Page Ten P H Y S I O T H E R A P Y April, 1956. SPO RTS: A REVELATION TO THE PARAPLEGIC By E. J. J. KRUG ER, m .c .s .p . ( m .a .c .b .p .) (Lond.). TO th e c a s u a l o b se rv er, it w as c e rta in ly a s tra n g e sight to w a tc h a n u m b e r o f p e o p le in w heel c h a irs c h asin g a fte r a b a ll in th e new g y m n asiu m o f th e J o h a n n e s b u rg G e n e ra l H o s p ita l. I t m u st h a v e b een eq u ally stra n g e to w a tc h a rc h e ry , ta b le te n n is, b a d m in to n , d a rts a n d ten n i- q u o its b e in g p la y e d fro m th e sa m e w heel c h a irs. A lth o u g h th is w as a n u n u s u a l sig h t, th e ex p ressio n o f sheer d e light o n th e faces o f th e p a rtic ip a n ts to ld v o lu m e s t o th e o n lo o k e r w h o k n e w t h a t th e y w ere p a rap leg ic s w h o fo u n d n ew jo y in life. In sp ire d by th e a ch iev e m en ts a n d success a t S to k e M a n d e v ille, s p o rts w ere in tro d u c e d to th e Jo h a n n e s b u rg G e n e ra l H o s p ita l a s a re g u la r a ctiv ity in th e re h a b ilita tio n schem e o f th e p a ra p le g ic p a tie n t. P re p a rin g th e p a tie n t to lea d a fa irly n o rm a l life in e m p lo y m e n t a n d a t h o m e is o n ly p ro v id in g so m e c o m p e n sa tio n fo r th is disa b ility , th e sense o f fru s tra tio n fro m w hich h e in ev itab ly m u st suffer, n e ed s e x p ressio n in such a w ay a s to relieve h im o f excessive energy. E v en fifteen y e ars a g o th e p ic tu re p re se n te d by p a r a ­ pleg ia w a s c erta in ly n o t p le a s a n t o r e n c o u ra g in g . T h e p a tie n t w ith b e d so res, b la d d e r a n d b ow el in fec tio n , c o n ­ tra c tu re s a n d m e n ta l d e p re ss io n p re se n te d a se rio u s a n d d ish e a rte n in g p ro b le m . T h a n k s to th e e x p e rt c o m b in a tio n o f m ed ic al, n u rsin g a n d p h y sio th e ra p y tre a tm e n ts , th e d e ta ils o f w h ic h c a n n o t b e d e sc rib e d h e re , it w as le a rn t h o w to r e h a b ilita te th e s e c ases a n d r e tu r n th e m to n o rm a l life to c a re o n c e a g a in fo r h o m e a n d fam ily. I f th e p a ra p le g ic c a n b e re h a b ilita te d to th is e x te n t, th e re a d e r m ay rig h tly a sk , w h a t m o re c a n s p o rts th e n a c h ie v e ? T o th is m o st n a tu r a l q u e s tio n I w o u ld like t c reply as fo llo w s: R A I S I N G O F M O R A L E . T h e loss o f th e u se o f th e low er extre m itie s o f th e b o d y is c e rta in ly a se rio u s m a tte r, b u t w h en th e p a tie n t becom es d e m o ra liz ed b y re aliz in g th e tr u e sta te o f affairs, a f a r w orse p ro b le m faces th e re h a b ilita tio n te a m . I t is d u rin g th e e a rly stages o f re co v e ry w h e n th e m in d o f tb e p a tie n t is p re -o c c u p ie d t h a t h e d isc o v ers p ro b le m s h e is a fra id to face. E x c e p t fo r his p h y sic al h a n d ic a p , o th e r p ro b lem s like re la tio n s h ip be tw ee n h u s b a n d a n d wife, p ro v id in g a m p ly fo r th e fam ily, a n d b e in g a b u rd e n to th e c o m ­ m u n ity a re to b e solved by th e p a ra p le g ic p a tie n t. F in d in g n o o b v io u s a n sw e r t o solve th e difficulties h e m o s t o ften s ta r ts lo sin g h e a rt a n d b e co m es a p a th e tic to w a rd s t r e a t ­ m e n t. A la rg e p e rc e n ta g e o f p a tie n ts becom es satisfied to sp e n d th e re st o f th e ir lives in bed o r in a n in ac tiv e m a n n e r a r o u n d th e h o u se . W e disc o v ere d t h a t th e n a tu r a l a n tid o te to th is a ttitu d e o f m in d is t o b rin g