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Friday, December 13, 2024 05:39
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Maimuna Rashid

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Hilal English

Healing Heroes: Inside Pakistan’s Leading Rehabilitation Center

November 2024

The Armed Forces Institute of Rehabilitation Medicine (AFIRM) is Pakistan's premier 400-bedded rehabilitation center, dedicated to restoring health and independence for patients with complex disabilities. Since its inception in the 1980s, AFIRM has led advancements in clinical care, research, and education in rehabilitative medicine.


AFIRM stands as Pakistan's cornerstone for rehabilitative care, offering exceptional services aimed at restoring health, independence, and dignity to patients with complex disabilities. As the only 400-bedded tertiary rehabilitation center in the country, AFIRM has established itself as a leader in clinical care, research, and education. Since its inception in 1980, AFIRM has grown exponentially, adapting to the nation's evolving healthcare challenges, particularly those arising from natural disasters, such as the devastating 2008 earthquake and the enduring War on Terror (WOT). These crises catalyzed the expansion and modernization of AFIRM, transforming it from a facility into a comprehensive rehabilitation institute with indoor units, specialized departments, and cutting-edge technologies. Today, AFIRM is recognized as one of the best rehabilitation centers in Pakistan and stands at the forefront of rehabilitative care in the region.
Historical Evolution and Expansion
AFIRM’s origins trace back to the 1980s when it was first conceptualized by then former President of Pakistan, General Zia-ul-Haq. A parallel institute was opened in civil sector by the name of National Institute of Handicap (NIH), which was later renamed to the National Institute of Rehabilitation Medicine (NIRM) in 2000.
Military doctors from AFIRM were sent to the United Kingdom (UK) for specialized training in the field of rehabilitation medicine. The fellowship in Rehabilitation Medicine was officially launched under the College of Physicians and Surgeons Pakistan (CPSP) in 1996, further formalizing the field within Pakistan.
However, AFIRM's pivotal moment came in 2005, when the devastating earthquake left behind one of the largest recorded numbers of spinal cord injuries. At the time, AFIRM was the only hospital in the country with a dedicated spinal injury program, which enabled it to manage the influx of patients effectively. This disaster underscored the vital role of rehabilitation medicine in national healthcare, pushing AFIRM to the forefront of the field.
The institute's expansion continued during the  WOT, as traumatic injuries, particularly amputations caused by explosive devices, required a further increase in AFIRM's capacity and services. This period saw a significant influx of injured military personnel, prompting the institute to quickly scale up its operations and expertise in handling complex traumatic cases.
AFIRM’s growth was not limited to physical infrastructure; it also established multidisciplinary rehabilitation departments, offering specialized care in various medical fields. The addition of indoor rehabilitation services in 2007 allowed for more intensive, round-the-clock care, transforming the institute from a small outpatient clinic into the largest and most sophisticated rehabilitation facility in Pakistan. Today, AFIRM continues to serve as a beacon of hope for patients facing life-altering disabilities, offering world-class care for neurological, musculoskeletal, and other complex conditions.


As the only 400-bedded tertiary rehabilitation center in the country, AFIRM has established itself as a leader in clinical care, research, and education. 


