F • CLINICAL ASPECTS OF SPINAL CORD INJURIES
579
who believe it is better to use too much bracing and then reduce the braces to the proper
size. It is not my experience, that the addition of more extensive bracing has ever con
veyed to the patient the feeling of failure nor is it much easier technically, as has been
argued, to cut down braces to a lower level than to start with small braces and build up,
if needed (Betts & Rosen, 1969).
In certain individuals with spastic incomplete lesions, the overaction of the quadriceps
may produce hyperextension of the knee, resulting in genu recurvatum. To avoid this
complication, the provision of a long caliper without locking knee joint hinge but with a
pad behind the knee to stop hyperextension, has proved very beneficial.
MEANS OF TRANSPORT
WHEELCHAIRS
For the paraplegic's and tetraplegic's locomotion, a wheelchair is indispensable and
represents the most essential equipment to promote their independence and social
reintegration into the community. The time has passed when the paralysed with function
of their upper limbs had to spend their lives in rigid and clumsy 'bathchairs' or even in
wicker-bodied invalid carriages. Changing demands, commensurate with the advances
made during the last quarter of this century in the rehabilitation of spinal cord sufferers,
have resulted in developments in the design and construction of wheelchairs. Following a
Symposium on Wheelchairs, organized by the Polio Research Fund and held under
my chairmanship in November 1963 in London (published in 1964 in the
Journal of
Paraplegia,
2, 20-70), in which medical experts, representatives of the Ministry of
Health, engineers, manufacturers and wheelchair users took part, much information has
been correlated in assessing design requirements, which has resulted in intensifying
research on this subject in this country and abroad (Nichols
et
a/., 1966; Agate, 1967;
Scott & Mason, 1966; Lewin & Brettgard, 1968). At that time, the National Health
Service alone purchased, at an average annual rate of 13,000 wheelchairs, and, during
1962-63, 23,000 wheelchairs were issued, of which 16,000 were loaned to new patients of
various disabilities. The total number of wheelchairs issued at that time was approxi
mately 67,000 (Jolly, 1964). There is no doubt that these figures have increased ever since.
Naturally, this large number of wheelchairs given free on permanent loan by the National
Health Service to severely disabled persons of various disabilities, must have some bear
ing on cost. Therefore, the Ministry's endeavour is to evolve wheelchairs, which on the
one hand will meet the needs of the majority of invalids and on the other lend themselves
to bulk production methods, such as the model 8 series, described in its
Handbook of
Wheelchairs
(Walker, 1964). In this connection, it is debatable whether model series i, 3
and 9 described in the handbook are really necessary for bulk production, even if one
considers disabilities such as cerebral palsy, arthritis, cerebo-vascular disease, multiple
sclerosis, etc. However, as far as wheelchairs for spinal paraplegics and tetraplegics are
concerned, the Ministry does not reject the prescription of the Everest and Jennings
wheelchair as far as Stoke Mandeville Spinal Centre is concerned, although it is not
