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CHAPTER 37
2 Those tetraplegics without wrist extensors but with good functioning biceps and
partial functioning triceps can use these appliances with the aid of a cock-up splint.
3 The very high tetraplegics without function of any muscles of the upper limbs can
now use the POSSUM or another similar electronic apparatus as mentioned in the chap
ter on Historical Introduction. Moreover, tetraplegics, when at home, will need a mobile
hoist (Fig. 263) which has proved of great help to their attendants to lift them from their
beds into their wheelchairs and vice versa and also for the transfer of these patients to the
bath and toilet.
The work of the occupational therapist should be in close co-operation with that of
the physiotherapist as one profession complements the other.
Rehabilitation by work whereby emphasis has been laid on early vocational training
can conveniently be classified in the following stages:
(i)
Work therapy in the early stages
Naturally, in the early stage of treatment when the patient is still bedridden because of
his fractured spine and his complications, work first starts in the form of simple handi
crafts, as taught and supervised by the occupational therapist. Everybody concerned
with occupational therapy for paraplegics must clearly understand that this is by no
means occupation merely as a diversional measure. It is used immediately to restore the
lost power of concentration and to revive initiative in order to shift the psychomotor
capabilities of the paraplegic from the paralysed to the normal parts of the body. This
type of work is invaluable in developing the mobility and dexterity of fingers and arms,
upon which the future earning power of the paraplegic depends, therefore, this represents
already the first step in the paraplegic's industrial rehabilitation. The objects to be
pursued in this work are punctuality, skill and speed, and it is up to the occupational
therapist to instil these principles into the patient. It should be noted that several patients
who showed particular interest and ability in leatherwork, needlework or rug and toy
making have actually continued this work later on and have started a business on their
own at home. For others, the skill achieved in making leather handbags proved useful
in their training later for shoe repair and woodwork.
In certain cases, specific pre-vocational training was introduced even in the early
stages following injury, by correspondence courses in commercial art, accountancy,
banking and law. In a previous publication (Guttmann, 1946) mention was made of the
first man to pass his examination in law at the Centre, 10 months after his injury. He
was a young officer who was admitted in June 1944 from the battle-front with a gunshot
injury in the right lung, causing a large haemothorax, and through the spine resulting
in a complete paraplegia below Tn/i2. He was encouraged to start his studies while
laid up in bed. Fourteen months after injury, he entered Oxford University as an under
graduate, and at that time he was provided with a special grant from the Ministry of
Pensions to employ an attendant to take him, sometimes on his back, to tutorials through
the narrow stairways of the College. Four term? later, he was elected secretary of the Law
Society at his College, and in the summer of 1947 ne passed his final examination and 2
months later was employed in a legal department.
