Page Ten P H Y S I O T H E R A P Y October, 1956. P H Y S I C A L ME D I C I N E IN P S Y C H I A T R Y R O N A L D R O BIN S-BR O W N E, M .D ., D .P hys.M ed., L.M ., M .R.C.S.* ♦ Specialist in P hysical M edicine, T a r a H o s p ita l, Jo h a n n e sb u rg , a n d G e rm is to n H o s p ita l. A p a p e r pre sen te d a t th e S outh A frica n M edical C o n g re ss, P re to ria , 1955. R eprinted fr o m M edical P ro c e ed in g s — M ediese B ydraes, Vol. 2, N o. 10, 4 A ugust, 1956 j A u gustus 4, pp. 399-404. IN physical d iso rd e rs b o th diag n o sis a n d tre a tm e n t a re usually c a rrie d o u t by th e d o c to r a lo n e a lo n g c o n v e n ­ tio n a l lines. P sy ch o lo g ica l p ro b lem s, how ever, re q u ire a less ste reo ty p ed a p p ro a c h . T h e p sy c h iatric p a tie n t’s sy m p to m s a re e ith e r th e d irec t o r in d ire c t re su lt o f m e n ta l tra u m a w hich m ay h a v e occurred a t a n y tim e d u rin g h is life, a n d a re o f such a diversified n a tu re th a t th e ro u tin e s a n d fo rm u la e w hich we a ssociate w ith physical d isease c a n n o t be ap p lie d . A tr u e psy c h iatric assessm ent is difficult, fo r it d e p en d s o n a n u m b e r o f o bscure fa cto rs. T h e d o c to r has to rely u p o n th e evidence o f a p a tie n t w ho is u n re lia b le a n d o n th e defensive, a n d o f relatives w h o a re in c a p a b le o f im p a rtia l testim o n y . M o re ­ over, h e sees th e p a tie n t d u rin g c o n su lta tio n s fo r o nly a b o u t 4 h o u rs a w eek. W h a t h a p p e n s to th e p a tie n t d u rin g th e re m a in in g 164 h o u rs o f th e w eek is o f u tm o s t im p o rta n ce , fo r a p a tie n t’s h isto ry a n d fam ily h isto ry a re n o t e n ough to d e te rm in e his c o n d itio n . H is e v eryday a c tio n s a n d r e ­ a c tio n s m u st be k n o w n if th e cause is to be tre a te d . T h e re m o v a l o f th e c au se is th e essence o f a ll tre a tm e n t. T h e p a tie n t sh o u ld , th ere fo re, be u n d e r o b se rv a tio n fo r 24 h o u rs a day. T h is re q u ire s a tea m o f w o rk e rs a n d the te a m grow s as o u r kno w le d g e increases. D iagnostic and T h era p eu tic T eam . T h e p e rso n n e l o f the., te a m sh o u ld c o m p r is e : " . ™ . ....... - (а) M e d ic a l: P sy ch ia trist, n e u ro lo g ist, p h ysician, n e u ro ­ su rg e o n , p a e d ia tric ia n , clinical e n ce p h alo g ra p h er, o p th al- m o lo g ist, E N T specialist, ra d io lo g ist, p h ysical m edicine specialist, etc. (б) P sycho-Social: C linical p sy c h o lo g ist; social w orker. (c) N ursing S ta ff.- (d) A uxilia rie s: O c c u p a tio n a l th e ra p is t, c ra ft in stru cto r, physical e d u c a tio n a list, sp o rts in stru c to r, p h y sio th e ra p ist a n d d ietician . C lo se c o -o p e ra tio n betw een th e v a rio u s d e p a rtm e n ts is en su red ' b y : (а) W eekly s ta ff conferences. (б) A d m in is tra tio n m eetings (Fig. I). (c) R e p o rts fro m n u rsin g staff; o c c u p a tio n a l th era p y , ph ysical e d u c a tio n a n d p h y sio th e ra p y d e p a rtm e n ts ; a n d fro m th e social w orkers. (d ) Im m e d ia te re p o rts to th e d o c to rs o n a n y u n u su a l fe atu re. T h e a d m in is tra tio n o f T a r a is to be c o n g ra tu la te d on th e efficiency a n d a d a p ta b ility o f th is system o f c o -o p e ra tio n . a n d c o -o rd in a tio n . P a tie n ts. A lcoholics, c ertifiable cases, th e c o n sp icu o u s a n d th e u n a ssim ila b le , a n d in fa n ts a re excluded fro m T a r a ; b u t oth erw ise th e p a tie n ts fo rm a c ro ss-sec tio n o f th e E u r o ­ p e a n p o p u la tio n a n d have th e a d v a n ta g e o f m ixing w ith p e o p le o f a ll types a n d fro m all w alk s o f life'; 835 in -p atien ts w ere a d m itte d d u rin g th e p a st year. T h ey live a t th e h o sp ital b u t a re allow ed 48 h o u rs ’ leave a t th e d isc re tio n o f th e d o c to r. T h e a tte n d a n c e s o f d a y -p a tie n ts d u rin g th e y ear were 2,457; these sta y e d fro m 10 a .m . to 3 p.m . T h e ir n u m b e r is in creasing because c e rta in p a tie n ts d o b e tte r in th e ir h o m e e n v iro n m e n t, w hile in cid e n ta l a d v an tag e s result fro m th e la rg e r tu rn o v e r o f p a tie n ts a n d th e re lie f a ffo rd e d th e sh o rt-h a n d e d n u rsin g staff. I n a d d itio n th e re were 1,464 a tte n d a n c e s o f o u t-p a tie n ts ,w ho c am e fo r special tre a tm e n t only. As so o n as a p a tie n t e n te rs T a r a (Fig. 2) he is u n d e r o b se rv a tio n . H e becom es a n in d iv id u a l nucleus in th e g ro u p s tru c tu re o f T a r a ’s m icrocosm . A specially qualified c le rk is resp o n sib le fo r re ce p tio n as ta c t a n d c are fu l q u e stio n - 1 ing a re e ssential to m a k e th e p a tie n t feel a t ease. T h e r e g is tra r o n d u ty is in fo rm e d o f th e p a tie n t’s a rriv a l and th e first interview is w ith th e p a tie n t him self a n d