Related to Material relating to the rehabilitation of spinal and spinal cord injuries
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'Battle and air raid casualties involving injuries to the spinal cord and cauda equina with resulting paralysis excite our deepest sympathy and undoubtedly deserve the very best surgical and medical treatment available...

Until recently [however], the medical profession still seemed to be possessed with the old idea that little could be done for these unfortunate sufferers. Experience during the present war has shown that these cases are by no means as hopeless and helpless as was previously thought and that the modern principles of rehabilitation can be successfully applied to these men to prevent their being cast on the human scrap heap.

Rehabilitation after spinal injuries seeks the fullest possible physical and psychological readjustment of the injured person to his permanent disability, with a view to restoring his will to live and working capacity.' (6)

 

Recommends rapid evacuation of war casualties to maximize effectiveness of treatment: 'With rapid evacuation - i.e., within 48 hours - there is seldom need at this stage to tamper with the paralysed bladder or to subject the skin to the hazards of spinal immobilisation in plaster.' (7)

 

Identifies pressure sores and urinary infection as principal causes of post-injury complications: 'Two complications, which are the common cause of sepsis and death after spinal injuries, need special and permanent attention: pressure sores and urinary infection.' (8)

 

Discusses method of treating pressure sores: 'The patient is nursed on a special bed, which is rigid to prevent sagging and which is high to facilitate nursing, but not so high that nurses of average height cannot turn the patient without dragging. He lies on an air or sorbo mattress, but even more important than special mattresses are plenty of small pillows to support the paralysed limbs and trunk in the various positions adopted as a result of frequent turnings. The skin is kept scrupulously clean and the pressure points have gentle massage after each turning. Some patients were turned every t to I hour during the day and every 2 hours at night. This can only be carried out successfully if there is sufficient nursing staff available, and this is one of the reasons why a spinal ward needs a larger nursing staff than a general ward.' (8)

 

Suggests standard method of treatment of paralysed bladder by suprapubic cystotomy is not necessarily the most effective: 'In the present war, suprapubic cystotomy has been adopted by most of the surgeons as a routine emergency method in the early treatment of the paralysed bladder on the battlefield. Judging by the presence of urinary infection which has always existed in patients admitted to the Centre after suprapubic cystotomy (in a considerable number of cases of severe ascending type even), and by the presence of contracted bladders which have developed after this procedure, there is no real reason to consider this method as the method of choice in the treatment of every case of paralysed bladder.' (10)

 

Notes that in his own clinic (Stoke Madeville), 'Whenever practicable, suprapubic drainage is discontinued to encourage better voluntary action of the bladder.' (10)

 

Emphasises the importance of psychological as well as physical care: 'The sudden conversion of a vigorous man into a helpless cripple naturally tends to severe psychological shock and reactive depression. From the beginning, the patient's mental condition needs careful attention and treatment to prevent anxiety or resentment, which lead to apathy and inactivity...

the creation of a cheerful atmosphere and high morale in the ward is of vital importance. The whole unit must be impregnated with enthusiasm, and this inspires the patient to cooperate to the full... Indifference, anxiety and resentment, as well as the over-cheerfulness and self-deception which some of the cases show, also need attention in later stages.' (11)

 

'The idea is to mobilise all compensatory mechanisms in the paraplegic, in order to shift his psychomotor capabilities from the lower to the upper part of his body.' (11)

 

Suggests plaster beds can have deleterious effect on recovery: 'There have been patients - especially those who were admitted in plaster beds - whose recovery from paralysis was impaired by superimposed stiffness of all joints of the lower limbs and the spine.' (11)

 

Emphasises importance of movement for rehabilitation: 'From the first, physiotherapy is started with passive movements of the paralysed limbs to prevent stiffness of the joints... As soon as possible, especially when some voluntary function has returned, movements of joints by suspension methods in slings (as recommended by Guthrie-Smith, 1943) are added and have proved very effective.

Active exercises play a cardinal part in the rehabilitation of spinal injured, and these should be started early.' (11)

 

Cites wheelchairs as promoting of active exercise: 'As soon as possible...-the patient is promoted to a wheelchair. This in itself adds greatly to his range of activity.' (11)

 

Use of parrallel bars in rehabilitation: 'Most of the exercises are done in the wards, which are equipped with Balkan beams and parallel bars.' (12)

 

Highlights importance of game-playing for especially British patients, and own role in developing sports for patients: 'Games play an important part in the physical and psychological readjustment of paraplegics. In a country in which the play instinct is so highly developed, games are always appreciated by the patient as a good method of rehabilitation... The writer has introduced a special game, which is called 'wheel-chair polo'. The idea of this game is to distract the patient's attention from his disability, to keep the man's intelligence and concentration lively, to promote a good blood circulation, to keep his healthy limbs supple, and to invigorate the body.' (13)

 

Suggests wind instruments would also provide an appropriate mode of excersise: 'It is also planned to form a musical band with these men, with wind instruments. Besides proving a form of entertainment and increasing the men's independence, it will also help to strengthen their abdominal muscles.' (13)

 

Ultimate goal of recovery is to return men to work: 'in time, patients tire of making toys and crave for some serious employment...  it is hoped that, in future, vocational training of the spinal injured can be started at an early date, while the man is still in bed... 

We are still in the pioneer days with rehabilitation of spinal injured persons, and there is much more to be done for these tragic war casualties, especially for adjustment of employment to their permanent disability.' (14-15)

 

'The aim of physiotherapy and occupational therapy in paraplegics is to mobilise all compensatory mechanisms in the injured person, in order to shift his psychomotor capabilities from the lower part of the body to the upper. Games play an essential part in the rehabilitation of traumatic paraplegics. Wheel-chair polo has proved especially successful. Early vocational training is the best form of occupational therapy in paraplegics. The importance of special facilities for employment in the physical and psychological readjustment of paraplegics is emphasised.' (15)