pESEMBER 1975 F I S I O T E R A P I E 9 P L A 1 f o r w o r k - in There is an old saying which goes “Y ou can only take her anywhere twice — the 2nd time to apologise fo r the Urst;” — and here I am apologising on the 1st occasion! 'A>u are squashed in to a sm aller room because o f me my antics and if you do n ’t know your next door n e ig h b o u r now, you will do before you leave here this afternoon! T here is a ratio n ale behind it— higher ceiling; better accoustics; less plate glass to sm ash an d a better chance of making ‘contact’ with you which is vital. Please b e ar w ith m e fo r 40 m ins: o r so — y o u can get up and stre tc h y o u r legs later! May I introduce my C hairm an to you . . . ! P rofessor du T oit Thank you fo r the introduction . . . and fo r inviting me here in the first place . . . This is proving to be a “day of firsts” . . . for me . . . To begin with: “TODAY IS T H E 1st D A Y of the rest of my life” and o f yours too — so I hope you are not going to feel as if y ou’ve wasted it by the end of this lecture/dem onstration. 2. It’s the 1st tim e I ’ve lectured outside the British Isles and 1 really do thank you fo r the opportunity to do so. 3. To get here — it was the 1st time I’d flown since 1934 and in those days ’planes were open cockpit affairs held together by string and optimism. I was taken up for a i hour spin at a garden fete in a 2 -seater bi-plane and was lent a pair o f goggles by the pilot. In 1934 I was somewhat sm aller than I am today and the goggles fell down off my nose within the first m inute. F o r the rest of the exhilarating and adrenaline-producing flight I wore them like a bra round my chest and just let the wind VJjpg tears o f joy to my eyes. This 1975 and Jub'Iee time jat in luxury inside a Jum bo Jet w ith 359 others and contemplated the extent of aviation progress with awe and amazement — my 1 st time in a m odern aircraft. 4. It is also the first time I have m et my “victim s” — I suppose we could have cheated and h ad a rehearsal but 1 promise you we have not done so . . . I am endeavo ur­ ing to prove a p oint by w orking on unsuspecting volun­ teers and if we had a rehearsal and I failed to make th at point, 1 would have no excuse at a l l . . . As it is, I have left a small door open fo r myself by allowing fo r the retort — “ well — we never had a rehearsal — so that’s why it didn’t succeed!” . . . 5. Finally — because o f the h o nour bestowed on me by your Society in sending me the invitation in the first Place, the H erm itage R ehabilitation C entre and I found ourselves spending the whole o f July either on television °r doing radio programmes — o r involving reporters in ? full day’s H erm itage activities before granting them an interview on th e w ork we w ere doing — and so I thank y°u again for enabling me to have my first shot at being a television star! . . .and I offer many congratulations on your Goilden Jubilee! We heard yesterday that: “A n E xpert is som eone who comes from m ore than 50 miles aw ay — and brings Three Acts by S. H. McLaren M.C.S.P. Superintendent Physiotherapist, Durham M in e rs R eh abilitation Centre. This paper w as read and a dem onstration given at the Jubilee Congress of the South African Society o f P h ysiotherapy Johannesburg July 1975. slides” . . . I’ve certainly com e from more th an 50 miles aw ay— b u t I haven’t any slides— ju st the ‘Real Thing’ . . . My audiences tend to react violently throughout the perform ance — it is one o f the quickest meithods I know of making enemies — but equally one finds friends who are prepared to believe in one’s methods and support one’s e ff o rts . . . vocally. T he sweeping statem ents I m ake may cause you to applaud o r ‘bo o ’ — b u t seldom to rem ain n eu tral — and this is how I like i t . . . It keeps my adrenaline supply flowing! So please ‘cheer’ the winners and ‘b o o ’ th e cheats as if you really were at the theatre. My introductions are always longer than the rest of the perform ance put together — please b ear w ith me! I am getting dow n to explaining the title of this session! Let me ask you a simple question — Q. Why do you voluntarily make the effort to go to (he theatre? T he facetious reto rt to .that is “ Because som eone gave me a free ticket” — but a m ore serious answ er to the question is “To be entertained” . . . A ll right — so w hat do we m ean by “ being en ter­ tained”? A. D ictio n ary definition is: “T o be A M U S E D O R D IV E R T E D and another phrase fo r E N T E