Related to National Spinal Injuries Centre, Stoke Mandeville Hospital.
Description:

'From its [the National Spinal Injuries Centre's] establishment, the daily routine for the patients whose numbers were increasing as a result of the D-Day invasion, was a combination of contemporary rehabilitative exercises and some new therapy devised by Guttmann. The regime that Guttmann followed was radical, in that rehabilitation methods were applied to those with spinal injury. Despite an initial lack of enthusiasm from the staff who held the contemporary opinion that there was nothing that could be done for such patients, active physiotherapy and remedial exercises, started while the patient was still in bed, were adopted in favour of the previous treatment of gentle massage of contorted limbs and bed rest. [note: 'Ludwig Guttmann, ‘Victory over Paraplegia’ in Ian Fraser (ed.), Conquest of Disability (London 1956), 65.'] If physiotherapy and exercise in bed were not enough, Guttmann also instructed his staff to throw medicine balls at the patients on the ward. [note: 'Susan Goodman, Spirit of Stoke Mandeville (London 1986), 143.']

While the patient was still in the ward attending to his exercise and physiotherapy, the curing process through competitive activity began.' (465)

 

'Guttmann exploited the competitive instincts of the men, thereby getting them to participate actively in their treatment. Exercise sessions were carried out in the wards in an attempt to encourage those who were still in bed.19 Competitions held in the wards included the timed ‘dressing exercises’, in which the patients had to get out of bed, dress themselves and get into their wheelchair.20 The record for this competition was four minutes.

When patients had gained some upper-body muscle tone, they were transported to the physiotherapy room, where they began a series of weightless movement exercises supported by ropes and pulleys.21 Once some control over movement had been established, the patients were given exercises such as hitting
a punch ball and pulling themselves upright between a set of parallel bars... Military protocol was still obeyed and officers and men were placed in separate wards. Female patients were kept in separate wards from the men, and were not exempt from the rounds of physical therapy...

The first moves toward more active sport and games for the patients at Stoke Mandeville came not from doctors or physiotherapists, but from the patients themselves. Two incidents had an impact on the development of sport in wheelchairs in Britain. In 1944, Guttmann watched from a window while the staff were having a break outside in the sun, occupying their time by throwing a ball around. The patients were sitting in their wheelchairs watching the staff, who began to include some of the patients in the game. The bending and stretching of the patients’ bodies gave Guttmann an idea, so from then on throwing balls to each other became a regular part of the patients’ exercise regime. On another occasion that same year, Guttmann discovered a number of patients trying to play a game which they had devised themselves. They had upended walking sticks so that the curved handle was on the ground and were pushing themselves around in their wheelchairs attempting to hit a wooden puck. [note: 'Goodman, op cit. [Susan Goodman, Spirit of Stoke Mandeville (London 1986)], 142.']' (465-466)

 

'Although wheelchair polo... failed as a long-term activity, the games in the gymnasium whetted the patients’ appetite for more. Guttmann searched around for a replacement. He chose archery, principally because it was beneficia in building up compensatory muscles in the upper body, as well as having the advantage of being a non-contact sport.' (467)

 

'Depression was a common result of long periods of inactivity, uncertainty and the slowness of the rehabilitative process. There were some suicide attempts. The authorities were aware of the problems faced by young men and women who had been severely disabled. The Service Subcommittee of the Research Board for the Correlation of Medical Science and Physical Education noted in its report: ‘The importance of the morale factor cannot be overstressed. It is essential to remove the inertia and despondency of hospitalisation and restore this will to get well.’ [note: 'Service Sub-Committee of the Research Board for the Correlation of Medical Science and Physical Education, Report on the Wounded and Disabled, Part III, 15 March 1944 in CMA SA/RBC C7.4.'] 