th o se w ho a cc o m p a n y him . T h e d o c to r tak e s a full h isto ry , c arries o u t a c o m p le te physical e x a m in a tio n a n d m ak es a psy c h iatric a ssessm ent. H e p rescribes o c c u p a tio n a l a n d re c re a tio n a l th e ra p y o n a special c ard d ra w n up 5 years ago. O c c u p a tio n a l th e ra p y is sta rte d w ithin 48 h o u rs. T h is is c h o se n by th e o c c u p a tio n a l th e ra p is t in c h arg e a fte r an interview w ith th e p a tie n t. M e a n w h ile th e p a tie n t is show n th e ro p e s (Fig. 3) by selected fellow p a tie n ts a n d is given a w eek in w hich to settle d o w n to th e h o sp ita l ro u tin e . T im e -T a b le . T h e a verage sta y o f th e p sy c h iatric pa tie n t a t T a ra is 8 w eeks; th e w eek (168 h o u rs) is divided up m ore o r less a c c o rd in g to th e fo llow ing p ro g ra m m e : 1. Seventy h o u rs a re sp e n t in th e w a rd s by 7 0 % o f the p sy c h iatric pa tie n ts. 2. A t o c c u p a tio n a l th e ra p y 25 h o u rs a re ta k e n up by 9 8 % . 3. N inety-five p e r cent, p a rtic ip a te in s p o rts (Fig. 4), c o n su m in g 15 h o u rs. 4. P hysical tra in in g involves 6 0 % o f th e cases, usin g 4 / h o u rs. " 5. Six h o u rs a re sp e n t o n p h y sio th e ra p y by 10% . 6. T w elve h o u rs a re p a sse d a t evening re c re a tio n and e n te rta in m e n t such as cin e m a, social c lub, w a rd e n te rta in ­ m en ts, co n ce rts, play s (F ig. 5), d an ces a n d in d o o r gam es, a t w hich 98 % a tte n d . 7. R e la x a tio n (e ith er g ro u p , p riv a te o r in ac tio n ) involves 65 % o f th e p a tie n ts fo r 1 h o u r. 8. A ll have c o n su lta tio n s w ith specialists fo r h a lf a n h o u r. 9. T w e n ty p e r cent, re q u ire special in v estig a tio n s, e.g. e le ctro e n ce p h alo g ra p h y , a ir e n ce p h alo g ra p h y , a rte rio g ra p h y , etc. w hich ta k e h a lf an h o u r. 10. A ll have special tre a tm e n ts (in clu d in g p sy c h o th era p y , E .C .T ., in sulin) w hich occupy a fu rth e r 2 h o u rs. 11. N in e ty -e ig h t p e r c en t o f p sy c h iatric p a tie n ts a tte n d th e fo llo w in g m eetings, w hich a llow fo r 3 h o u rs : (a) W ith m edical su p e rin te n d e n t (Fig. 6); (b) R e c re a tio n c o m m itte e; (c) S p o rts c o m m itte e ; (d ) L ib ra ry c o m m itte e ; (e) W ard re p re se n ta tiv e s (Fig. 7). 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. ) October, 1956. P H Y S I O T H E R A P Y Page Eleven physiotherapy. T h is is a p p lie d as th o u g h th e sy m p to m s resulted fro m p h ysical disease. T h u s fo r p a in , d ia th e rm y is usually a p p lie d a n d fo r im p a ired m uscle p o w e r, fa ra d ic stim ulation. T h e tense p a tie n t is given h e a t, sedative m a s s a g e a n d h y d ro th e ra p y , a n d is ta u g h t to relax. T h e lethargic p a tie n t h a s .c o n tr a s t b a th s, e lectrical stim u la tio n , high frequency, stim u la tiv e m assage a n d to n ic u ltra -v io le t light th era p y . A bove all, how ever, th e p h y sio th e ra p ist m u st ra d ia te reassurance. O ccupational a nd R e cre atio n al T herapy. O c c u p a tio n a l a n d re creational th e ra p y is a n in te g ral p a r t o f th e field co v ered by physical m edicine a n d re h a b ilita tio n . I sh o u ld define occu p a tio n a l th e ra p y as ‘a n y a ctivity, m en ta l o r physical, prescribed by a p h y sic ia n fo r its rem e d ia l, d iag n o stic , or prognostic v a lu e .’ I t seeks to a ro u s e in te rest, c o u ra g e a n d confidence, a l l . o f w hich a re necessary fo r overcom ing disability a n d fo r th e p a tie n t’s re tu rn as a n o rm a l m em ber o f society. Its h isto ry d a te s b a ck to th e e arly E g y p tia n s. I t h as a t various tim es been called div ersio n a l, m o ra l, c u re o r w o rk therapy. Its a p p lic a tio n d epends, n o t o n a p r io r classifi­ c ation o f p a tie n ts , b u t o n th e resu lts it achieves w ith each individual p a tie n t. U n til re cently o c c u p a tio n a l th e ra p y was c o ntrolled m ainly by lay pe rso n n el as a rts a n d c ra fts te a c h e rs ; how ever, it is g ra d u a lly falling u n d e r m ed ic al guidance. Its aim s a n d m odus operandi c a n be su m m ed up as fo llo w s : O bjects a nd O peration: (1) O bserving Behaviour. T h is is fu n d a m e n ta l to tre a tm e n t, fo r in th e a tm o sp h e re o f th e consulting ro o m it is n o t p o ssib le to envisage th e p a tie n t in social situ a tio n s. T h e set-up a t T a r a m akes o b se rv a tio n o f sp o n ta n eo u s b e h a v io u r possible, th u s p ro v id in g a b a ck ­ g ro u n d fo r a living diag n o sis a n d p ro g n o sis. T h e p a tie n t is c o n sta n tly w a tched a t w o rk a n d play. H e c a n n o t keep up a p re te n ce all th e tim e a n d d a ta c a n be o b ta in e d on, e.g. in te r-p erso n al re la tio n sh ip , w o rk to le ran c e , tea ch in g to le r­ ance, a p p lic a tio n , m em o ry , ju d g e m e n t, a p titu d e s , p e rso n al habits, re liability a n d e n d u ra n c e . A t w eekly sta ff m eetings (Fig. 8) th ese findings a re d iscussed w ith th e d o c to r w ho in te rp rets th e m a n d d irects fu rth e r tre a tm e n t a n d o b se rv a ­ tion. 2. A ssessing A b ility . T h e w ay a p a tie n t tac k les a task, the m eth o d s used, his p o w e r o f c o -o p e ra tio n a n d his a b ility to mix w ith his fellow s a re c arefully n o te d , special regard being p a id to his c o n c e n tra tio n , n a tu r a l de x te rity , e n d u ra n c e a nd intelligence. 