th e s e p a tie n ts in c o n ta c t w ith th e ir fellow sufferers o n th e field o f sp o rts. T h e c h an g e o f e n ­ v iro n m e n t, th e c h a n g e o f th e te d io u s m e th o d s o f exercising, a n d o b se rv in g th e a ch iev e m en ts o f o th e rs q u ick ly stirs th e desire t o d o th e sam e. B e fo re lo n g th e a p a th y a n d d e p re s­ sio n d is a p p e a r a n d th e in ac tiv ity o f th e p a tie n t is c o n v e rte d in to a ctiv ity w h ic h gives h im a new zest fo r life. I recall o n e case in p a rtic u la r, w h e re th e p a tie n t, a fte r fra c tu rin g his sp in e , w as c o nfined to b ed fo r c lo se on e ighteen m o n th s , b e fo re a n y re a so n a b le success c o u ld be o b ta in e d w ith h is re h a b ilita tio n p ro g ra m m e . T h is delay, w hich w as e n tire ly d u e t o his lo sin g a ll h o p e a n d fa ith , c a u se d th e p a tie n t to suffer b a d ly w ith b e d so res a n d b la d d e r infec tio n . O n c e w e su cceed ed in ra is in g his in te re s t in th e p a ra p le g ic s p o rts , a ll h is difficulties, p h y sic al a n d m en ta l, seem ed t o d is a p p e a r o v e r n ig h t. H e w as sh o rtly a fte rw a rd s d isc h a rg e d a s fully re h a b ilita te d a n d leads a t p re se n t a very n o rm a l life. Competition. T h e p a ra p le g ic p a tie n t q u ite o fte n n u rse s th e id ea th a t n o b o d y else c o u ld b e w o rse o ff t h a n h im self. W hen tak in g p a r t in sp o rts h e sees t h a t o th e rs a re m o re h a n d ic ap p e d b u t realizes t h a t th ey , n e vertheless, a re try in g desperately t o lea rn h o w to live w ith th e ir d isa b ility . T h is a ttitu d e b ecom es in fe c tio u s a n d re u slts in a sp irit o f c o m p e titio n in w hich ev ery o n e trie s t o a chieve so m e th in g m o re o r better th a n h is fellow sufferer. T h is is o n e o f th e m o s t im p o rta n t ste p s in th e re h a b ilita tio n o f th e p a rap leg ic , n am ely, to fo rg e t his o w n tro u b le s a n d to le a rn to live w ith o th er p e o p le . H a v in g le a rn t th is m o s t im p o rta n t lesson, he is re a d y to a d ju s t h im self to th e new c irc u m sta n c e s a t hom e a n d w o rk by relying e n tire ly o n h is ow n a b ility. Developing Muscle Power. P h y sic a l re h a b ilita tio n o f th e p a ra p le g ic is e n tirely based o n a b n o rm a l s tre n g th in th e t r u n k a n d u p p e r extrem ities. T o a chieve th is , th e p a tie n t h a s to la b o u r fo r h o u rs o n end. T h is stre n g th e n in g p ro c ess b eco m es la b o rio u s a n d tedious a n d q u ite o fte n a p p e a rs t o h a v e c o m e t o a sta n d still. T ak in g p a r t in a g a m e o f n e tb a ll o r c o m p e tin g fo r th e highest sc o re o n th e a rc h e ry ta rg e t expels th e id ea o f exercising w hile th e p a tie n t uses h is m uscle p o w e r to th e u tm o st. I t is in te re s tin g to n o te t h a t th e d a y fo llo w in g a p ro g ram m e o f stre n u o u s sp o rts th e p a tie n ts u sually suffer fro m m uscle stiffness a n d tire d n e s s w hich is a n in d ic a tio n o f th e excellent exercise v a lu e o f th e gam es. R eflecting o n th e c ases u n d e r m y c a re I recall o n e in in p a rtic u la r w h o is a P o lio p a rap leg ic , to ta lly paralyzed in legs a n d tr u n k w ith so m e w eak n ess in th e a rm s . T his p a tie n t a f te r m o n th s a n d m o n th s o f tre a tm e n t w as only lim ited to th e p a ra lle l b a rs fo r w a lk in g a n d co u ld n o t lean o u t o f th e c h a ir t o p ick u p a n o b je c t fro m th e flo o r. A fter several s tre n u