Guttmann heartily endorsed this sentiment, writing: ‘The whole unit must be deliberately impregnated with enthusiasm.’ [note: 'Ludwig Guttmann, ‘The Treatment and Rehabilitation of Patients with Injuries of the Spinal Cord’ in Zachary Cope (ed.), History of the Second World War (London 1953), 499.']... efforts were made to restore some normality by constant rounds of exercise and games, regular visits to the local pub and cinema, and projects such as the production of a journal aimed particularly at the Paraplegic Branch of the British Legion. Named The Cord, the magazine kept up the spirits of those at Stoke Mandeville with amusing anecdotes, articles on general medical care of the paraplegic body and news of ‘Stoke Mandevillians’.' (267)

 

'At the Spinal Unit at Stoke Mandeville, sporting and recreational activity was regarded as an important part of the process leading to the ultimate goal of rehabilitation, i.e. to be able to work for a living... An experiment with employment had been carried out at Stoke Mandeville in 1944, when a few patients had started working in a factory. The experiment was very successful, proving that those regarded as having serious residual disablement could put in a day’s work. It also ensured that the Spinal Unit received more funding to increase the provision of vocational facilities at the hospital.28 The main problem for paraplegics was their mode of transport, as an old furniture van was the only conveyance that could carry the men in their wheelchairs, and it was judged to be ‘of quite remarkable discomfort’. [note: 'The Cord, 1, 1 (Autumn 1947), 19.'] This made working outside the hospital very difficult, and so facilities were established inside the hospital to aid the adoption of new skills. At the Unit itself, occupational therapy, which had been an activity for many years in British hospitals, was available, and Stoke Mandeville opened its own workshop with machines which had been improved and adapted to hand-controls, where the men could practise carpentry, making and repairing shoes and clock and watch assembly and mending... 

The idea of training centres for disabled people was not new, as many had been established by charities and personal patronage specifically for disabled soldiers after the first world war. The key difference in the second world war, and indicative of the greater level of government involvement in all aspects of people’s lives, was that the responsibility for the establishment and operation of these centres was not placed in private hands — although a certain amount of care remained the work of charities — but rested instead with the state.' (267-268)

 

''The 1946 Report of the Standing Committee on Rehabilitation and Resettlement of Disabled Persons made no mention of sport or physical therapy, merely referring to the activities at Stoke Mandeville as ‘modern methods of treatment and rehabilitation’... Government reports also stressed the achievements of the Spinal Unit in rehabilitation. Patients at Stoke Mandeville had been able to ‘undertake remunerative employment under suitable conditions’ [note: 'Ministry of Labour and National Service, Report of the Standing Committee on the Rehabilitation and Resettlement of Disabled Persons, 1946.'] (471)

 

'The link between rehabilitation and sport remained strong at the Spinal Unit. Archery continued to be practised and there were various internal competitions between wards throughout 1946 and 1947. Then in 1948, a competition was organized between Stoke Mandeville and the Star and Garter Home in Richmond. Sport may have been an important aspect, but it was only one component, the main reason for the competition being to demonstrate the hospital’s work to the Minister of Pensions. Hilary Marquand was coming to Stoke Mandeville to present the hospital with a cut-down London bus so that the patients could be taken on outings and more importantly, transported to work. [note: 'Bucks Herald (6 August 1948).'] The approval of the Ministry of Pensions was important to the Unit as that particular Ministry funded Stoke Mandeville.' (472)

 

'As well as training and employment, the Spinal Unit continued to concentrate heavily on its sports programme, to such an extent, that by 1948 it was being criticized for neglecting its true function, which was to rehabilitate disabled ex-servicemen and get them back to work and to leading an independent life. In 1948, a representative of the Ministry of Labour and National Service went to Stoke Mandeville to examine the levels of training in the workshops and the rehabilitation potential of the Spinal Unit. As was so often the case, the visit presented an opportunity for Guttmann to get his patients to show off their proficiency in sport. ‘There were some excellent demonstrations including basketball and badminton by the women. Dr Guttmann has also introduced archery as he finds it excellent for developing shoulder muscles. [note: 'Report by Norah Hill on her visit to Stoke Mandeville, 25 October 1948 in PRO LAB 18/469.']' (472-473)

 

'active rehabilitation using remedial exercises, physiotherapy and exercise lessened the long-term effect of severe wounding. It had been applied to those with a range of injuries during and after the war at different centres, but it was the opening of Stoke Mandeville in 1944 that heralded a new regime for those ex servicemen with spinal paralysis. The funding of the Spinal Unit by the Ministry of Pensions, and its expectation that the severely-disabled could be returned to work, as enshrined in the Tomlinson Report, was essential to the whole enterprise.' (474)