R T A IN M E N T IS H O S PIT A B L E R E C E P T IO N . . . I’ve certainly had my share o f “en tertain m en t” since I came to Johannes­ burg — I hope you’re going to get a little this afternoon! So — Let’s go to the th eatre to be entertained — namely to be am used or diverted. L et’s take any play and divide it roughly into 3 ACTS. A C T 1 W e are introduced to the m ain characters and get o u r first inkling of the direction o f the story. A C T 2 T he p lo t (or at least the essence o f the plot) is revealed and the characters all take on a definite shape and personality, so th a t they are easily recognisable. By A C T 3 A ll loose ends are tied u p (neatly fo r the m ost part) fo r the c o n d u sio n o f the stage p erform ance and we file off hom e feeling refreshed or invigorated (o r w hatever) to tackle “ tom orrow ” with a renew ed zest. T h a t’s you and me going to the theatre — w hat has all this to do w ith R ehabilition o f Injured Industrial W orkers? A great deal in my opinion. Consider the title PL A Y F O R W O R K IN 3 ACTS Act 1 We are introduced to the p atient w ho, at this stage, is m erely a nam e, a sex, an address, an age and a diagnosis on a piece of paper. (This piece o f paper is equivalent to the theatre program m e which gives us a little biographical detail of each o f the artistes). T he p atient is a t this point an unknow n quantity — personalitywise. . . H is bread-earning working capacity has been abruptly R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) 10 P H Y S I O T H E R A P Y DECEMBER, 197S curtailed by some form of accident — and he presents a w o rrie d — frightened, nervous, uncertain, reticent, poss­ ibly som ew hat belligerent face to his audience. A t this stage the “audience” comprises doctors; nurses and physiotherapists and it is the “getting to know cach o th e r” period. It can present quite a variety of problems. Slowly his character emerges so that by the T heatre In terv al (end of A ct 1) we know roughly w hat makes him tick and w hat his capabilities really are. A fter the interval, during which he m ight have been lulled into a state of false security, we open fire with every w eapon at o u r disposal — and shatter the last o f his defences. We D IVER T his attention from the injury which has become p aram o u n t during the enforced rest period to counteract SH O C K so th at by ACT III we have proved to him h o w much be is capable o f doing — despite his reservations on th at score. We have tied up all the loose ends concerning his return to the bosom o f his fam ily — his work resettlem ent and any financial or social problem s and so dow n com es the final curtain on the ‘new ’ man — H e has passed m uster, and we, in the auditorium , feel satisfied that th e time spent involving ourselves with the “play” has been w orthw hile and u p ­ lifting, and has diverted our thoughts from our own dilem m as tow ards those of other people. By helping to untangle their physical and m ental p ro b ­ lems, surely we help ourselves and so there is a reciprocal audience/perform er reaction fo r the good o f both? T here is a form o f censorship (w hich I expect is w orld­ wide) on all films and theatre productions, and here it is: (i) “ U ” — U niversal — fo r anyone of any age. (ii) “A ” — fo r adults only. (iii) “X ” — again fo r adults — denoting either: (a) H o rro r — m odern science fiction o r a F ra n k ­ enstein’s m onster story, or (b) “ naughty” — the sexually uninhibited type of production. T hese last two ca te g o rie s— “A ” and “X ” are technic­ ally for those over 16 years old — and it is a t this age th a t we adm it male patients fo r treatm ent at the H erm it­ age — w ith an u p p er age limit of 65. M y type o f treatm ent is N O T geared for: (a) very small children, (b) very pregnant w omen, or (c) geriatrics, and those who have been to th e C entre will be saying “ She’s U N D E R S T A T IN G there — its “X ” category — n ot just “A ” ; — Surely you d o n ’t blam e us fo r not a d ­ vertising th e “ X ” bit on the bill poster outside the gates? — i t ’s a little surprise fo r th em when they arrive! . A t this mom ent in tim e — you are the audience — and I am producer, director, and to a certain extent — au th o r o f w hat you are a b o u t to witness! and I hope you’ll find som e of it educationally entertaining. My six ‘V IC T IM S ’ are the stars o f the perform ance — who will enact the c o m ed y — o r dram a — or w hatever — and there is no script fo r th e