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

'It was a new approach [in 1944] to teach that bedsores and urinary infection were by no means inevitable consequences of a spinal paraplegia and to convince the nursing staff that the proper treatment of pressure sores could be as gratifying a life-saving achievement as the successful operation of a perforated duodenal ulcer or brain tumor.' (256)

 

'The rehabilitation of traumatic spinal paraplegics... cannot be one person's job - it is team work in which the physician or surgeon in charge has to act as the leader and co-ordinator until the paraplegic's return to a useful life. One of the fundamentals in team activities is that the various members of the team - nurses, physiotherapists, occupational therapists, vocational instructors and social workers [nb: no physician in this list] - learn to respect each other's work as that of equal partners. For, in the management of paraplegics there is not the same clear division in the activities of the nurse and the physiotherapist as exists, for instance, in the pre- and post-operative care of short-term surgical patients. A distinct feature in the management of these long-term patients is the close integration of the work of the various members of the team.' (257)

 

'When the patient has arrived at the hospital, the principle of care in lifting and turning the patient in one piece by four attendants from the stretcher on to his bed, X-ray or operating table, must be strictly adhered to, as this is the main factor in preventing further damage to the spinal cord or spinal roots. The routine procedure at Stoke Mandeville Spinal Centre in dealing with traumatic paraplegia in the initial stage after fracture or fracture dislocation is the employment of postural reduction on sorbo packs and regular turning, the technique of which is follows: The patient is placed on sorbo packs with one, two or three additional pillows underneath the fracture to produce hyperextension of the spine in the physiological position, in order to restore, as far as possible, the normal curvature of the spine (see Plate XLV). From the basic, supine position the patient is turned first on to one side (Plate XLVI), the hyperextended position being maintained by the use of a big sandbag to support the pillow in the back, then back to the supine position, and then on to the other side. The lifting and turning is carried out by three or four attendents working under the guidance of the sister or nurse in charge of the case, and they are made fully aware of the details of the fracture and the importance of carrying out the lifting and all movements simultaneously, so that the patient is turned in one piece without dragging.' nb: refs are to two v. clear images of 'supine' and 'side' positions.