Land Mine Victims Program Update

July 31, 2007

Michael Lear, CTP RYT, Movement Education Specialist



photo by Mail & Guardian

“Less than 10 percent of landmine survivors have access to proper medical care and rehabilitation. “ (Land Mine Survivors Network)
Real Medicine’s Team Whole Health Physical Therapy Enhancement Program, conducted in Sri Lanka by Body Workers Without Borders, has successfully trained PT’s in The Trager® Approach to more effectively address chronic pain associated with Sciatica, Ankylosing Spondylitis and Osteoarthritis as well as chronic spasticity related to Parkinson’s Disease and Cerebral Palsy. Post Traumatic Stress Pain and the underpinning psychological trauma related to the 2004 Tsunami was also effectively alleviated utilizing The Trager® Approach.

Optimal psychophysical re-integration and physical rehabilitation is paramount for those suffering from the pain and emotional challenges associated with limb loss. The Trager® Approach to Movement Education, provides an effective, pleasurable and relaxed, state dependent learning model ideal for such acute psychophysical trauma.

Educational and Clinical Services
Training Physical Therapists in progressive, lasting approaches to releasing dysfunctional compensatory muscle patterning and relieving Post Traumatic Stress related and/or Phantom Limb Pain of amputees associated with land mine accidents and limb loss.

Instruct therapists and patients in self care protocols as well as provide training to Lay Care givers in fundamental yet effective methods for relieving muscular and tension related pain and discomfort.

Active participation in clinical activities and demonstrate applications of The Trager® Approach for specific conditions.


Photo: JCRCI Thierry Gassmann

According to the Landmine Survivors database, while there seems to be a number of rehabilitation centers available, it appears that many are underutilized due in part a lack of transport for the clients, lack of patient education on the benefits of long term physical therapy interventions, lack of immediate results and the time and energy it requires to come regularly for sessions. Further, “In Zambezi province, Landmine Survivors Network (LSN) conducts home and hospital visits to assess the individual needs of landmine survivors and other persons who have experienced limb loss. LSN provides peer counseling, referral to services and direct support as needed.”

A program to educate lay caregivers in basic healing touch may bridge these gaps and provide local communities with local healers to facilitate this educational process of the benefits of physical therapy and related treatment protocols.


The Trager® Approach

Developed over 70 years ago by Dr. Milton Trager for the treatment of polio and sciatica, The Trager® Approach remains an innovative approach to movement education and self care which facilitates lasting neuromuscular change without setting up burnout or injury for the therapists.

The Trager® Approach utilizes gentle touch and rhythmic movements to cultivate a state of deep relaxation to release muscle holding patterns residing in the unconscious mind (like those induced by severe trauma) that often manifest as functional limitation, or pain. The rhythmic movements also introduce a new feeling state from which the patient can recall and experience the associated muscular changes. The effects of this work are cumulative and, through a series of sessions over time, can lead to increased self reliance that may reduce the frequency of visits and free up valuable resources at often inundated rehabilitation centers.

Participants also learn Mentastics® Self Care Movements to maintain their own well being and comfort while working. The efficacy of any treatment is largely influenced by the well being of the therapist. In demanding environments such as these in remote areas, having the ability to stay relaxed, comfortable and focused is essential to being able to administer the best possible treatment to patients.

An Introduction of The Trager® Approach for Physical Therapists

This Four-Week program is designed to introduce and reinforce the fundamental principles of The Trager® Approach to enhance their treatment protocols for chronic muscle pain, spasms, Post Traumatic Stress related pain, Cerebral Palsy, Parkinson’s Disease and other neuromuscular disorders, as well as educate therapists in self care. All programs are scheduled to integrate with existing staff schedules and clinic operations.

Lay Care Givers Healing Touch Workshop – An Introduction to The Trager® Approach

This is where I believe we can have our greatest impact; teaching everyone to be a healer. Through the introduction of the fundamental principles of The Trager® Approach, this program is designed to provide basic knowledge of healing touch to the care giver to empower them to participate in the ongoing care of their "patient" in between visits to rehabilitation centers. Ideally, this training follows the first Physical Therapy training by a couple of months and can coincide with a review training for the therapists.

Note: It is important that the physical therapists are somewhat proficient with the technique to support the learning of the lay caregivers and to be an ongoing resource for them. Having therapists assist these workshops when possible is highly recommended. The format for the following protocol can be modified depending on the availability of participants.

Program Value

While it is hard to quantify the value of restoring normal healthy function to individuals who have suffered substantially, it is necessary to summarize the cost of this education program and its cost benefit per patient treatment. The projected costs for a two-month program (two, one month programs) as outlined, is approximately $11,650. This includes airfare and accommodations and compensation for the trainings. Airfare, accommodations and ground transportation are based on Sri Lankan figures and will likely vary with the Mozambique project. There are 76 hours of education, sessions, and demonstrations, however not all therapists will be able to participate in every hour. The figures below are calculated on 56 total hours of participation. In the Sri Lankan model, the cost of each CE hour for each one-month program is based on training at least 15 therapists, but not limited to this amount, from various centers in Sri Lanka. The cost benefit per patient treated at Navajeevana is based on the 2005 annual report. Figures from the other centers in Galle and Jaffna were not available however the Galle center is larger while the Jaffna center is similar in size to Navajeevana. The Jaffna center treats more landmine victims than the other centers. Navajeevana treats 453 patients per month in their physical therapy clinic. Based on this information, it may be assumed that over 453 patients monthly benefited from this program.

The cost of the program based on a model where total value/cost is related to the training of 15 therapists only is $7.98 per Continuing Education hour. If the total value were to be split with the cost benefit per patients treated, the CE cost/hr. would be reduced to $3.99 per hour. Training more therapists would further increase the value by reducing the cost/hr. Based on a model where total value is related to the cost benefit per patient per single treatment (using only Navajeevana patient data of 453) the program cost equals $14.97 per treatment. Split with the value of therapist training, the cost drops to $7.40 for a single visit. Multiple visits by patients, which are most common during initial rehabilitation phases, further reduce this cost benefit. Using the split value consideration, one visit per month by each patient reduces the cost of treatment benefit per visit to $.62. This will drop even further into the next year and so on.

Translation if Necessary Cultural Differences – receptivity of therapists and members of the community to potentially abstract concepts of healing. (Please note however that some of this material may be more consistent with their indigenous beliefs than allopathic approaches)

To Donate in support of this program please mention Physical Therapy Enhancement Mozambique in the memo section of Pay Pal or on your check. Thank you in advance.

Country Page: Mozambique Initiative Page: Land Mine Victims Treatment Program