3. Providing C reative O utlets. M a n ’s in h e re n t desire to c reate is o fte n b lu n te d by m en ta l, m o n e ta ry a n d social set­ backs o r by u n resolved e m o tio n a l difficulties. I t c an , h o w ­ ever, be re sto red by c are fu l se lection o f in te restin g o c cu p a ­ tions, th e use o f c o lo u rs a n d designs (Fig. 9) a n d by e n ­ co u rag e m e n t w ith tim ely advice a n d help. Sam ples o f the w ork tu rn e d o u t by p a tie n ts a re o n e x h ib itio n fo r all to see. 4. Providing O pportunities f o r E m o tio n a l E xpression. G enerally speaking, p e o p le a re u n a b le to express em o tio n s w ith th e sam e in te n sity as th ey a re felt. Socially u n a c c e p t­ able a n d , th e re fo re , u sually u n e x p en d e d energy is directed into c o n stru ctiv e ch an n e ls. T h e p a tie n t is th u s relieved o f his often u n c o n sc io u s b u rd e n . T h o se w ith fru stra te d aggressions h a m m e r aw ay a t m e ta lw o rk (F ig. 10), saw aw ay a t c a rp e n try (Fig. 11) a n d p u m m e l th e clay a t p o tte ry (Fig 12). R e p e titiv e m ec h an ic al w o rk (e.g. ru g m aking, sewing, w eaving (F ig 13) a n d b a sk e try (F ig 14) is fo u n d useful in th e tre a tm e n t o f a n x io u s a n d "a g ita te d p a tie n ts. D u rin g a n d a fte r sessions o f re la x a tio n (F ig. 15) th e re a re often bu rsts o f te a rs a n d m u ch talk in g , a fte r w hich th e p a tie n t feels better. A rt th e ra p y (F ig 16) a n d m usic th e ra p y a re o th e r fo rm s o f e m o tio n a l e x p ressio n w ith w hich we a re exp erim e n tin g . A m usic ro o m (Fig. 17) w ith a p ia n o , ra d io g ra m a n d re co rd lib ra ry is a v ailab le fo r th e p a tie n t. 5. P h ysic a l R econditioning. M e n ta l illness u su a lly com es o n g ra d u a lly a fte r lo n g p e rio d s o f suffering. T h e p a tie n t neglects him self, loses in te rest, e ats b adly, sm o k e s heavily a n d d rin k s excessively. H e becom es unfit, lo sin g w eight a n d suffering fro m hy p o v ita m in o sis. T h e d ietician h a s to m ak e th e fo o d tem p tin g a n d a p p etisin g a n d th is is served in a p le a s a n t e n v iro n m e n t (F ig 18). B y careful selection o f o c c u p a tio n w ith p o ssib le a d a p ta tio n s a n d a d ju s tm e n ts , as well as by g ra d u a te d physical tra in in g (F ig . 19) a n d sp o rt, th e p a tie n t is p u t o n th e ro a d to w a rd s a m o re a ctive a n d n o rm a l life. 6. Im proving Concentration. T h e p o w e r o f c o n c e n tra tio n is u sually im p a ired by illness a n d is g ra d u ally re sto red by p ro v id in g inte restin g a n d v a rie d o c c u p a tio n s, by c o n s ta n t e n co u ra g em e n t a n d by in sisting o n th e highest s ta n d a rd o f w o rk o f w hich th e p a tie n t is cap a b le . M e ta l w o rk , le a th e r w o rk (Fig. 14) a n d c a rp e n try a re p a rtic u la rly useful in p r o ­ m o tin g th e pow er o f c o n c e n tra tio n . 7. Developing Confidence. W h en new p a tie n ts a re sh o w n sam ples o f w o rk th a t o th e rs h ave d o n e , th ey u su a lly say th a t, th ey a re u n a b le to do such w o rk . B u t w hen, u n d e r g u id an c e th ey , to o , tu rn o u t a goo d article , th e ir confidence, u sually im p a ire d th ro u g h illness, is re -established. 8. R esto rin g Independence. P a tie n ts lack initiativ e a n d re q u ire s u p p o rt a n d en co u ra g em e n t. I t is th e a im o f th e th e ra p e u tic tea m to m a k e th em a w a re o f th e ir c ap a b ilitie s a n d lim ita tio n s a n d to m a k e th e m less d e p e n d e n t o n o th ers. T o th is e n d th e p a tie n ts a re a llow ed to elect th e ir o w n com m itte es. 9. Developing a Sense o f R esponsibility. T h ro u g h th e m icrocosm o f th e sta ff-p a tie n t c o m m u n ity th e p a tie n t is m a d e a w a re th a t e v ery b o d y plays a p a r t in society. T h e p a tie n ts h a v e th e ir o w n re c re a tio n c o m m itte e, its c h a irm a n , secretary a n d th e d in in g -ro o m re p re se n tativ e being re c o m ­ m ended by th e d o c to r. T h e p a tie n ts also elect th e ir ow n w a rd repre se n tativ es. S om e ta k e o n lib ra ry (F ig. 20), sn o o k e r (F ig. 21), w heelchair, te le p h o n e (Fig. 22) a n d sp o rts e q u ip m e n t (Fig. 23) d u tie s ; o th ers ta k e o n s p o rt field d u ties e.g. c ric k et (Fig. 24), h o ckey (F ig. 25), soccer, so ft b all, (F ig. 26), b a sk e t ball, a rch e ry (Fig. 27), c ro q u e t (Fig. 28), ten n is (F ig. 29), te n n iq u o its (Fig. 30), golf, bow ls (Fig. 31) a n d sw im m ing (F ig. 32). O th e r re sp o n sib ilitie s include a rra n g in g o f evening e n te rta in m e n ts a n d w eek-end re c re a ­ tions. 