Related to Material relating to the rehabilitation of spinal and spinal cord injuries
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Guttmann defines rehabilitation in terms of working capacity: 'Rehabilitation after peripheral nerve lesions means restoration of the working capacity of the injured person.' (305)

 

He places particular emphasis on the importance of beginning rehabilitation as soon as possible after an injury: 'Dr. E.A. Nicoll's opinion expressed on this subject in a recent paper on fractures "Rehabilitation starts on the first day of treatment" can be accepted in the full meaning of the words also for peripheral nerve lesions.' (305)

'precautions should be taken in all General and Military hospitals, particularly in Military Base-Hospitals, that the injured can be seen immediately by a Nerve Specialist versed in the after treatment of peripheral nerve lesions. Neglect of this vital principle of rehabilitation in the first period, even in the first days after injury, accounts for much of the prolonged disability of the injured person with all its economic con.sequienices.' (305)

 

He emphasises the importance of specialized centres for the treatment of nerve injuries: 'The congregation of cases in a single department under the same specialized staff, with continuous treatment under the same supervision, is certainly the best guarantee for a systematic study of the whole question, and for better results. The success of a centralized treatment and care of peripheral nerve injuries in other countries was shown by the "Peripheral Nerve Centres" in the U.S.A. during the last war and particularly by Foerster's work in Germany during and after the last war.' (305)

 

He also highlights the importance of continuing care of patients after discharge from hospital, especially in relation to returning to an occupation: Of the same importance as the primary supervision immiiediatelv after injury is the late supervision of these cases after their discharge from hospital... One of the main tasks of the "after-care service" is (1) to provide the injured man with light and graduated work in his former occupation ultil he is fit for heavy work; (2) to supervise this light and graduated work. In my own experience the best results in supervising the injured persons during the reconditioning period were obtained with the help of industrial medical officers and general practitioners.' (306)

 

He suggests ther should not be any absolute distinction between 'hopeful' and 'hopeless' cases: 'Cases with peripheral nerve lesions can be grouped into those in which restoration of nerve conduction is possible and those in which there is no chance of nerve regeneration. In regard to treatment, however, this distinction is not an absolutely strict one as similar principles have to be considered in both cases up to a certain point.' (306)

 

Guttmann considers maintenance of the 'elasticity' of muscles of paramount importance in rehabilitation: ''The position of paralysed limbs follows the principle of close approximation of the points of attachment of the paralysed muscles. The principle underlying treatment is to maintain and increase elasticity of the affected muscles. All experts on the subject agree that overstretching of a paralysed muscle even in the very first period after injury means a severe and often irreparable additional damage of the paralysed muscle.' (306) - these comments prompt a discussion of the importance of splints in maintaining appropriate body position.