Comprehensive Range of Services
AFIRM offers an integrated approach to rehabilitation, addressing a variety of conditions, including:
Stroke
Spinal cord injuries
Traumatic 
Amputations
Cerebral Palsy (CP)
Geriatric rehabilitation
Musculoskeletal diseases, such as arthritis and joint disorders
Orthopedics and sports injuries
Pain management
Key Departments and Units
One of the defining features of AFIRM is its multidisciplinary approach to rehabilitation. AFIRM has developed highly specialized departments that cater to the unique needs of its diverse patient population. These departments work in tandem to deliver holistic care.
Pain Clinic. The Pain Clinic at AFIRM is a dedicated facility specializing in advanced, minimally invasive treatments to manage pain and enhance patients' quality of life. The clinic employs state-of-the-art techniques, such as ultrasound-guided injection procedures, which enable precise interventions, including intra-articular injections, genicular nerve blocks, radiofrequency ablations, Platelet-Rich Plasma (PRP) therapy, motor point blocks, and nerve blocks. These procedures are aimed at targeting musculoskeletal and neuropathic pain, promoting faster recovery and improved functional rehabilitation. By combining modern technology with personalized care, the clinic ensures comprehensive and effective pain management for its patients.
Physical Therapy Department
Equipped with modern technologies and therapeutic modalities, this department focuses on improving gross motor function, including mobility, balance, and strength. It features separate therapeutic areas for male and female patients, including designated male and female gyms, as well as a specialized amputee gym. Additionally, the department is equipped with advanced equipment like an anti-gravity and underwater treadmill ensuring comprehensive rehabilitation tailored to the needs of each patient while respecting cultural sensitivities.
Hydrotherapy Unit. Water-based therapies offer significant advantages for musculoskeletal and neurological rehabilitation, particularly in easing pain and improving joint mobility. AFIRM’s hydrotherapy unit is designed to provide a low-impact, high-effectiveness treatment option for patients recovering from surgery, injury, or chronic pain conditions.
Occupational Therapy Unit. This unit focuses on enhancing fine motor skills and improving patients' daily functioning. It includes a Cerebral Palsy (CP) section and sensory integration therapy tailored for children with developmental challenges, providing a nurturing environment that encourages skill development.
Vocational Training Centre. Beyond clinical rehabilitation, AFIRM emphasizes social reintegration through vocational training, offering patients skills to help them return to productive roles in society. This is particularly important for those affected by permanent disabilities, empowering them to live independently. The courses that we run include computer training, tailoring, zari work, electrical and mobile repairing. All these courses are recognized by the National Testing Board. 
Speech Therapy Unit. This department aids patients who have lost communication abilities due to neurological conditions, stroke, or trauma, offering personalized rehabilitation plans to restore speech and language skills.
Psychological Counseling Unit. Recognizing the emotional toll of severe injury or disability, AFIRM provides comprehensive mental health support through individual counseling and family therapy, addressing both immediate emotional needs and long-term psychological well-being.
Artificial Limb and Appliance Centre. AFIRM operates Pakistan’s largest Amputee Program, with over 2,000 patients actively enrolled, including more than 600 active-duty soldiers and 400 retired soldiers. As part of the Pakistan Army's policy, war-wounded soldiers are retained in service and rehabilitated to their fullest potential. 
The Artificial Limbs and Appliance Centre at AFIRM is central to this effort, offering advanced care and custom-made artificial limbs. Utilizing cutting-edge prosthetic technology, AFIRM provides amputees with sockets, silicone liners, prosthetic feet, and various orthotic devices, all fabricated in-house. Soldiers with upper limb amputations are provided with myoelectric prostheses. The bionic hand has revolutionized upper limb amputee care; this computerized hand features 14 different grips, significantly enhancing a patient's functional abilities.
AFIRM has made significant strides in advancing prosthetic technology through the indigenous production of myoelectric hands. In collaboration with the National University of Sciences & Technology (NUST), AFIRM has successfully developed a dual-grip myoelectric hand, which is already in use. This innovation allows users to control their prosthetic hand with electrical signals from their muscles, enabling more functional and intuitive movements. Furthermore, the development of a six-grip hand is currently in progress, which will offer even greater dexterity and functionality, further enhancing the quality of life for amputees. 



Home Modification Advisory Cell. To further bridge the gap between hospital care and successful reintegration into society, AFIRM has established a Home Modification Advisory Cell. This specialized service guides patients on adapting their homes and routines to accommodate their new physical realities. By providing personalized advice on improving accessibility and safety, the cell ensures that patients can manage their activities of daily living (ADLs) more independently and confidently. 



Sports-Integrated Rehabilitation. At AFIRM, we have taken an extra step by engaging our patients in sports activities, providing them with the necessary infrastructure, training, and specialized components. These highly motivated individuals have gone on to compete in numerous national and international sports events, bringing home honors and winning medals.
Halotherapy Unit. At AFIRM, this unit provides therapeutic treatment suing salt-infused air to support respiratory health, skin conditions and relaxation. It mimics the microclimate of salt caves to enhance respiratory function, alleviate allergies, and promote overall well-being.



Advanced Diagnostic and Electrophysiological Services. AFIRM is equipped with some of the most advanced diagnostic and therapeutic tools available in the country, making it a leading center for complex neurodiagnostic:
Nerve Conduction Studies (NCS) and Electromyography (EMG). Essential for diagnosing neuropathies, muscle disorders, and motor neuron diseases.
Visual Evoked Potentials (VEPs). Used for assessing the integrity of the visual pathway, this technology allows for early diagnosis of conditions that affect the brain's ability to process visual information and is performed by experts at the institute.