o u s g am es it w as n o te d w ith a sto n ish m e n t h o w m o b ile sh e b e ca m e especially in th e h a n d lin g o f the wheel c h a ir a n d th e p ick in g u p o f objects. S he benefited so m u ch fro m th e ge n era l exercise t h a t sh o rtly afterw ards she fo u n d it p ossible t o n e g o tia te a p a ir o f cru tc h es. Augmenting Kidney Action. I n th e case o f a sp a stic p a rap leg ic , w here th e sp in a l c o r d ' is severed, g ro ss in te rfere n c e w ith th e u rin a ry functions ta k e s p lace re su ltin g o fte n in re te n tio n . A s th e kidneys a n d b la d d e r c a n n o t free th e b o d y o f th e w a ste p ro d u c ts o f m e ta b o lism , th ese p ro d u c ts re m a in in th e b lo o d stream m a k in g th e p a tie n t feel a n d lo o k ill. T h e o n ly o th e r way to a u g m e n t th e a c tio n o f th e kid n ey s is th ro u g h th e sweat g lan d s w hich c o m e in to a c tio n by m ea n s o f very strenuous exercises. A g a m e o f n e tb a ll seem s to b e th e a n sw e r t o this q u e s tio n as it m a k e s h ig h d e m a n d s o n th e m u sc u la r system to k e ep u p w ith th e very fa st pace. I t w as specially observed t h a t so m e n ew com ers to th e te a m ex ch a n g ed a p a le sickly c o lo u r fo r a h e a lth y r a d ia n t one. ■ H a v in g p o in te d o u t so m e o f th e m a in benefits to be d e riv e d fro m sp o rts , I w o u ld lik e t o m a k e o n ly a few rem arks c o n c e rn in g so m e o f th e g am es. N e tb a ll.— T h is is a very s tre n u o u s g a m e a n d depends o n e x cellent m u sc le a n d b a la n c e c o n tro l. I t c a n b e a very ro u g h g a m e w ith in ju rie s as a re su lt, b u t u n d e r th e proper c o n tr o l it is as safe a s a n y o th e r. A s a ll parap leg ic s have th e ir o w n c h a irs , th e re q u ire m e n ts fo r th is g am e a re a n e tb a ll a n d tw o g o a l p o sts. O n a c c o u n t o f its simplicity 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. ) April, 1956. P H Y S I O T it can either be played i n d o o r s o r o n a very h ar d even surface outside. Archery.— An excellent s po r t for devel opi ng the a rm s and up pe r tr u n k . It c an either be exercised i n d o o rs o r outside but it m u st be realized t h a t it is essentially a dangerous ga me a n d the necessary sa f egu ar ds mu st be take n. Although the financial o u t la y o f this spo rt is on the high scale, it is o n e o f the mo st p o p u l a r games. Badminton and T ab le T ennis.— Thes e tw o game s are naturally very fast a nd d e m a n d agility, skill a nd c o n c e n ­ tration o f the pa tient. W h e re a s the prev ious two games mentioned a r e excellent for developing muscle power, the latter two mainl y de velop men ta l c o n c e n tr a tio n . Darts.—T h is is a very light ga me which provides relaxa­ tion and a m u s em en t but yet calls for acc uracy. T h is is very much enjoyed by the patie nts when interp osed between strenuous activities. T he a b o v e m en ti o ne d are on ly a few o f the great variety of sports in which the paraplegic patient can t ak e p ar t a nd excel himself. O t h e r types like javelin, th r o w i n g the h a m m e r, etc., will, we hope, be intro duc ed sho rt ly to the pr og ra m m e. Once the paraplegic ha s o v e r c o m e his disability an d gained confidence in himself, a new life o p e n s befo re him wherein he can c o m p e t e with his fellow men a n d onc e again live a ha p py , n o r m a l life. W heelchair A rchery. H E R A P Y Page Eleven SOUTH AFRICAN SO CIETY OF PH YSIO TH ERAPISTS GROUP ENDOWMENT FUND W e h a v e plea sur e in a n n o u n c i n g t h