m . . . T heir comm ents will be asides — (theatrically audible I hope!) and ad- libbing plus plus — I have “p ro m p t sheets” fo r m y own use (exercise cards) and they w ear their own “ program m e in fo rm atio n ” — their n a m e s . . . T heir personalities will emerge during the unrehearsed perform ance. M an is a histrionic anim al and I ’m sure 'these volunteers will not fail to grab the oppo rtu n ity of perform ing fluidly before such a distinguished audience! T h ro u g h o u t this I shall be peripatetic — and thus, I hope, give the erroneous im pression th a t I ’m working h ard er than anyone else . . . A re th ere any guide lines fo r m e as th e director/ producer? These are the ones I w ork a lo n g . . . A lth o ’ som e o f you may have heard m y long list 0 dogmatic, sweeping statements w hich I d a re to cal “ rules” — I am going to produce them again— becausi they work in my kind of CHA LLENG IN G rehabilitatiot and, therefore, I feel, have a bearing on th e type 0| activity y o u ’ll see this afternoon (if the volunteers haven’ escaped th r o ’ a side entrance). . . In a Residential Centre like the Hermitage — ones again has a captive audience . . . I can ’t see it w ould evei work a t a D ay Centre — patients are ju st not self destruc. tive animals! M ost of you have heard all this before . . . bu t hen goes: My “ R U L E S F O R R U N N IN G A REHABILl. T A T IO N C E N T R E ” are simple, basic and uncomplicat. ed and OFTEN CONTROVERSIAL . . . (1) N ever A SK a patient if he thinks he can do an exercice — EXPECT HUM T O D O IT — and 9 times out of 10 he w i l l . . . W e are 99% PSY C H O LO G ISTS! (2) N E V E R SH O W C O N C E R N if he sprains the other ankle during a class . . . it will C U R E the O RIG INAL IN JUR Y ’cos h e w on’t know which onef^. limp with! v R E M E M B E R . . . Confucius — H e s a y . . . “W hat you fussing about? Y ou’ve G O T L EG ON O T H E R SIDE! (3) N E V E R concentrate on the IN JU R E D LIMB ■— give com petitive, general activities during a class — and thus TRICK H IM IN T O using his injured limb . . . U SE WHOLE M A N — N O T T W ID D L E Y BITS OF H IM ! I don’t care tuppence w hether a m an walks o r runs correctly once I ’ve whipped his sticks or crutches away from him. I W A N T H IM T O W A L K A N D R U N any. way he can until h e ’s forgotten whioh leg he w as suppo­ sed to limp on in the first place — and then correct him. T ake his mind off his injured limb — D O N ’T concen­ trate all his attention on to it! (4) Never use the same exercises twice . . . T h e patient will be bored and learn to d o trick movements if he know s w hat’s coming next. T H IS K EE PS T H E THERAPIST MENTALLY ALERT TOO! T his is another cheat because I ’ve done several o f these exercises before an a u d ie n c e — but, one hopes, in front of different people in m ost instances! (5) Always mix everyone up — different ages, sexes and injuries. Y our p atien t is N O T going out of ho sp ital into a world com posed entirely of people with the same d isability/ at the same age as h im self. . . O R ALL U N I-SEX ! v BUT LASSES R em em ber th a t — T H E IN JU R E D M A N IS S T R O N G E R T H A N THE A V E R A G E HEALTHY W O M A N — and can do much stronger exercises than you can — so d o n ’t waste his time on wishy w ashy exercises . . . Offer a m an a challenge and he will respond. T he cavem an days are n o t so f a r behind when brute strength com bined with cunning were 'required fo r mere s u r v iv a l. . . Lots of competitive games and activities to stimulate brain and body . . . T h ere’s a play on th e w ords “PL A Y F O R W O R K ” — in the title — all this is in the fo rm o f games — adult “P L A Y SC H O O L” ! I ’m often asked if som e of these activities are not lethal to an already injured m an . . . Selfpreservation is the strongest of all the instincts and provided the patient is “free to escape” w hen th e pain is too great he will no t harm him self. (6 ) A lways use names — T he only personal p a rt o f a patient — otherwise he’s ju st a computerised number on a filing card . . . R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) pESEMBER 1975 F I S I O T E R A P I E 11 FOR t h e SAM E r e a s o n — A lw ays use co n ta ct. . . p a tie n t to p a tie n t th e r a p is t to tie n t. . . SO m uch conveyor belt; m echanised, com- nterised work goes on th at h e has often lost the ability ‘touch’ and ‘F E E L T O U C H E D ’. (My contact was to shake hands “ M ice o r M en grl‘T O