; Olena  Lazarieva

doi:10.15391/prrht.2024-9(5).06

Authors

Nataliia Shestopal Department of Therapy and Rehabilitation Department, National University of Ukraine on Physical Education and Sport, Kyiv, Ukraine. https://orcid.org/0000-0003-4860-2433
Helen Bismak Department of Therapy and Rehabilitation Department, National University of Ukraine on Physical Education and Sport, Kyiv, Ukraine. https://orcid.org/0000-0002-6495-6170
Olena Lazarieva Department of Therapy and Rehabilitation Department, National University of Ukraine on Physical Education and Sport, Kyiv, Ukraine. https://orcid.org/0000-0002-7435-2127

DOI:

https://doi.org/10.15391/prrht.2024-9(5).06

Keywords:

upper limb, gunshot wounds, physical therapy, principles of neuroplasticity

Abstract

Purpose. To evaluate the impact of physical therapy (PT) measures on the fastest possible recovery of military personnel after gunshot wounds to the upper limb (GWUL), taking into account the principles of neuroplasticity.

Material & Methods: The study involved 72 patients aged 28 to 52 years diagnosed with gunshot wound of the upper limb (GWUL), who were divided into two groups - the main group (MG, n=36) and the control group (CG, n=36). Patients in the MG underwent rehabilitation according to the developed PT program, which included: motor activity of targeted actions to simulate situations significant for each patient and his professional activity, bimanual therapy, therapeutic massage, therapeutic exercises, special training devices of the Thera-Band progressive exercise system, Artromot training devices. And the CG - according to the standard program carried out in a medical institution: therapeutic exercises, physiotherapy, kinesiotherapy, Artromot training devices, therapeutic massage. For a comprehensive examination of patients in both groups, medical, biological and sociological methods were used: the DASH scale (Disability of the Arm, Shoulder and Hand Outcome Measure), questionnaires (military questionnaire), goniometry, dynamometry and methods of mathematical statistics.

Results: After PT, the DASH severity scores (p<0.05), goniometry scores in the elbow joint of the upper limb (p<0.05), and dynamometry scores (p<0.05) were significantly better in MG patients than in CG. MG patients experienced significantly fewer limitations associated with upper limb dysfunctions compared to CG, which had a positive effect on the ability to perform exercises related to professional activity according to the results of the military questionnaire.

Conclusions: The application of neuroplasticity principles in the PT program in the MG contributed to the improvement of the functional state of military personnel, as well as their professional and social capabilities, and can be applied to wider practical implementation in specialized medical and rehabilitation institutions.

References

Allami M., Yavari A., Karimi A., Masoumi M., Soroush M., Faraji E. (2017). Health-related quality of life and the ability to perform activities of daily living: a cross-sectional study on 1079 war veterans with ankle-foot disorders. Military medical research. 4. 1. 37. https://doi.org/10.1186/s40779-017-0146-1

Bressi F., Bravi M., Campagnola B., Bruno D., Marzolla A., Santacaterina F., Miccinilli S., Sterzi S. (2020). Robotic treatment of the upper limb in chronic stroke and cerebral neuroplasticity: a systematic review. Technology in Medicine. 34 (5 Suppl. 3). 11-44. Technology in Medicine. PMID: 33386032

Cecatto R.B., Chadi G. (2007). The importance of neuronal stimulation in central nervous system plasticity and neurorehabilitation strategies. Functional Neurology. 22(3). 137-143. PMID: 17925162

Chandra N., Sundaramurthy A., Kobeisi F. (2015). Acute pathophysiology of blast injury—from biomechanics to experiments and computations: implications on head and polytrauma. Q: Neurotrauma of the brain: molecular, neuropsychological and rehabilitation aspects. Chapter 18. PMID: 26269922 Bookshelf ID: NBK299229

Enemark Larsen A., Rasmussen B., Christensen J. R. (2018). Enhancing a client-centred practice with the Canadian Occupational Performance Measure. Occupational therapy international. 5956301. https://doi.org/10.1155/2018/5956301

Epstein R. A., Heinemann A. W., McFarland L. V. (2010). Quality of life for veterans and servicemembers with major traumatic limb loss from Vietnam and OIF/OEF conflicts. Journal of rehabilitation research and development. 47. 4. 373–385. PMID: 20803405 https://doi.org/10.1682/jrrd.2009.03.0023

Gillick B.T., Zirpel L. (2012) Neuroplasticity: an appreciation from synapse to system. 93(10). 1846-1855. PMID: 22613094 https://doi.org/10.1016/j.apmr.2012.04.026

Inoue K., Schauler E., Jordan C.H., Moore M.J., Jackson C.A. (2023). Veterans and military mental health issues. In: StatPearls [Internet]. Treasure Island (Florida): StatPearls Publishing; 1. PMID: 34283458 Bookshelf ID: NBK572092

Johnston M.V. (2009). Plasticity in the developing brain: implications for rehabilitation. Dev Disabil Res Rev. 15(2). 94-101. PMID: 19489084 https://doi.org/10.1002/ddrr.64

Kerr A.L., Cheng S-Y., Jones T.A. (2011). Experience-dependent neural plasticity in the adult damaged brain. Commun Disord. 44(5). 538-548. PMID: 21620413 PMCID: PMC3162127 https://doi.org/10.1016/j.jcomdis.2011.04.011

Kleim J.A., Jones T.A. (2008). Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage. J Speech Lang Hear Res. 51(1). 225-239. PMID: 18230848 https://doi.org/10.1044/1092-4388(2008/018) .