10. R estoring S e lf-E ste e m . T h e u n re m ittin g efforts o f th e th e ra p e u tic te a m in a c o n tro lle d e n v iro n m e n t re sto re the p a tie n t’s confidence a n d self-esteem . I n this respect the sta tu s e n joyed by m em b ers o f th e re c re a tio n c o m m itte e (Fig. 33), p a rtic u la rly by th e c h a irm a n , the se c re tary a n d th e d in in g -ro o m re p re se n ta tiv e (Fig. 34), has h a d a m o st valu a b le effect. 11. R ecognition o f the P atient as an Individual. By tre a tin g th e p a tie n t as a n in d iv id u a l w h o h a p p e n s to be ill, in stead o f as a m ere vehicle fo r a n illness, th e th e ra p e u tic te a m does m u ch to in c u lc a te self-respect. 12. Integration into So c ie ty. T h is c a n be ach iev e d by en co u ra g in g th e p a tie n t to find h is place in th e p a tie n t co m m u n ity th ro u g h g ro u p a ctiv ities, o f w hich m o st im p o r­ ta n t a re s p o rt a n d re c re a tio n . G ro u p th e ra p y fo r p a tie n ts w ith sim ila r p ro b lem s also helps to stre n g th e n fellow-feeling. M o re o v e r, T a r a has its social c lub, w hich is o p e n to all e x -T a ra p a tie n ts a n d th e re a re re g u la r evening m eetings in to w n to w hich selected p a tie n ts fro m T a r a a re ta k e n to m ingle w ith th e m em bers. M e m b ersh ip o f th is c lub e n titles 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. ) Page Twelve P H Y S I O T H E R A P Y October, 1956. o n e to use th e a m e n ities o f T a ra d u rin g w eek-ends and ho lidays. A t o u r Y .M .C .A . c a n te e n (F ig 35) th e p a tie n ts m ay p u rc h a se re q u isite s a t a p p ro x im a te ly c o st a n d c a n e n te rta in th e ir .visitors. T o fu rth e r th e w o rk o f social in te g ra tio n th e social w o rk e r k eeps th e d o c to r in fo rm e d a b o u t th e p a tie n t’s w ork a n d his do m estic a n d so c ial life. 13. R ehabilitation. I define th is as ‘th e o p tim u m re s to ra ­ tio n to th e p a tie n t’s n o rm a l p hysical, m en ta l, so c ial a n d eco n o m ic s ta n d a rd s .’ T h is is th e u ltim a te g o a l (F ig. 36) o f a ll o u r w ork. T h e p sy chologist a n d th e social w o rk e r w ith the help o f th e D e p a rtm e n t o f L a b o u r c an , if necessary, find su ita b le e m p lo y m en t. In re ce n t tim e s sex d e te rm in a tio n has becom e a n im p o rta n t fa c to r in th e pro cess o f re h a b ilita tio n . I t has received m uch p u b licity in th e press a n d it is no lo n g e r e n o u g h to decide w h e th er o n e is m a n o r m ouse. T a r a seem s to be th e ideal p lace fo r th e tre a tm e n t o f p ro b le m s a risin g fro m sex diversities. The generous support o f the fo llo w in g sponsors m ade possible the reproduction o f the colour p la te opposite. A b b o tt L a b o ra to rie s S.A . (P ty .), L td . N o rm a n A n ste y L im ite d , J o h a n n e sb u rg . T h e B ritish G e n e ra l E le ctric C o . (P ty.), L td ., re p re se n tin g W a tso n & S o n s (E le c tro -M e d ic a l) L td ., la rg e st B ritish m a n u ­ fa c tu re rs o f X -ra y a p p a ra tu s , a n d H a n o v ia , S lough, m a n u fa c tu re rs o f a c tin o -th e ra p y a n d u ltra -v io le t bacteric id a l e q u ip m e n t. G re a te rm a n s W h o le sa le L td ., Jo h a n n e sb u rg . K o d a k (S o u th A frica ) (P ro p rie ta ry ) L im ite d . L e n n o n L im ite d , M a n u fa c tu rin g a n d W h o le sa le C h e m ists a n d D ru g g ists. J o h n O r r & C o . (T ra n sv a a l) L td ., J o h a n n e sb u rg . P a to n s & B a ld w in s L im ite d , m a n u fa c tu re rs o f P & B B eehive K n ittin g W ools. M e rc k -S h a rp & D o h m e , P .O . B ox 5933, J o h a n n e sb u rg . M o ss S m o lla n & S o n s (P ty .), L td ., M a ritim e H o u se , L o v ed a y S tre e t, Jo h a n n e s b u rg , re p re se n tin g th e Y o rk s h ire In su ra n ce C o ., L td ., (A ll classes o f in su ra n c e effected). The generous support o f the fo llo w in g sponsors m ade p ossible the reproduction o f the colour p la te overleaf. A llen & H a n b u ry s (A frica ) L im ite d . D u n lo p S o u th A fric a L im ite d , m a n u fa c tu re rs o f S p o rts G o o d s a n d D u n lo p illo . H a rle y S p o rts (P ty .), L td . (T o m K u k u ljev ic ). S to ck ists o f a ll S p o rts G o o d s a n d Specialists in R a c k e t R e strin g in g and R e p a ir. A lex. L ip w o rth L td ., Jo h a n n e sb u rg . M e d ica l D is trib u to rs , Jo h a n n e sb u rg . P ro te a H o ld in g s L im ite d , P .O . B ox 7793, Jo h a n n e sb u rg , a n d th ro u g h o u t S o u th e rn A frica . S pecialists in E q u ip m e n t fo r R e h a b ilita tio