U C H ” is g oing o u t — in th e fo rm o f m a s sa g e . . . p N.F. is ta k in g its p la c e b u t n o t by e v e ry o n e — so I do “G ro u p to u c h in g ” — “ su b tly ,” I h o p e . . . a n d b y th a t I mean I h o p e I d o n ’t lea d th e p a tie n ts in to th in k in g w e ’re about to have a n orgy! (7) Always find out w hat his hobbies a r e . . . T hese may re q u ire a greater degree o f physical fitness th a t his bread and butter work . . . viz D R A U G H T S M A N who was keen A M A T E U R ' C Y C LIST . . . B A N K O L B R K m ay be keen m o untaineer . . . (8 ) Alway teach LIFTIN G in some form .. . saves endless ‘back in ju ry ’ patients in fu tu re years. | (9) Use a piece of apparatus to take the patients mind off his injury . . . (10) N E V E R S T R IP O F F Y O U R P A T IE N T to the minimum of clothes — he or she may be genuinely self- conscious a'bout acne or scars or, like me, being the w rong shape. . . Let them E X E R C IS E in any loose garm ents they like — an d when T H E Y are ready to shed them — they w ill. . . (11) Always find the winners of a race . . . all of us like to be praised and the p atien t works m uch hard er if he has the chance of a “ p at on the back” . . . He may cheat a bit in order to win — b u t it’s all p a r t of the small boy com ing out o f the grown man and is to be encouraged — P R O V ID E D T H E THERAPIST IS OBSERVANT E N O U G H T O SEE T H E CHEAT HAPPEN! Keeps me a l e r t . . . Press-ups m ake a G O O D “P U N IS H M E N T ’ . . . (12) Always m ake him laugh — with you and a t h im ­ self — and be p rep ared to laugh at yourself, too . .. Remember Three Things: (i) If a m an gets w rapped up in him self it makes a very sm all p a r c e l. . . (ii) L A U G H T E R IS A G O O D A B D O M IN A L E X E R ­ CISE, and (iii) H E W H O L A U G H S — LASTS! And lastly — ALWAYS M A K E H IM W O R K SO H A R D T H A T HE W ANTS T O G O back tio work because it’s less strenuous th an being ‘rehabilitated’! Let’s have a look at the “play fo r to d ay ” — CLASS — (a) w ith blankets, (b) w ith p o les a n d q u o its. A B S T R A C T S “ AIRWAYS OBSTRUCTIO N IN C H IL D R E N ” by Thelma Morony. Aust. J. Physiother., XX(2), 107-111 (June, 1974). The role o f physiotherapy in thoracic conditions has changed over the years and has become increasingly im­ portant in cases of airways obstruction in children. In this article, the au th o r attem pts to “ emphasise differences which exist (in the treatm ent of such cases), because of differences in years, from the neonate to the adolescent.” A close examination of basic anatom ical and physiological principles is made in order to put forward a more scientific explanation o f the different clinical picture in children. As the a u th o r suggests, “ Airways obstruction . . . tends to be much m ore severe in infants than in older patients” because “ the smaller the radius of the airway, the greater tendency to collapse” , and thus there is a more com m on occurence o f atelectasis in children. The types of airways obstruction in “ the paediatric age 'g ro u p ” are mentioned and a detailed account of the physiotherapy which the author finds beneficial is given. Team w ork and parent co-operation are regarded as im­ portant in the successful treatm ent o f such cases. M ention is also m ade o f “ oxygen therapy” , “ inhalation therapy” and resuscitation, and the author points out the value of “ objective testing of pulm onary function . . . for satisfactory diagnosis and assessment of treatm ent and progress . . .” BOOKS RECEIVED FO R REVIEW “A POCKET BOOK OF EXERCISE THERAPY” Author: M . Dena Gardiner, 1 .C.S.P. Publishers: G. Bell & Sons Ltd., L ondon. 1975. Available: Book P rom otions (Pty) Ltd., 311 Sanlam C entre, M ain R oad, W ynberg, ,Cape, S.A. Price: R2,50. BOOKS AVAILABLE from W illiam H einem ann (South A frica) Pty. Ltd., P.O. Box 11190, Johannesburg. Publications relevant to the S tudy & C erebral Palsy in C hildhood. Title: H andling o f th e Y oung C erebral Palsied Child at H om e (2nd Ed.). Author: N ancie R. Finnie. Price: R5,90. Title: O rthopaedic Aspects o f C erebral Palsy. Author: R o b ert L. Samilson. Price: R12,50. Title: P hysiotherapy in Paediatrics. Author: R obert A. Shepherd, M.A.P.A. Price: R12,50. Title: M otor D evelopm ent in the D ifferent Types of C erebral Palsy. Author: B ertha B obath, F.C.S.P. and K arel B obath, M .D ., F .R .C . Psych. D .P.M . Price: R4,70. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )