CHAPTER 33
PRINCIPLES AND TECHNIQUES OF
PHYSIOTHERAPY
The role of the medical and physiotherapy staff
One of the predominant activities of the specialist in charge of a spinal unit and his senior
medical staff is the planning and personal supervision of the physical treatment of his
patients. For, upon their knowledge of each case and their functional and psychological
analysis of the patient's disability, depend indication, duration and modification of the
various forms of physiotherapy. In every case, a constructive programme has to be
devised, and never is the physiotherapy department called upon blindly for 'physio
therapy, massage or remedial exercises', just to make the patient feel 'that something is
being done'. For each instance, the physiotherapist in charge of the case must receive
detailed instruction about the patient's disability and the treatment to be applied, which
must be carried out in concert with that of the other members of the team: the nursing
staff, physical training instructor, occupational therapist, and vocational training
instructor, for all these personnel also take part in the physical restoration and psychological
readjustment of the paraplegic and tetraplegic. On the other hand, physiotherapists have
to take part in certain procedures which are usually considered as the prerogative of the
nursing staff, such as the proper positioning of the paralysed in the acute stages and, in
particular, assisting in overcoming respiratory distress and lung complications of tetra-
plegics. With her specialized knowledge and experience, she can greatly assist the patient
to accomplish his satisfactory return to the community. For, by her regular contact with
the patient, she learns problems which may have not been revealed to other members of
the team. Therefore, she can act as a vital link in the chain of communication and can
pass on important information to the medical officer in charge of the case and to other
members of his team, which is so helpful for a successful rehabilitation.
It has been our experience throughout these years, that the physiotherapists connected
with the physical restoration of spinal cord sufferers have become deeply interested in
and even fascinated by the daily problems of their cases. This has, no doubt, developed
as a result of the establishment of a regular, weekly session, nick-named 'Circus', in the
Physiotherapy Department, held regularly by the Director of the Centre and his whole
medical staff. At these sessions, every patient is seen, and details of progress and treat
ment discussed with the physiotherapist in charge of the case. Throughout the years,
societies of physiotherapists and remedial gymnasts, as well as the speciality of physical
medicine as a whole, have benefited greatly from the new approach to the treatment and
rehabilitation of traumatic spinal paraplegia. Their rather passive and palliative approach
of the past towards these patients has been replaced by a programme of purposeful
activity and dynamic rehabilitation. The fundamental change which has taken place in
the attitude of the physiotherapist towards paraplegic patients is best evidenced by
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