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CHAPTER 4
The Spinal Injuries Centres of the Veterans Administration in U.S.A. are still
confronted with serious disadvantages. They are restricted to spinal cord injured patients
who are or have been members of the Armed Forces. Moreover, the vast majority, if not
all of these patients are not admitted immediately after onset of paraplegia or tetraplegia
to receive a comprehensive treatment from the start but are transferred at later stages
from hospitals concerned with their initial treatments, consisting of immediate or early
laminectomy or fusions as methods of choice, while the all-important initial management
of the paralysed bladder or the prevention of pressure sores are not fully understood or
are even neglected. The patients are transferred after weeks or months to the Spinal
Injuries Centres of the V.A., often with serious complications, especially of the urinary
tract, for 'rehabilitation'. Only recently, a detailed account of this unsatisfactory state
of affairs resulting from such dichotomy of management has been given by Jacobson &
Bors (1970) concerning war casualties of spinal cord lesions from the Vietnamese Combat.
Civilian patients with spinal cord afflictions, including traumatic lesions, are treated in
private hospitals mainly by neurosurgeons or orthopaedic surgeons and later in general
Rehabilitation Centres, and there is indeed a great shortage of proper Spinal Injuries
Centres for civilians in the U.S.A. This has been realized by leading members of the
medical profession and the House of Representatives of the U.S.A., and it is significant
that an outstanding surgical society such as the Gushing Society of the American Neuro–
surgeons, at their Congress in Chicago, 1967, passed a resolution urging the Government
and Congress to establish Spinal Injuries Centres for civilians. Efforts are recently being
made by the authorities concerned to set up regional Spinal Centres for civilians, and the
first of this kind has been set up at Phoenix under Dr J.Young and Dr D.Cheshire has
joined him recently as director of research. Dr Young who formerly was director of the
Craig Rehabilitation Centre in Denver (Ohio), is very determined to develop a compre–
hensive management of paraplegics and tetraplegics from the start and throughout all
stages in his Centre.
Sport amongst paraplegics in U.S.A. has been practised since 1947, fast almost
exclusively in basketball, and the U.S.A. teams have excelled themselves by their skill
in this sport at the Stoke Mandeville Games for many years. Gradually they also have
included many other events in their sports and Mr Ben Lipton of the Bulova Industrial
Training Centre for watch-making, New York, has played a leading part in the develop–
ment of sport for paraplegics.
