Page 8 P H Y S I O T H E R A P Y DECEM BER, 1972 WENELA PHYSIOTHERAPY and REHABILITATION CENTRE T h i s C e n t r e i s p a r t o f t h e W e n e l a H o s p i t a l i n J o h a n n e s b u r g . It is s i t u a t e d a b o u t o n e m i l e f r o m t h e c e n t r e o f t h e c i t y o n i t s s o u t h e r n s i d e n e a r B o o y s e n s R a i l w a y S t a t i o n . T h e h o s p i t a l c o m p l e x c o n s i s t s o f t h e n e w s e c t i o n a n d t h e o l d e r p a r t . I t c o m p r i s e s 3 7 w a r d s — s u r g i c a l , m e d i c a l , e y e , s p i n a l i s o l a t i o n a n d p n e u m o c o n i o s i s m e d i c a l b u r e a u x , o p e r a t ­ i n g t h e a t r e s , r e c o v e r y r o o m a n d s p c c i a l c a r c u n i t . X - r a y d e p a r t m e n t s a n d a d m i n i s t r a t i v e o f f i c e s . T h i s h o s p i t a l is c o n n e c t e d w i t h t h e S o u t h A f r i c a n C h a m b e r o f M i n e s . It s e r v e s a s t h e m a j o r c e n t r a l h o s p i t a l o n t h e e a s t , c e n t r a l a n d w e s t R a n d a n d o t h e r p l a c e s in t h e T r a n s v a a l . O r a n g e F r e e S t a t e a n d N o r t h e r n N a t a l . I t s m e d i c a l s t a f l ' is c o m p o s e d o f t h e C h i e f M e d i c a l O f f i c e r a n d t e n o t h e r m e d i c a l o f f i c e r s . It a l s o h a s a t i ts d i s p o s a l o r t h o p a e d i c s u r g e o n s , n e u r o s u r g e o n s , E . N . T . s u r g e o n s , o p h t h a l m i c s u r g e o n s , t h o r a c i c s u r g e o n s , g e n e r a l s u r g e o n s , r a d i o l o g i s t s a n d p h y s i c i a n s . P h y s i o t h e r a p i s t s , r a d i o g r a p h e r s , m e d i c a l t e c h ­ n o l o g i s t s a n d a d e q u a t e n u r s i n g s t a f f r e p r e s e n t p a r a m e d i c a l a n d n u r s i n g s e r v i c e s . T Y P E S O F P A T I E N T S T R E A T E D T h e p a t i e n t s t r e a t e d i n t h i s h o s p i t a l a r e m a l e i n - p a t i e n t s e m p l o y e d i n t h e m i n i n g i n d u s t r y . M o s t o f t h e s e p a t i e n t s a r e r e f e r r e d t o t h i s h o s p i t a l f r o m t h e i r l o c a l m i n e h o s p i t a l s b y t h e i r o w n S e n i o r M e d i c a l O f f i c e r s . A p a t i e n t m a y b e r e f e r r e d f o r o n e o f t h e f o l l o w i n g : — S p e c i a l i s t s ’ a t t e n t i o n , o p i n i o n , t r e a t m e n t , p h y s i o t h e r a p y o r a c o m b i n a t i o n o f t w o o r m o r e o f t h e s e . I n t h e i r m a j o r i t y t h e p a t i e n t s a r e t r a u m a t i c c a s e s i n j u r e d a t w o r k o r o u t s i d e w o r k . T h e s e p a t i e n t s a r e : — ( i ) U p p e r a n d l o w e r l i m b f r a c t u r e s . ( i i ) B r a c h i a l P l e x u s l e s i o n s . ( ii i ) O t h e r P e r i p h e r a l n e r v e i n j u r i e s ( m o s t l y u p p e r l i m b ) . ( i v ) R e - e d u c a t i o n a f t e r t e n d o n t r a n s f e r s ; a n d ( v ) M a n y r e c e n t i n j u r i e s o f m a j o r e x t e n t . ( v i ) W e a l s o r e c e i v e p a r a p l e g i c s a n d q u a d r i p l e g i c s , h e m i - p l e g i c s d u e t o h e a d i n j u r i e s a n d a f a i r n u m b e r o f m e d i c a l a n d s u r g i c a l c o n d i t i o n s . O u r p a t i e n t s a r e t r i b e s m e n f r o m A n g o l a , B o t s w a n a , M a l a w i , S w a z i l a n d , P o r t u g u e s e E a s t A f r i c a , L e s o t h o , T r a n s - k e i a n d v a r i o u s p a r t s o f t h e R e p u b l i c . W i t h s o m a n y d i f f e r e n t t r i b e s m e n w i t h d i f f e r e n t t r a d i t i o n s , c u l t u r e s , c u s t o m s a n d c r e e d s w e o u g h t t o h a v e d i f f i c u l t i e s i n l a n g u a g e a n d d i r e c t c o m m u n i c a t i o n . H o w e v e r , t h e m i n e s h a v e d e v e l o p e d t h e i r o w n c o m m u n i c a t i o n l a n g u a g e c a l