[Rehabilitation of multiple injured patients]

Severe multiple trauma raises difficult problems of rehabilitation. In the most usual cases, other injuries are associated with head injuries and coma, and they must be systematically screened by a very complete radiological assessment and a thorough clinical examination. Rehabilitation will be passive as long as the injured person is comatose; however, it is very important as it allows preventing bedsores and the reduction of joint amplitude that may have serious consequences later on. The associated fracture of the limbs require orthopedic or surgical solutions. External fixation devices, which are sometimes used, complicate the rest of rehabilitation. Fractures of the spine are fortunately rare, even more so when associated with lesions of the cord causing paraplegia and tetraplegia. Thoracic complications are frequent and sometime produce a complicated postoperative period so that the removal of the tracheal tube, and sometimes the suppression of feeding through a nasogastric tube or gastrostomy, will be delayed. The management of head injuries is complex. First of all the injured person, whose consciousness often is fluctuant for some times, must be reassured, pampered, then progressively helped to cooperate and to take care of himself again. The disorders, including disorders of speech, of vision, deficiencies, disorders of balance, of coordination, will be as completely assessed as possible through a complete examination. The existence of frequent orthopedic disorders will hinder the progress towards self-reliance. Simultaneously, the cognitive functions will be restored: the memory is often severely disturbed, and disorders of attentiveness and reasoning must also be dealt with. As far as possible, attempts will be made to treat the very