After Russia launched a full-scale invasion, the issue of child rehabilitation in Ukraine became critically important. The enemy is not only targeting military facilities — residential areas, schools, hospitals, maternity wards, and even playgrounds are also under attack. Children are among the victims. These injuries often have serious consequences: amputations, multiple traumas, burns.
So today, specialists face a difficult and important task — to create an effective rehabilitation system that is sensitive to children’s needs.
In this article, we discuss how a child should be rehabilitated after an amputation caused by a rocket or artillery strike. What challenges does the team of specialists who help the child return to life face? What role do parents play? And why is play not just entertainment, but an important part of the rehabilitation process?
Serhii Khuda, acting head of the rehabilitation department at St. Nicholas Children’s Hospital and a physical therapist, talks about the specifics of children’s recovery and the challenges faced by young patients, parents, and specialists.
Children’s rehabilitation: specifics and challenges
The first difference between the rehabilitation of adults and children with amputations is that we currently have significantly fewer healthcare facilities that can provide quality rehabilitation assistance to children. At the beginning of 2022, the main focus was mainly on adults.
An adult patient can choose any rehabilitation facility — close to home or in another region. With children, it doesn’t quite work that way. Fortunately, however, the number of amputations among children is also significantly lower than among adults. This is because children can be rescued in time (it is easier to transport a child to a hospital than a soldier from the front line), and they do not suffer from tourniquet syndrome.
However, this does not mean that this area does not need to be developed. On the contrary, it needs to be developed because we do not know what will happen next. Ukraine is the most heavily mined country in the world. Sooner or later, after the end of the fighting, children will go into forests that have been mined or shelled. These will be delayed consequences that are, unfortunately, inevitable. And we need to prepare for them now.
The Ministry of Health is currently implementing a flagship project aimed specifically at child rehabilitation. The minister has announced plans to establish a network of institutions to provide such assistance. It is not yet fully formed. Training for these teams is also planned for the future.
The gradual nature of rehabilitation and the role of parents
The stages of rehabilitation should be divided. The acute stage is very important. This is the stage after surgery. It is necessary to teach the patient how to move correctly, to teach them and their parents how to bandage the stump and how to do it correctly.
Much attention is paid to educating parents. After all, a traumatic experience is not only physical but also psychological trauma. If adults do not always cope with this, it is even more difficult for children. Sometimes it is the parents who become the key specialists at this stage, because they have more access to the child and can act with less stress for them. Therefore, educating parents is extremely important in acute rehabilitation. There is a psychologist for the child, and there is a psychologist for the parents — after all, it is a traumatic experience for them too.
After the acute stage, rehabilitation continues. It includes strength exercises, prevention of complications, and correct positioning. Specialists teach parents how to work with postoperative scars, how to load the skin and stump. And this is already the stage of preparation for prosthetics.
While rehabilitation for adults is essentially complete once they receive a prosthesis, this is not the case for children.
It is much more complicated in the context of children still being in the so-called active growth zone. And if, for example, children have an amputation and the growth zone is preserved, this means that when a child has undergone surgery, perhaps in a year they will start to grow, and the bone will grow, and the shape of the stump itself will change. It may be sharp and may require reamputation.
But this is also a positive thing, because bone growth often has a positive effect on the use of a prosthesis. After all, there is the so-called shoulder of prosthesis use: something has to lift, for example, a leg. So if there is growth, there is a way to move the limb.
And before the child’s growth stops, they will still be in contact with their rehabilitation team and specialists until they have a permanent prosthesis. The child will also grow, so the prosthesis will need to be changed (length, socket volume), and the child may/will return for rehabilitation from time to time.
Is prosthetics necessary for children?
A separate question arises: is prosthetics always necessary? Some children are not yet old enough to use a prosthesis. Sometimes a prosthesis is only for aesthetic reasons, which is important for parents but not for the child.
Most parents want bionic prostheses. But this is not always appropriate. For example, children with hand amputations often cope perfectly well with one hand. They are impatient and will not train for long — they fasten a button with one hand and run on. They need to play and live.
There are children who are so skilled at using crutches that they do not need a prosthesis. For example, after having his leg amputated due to cancer, a boy named Mykhailo uses a prosthesis in everyday life. But not on the playground. Because it is easier for him to run and play football with crutches.
If the choice is between a prosthesis and a wheelchair, then, of course, it is better to teach the child to use a prosthesis. But it depends on the level of amputation, the complexity, and the child’s motivation. And the child may say, “No.”
Let’s go back to basics: what is rehabilitation? It is either restoration or compensation for lost function. And if a prosthesis is something that really helps functionally, then it is worth using. But the mere presence of a prosthesis is not a guarantee of quality of life.
When a soccer ball becomes a rehabilitation tool
Even in the acute stage of rehabilitation, there is a component of play. It is present in every part of rehabilitation when it comes to children. It is an important motivational tool. This does not mean that 17-year-old boys or girls play with puzzles. There are other activities that allow you to involve the child in the process.
Play is the rehabilitation specialist’s “entry ticket” to the child. It is a bridge for building trust. The child develops through play. And this is one of the elements of returning to normal life. Play works well when the child has fears — it helps to distract them.
“We don’t choose the game. The game chooses us. First, we establish contact and find out about the child’s interests: soccer, badminton, mosaics, bracelets. Play in rehabilitation is closely related to what the child loved before the injury. For example, I might suggest to a patient who played soccer: “Friend, don’t want to do boring exercises? Let’s play soccer instead. Let’s see who can kick the ball more times with their hand, foot, or head.” Through such games, the child returns to activity.
There is a methodology to the game. We can use the game to develop a certain quality — for example, strength. For parents, it’s just “strength,” but for a specialist, it can be maximum strength, explosive strength, or strength endurance. The choice of exercise depends on the goal: to jump, climb a floor, or walk a distance. And the game is selected according to these needs.
So that parents don’t think we’re just playing, we discuss the action plan, examination, and goals with them. Because a frequent question is, “When will rehabilitation end?” And the answer is that it all depends on the goals. If the goal is to conquer Everest, that’s one story. If it’s to make yourself a sandwich, that’s a completely different story,” says Serhii Khuda.
The rehabilitation of such children is not a one-time event, but a long process in which all components are important: the coordinated work of a multidisciplinary team, the participation of parents, psychological support, correct positioning, and gradual loading. Play in this process is not about “entertainment” but about a tool for interaction, motivation, and the gradual return of the child to an active life.
Finally, it is extremely important not to waste time: rehabilitation should begin in the hospital, in the first days after stabilization. And it should not end after discharge — after all, a child’s life is not divided into “before” and “after” rehabilitation. It continues. And our task is to make it dignified, painless, and fulfilling.