l e d F A N A K A L O w h i c h is e a s y t o u n d e r s t a n d a n d s p e a k . S T A F F I N G O F T H E R E H A B I L I T A T I O N C E N T R E T h e r e a r e f o u r p h y s i o t h e r a p i s t s in t h i s h o s p i t a l : M r . A . R o t h b e r g ( S u p e r i n t e n d e n t P h y s i o t h e r a p i s t ) , M i s s A . G a m m o n ( M . C . S . P . ) , M r . B . B . N g c o b o ( N a t i o n a l D i p l o m a ) a n d m y s e l f . M r . A . R o t h b e r g , w h o s t a r t e d t h e R e h a b i l i t a t i o n C e n t r e i n t h i s h o s p i t a l i n 1 9 4 6 , h a s o r d e r l i e s t r a i n e d i n t h e d e p a r t m e n t . T h e s e o r d e r l i e s h e l p u s i n p r e p a r i n g t h e p a t i e n t s b e f o r e t r e a t m e n t a n d c l e a r u p a f t e r t h e t r e a t m e n t s . T h e o r d e r l i e s f u r t h e r h e l p u s w h e n w a l k i n g t h e p a t i e n t w i t h c r u t c h e s . T h e p h y s i o t h e r a p i s t s t a n d s i n f r o n t o f t h e p a t i e n t g i v i n g o r d e r s a n d d i r e c t i o n w h i l e a n o r d e r l y is b e h i n d t h e p a t i e n t f o r s u p p o r t t o p r e v e n t t h e p a t i e n t f a l l i n g b a c k w a r d s . T h e o r d e r l i e s a l s o a c t a s p o r t e r s , t r a n s p o r t i n g t h e s p i n a l c a s e s f r o m a n d t o t h e C e n t r e . A l l t h e o r d e r l i e s a r e m a l e e x c e p t o n e l a d y w h o is e m p l o y e d a s c r a f t s i n s t r u c t r e s s . S h e a t t e n d s m a i n l y t o t h e a r m a n d h a n d i n j u r i e s b y s h o w i n g t h e m k n i t t i n g , p a i n t i n g , b e a d w o r k , m o d e l l i n g , e t c . B . D . M A S H E G O Physiotherapist (National Diploma) P a r t o f W e n e l a H o s p i t a l . T h e S p e c i a l i s t i n P h y s i c a l M e d i c i n e , D r . C . A d l e r , hold s a w e e k l y r e v i e w a n d d i s c h a r g e c l i n i c a n d a c l i n i c f o r a s s e s s ­ m e n t o f s p i n a l c a s e s . E Q U I P M E N T I N T H E P H Y S I O T H E R A P Y D E P A R T M E N T O u r p h y s i o t h e r a p y d e p a r t m e n t is e q u i p p e d w i t h t h e usual p h y s i o t h e r a p e u t i c m a c h i n e s s u c h a s F a r a d i c a n d F a r a d i c - G a l v a n i c a n d o t h e r m u s c l e s t i m u l a t o r s , s h o r t - w a v e d i a ­ t h e r m y , i n f r a - r e d l a m p s . K r o m a y e r a n d m e r c u r y v a p o u r u l t r a - v i o l e t l a m p s , u l t r a - s o u n d a n d w a x b a t h s . F o r s t r e n g t h e n ­ i n g m o v e m e n t s w e h a v e w e i g h t s a n d p u l l e y s y s t e m s , s pr in gs , s u s p e n s i o n u n i t s , s p e c i a l b o o t s a n d s a n d b a g s . F u r t h e r , we h a v e p l i n t h s , b e d s w i t h w o o d e n c r o s s b a r s o n t o p s o a r r a n g e d t h a t w e c a n u s e t h e m f o r s u s p e n s i o n t h e r a p y . T h e s e types o f b e d s a r e s t i l l k e p t i n u s e t o b e s h o w n t o t h e s t u d e n t s who c o m e h e r e f o r t h e i r l e c t u r e s s o t h a t i f it h a p p e n s t h a t after c o m p l e t i o n o f t h e i r s t u d i e s t h e y a r e e m p l o y e d i n a n o u t s i de h o s p i t a l w h e r e G u t h r i e S m i t h s u s p e n s i o n f r a m e s a r e not e a s i l y o b t a i n a b l e , t h e y c a n i m p r o v i s e s u c h b e d s w h i c h serve a l m o s t t h e s a m e p u r p o s e . W e h a v e a s t a t i o n a r y b i c y c l e and t w o b e d c y c l e e x e r c i s e r s o t h a t t h e p a t i e n t c a n c y c l e while l y i n g o n t h e b e d . T h e s e a r e u s e d f o r m o b i l i s a t i o n and s t r e n g t h e n i n g m o v e m e n t s i n l o w e r l i m b i n j u r i e s . W a l l bars, p a r a l l e l b a r s , b a c k e n t e n s i o n e x e r c i s e r , t i l t i n g t a b l e s for p o s t u r a l d r a i n a