Related to Material relating to the rehabilitation of spinal and spinal cord injuries
Description:

Characterizes rehabilitation of spinal injury as lagging behind change in attitude towards disability at the start of WW2: 'in the early stages of World War II, when the modern conception of rehabilitation of the disabled was generally accepted for amputees and other crippling disabilities, spinal paraplegia was not included in this concept.' (115)

 

Suggests that early specialized units in Britain suffered from a lack of staff members who could devote full-time attention to spinal nerve injuries: a fundamental step forwards in a new approach to the management of spinal paraplegia was taken in Great Britain by the Peripheral Nerve Committee of the Medical Research Council under the leadership of Dr. George Riddoch, Neurological Consultant to the British Army, Ministry of Health and Ministry of Pensions, when it was decided to congregate spinal cord casualties in special units... However, the first spinal units did not prove satisfactory as they were attached to neurosurgical or orthopaedic units and no one member of their staff devoted more than a part of his time to the care and management of spinal injury patients.' (115)

 

Suggests that during the early years of Stoke Mandeville unit it was necessary to demonstrate that rehabilitation was possible in the first place, as well as to ameliorate the adverse effects of estabished modes of treatment: 'Two groups of patients were admitted:

1. Those in the acute stages of paraplegia following gunshot injuries, fracture dislocations and transverse myelitis. These patients were of particular importance to prove that it was in fact possible to avoid those complications which, throughout the ages, were considered as inevitable and the causes of the paraplegic's early death, namely sepsis, due to pressure sores and ascending urinary infection leading to renal deficiency...

2. Those in later stages of paraplegia suffering from many complications as a result of incompetent initial treatment, lack of proper facilities, or sheer neglect. Their condition was often extremely serious, demanding greatest vigilence and prolonged intensive efforts on the part of all concerned with their management to restore them both physically and mentally.' (116)

 

Highlights tendency of authorities to classify paraplegically injured individuals as 'incurable', and the contrasting efforts at the hospital to return patients to working life: 'it was quite revolutionary to teach and impress on the authorities of medical and social services, in particular the Ministry of Labour and Housing Authorities, that the mere fact that a person was a paraplegic did not justify care in one of the institutions for 'incurables', but that in spite of his severe physical handicap, rehabilitation to a useful life and employment was possible in the great majority of cases. In this connection the first experiment to prove that paraplegics could work side by side and in competition with able-bodied workers was carried out with our first six rehabilitated paraplegic ex-servicemen at the end of 1944.

It was also during the war that sport and regular work were introduced as essential parts in the medical treatment of these patients which, in due course, proved so very successful for their physical, psychological and social rehabilitation.' (117)

 

Includes statistics on admissions, recovery rates, and rates of re-employment of patients. (118-123)

 

Notes the emergence of dedicated out-patient care between 1951 and 1962: 'A systematic out-patient service was organised to deal with routine clinical check-ups for the increasing number of patients discharged to their homes and other institutions, in particular, for those who had found employment and were anxious to have as little time off work as possible. This has proved to be a most essential part of our work in detecting and treating any deterioration in a paraplegic's condition and thus keeping as many of them as possible at their work.'  (123-124)

 

Emphaises importance of specialist unit as a research centre and for attracting scientific attention to spinal injury: 'From the beginning, intensive clinical and experimental research has gone hand in hand with the clinical work. Research workers from this country and abroad have visited the Centre and some of them co-operated in research on certain physiological problems of the spinal man...

Meetings of medical and scientific organisations such as the Neurological and Orthopaedic Section of the Royal Society of Medicine, the British Biochemical Society, the British Society of Biological Engineering and Sections of International Congresses have been held at the Centre throughout the years. Regular International Scientific Meetings of Paraplegia have been held since I954 on the occasion of the Annual International Stoke Mandeville Games. As a result of these meetings the International Medical Society of Paraplegia was founded in I96I at Stoke Mandeville' (124)

 

Notes growing importance of unit for training: 'Throughout the years the Centre has been engaged in teaching undergraduates and post-graduates of the medical profession as well as nursing, physiotherapy, and occupational therapy professions, and this activity has immensely increased in recent years...

Physicians, surgeons and medical students as well as administrators have visited the Centre from many hospitals in this country and abroad, and the Centre takes part in the regular post-graduate courses arranged by the British Council...

Apart from regular visits of groups of nurses sent to the Centre for formal lectures from the Royal College of Nursing, three-monthly Post-Graduate Courses have been introduced since I953 which are attended by nurses from this country and from all over the world. Some of these post-graduate nurses continue working in the Centre after the course to gain more detailed experience...

In addition to full-day visits of individuals and groups of physiotherapists and occupational therapists from teaching schools, annual post-graduate courses for physiotherapy are held which have become quite popular.' (124-125)

 

Finally, discusses the significance of sport for rehabilitation, and the hospital for the emergence of the paralympic movement: 'Since the inception of the Stoke Mandeville Centre, sport has played a very important part in the physical, psychological as well as social rehabilitation of the paralysed, and the profound value of sport in preventing these patients from retiring into inactivity cannot be exaggerated. As I have already pointed out, sporting activities are included in the medical treatment and this has encouraged many patients to continue sport for their physical well-being and recreation after discharge from hospital. Interest and enthusiasm in competitive sport increased steadily, and in 1948 the Stoke Mandeville Games were founded as a sports movement for the paralysed. These Games, which at first were held annually as a national event, have developed since 1952 into the first organised annual sports festival for severely disabled people in the world...

As off-shoots of these Games the British Commonwealth Paraplegic Games and, more recently, the Pan-American Paraplegic Games have been founded.' (125)