n a n d Physical M edicine. R e c k itt & C o lm a n (A frica) L td. S chlesinger O rg a n isa tio n . U n io n M e d ica l S u pplies L td., C a p e T ow n. F ig 1. A d m in is tra tio n c o n fers w ith re p re se n ta tiv e s o f the th e ra p e u tic team . Fig. 2. T a r a H o s p ita l is in H u rlin g h a m , a q u ie t, select n o rth e rn s u b u rb o n th e o u ts k irts o f Jo h a n n e sb u rg . I t covers a n a re a o f 61 acres, 34 o f w hich h a v e been developed. Fig. 3. A p a tie n t g uide show s a n ew p a tie n t th e m o b ile p o s t office. Fig. 4. Scene o n 9 -h o le g o lf course. Fig. 5. P a tie n ts w a tch a p la y p ro d u c e d a n d a cted by fellow p a tie n ts . Fig. 6. T h e M e d ica l S u p e rin te n d e n t a n d c e rta in m em bers o f th e te a m listen to p ro p o s itio n s fro m p a tie n ts to im prove th e ir w elfare a t T a ra . Fig. 1. T h e w a rd re p re se n ta tiv e s m eeting, a d o c to r a n d n u rsin g sta ff b e ing p re sen t. Fig. 8. T h e d o c to r m eets a ll m em b e rs o f th e tea m . Fig. 9. S o ft c ra fts sh o w in g fe lt w o rk a n d em b ro id ery . F e m ale s fill th is section, w hich is m o s t socializing. N o te the finished articles. Fig. 10. H a m m e rin g a w ay a ggressions a t m e ta l w ork p ro m o te s c o n c e n tra tio n . A n u m b e r o f fem ales h a v e w o rk e d here. N o te th e specim ens. Fig. 11. Saw ing a t c a rp e n try re q u ire s c o n c e n tra tio n . E x h ib its a re show n. Fig. 12. P u m m ellin g clay, o n e o f th e best o u tle ts fo r s u p ­ pressed em o tio n s. Fig. 13. W eaving, u su ally se dative. T h e c o lo u rs a n d p a tte rn s stim u la te in te rest. M ix e d g ro u p s. P ro d u c t a re show n. Fig. 14. B a sk e try , m ain ly used fo r re la x a tio n , is very sociable. L e a th e r w o rk aid s c o n c e n tra tio n . E m b o ssin g a n d p a in tin g in d u c e in te re s t. M ixed g ro u p s. N o te th e sam ples. Fig. 15. A fem ale class a t re la x a tio n . Fig. 16. A r t th e ra p y m u st be d o n e in a q u ie t a tm o sp h e re. T h e d o c to r listens to p a tie n ts ’ in te rp re ta tio n s o f draw ings, w hich a ssist in d iagnosis. Fig. 17. M usic ro o m . A p a tie n t plays th e p ian o . Fig. 18. P a r t o f d in in g ro o m . N o te th e lig h t, c lean c o n d i­ tions. W a ite rs a re c o rre c tly a ttire d . Fig. 19. A fem ale g ro u p s q u a re d a n cin g w hile a p a rt-tim e p ia n ist plays. | Fig. 20. A p o rtio n o f th e lib ra ry . P a tie n ts ’ d u tie s a re to assist th e lib ra ria n . Fig. 21. T h e s n o o k e r ro o m is very socializing. M a inly m ales. C o n c e n tra tio n is essential. Fig. 22. T e le p h o n e d u tie s a re ta k e n on by fem ales. M essages a re w ritte n on th e b o a rd . T h is re sto res confidence. Fig. 23. P a r t o f e q u ip m e n t ro o m . N o te th e c o m pleteness; also th e c u p s a n d tro p h ie s. Fig. 24. C ric k e t (fo r th e y o u n g e r m ales) assists c o n ­ c e n tra tio n . Fig. 25. H o c k ey . O u r p a tie n ts a re divided in to 2 m ain sides— yellow (The Tigers) a n d red (The L io n s)— to stim u la te the c o m p e titiv e sp irit. N o te th e m ixed g roup. Fig. 26. S o ftb a ll is a g o o d o u tle t fo r su p p ressio n s, socializing fo r te a m a n d sp e c ta to rs . M ixed g ro u p , w ith a w ide range o f ages. Fig. 27. C o n c e n tra tio n is e ssential in a rch e ry . M ixed group. L ess a ctive, e.g. w he el-c h air p a tie n ts. Fig. 28. C ro q u e t is so c ializing fo r th e less a ctive (m ainly fem ales). Fig. 29. T en n is o n o n e o f th e 4 c o u rts fo r a physically fit m ixed g ro u p . Fig. 30. T e n n iq u o its (m ixed g ro u p ) m a in ta in s c o n c e n tra tio n . 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. ) P I O N E E R . C T 6 0 4 b 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. ) 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. ) October, 1956. P H Y S I O T H E R A P Y Page Thirteen Fig. 31. Bowls. T h is show s o n e o f o u r tw o re g u la tio n size greens. I t is m o st so c ializing a n d relaxing. M ixed g ro u p s. Fig. 32. Sw im m ing b a th (17 ft. X 37 ft.), m ix e d g ro u p s. Socializing a n d stim ulative. Fig. 33. A re cre atio n c o m m itte e m eeting. A ll th e re p re ­ sentatives o f th e p a tie n t c o m m u n ity a re p re se n t w ith m em b e r o f team. Fig. 34. T he d in in g ro o m re p re se n ta tiv e h a n d s serviettes :o new patients, c o n d u c ts th e m to th e ir tables a n d in tro d u c e s them. Fig. 35. T he Y .M .C .A . c a n te e n w here p a tie n ts e n te rta in \ isitors. Fig. 36. A re h a b ilita te d p a tie n t e sc o rts a new p a tie n t to town and is responsible fo r him u n til he re tu rn s . The Occupational T h era p ist. T h e o c c u p a tio n a l th e ra p is t is a properly tra in e d a n d fully q u alified person. I t is by n o means essential fo r h e r to be a n e x p e rt o n c rafts. I t is fa r more im portant th a t she has a n a w