F- CLINICAL ASPECTS OF SPINAL CORD INJURIES
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make him aware of his responsibility towards his family and the community. Details of
physiotherapy and work therapy are discussed in the respective chapters.
The creation of a cheerful atmosphere and good morale in the ward cannot be stressed
too much. The whole unit must be deliberately impregnated with enthusiasm, for this
inspires the patient to co-operate to the full and will help to re-organize his disrupted
personality and thus restore the psycho-physical entity of the organism.
The psychological guidance of the paraplegic patient is, of course, primarily the
responsibility of the medical officer in charge of the case. He has to create a close doctor-
patient relationship, which will win the patient's confidence and make it easier for him
to disclose his anxieties. On the other hand, he has to co-ordinate the work of his team of
workers—nurse, physiotherapist, work therapist and welfare officer—concerned with the
patient's management. Every member of the team must be familiar with the patient's
personality and emotional reactions and conflicts. This will help to wean him from his
initial passive attitude into an active role, in which he will learn to consider himself
as the most important member of the rehabilitation team. Group exercises and team sport
have proved invaluable in developing competitive spirit and comradeship and preventing
a 'spoiled child mentality' (see Chapter on Sport).
A very important point in the psychological guidance is not only to make the patient
aware of his capabilities by utilizing his existing and developing dormant talents, but also
of his limitations caused by his physical defect. Only then will the paraplegic regain a
psycho-physical harmony enabling him to cope with the demands of daily life, once he
has left the protective life of the hospital.
Drug addiction and alcoholism, although in our material rare, can be most adverse
to the patient's rehabilitation, and it demands great patience and firmness on the part of
the patient's attendants to get him over these hurdles.
Equally as important as the psychological management of the paraplegic and tetra-
plegic is the psychological readjustment of the patient's relatives to the whole problem.
They have to be instructed in detail by the staff, during their visits to the hospital, on
how to deal with the patient sensibly and properly once he has returned home. They
must not be overprotective but must learn when to assist and when to resist unreasonable
demands. In particular and above all, everything should be done to help in the social
re-integration of the paraplegic, by encouraging him to take up regular work and employ
ment.