Urodynamic Testing. Critical for patients with spinal cord injuries, this test helps in the diagnosis and management of urinary dysfunctions.
DEXA Scan. Used to assess bone density and diagnose conditions like osteoporosis, particularly in immobilized or elderly patients.
Indoor Facilities. AFIRM's indoor wards offer specialized, round-the-clock care in areas like:
Neurorehabilitation Ward. Focused on patients with traumatic brain injuries, stroke, and neurological disorders, offering both acute care and long-term rehabilitation.
Spinal Cord Injury Ward. Designed for individuals with spinal cord injuries, this ward provides extensive support, including family integration to facilitate holistic recovery.
Musculoskeletal Ward. Serves patients recovering from fractures, joint replacements, and chronic musculoskeletal diseases, ensuring they regain strength, mobility, and function.
Amputee Ward. The ward focuses on personalized rehabilitation plans, including prosthetic fitting and training, pain management, and counseling services. The goal is to optimize each patient’s recovery, improve mobility, and help them regain independence, whether through advanced prosthetics or adaptive strategies.
Research and Innovation
AFIRM is not just a hub for clinical care; it is a leader in rehabilitation research in Pakistan. The institute is dedicated to advancing the science of rehabilitation through rigorous research that focuses on improving patient outcomes, developing new therapeutic methods, and enhancing the quality of life for individuals with disabilities. Research areas include:
Neuroplasticity and Stroke Recovery
Prosthetic Innovation and Amputee Rehabilitation
Spinal Cord Injury Management
Assistive Technology for Children with Disabilities
Urodynamics
Interventional Pain Management
AFIRM actively conducts clinical trials and participates in international research collaborations, ensuring that it remains at the forefront of the latest advancements in rehabilitation medicine. It encourages its staff to publish in peer-reviewed journals, contributing to global medical literature on rehabilitation practices. Additionally, research findings are frequently integrated into clinical practice at the institute, ensuring that patients benefit from the most current, evidence-based treatments.

Training and Capacity Building
AFIRM offers a range of specialized educational programs to build professional capacity in rehabilitation medicine:
4-year Fellowship Program. One of AFIRM’s most impactful contributions to the healthcare sector in Pakistan is its role in training rehabilitation specialists. Out of the 80 rehabilitation specialists in the country, 67 have been trained at AFIRM, a testament to its leadership in rehabilitation medicine education. AFIRM runs a highly respected fellowship training program under CPSP, where doctors undergo extensive hands-on training in various subspecialties of rehabilitation medicine.
12-month Rehabilitation Nursing Training Program. This program, accredited by the Pakistan Nursing Council (PNC), equips nurses with the skills required to provide comprehensive care to patients undergoing rehabilitation. The training emphasizes patient-centered care, focusing on the unique needs of individuals recovering from traumatic injuries or living with disabilities.
5-year Doctor of Physical Therapy (DPT). In collaboration with the National University of Medical Sciences (NUMS), AFIRM provides a rigorous 5-year DPT program. This degree trains students in the latest techniques of physical therapy, with an emphasis on rehabilitation sciences, preparing them to address musculoskeletal, neurological, and functional impairments in patients.
4-year Bachelor of Science in Occupational Therapy (BS-OT). Also offered in partnership with NUMS, this 4-year BS-OT program is designed to produce competent occupational therapists who specialize in helping patients regain independence in daily activities through adaptive methods and therapeutic techniques. The curriculum covers a broad spectrum of occupational therapy practices, tailored to meet the needs of a diverse patient population.
By fostering a generation of highly skilled specialists, AFIRM ensures that rehabilitative care continues to advance throughout Pakistan, reaching even the most remote and underserved populations.
International Collaborations and Professional Development
AFIRM is not only the largest rehabilitation center in Pakistan but also a leader in fostering international collaboration and expertise. The institute regularly hosts international teams of rehabilitation physicians from countries such as the U.S., Australia, Saudi Arabia, and others. These visits foster knowledge exchange and ensure that AFIRM remains at the forefront of rehabilitative care.
AFIRM also maintains robust exchange programs with Australia, Turkey, the U.S., the UK, and Switzerland. These programs provide valuable opportunities for AFIRM doctors to receive on-the-job training (OJT) in some of the world’s leading rehabilitation centers. This international exposure ensures that the staff at AFIRM remain updated on the latest rehabilitation techniques and technologies, which they bring back to benefit patients in Pakistan.
AFIRM’s journey from a modest outpatient facility to a world-class rehabilitation center mirrors the resilience, determination, and commitment of its staff and leadership. Through a combination of cutting-edge medical technology, a multidisciplinary approach, and international collaboration, AFIRM has cemented its place as Pakistan’s premier rehabilitation center. The institute’s mission is not only to restore patients' physical abilities but to reintegrate them into society as empowered, independent individuals. In doing so, AFIRM continues to redefine rehabilitation care in the country, making it a model for other developing countries in the region.



 

Maimuna Rashid

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