areness o f p eople, k n o w s how to handle th em a n d h ow to fo ste r g o o d in te r-p e rs o n a l relationships. She sh o u ld be a g o o d te a c h e r a n d observ er, able to a d ap t th e selected c ra ft to th e p a tie n t’s re q u ire m e n ts and be ready a n d a b le to d ra w u p a d e q u a te re p o rts . The patient is p e rsu ad e d a n d n o t c o erc ed in to ta k in g p a rt in some activity a t T a ra . T h u s th e g re a te r th e scope th e easier it is to c o p e; a n d a m o n g s t th e a m e n itie s T a r a h as to offer, some activity th a t a p p e a ls to th e p a tie n t c a n alw ays be found. W e d o n o t w a n t to k n o w w h a t o c c u p a tio n a l therapy the p a tie n t is d o in g , b u t w h a t o c c u p a tio n a l th era p y is doing for th e p a tie n t. (T h e Society re p re se n tin g the occupational th e ra p is t is a new b ody w hich is grow ing rapidly and w ill no d o u b t play a g re at p a r t in th e fu tu re). The m uch p roclaim ed benefits o f m o d e rn c iv ilization are to a considerable e x te n t offset by a m o re intensified competitive sp irit a n d by th e in creased s tra in o f everyday life. T he rise in th e c o st o f living, w ar, th e th re a t o f w ar and its afterm ath, the insecurity o fte n a tte n d a n t o n longevity and the en tran ce o f w om en in to n e a rly a ll w alks o f life are some o f the fa cto rs w hich help to fill th e w a rd s o f such institutions as T a ra . It was G a len w ho sa id : ‘O c c u p a tio n is N a t u r e ’s best physician.’ A m o d ern sequel o f th is d ictu m c o u ld well read: ‘O c cu pational th e ra p y is N a tu r e ’s best m ed ic in e .’ S U M M A R Y . 1. T he psychiatric p a tie n t re q u ire s 24 h o u r s ’ d a ily o b se rv ­ ation for diagnosis a n d th era p y . 2. T he d o c to r’s tim e is lim ite d a n d he th e re fo re re q u ire s assistance from the diag n o stic a n d th e ra p e u tic team . 3. T he type o f p a tie n t a d m itte d to T a r a a n d his in tro ­ duction to the h o spital ro u tin e is o u tlin e d . 4. T he p h y siotherapeutic an g le is described. 5. O ccupational th era p y is defined, a s is o u r c o n ce p t th at it consists n o t m erely o f c ra fts b u t th e w ider field embracing g roup activity a n d g ro u p p a rtic ip a tio n o f all kinds necessary to resocialize th e p a tie n t to face his daily problem s in the o u tsid e w orld. 6. T he role o f the o c c u p a tio n a l th e ra p is t is in d ic a te d . O P S O M M IN G . 1. V ir diagnose en te ra p ie is d it n o o d s a a k lik o m die psigiatriese pasient 24 u u r p e r d a g w a a r te neem . 2. D ie geneesheer se ty d is b e p erk , en hy h e t d e rh alw e die hulp van die diagnostiese en te ra p e u tie s e sp a n nodig. 3. ’n Beskrywing w ord v e rstrek van d ie tip e p a sie n t w at to t T a ra toegelaat w ord, en sy voo rste llin g a a n d ie h o sp ita a l- roetine w ord kortliks beskryf. 4. D ie fisioterapeutiese sy v an d ie s a a k w o rd bespreek. 5. A rbeidsterapie w ord om skryf. So o o k on s o p v a ttin g d a t dit nie bloot u it h u lp k u n ste b e staa n nie, m a a r o o k u it die breer aspekte, insluitende gro e p b ed ry w ig h e id en a l die \erskillende soorte g roepbedryw igheid en al die verskillende C ontinued on P age 16 SOUTH AFRICAN SO CIETY OF PHYSIOTHERAPISTS GROUP ENDOWMENT FUND W e have p lea su re in a n n o u n c in g t h a t a G ro u p E n d o w m e n t F u n d h a s been in a u g u ra te d f o r m em b e rs o f th e S o u th A fric a n Society o f P h y s io th e ra p ists a n d w ill be u n d e rw ritte n by T h e C olonial M u tu a l Life A ssurance S ociety L im ite d (h e re in a fte r re fe rre d to a s th e U n d e rw rite rs). T h e Fund will enable m em bers of the S ociety to o b ta in assurance a t a low er cost th a n is possible w ith individual c o n tra c ts and will enable them n o t only to insure th e ir lives fo r th e benefit o f th e ir dependents b ut to save for th e ir retirem e n t by deduction of reg u lar m onthly co n tributions from sala ry . M em b e rs o f the S ociety who wish to insure un d er th is schem e m ust com plete a sh o rt P ro p o sa l F orm to g e th er w ith a S to p O rd e r for the deduction of co n tributions m onthly from s a la ry . T h e T ru ste e s o f th e F u n d will h o ld a t th e S o c iety ’s h e a d q u a rte rs a m a s te r policy o n th e sc h e d u le s o f w hich will be e n te re d full p a rtic u la rs o f e ach m e m b e r’s assu ra n ce . T h e benefits c o n sist o f g u a ra n te e d a m o u n ts p a y ­ a b le a t th e age selected by th e m em b e r, o r o n p rio r d e a th , a n d a re su b je ct to in cre ase by a n n u a l b o n u s a d d itio n s. A d d itio n a l benefits in th e fo rm o f C a sh P a y m e n ts su b je ct to in cre ase by b o n u s a d d itio n s as d e clare d in th e U n d e rw rite r’s A c c id e n t D e p a rtm e n t a n d w aiver o f fu tu re c o n trib u tio n s a re p a y a b le u p o n d isa b le m e n t d u e to c e rta