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CHAPTER 33
quoting from an article—'Looking Back'—written in 1949 by a former physiotherapist
of this Centre for
The Cord, 2,
33-35, the journal of British paraplegics: 'Such small
and disheartening knowledge as we had of the occasional paraplegic treated during our
training in no way encouraged us to hope that we should come into further contact
with them'. But, she concludes: 'From the days of dread of having to go and move some
wretched immobile paraplegic's toes, hoping to avoid embarrassing questions, yet remain
falsely optimistic, one can now with confidence sum up the probable picture and
thoroughly enjoy the years spent in helping him to become an individual—independent,
mobile and reasonably fit'. In recent years, it has become routine for many physiotherapy
training schools to send their students to this Centre for lectures, and throughout the
years numerous physiotherapists from many countries came to Stoke Mandeville to be
trained in our methods. Moreover, post-graduate courses in physiotherapy in spinal
paraplegia are held every year by the senior medical staff and physiotherapy staff, for
merly under the leadership ofMiss D.Bell and since her retirement, most efficiently under
that of Miss I.Bromley, Superintendent Physiotherapist.
Techniques
Details of the principles and techniques of physiotherapy as introduced and developed
in this Centre since 1944, have been published elsewhere (Guttmann, 1946, 1949, 1967;
Hobson, 1956) and they are here summarized and supplemented. Moreover, Miss
E.P.G.Hobson (1956), a former physiotherapist of this Centre, published a short mono
graph on 'Physiotherapy in Paraplegia'.
The two fundamentals in the physical treatment of paraplegics and tetraplegics are
early start and continuity until the maximum of benefit is accomplished. The chief
objects to be pursued are as follows:
i. Physiotherapy applied to the paralysed parts of the body
This comprises:
a Prevention and treatment of contractures and atrophy (correct positioning, passive
stretching, passive and auto-assisted movements).
b Electrotherapy in lower motor neuron lesions.
c Management of the respiratory disturbances in tetraplegia.
d Treatment of spasticity (see special chapter on Spasticity).
(a) In the early stages, the physiotherapist has to assist the nursing staff in keeping the
paralysed limbs in proper position, in order to prevent continuous adduction, flexion,
internal rotation of the legs, drop foot, claw toes, and pressure to the neck of the fibula.
In particular, the customary practice of placing a 'donkey' underneath the knees should
be avoided, as it produces flexion of knees and hips which, if continued for long periods,
inevitably leads to contractures of the flexor muscles of the knees and hips, which in turn
encourage and increase flexor spasticity once the period of flaccidity in cord lesion has
ceased.