a t a G r o u p E n d o w m e n t F u n d ha s been in au g u r a te d for m em b e rs o f the So u t h Afri can Society o f P h y s io th e ra p is ts an d will be u n d e r w r it t en by The C olonial M u tu a l Life Assurance Society L im ited (herei naf te r referred to as the U nde rw ri ter s). T h e F u n d w ill e n a b le m e m b e rs o f t b e S o c i e t y t o o b t a i n a s s u r a n c e a t a l o w e r c o s t t h a n i s p o s s ib le w ith i n d iv id u a l c o n t r a c t s a n d w ill , e n a b le th e m n o t o n l y t o i n s u r e t h e i r liv e s f o r t h e b e n e fit o f t h e i r | d e p e n d e n t s b u t to s a v e f o r t h e i r r e t i r e m e n t by d e d u c ti o n o f r e g u l a r m o n th l y c o n tr i b u ti o n s f r o m s a l a r y . M e m b e r s o f t h e S o c i e t y w h o w ish to i n s u r e u n d e r t h is s c h e m e m u s t c o m p l e te a s h o r t P r o p o s a l F o r m t o g e t h e r w ith a S t o p O r d e r f o r t h e d e d u c ti o n o f c o n tr i b u ti o n s m o n th l y f ro m s a l a r y . T h e T ru ste e s o f the F u n d will hold at th e So ci ety ’s h e a d q u a r te r s a m as te r policy o n the sch ed ule s o f which will be en ter ed full p a r tic u la r s o f each m e m b e r ’s assu rance. T h e benefits co nsist o f g u r a n te ed a m o u n t s p a y ab le at th e age selected by t h e m e m b e r, o r on p ri o r de a t h , a n d a r e subject to increase by a n n u a l bo nu s addit io ns. A d d i t io n a l benefits in the f o r m o f C a sh P a y m e n t s subject to increase by bo n us a d d it i o n s as de clared in the U n d e r w r i t e r ’s Ac cident D e p a r t m e n t a nd waiver of fu tu re c o n t r i b u t i o n s a r e p a ya b le u p o n di sa b le m en t d u e to cer tai n c o n tin ge nci es p r i o r to the selected age a s set o u t o n the m as 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 he m em b e r’s a g e on e n try into the sc h e m e ; (2) T he m onthly c o n tribution to be p a id ; (3) T he selected age a t which the sum assu red is payable. A L L M E M B E R S W I L L R E C E I V 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 I T S . I n I h e e v e n t o f a m e m b e r l e a v i n g t h e S o c i e t y , t h e e n r o l m e n t w ill b e c o n v e r t e d i n t o a n o r d i n a r y p o l ic y w i t h t h e u n d e r w r i t e r s . B e n e f it s a n d c o n t r i b u t i o n s w ill r e m a i n u n c h a n g e d b u t f u t u r e c o n t r i b u t i o n s w ill r e q u i r e t o b e p a i d d i r e c t t o t h e u n d e r w r i t e r s . S u c h a p o l ic y o n t h e lif e o f a f e m a le m e m b e r m a y , i n c e r t a i n c i r c u m s t a n c e s , b e c o n v e r t e d i n t o a p o l ic y o n t h e lif e o f h e r h u s b a n d i f h e is i n s u r a b l e a n d n o t m o r e t h a n 10 y e a r s h e r s e n io r . The Fund is similar to that which has operated fo r the benefit o f members o f the South African Nursing Association fo r many years and the Executive o f your Society hope that all members will give the Fund their fu ll support. C U T H E R E . 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 . Please supply me with details. N a m e ..................................................................................... A d d r e s s ................................................................................ D a t e of B ir th ....................................................................... W h er e e m p l o y e d ................................................................ H o w mu ch can you afford 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. )