in c o n tin g e n cies p r io r to th e selected age as set o u t o n th e m a s te r policy. B E N E F IT S W IL L D E P E N D U P O N : (1) T h e m em ber’s a g e on e n try in to the schem e; (2) T h e m onthly contribution to be p a id ; (3) The selected a g e a t which the sum assured is payable. A L L M E M B E R S W I L L R E C E IV E A C E R T I F I C A T E O F E N R O L M E N T G I V I N G F U L L D E T A I L S O F C O N T R I ­ B U T I O N S A N D B E N E F IT S . In th e ev e n t o f a m e m b e r le aving th e S o ciety, th e e n ro lm e n t will be c o n v e rte d in to a n o r d in a r y po licy w ith th e u n d e rw rite rs. Benefits a n d c o n tr ib u tio n s will re m a in u n c h a n g e d b u t fu tu re c o n tr ib u tio n s w ill re q u ire to be p a id d ire c t to th e u n d e rw rite rs. S u ch a p o lic y o n th e life o f a fem ale m e m b e r m a y , in c e rta in c irc u m s ta n c e s , be co n v e rte d in to a p o lic y o n th e life o f h er h u s b a n d i f he is in s u ra b le a n d n o t m o re th a n 10 y ea rs h e r s en io r. T he F und is sim ilar to th a t which has o p era te d f o r the benefit o f m em b ers o f the S o u th A fric a n N u rsin g A sso cia tio n f o r m a n y y e a rs a n d the E x ecu tive o f y o u r S o c ie ty hope th a t a ll m em bers w ill give the F und th e ir f u l l support. CUT HERE. T o the T R U S T E E S G R O U P E N D O W M E N T F U N D , S.A . S O C IE T Y O F P H Y S IO T H E R A P IS T S , P .O . B O X 1106, P R E T O R IA . P le ase su p p ly m e w ith d etails. N a m e .............................................................................. A d d r e s s .......................................................................... D a te o f B irth ................................................................. W h ere em p lo y ed .......................................................... H o w m u ch c an you affo rd to pay each m o n th : 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. ) Page Sixteen P H Y S I O T H E R A P Y October, 1956. BRANCH NEWS M iss Lovely, o f th e sta ff o f A d d in g to n H o s p ita l, D u rb a n , is a t p re sen t on leave in E n g la n d . M eanw hile, M rs. P. P ilk in g to n a n d M rs. G re en w ay h a v e ta k e n u p p o sts a t A dd in g to n . T h e m em b e rs o f th e N a ta l a n d Z u lu la n d B ra n ch offer th e ir co n d o le n ce s to M iss C h e rrin g to n (A d d in g to n H o sp ita l), o n th e occasion o f th e d e a th o f h e r fa th e r, w ho d ied on A u g u st 28th a fte r a long illness. M iss C o re e n K n o x -P e rk in s (A d d in g to n H o s p ita l) is o n a trip to visit frien d s in th e U .S.A . M r. A. D . M o ig h a s ta k e n up a p o st a t E d e n d a le H o sp ita l, P ie te rm aritz b u rg . M iss J. T h o m a s-D av ies, fro m th e U n ite d K in g d o m , a n d M iss J. R o b e rts , fro m N ew Z ea la n d , h a v e jo in e d th e sta ff o f th e K in g E d w a rd V III H o s p ita l, D u rb a n . N O R T H E R N C A P E B R A N C H N O T E S M em bers a re d e lighted to h e a r th a t M iss D . T re d re a re tu rn s to S.A . in S e p tem b e r a fte r successful eye o p e ra tio n s in L o n d o n . N ew s o f M r. E. J. N ic h o lso n is th a t h e h a s been a p p o in te d to th e R e h a b ilita tio n O rth o p a e d ic H o s p ita l, S ta n m o re , E ngland. T h e H elen B ish o p O rth o p a e d ic A fte r-C a re H o m e is at p re sen t w ith o u t a p e rm a n e n t P h y s io th e ra p ist. M iss S etzer a n d M rs. Y e o w a rt a re d o in g p a r t tim e w o rk th e re to help bridge th e g ap a little. W E S T E R N P R O V IN C E B R A N C H W e wish M r. M a c M u rra y well in h is new office as E x am in er to th e R o y a l C ollege o f S urgeons. H e has alw ays been a g ood frie n d to P h y sio th e rap ists. M r. H o d g e s has left a well fu n c tio n in g w o rk sh o p in C a p e T o w n a n d h a s g one to R h o d e sia to b ring to th a t c o m m u n ity h is a b le h elp in th e sh a p e o f T a y lo r’s B races, G o rm a n S prings a n d C a m p C orsets, etc. H e w as a tonic to k n o w a n d h e m a d e it his business to be au f a i t w ith the latest tre n d s fro m overseas. M r. B ill W o o d g ate. W e w ish h a p p in e ss in his new p o st a t th e L ad y M ic h a e l’s O rth o p a e d ic H om e, P lu m stea d . M rs. Sw eet. W e wish h e r jo y in h e r new h o m e a t T o k a i. M iss J. G o ld m a n . W e tru s t h e r se m i-re tire m e n t is h a p p y a n d w ith th e b e tte r w e ath e r we h o p e to see m o re o f her. M r. K . N icol. li is n o lo n g er necessary to re a d P ro f. Spock, as he h as g a ined a w ealth o f experience lo o k in g a fte r J u n io r w hilst M rs. N ic o l w as overseas. O u r G e n era l M e e tin g o n Ju ly 22nd w ith M iss J. B lair as guest sp e a k er w as a pleasure. W e w ere a b le to lea rn a t first h a n d w h a t C .E .C . w ere d o in g fo r us. I t is a p ity th ere c a n n o t be m o re m ig ra tio n a n d in te rch a n g e o