Kleim J.A. (2011). Neural plasticity and neurorehabilitation: teaching the new brain old tricks. J Commun Disord. 44(5). 521-528. PMID: 21600589 https://doi.org/10.1016/j.jcomdis.2011.04.006

Kopp B., Tabeling S., Moschner C., Wessel K. (2008). Cognitive functions of the prefrontal cortex: neuroscience and clinic. Nervenarzt. 79(2). 143-152 PMID: 17701391 https://doi.org/10.1007/s00115-007-2319-8

Loskutov A. E., Domanskyi A. M., Zherdev I. I., Lushnia S. L. (2021). Features of medical care in patientswith elbow joint gunshot wounds. Orthopedics, traumatology and prosthetics. 1. 5–8. https://doi.org/https://doi.org/10.15674/0030-5987202115-8

Lototskyi I.R., Dzyama V.V., Romaniv I.V. (2016). Improving the physical training of military personnel by means of applied sports. Improving the system of physical training in the Armed Forces of Ukraine in today's conditions and bringing it to compatibility with the standards of the armies of NATO member countries: materials of the International science and method conference, Kyiv, December 13–14 2016. Kyiv: NUOU. 82–84.

Lysun D. M. Limb injuries as a result of modern combat operations: clinical and epidemiological analysis: diss. ... candidate honey. Sciences: 14.01.21 / DU Institute of Traumatology and Orthopedics of the National Academy of Sciences of Ukraine. Kyiv, 2019. 156 p.

Moore J. H., McMillian D. J., Rosenthal M. D., Weishaar M. D. (2005). Risk determination for patients with direct access to physical therapy in military health care facilities. The journal of orthopaedic and sports physical therapy. 35(10). 674–678. PMID: 16294989 https://doi.org/10.2519/jospt.2005.35.10.674 .

Muñoz-Cespedes J.M., Rios-Lago M., Paul N., Maestu F. (2005). Functional neuroimaging studies of cognitive recovery after acquired brain damage in adults. Neuropsychol Rev.15(4). 169-183. PMID: 16395622 https://doi.org/10.1007/s11065-005-9178-5

Oderov A., Klymovych V., Pidleteychuk R., Dobrovolsky V., Korchagin M. (2020). Peculiarities of the organization and content of the physical training system in the armed forces of NATO member states and Ukraine. Ukrainian Journal of Medicine, Biology and Sports. 5(2). 271–282. https://doi.org/10.26693/jmbs05.02.271

Practical biomechanics: manual / A. N. Laputin and others; ed. A. N. Laputin. Kyiv: Naukovyi svit, 2000. 300 p.

Price C.J., Friston K.J. (2002). Functional imaging studies of neuropsychological patients: applications and limitations. 8(5). 345-354 PMID: 12499409 https://doi.org/10.1076/нейр.8.4.345.16186

Prigatano G.P., Braga L.W., Johnson S.F., Souza L.M. (2021). Neuropsychological rehabilitation, neuroimaging and neuroplasticity: A clinical commentary. NeuroRehabilitation. 49(2). 255-265. PMID: 34397433 PMCID: PMC8543255 https://doi.org/10.3233/NRE-218024

Raymont V., Salazar A. M., Krueger F., Grafman J. (2011). "Studying injured minds" - the Vietnam head injury study and 40 years of brain injury research. Front Neurol. 28. 2-15. PMID: 21625624 PMCID: PMC3093742 https://doi.org/10.3389/fneur.2011.00015

Romero S.G., Manly C.F., Grafman J. (2002). Investigating cognitive neuroplasticity in single cases: lessons learned from applying functional neuroimaging techniques to the traditional neuropsychological case study framework. Neurocase. 8(5). 355-68. PMID: 12499410 https://doi.org/10.1076/нейр.8.4.355.16187

Saiko O. V., Luchkevich M. P. (2012). Basic principles of the organization of medical rehabilitation of servicemen who participated in peacekeeping operations (emergency situations) based on the medical facilities of the Ministry of Defense of Ukraine. Practical medicine. 18(4). 82–90.

Stevelink S.A.M., Malcolm E.M., Mason C., Jenkins S., Sundin J., Fear N.T. (2015). The prevalence of mental health disorders in (ex-)military personnel with a physical impairment: a systematic review. Occupational and environmental medicine. 72 (4). 243–251. DOI: 10.1136/oemed-2014-102207

Veehof M.M., Sleegers E.J.A, Veldhoven N.H.M.J., Schuurman A.H., Meeteren N.L.U. (2002). Psychometric qualities of the Dutch language version of the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH-DLV). Journal of hand therapy : official journal of the American Society of Hand Therapists. 15 (4). 347–354. https://doi.org/10.1016/s0894-1130(02)80006-0 .

Warraich Z., Jeffrey A Kleim J.A. (2010). Neural plasticity: the biological substrate for neurorehabilitation. Suppl. 2. 208-2019. PMID: 21172683 https://doi.org/10.1016/j.pmrj.2010.10.016

Yahodzinskyi V. P., Yuriev S. О., Kisilyuk O. M., Hlibovuch I. V., Nikitin A. M., Rodionov M. O., Kostyushko I. A., Desyatka O. A., Didenko O. V. (2021). Efficiency of military-applied sports to increase the level of cadets’ special physical fitness. Scientific journal of the M.P. Drahomanov NPU. 9 (140). 111–114. https://doi.org/10.31392/NPU-nc.series15.2021.9(140).25

Yuriev S., Mikhnyuk O., Rodionov M., Nikitin A., Bukov R., Polozenko D., Pidoprygora M., Arefieva L. (2021). The role and place of applied military sports in the physical training of future officers of the Armed Forces of Ukraine. Scientific journal of Drahomanov NPU. 9. 149–152. DOI:10.31392/NPU-nc.series15.2021.5(135).36