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CHAPTER 33
Exercises to restore independence
SELF-DRESSING
To prepare paraplegics for future independence, self-dressing exercises are included
in our programme, as soon as they are able to raise themselves from the lying to the
vertical position. They are taught and encouraged by both the physiotherapist and
nursing staff to dress themselves in the minimum of time. This procedure includes
hoisting themselves from their beds on to their wheelchairs, either with or without the
aid of a chain handle fixed over the bed. In due course, paraplegics will develop their own
most suitable individual technique, especially with regard to putting on their trousers,
socks and shoes. It was found that a well-trained paraplegic, paralysed at or below Tio,
should be able to dress himself completely (without putting on his calipers) in about 5
min, higher lesions between 8 and 18 min. Timing of these patients during the dressing
exercise by the physiotherapist or nurse is important for promoting punctuality in their
routine daily activities in the ward and attendance at the physiotherapy department and
workshop, and this is a useful preliminary for their employment later.
TRANSFER FROM BED TO WHEELCHAIR, FROM WHEELCHAIR TO CAR, ETC.
This training is essential for the paraplegic's ambulation. Here again, physiotherapist,
occupational therapist and nursing staff have to share in the training and assist the patient
until he becomes proficient in this, by no means easy performance. Knocking the hip
against the armrest of the wheelchair, or the ankles or feet against the footrest of the
wheelchair or the edge of the floor of the car must be avoided to prevent bruises and sores.
Transfer from bed to wheelchair or wheelchair to the bath, toilet or car and vice versa
should always be carried out without haste and under strict visual guidance. The phrase
'Look before you leap!' should become engrained in the paraplegic's brain, as this will
be the best prevention ofbruises, traumatic bursae and last but by no means least, fractures
of the legs. A few of our paraplegics fractured legs, by sheer carelessness, when trans
ferring themselves from the chair on to the toilet.
The technique of transferring from wheelchair on to the bed, toilet, bath or car and
vice versa naturally varies according to the level of the lesion, age, individual aptitude
and skill of the patient on the one hand, and type of bed, wheelchair, toilet, bath, motor
tricycle or car on the other, and in due course, every paraplegic has to adopt by training,
his own favourite routine. Some prefer, when transferring from bed on to the wheel-
chair, to have the chair parallel to the bed, while others have the chair standing at right
angles to the bed. The easiest and safest procedure for beginners is, to have the chair
fixed by its brakes alongside the bed. The patient, sitting as near to the edge of the
bed as possible, should hold with one hand the handle of the movable bedpole and with
the other support himself on the farside armest of the chair. He then lifts his body on to
the seat of the chair and afterwards moves one paralysed leg after the other with his
hands on to the footrest. At a later stage, the paraplegic may dispense with the handle of
the bedpole altogether and push off the bed with his extended arms. The transfer from
bed on to the wheelchair and vice versa is greatly facilitated, and knocking of the hip
