PHYSICAL THERAPY AND OCCUPATIONAL THERAPY FOR MILITARY PERSONNEL WITH GUNSHOT SHOULDER INJURY

Purpose. To conduct a comprehensive analysis of scientific literature regarding the contemporary state and specific characteristics of physical therapy and occupational therapy practices for military personnel with gunshot injuries to the shoulder, emphasizing current clinical practices, rehabilitation protocols, and therapeutic strategies.Materials and methods. This analysis employed bibliometric and structural-logical methods, examining an extensive range of recent literature sources. The literature selected included clinical studies, reviews, and expert recommendations, specifically targeting anatomical and physiological considerations pertinent to shoulder gunshot injuries and the resulting complications. Special emphasis was placed on examining the application and effectiveness of various physical and occupational therapy methods utilized during different rehabilitation phases to restore upper limb function in military personnel. Results. The findings underscore the critical role of physical and occupational therapy in the comprehensive rehabilitation process for military personnel with gunshot shoulder injuries. The complexity of such injuries often involves simultaneous damage to soft tissues, bone structures, vascular components, and nerves, necessitating a multifaceted and multidisciplinary therapeutic approach.A systematic assessment process is pivotal, involving tools such as manual muscle testing, goniometry for active and passive range of motion measurement, pain assessment scales, sensitivity evaluation, and standardized questionnaires like DASH (Disabilities of the Arm, Shoulder and Hand) and HADS (Hospital Anxiety and Depression Scale). These tools provide objective measures of functional impairment levels, forming the basis for customized therapeutic interventions.Implementation of the International Classification of Functioning, Disability and Health (ICF) framework facilitates a structured and detailed analysis of patient impairments, activity limitations, and participation restrictions, alongside considering contextual factors, including environmental influences and personal attributes. This comprehensive framework significantly enhances the efficiency and precision of rehabilitation planning and execution.The analysis identified modern therapeutic strategies employed within physical therapy programs, notably proprioceptive neuromuscular facilitation (PNF) techniques, therapeutic exercises involving different types of muscular contractions, sensorimotor training, and plyometric exercises. Clinical evidence indicates that integrating these approaches significantly improves muscular strength, endurance, joint range of motion, and proprioceptive sensitivity. Moreover, a phased approach in rehabilitation protocols, adjusting therapeutic interventions to match patient recovery stages, effectively mitigates risks of secondary complications and recurrent injuries.Occupational therapy was determined to play an integral role, specifically targeting the restoration of meaningful activities, enabling military personnel to resume important life roles. Core occupational therapy methods involve modifying daily activities, adapting environmental conditions, and employing therapeutic occupations to foster skill restoration and patient independence. The tailored nature of occupational interventions, progressively increasing in complexity, has shown effectiveness in enhancing patient motivation, improving adherence, and significantly contributing to their quality of life and community reintegration.Conclusions. Effective rehabilitation for military personnel suffering from gunshot shoulder injuries is best achieved through an individualized, multidisciplinary, and phased approach that incorporates both physical and occupational therapy. The structured use of functional assessments, clearly defined rehabilitation stages, personalized interventions, and continuous patient monitoring ensures the timely adjustment of rehabilitation measures, significantly enhancing overall outcomes. Further research should explore the long-term impacts of shoulder gunshot injuries and refine differentiated, evidence-based rehabilitation algorithms tailored specifically to the diverse needs of military personnel, ultimately fostering greater independence, satisfaction, and reintegration into civilian life.