g e a n d f o r s t a n d i n g t h e p a t i e n t u p f o r the f i r s t t i m e a n d w a l k i n g a i d s . F o r t h e r e h a b i l i t a t i o n o f t h e s p i n a l c a s e s w e h a v e the t i l t i n g t a b l e u s e d a s a b o v e ; w a l k i n g m a c h i n e s , c r u t c h e s , c a l i p e r s a n d b o o t s , w h e e l c h a i r s , s t a b l e b e d s , s t a i r s , stabl e S t a n d i n g a p p a r a t u s i n w h i c h t h e p a t i e n t c a n b e f ix e d with b e l t s a n d p l a y t a b l e t e n n i s , t h r o w j a v e l i n , d i s c u s and s h o t - p u t . P l a y i n g i n t h e e r e c t p o s i t i o n h e l p s t h e p a t i e n t to p r a c t i s e b a l a n c e a n d s t r e n g t h e n t h e a b d o m i n a l w a l l mus cl es a n d f i n a l l y g i v e s t h e p a t i e n t a c h a n c e t o s e e h i m s e l f i n the s t a n d i n g p o s i t i o n a n d c o m p e t i n g w i t h n o r m a l p e r s o n s . 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. ) For encouragement o f deep breathing we have a table where chest patients sit around and “play football” by blow­ ing table tennis balls into small goals. Finally we have a radio and a radiogram, which are very useful for class and group exercises. SUPPLY OF APPLIANCES (i) Spinal Cases: Before discharge a completely para­ plegic patient is issued with a wheelchair complete with four-inch-thick foam blocks, one pair o f alu­ minium elbow crutches, a pair o f calipers complete with boots. The patient may be issued with a spinal brace depending on the stability o f the fracture site. In incomplete lesions, e.g. lesions of the cauda equina, where a patient suffers a mono- or bilateralfoot drop, he is issued with two sticks and boots with below knee calipers and toe-raisers. (ii) Lower Limb Fractures: A patient with severe fractures o f the pelvis is usually supplied with a pair o f elbow crutches and boots. One o f the boots may be raised if one leg is .shorter than the other.., A patient with fractures of'tibia or tibia and fibula and a patient who has suffered foot injuries walks often much better when he has the benefit o f boots with heels. It has, therefore, become routine to supply boots and one stick (if necessary) to these patients. Patients with fractured femur rarely need, walking aids on discharge. If necessary, they are supplied with crutches or sticks and boots. It must be borne in mind that these patients return to work and not to a con­ valescent home. If the patient is seriously injured or handicapped, :he is then repatriated after being compensated. In complicated lower limb fractures where the anterior tibial nerve is involved, the patient is issued with boots, one with a toe-raiser. A stick may be supplied if necessary. (iii) Due to a higher rate o f successful upper limb tendon transplants and intensive, successful rehabilitation in this hospital, upper limb splints are worn very tem­ porarily prior to operation. Since I have arrived in this hospital, in September, 1970, I have never seen a patient discharged home with an upper limb splint. Amputees: A patient with above or below knee amputation is supplied with the appropriate prosthesis and usually only one stick. But, due to physiotherapy which the patient receives, especially if he is referred to us as early as possible, the below knee amputees rarely need a stick. A patient with upper limb amputation, is supplied with an arm prosthesis and fully trained how to use it before he is discharged home. SOME IMPROVISATIONS Apart from a Guthrie Smith suspension frame, we have seven stabilised beds with adjustable, wooden cross-bars- on top so that we are able to carry out suspension therapy and resistances with springs almost from any angle as mentioned before. For the hand we have pieces o f hose pipes, sponges taken from axillary crutch paddings with which' the patient can practise grip before trying the strong hand