f P h y sio th e r­ apists. C h a n g e o f a d d re ss : M rs. E . M yer, 7 O a k ley C o u rt, P ro te a R d ., C lare m o n t. S O U T H E R N T R A N S V A A L B R A N C H N E W S O n Ju ly 12th, D r. Ja c k G e a r gave th e b ra n c h a very s tim u la tin g a n d inte restin g talk on “ S om e P itfalls in th e E v alu a tio n a n d M e dical T re a tm e n t” . T h e ta lk was th o ro u g h ly e n jo y e d by all m em bers present. A F ilm evening w as h eld o n A u g u st 21st. A d is a p p o in t­ ingly sm all a u d ie n ce saw th re e very goo d films. T w o o f w hich w ere o f g eneral in te rest a n d o n e o f “ S hort-w ave T ec h n iq u e .” M A R R IA G E S M iss S. L e v itt to M r. J. H a lp e m , A u g u s t 5th, 1956. M iss E ileen B o o th — M edw ay. M rs. M e dw ay is still a t W yn b erg H o sp ita l. C o n tinued f r o m P age 5 It w as o nly p ossible to a tte n d a b o u t a q u a r te r o f the lectures. T h e c o m p le te pro c ee d in g s a re to be pu b lish ed in Ja n u a ry so th a t yo u will be a b le to re a d th em then. O ne of th e m o s t helpful a n d stim u la tin g lectures discussed the m e th o d o f using “ to n ic neck reflex” in th e tre a tm e n t of hem iplegia. A m o n g st th e tips th a t I p icked u p w as glosso-pharygeal b re a th in g o r frog bre ath in g . P a tie n ts w ith re sp irato ry p a raly sis a re ta u g h t to “ g u lp ” a ir in to th e lungs, so th a t they b ecom e filled a fte r 10 “ gu lp s” a n d th e re fo re c a n b u ild up th e ir v ital capacity. In c o n clu sio n 1 m u st say h o w m uch I enjoyed th e con­ ference a n d h ow g ra te fu l I a m th a t 1 h a d th e o p p o rtu n ity to a tte n d it as th e re p re se n ta tiv e o f th e S o u th A frica n Society o f P h y sio th e rap y . L e t us d o everything in o u r p o w e r to see t h a t S o u th A frica is fully re p re se n ted a t th e n e x t W orld C o n fe d e ra tio n in Paris. C ontinued fr o m P age 13 so o rte gro e p d ee ln e m in g w at n o d ig is om die p a sie n t o p n u u t te sosialiseer so d a t hy sy da ag lik se p ro b le m e in d ie buite- w ereld w eereens die h o o f k a n bied. 6. D ie ro l v an die a rb e id ste ra p e u t w o rd aan g e d u i. T h e c o lo u r p h o to g ra p h s (Figs. 1— 36) w ere tak e n by the a u th o r a n d they show th e v a rio u s a ctiv ities o f th e Physical M e d icin e D e p a rtm e n t. 1 wish to th a n k D r. H . M o ro ss, M e d ica l S u p e rin te n d en t o f T a ra , fo r his very k in d a dvice a n d c o -o p e ra tio n in m aking th is p re se n ta tio n possible. F O R S A L E P r i v a t e P r a c t i c e in E a s t L o n d o n . F u lly eq u ip p e d tre a t­ m e n t ro o m s in new M e d ica l C e n tre . O w n er w ishes to re tire fo r do m estic reasons. F o r fu rth e r p a rtic u la rs a p ply: P .O . 25, P h y s io th e ra p y D e p a rtm e n t, G e n era l H o sp ita l, J o h a n n e sb u rg . P h y s i o t h e r a p i s t re q u ire d , full-tim e o r p a rt tim e from 1st J a n u a ry , 1957, fo r P riv a te P ra c tice in G e rm is to n . F o r f u rth e r p a rtic u la rs p lease w rite to M r. J. M . B o th a , 203 M edical C e n tre , G e rm is to n , o r P h o n e 51-1933. L o c u m w a n ted to ta k e o ver P riv a te P ra c tice a t D u rb a n N o r th , N a ta l. O w n e r going o verseas in M a rc h . L ocum re q u ire d J a n u a ry 1957 to S e p tem b e r 1957. L o cu m n o t re q u ire d on S alary basis, b u t to ta k e o ver a ll p ro fits and p a y expenses. C a r a necessity. F o r fu rth e r p a rtic u la rs a p p ly : P . U n ia ck e , R o o m s 1 6/17, 11, B ro a d w ay , D u rb a n N o rth . A E s t a b l i s h e d P r i v a t e P r a c t i c e in E d u c a tio n a l C ity for im m e d ia te sale. F o r fu rth e r p a rtic u la rs a p p ly : P .O . 28, P h y s io th e ra p y D e p a rtm e n t, G e n e ra l H o sp ita l, Jo h a n n e sb u rg . 1 M a i n s O p e r a t e d P o r t a b l e U n i t in b lack case giving ga lvanism a n d sin u so id a l, in p erfect c o n d itio n . M a k e rs : M e d ica l S upplies A sso c ia tio n , M o d e l 0. £20. A p p ly : M rs. A . C lose, P.O . B ox 355, L iv in g sto n e , N o rth e rn R h o d e sia. O l d E s t a b l i s h e d P h y s i o P r a t i c e fo r sale in S o u th e rn R h o d e sia . D o m e stic re a so n s f o r sale. F o r f u rth e r p a rtic u la rs a p p ly :— P . 027, P hysio D e p t., G e n e ra l H o s p ita l, J o h a n ­ nesburg. S IT U A T IO N S V A C A N T V a c a n c y occu rs fo r a p a r t tim e fully q u alified p h y sio ­ th e ra p is t. H o u r s : 9 a .m .— 1 p .m . M o n d a y s to F ridays. A p p ly : Secretary, U n ite d C e re b ra l P alsy A sso c ia tio n o f S o u th A frica, P . O . B ox 10398, o r ’P h o n e 33-3367 /8. L o c u m P h y s i o t h e r a p i s t re q u ire d fo r p riv a te p ra c tic e fo r N o v e m b e r o r D e ce m b er, 1956. D ire c t e n q u iries to — 13, B rig h t S tre et, S o m e rse t W est, C ape. 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. )