springs, apart from the conventional dumbells, etc. If the patient needs a temporary cock-up splint, we some­ times improvise with flexible cramer wife padded and re­ inforced with a bandage. If a patient’s leg is in plaster o f paris and he is to start with partial weight bearing.on the affected leg, instead, of. the surgical heel, one can fix a rubber heel , with leather straps and the patient walks with this. DECEMBER, 1972 P H Y S I O . If the patient has a sore on the back o f the heel and cannot wear his boots due to this, we sometimes use an old boot, cut the back part o f the “ uppers” off and make a home-made sandal out o f it. THINGS I HAVE LEARNED SINCE QUALIFYING (i) Some surgeons allow a patient who has had meni­ scectomy to take weight as early as possible, even within 24 hours after the operation without causing any side effects. For knee mobilisation, however, we wait until the stitches are taken out. (ii) If equipment is well looked after, it lasts a long time. To make this point to the students, some o f the machines in the department are over 20 years old, yet are still working well. (iii) There can be full co-operation between physio­ therapists and the nursing staff and between the physiotherapists and the patients. The patients here are very eager to come to the “school” as they want to “pass” and go home or back to work. (iv) With proper nursing care and rehabilitation, our paraplegic patients are ready for discharge between four and six months. Complete paraplegics, with a lesion at the anatomical level o f T12/L1 or lower we expect to be walking with calipers and elbow crutches within four months from the accident. (v) There is a “self-propulsion trolley” on which a para­ plegic patient, lying prone, is able to propel himself up and about. On this trolley the patient is, thereby, strengthening his arms and back extensors. (vi) A “three-section bed” makes it possible to give patients who are in “back-lying” to carry out knee flexion and extension exercises without interfering .with the hip joints, where this has to be avoided. (vii) It struck me that carcinoma is not strictly a disease o f the old age. We have had young patients o f between 18 and 25 years with malignant tumours o f the spine, mouth and rectum. (viii) Stevens-Johnson Syndrome: A disease characterised by haemoptysis, measles-like rash, pyrexia with bucal blebs, peeling o f superficial layer o f skin, looseness of the skin looking like first degree burns but without fluid exudation; superficial ulceration o f skin-around eye's, mouth, penis, scrotum and scalp, tachycardia o f approximately 120, normal blood pressure. The patient is agitated, unable to open his mouth with teeth tightly clenched. The patient died about three days after admission. (ix) I saw on X-rays that not all'hearts are situated more on the left side; we had a patient whose heart was situated on the right side. (x) Our patients can spend up to six hours in the physio­ therapy department, arriving in the Centre in the morning, leaving for lunch and returning in the after­ noon. The patients are treated and given time .to rest and then treatment can be continued again. The system in this Centre is. that no physiotherapist “owns” a patient. Patients are treated by all physio­ therapists. With this system one patient can receive more than six treatments in a day from different physiotherapists with different treatment methods. We are allowed to apply any technique and treat­ ment methods we have learned in our training, to' ' which we add the special experiences o f this depart­ ment. I have found that my previous training has stood me in good stead and is respected by the other members o f the staff. ACKNOWLEDGEMENTS I wish to express appreciation to Mr. A . Rothberg, our Superintendent Physiotherapist, for his help and advice in the preparation o f this article. H E R A P Y P age 9 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. )