Page Twenty-Four P H Y S I O T H E R A P Y July, 1954, SPRING GYM N ASTICS B y M ISS J. BLA IR , M.c.s.p. (Teacher’s Certificates): Senior Lecturer in Physiotherapy University o f the W itwatersrand. J T is not always possible to devise really strong resisted exercises without a great deal o f paraphernalia and equip­ m ent; an d the private practitioner in particular, often finds herself in a position where her patient needs resistance at home, and there is difficulty in devising a method. I p u t forw ard the following little unit (D iagram 1.) as being a suggestion in treating som e o f the patients. 1. Foot Exercises (D iagram II) : W ith three slings and tw o springs there are m any resisted exercises th a t can be perform ed and perhaps many others th at could be. F o r m ost o f th e leg exercises one sling is around the waist an d one on each foot, the two springs, the weight of which is dependent on the patient’s strength, placed in the circuit parallel with the legs (D iagram II). The patient is in long sitting and controls the tension o f the springs with the position o f her tru n k and their angle o f pull with her hands. W ith th e springs on slight tension to begin with, all ankle and mid torsal jo in t movements are given against th e resistance o f the spring. 2. H ip and Knee Extension : W ith the patient leaning back against the tru n k sling, hip and knee extension is given alternatively, the direction o f the spring being controlled by the patient’s hand on the trunk belt and spring junction. 3. H ip Exercises : (a) H IP U P D R A W IN G (Diagram III). 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. ) July. 1954. P H Y S I O t h e r a p y Page Twenty-Five F o r this exercise th e patient is in long sitting and both springs m ust be on slight tension to begin the exercise. (b) L EG A B D U C T IO N A N D A D D U C T IO N (D ia­ gram IV). IV. T he patient leans back against th e tru n k sling until she is in the h a lf lying position and th e springs on tension; single or double leg abduction and adduction, circumduction o r flexion can then be performed against resistance. 4. Trunk Exercises (D iagram s V and VI). V. / VI. With the patient in long sitting and the arm s in wing position o r holding the sling spring junction • trunk extension, side flexion and ro tatio n may be given,’ the tension o f th e springs being controlled by the’ position o f the trunk, i.e. if increased resistance is required springs m ust be a t a greater tension. 5. H ead Exercises (D iagram VII). F o r these exercises it is m ore com fortable for the patient to be in a crook sitting with the peripheral -slings around the thighs if possible. T he patient has a head rest position o f the arm s to guide an d control the angle o f pull o f the springs and head sling. H ead extension, head and neck extension, head side flexion and head rolling are all possible against the resistance o f the springs. A n excellent hom e treat­ m ent for cervical osteoarthritis. 6. Arm Exercises (D iagram VIII). VII. By detaching one sling and spring and having the circuit: sling-spring-sling, arm exercises can be per­ form ed with one sling o n th e leg for anchorage or fixation. This sling m ay be placed around the thigh— as in D iagram V III, or around th e foot depending on the required resistance and range o f movement. 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 Twenty-Six P H Y S I O T H E R A P Y July, 1954. VIII. Similarly this unit m ay be equally well employed in. giving leg exercises (D iagram IX ), the arm o r han d being th e anchorage an d the position o f the arm con­ trolling the angle o f pull an d tension o f the spring.. IX. In this article I have deliberately not specified conditions for which these exercises can be used; that is up to the physiotherapist to a d a p t the basic idea to th e needs of tier individual patient. These exercises are merely suggestions given in good faith, and I would m ost heartily appreciate other ideas and opinions o n Spring Gymnastics. I am sure there is trem endous scope fo r simple methods o f Re­ habilitation. Mrs.. G uthrie Smith has already blazed the trail, an d an interchange o f ideas is always a stimulus. M ay I hope th a t this is the first o f many articles on similar lines ? j AVALON A BRIEF A C C O U N T O F T H E W ORK D O N E AT TH E R EH A BILITATIO N CENTRE. * / B y SU SIE O O ST H U IZ E N , m .c .s .p ., Superintendent. IN 1952 the A valon Association fo r the reHabilitation o f the Physically H andicapped transferred its Centre from T ulbach in the C ape to “ Tussenkoppies” F a rm near Johannesburg. In th e beginning this new centre, which was ju s t a farm , h ad to be p u t into some sort o f shape in o rder to accom m odate 9 patients, and an old b arn was converted into a gym, etc. A t first it was doubtful w hether there w ould be a dem and fo r such a C entre. B ut soon, after some propaganda, it was discovereed th a t m ore accom ­ m odation would be necessary an d the total was then brought up to 20 beds, and now the dem and is so great th a t over 100 names are on the w aiting list. Cases are drafted from various organisations o r directly. A m ong th e organisations interested are : T he Cripple C are O rganisations, H ospitals, W elfare O rganisations, M ilitary Pensions D epartm ent, Social W elfare D ep art­ ments, W .C .A . an d L ab o u r D epartm ents an d D octors. A medical certificate is necessary in all cases applying for admission, which includes the history o f the case, suggested lines o f treatm ent, an d probable d uration o f stay a t the C entre. Close co-operation exists between all'these different departm ents an d th e Superintendent, an d th e services o f honarary doctors are available a t any time. T o quote examples o f how the C entre operates from the co-ordination with allied organisations a short history is given below o f Frankie W right. H ere was a boy who, a t th e age o f 9 years, h ad his right leg am putated above the knee, due to osteomyelitis, an d for th e following 30 years he h ad a recurrent osteomyelitis in the left hip. The picture then was th a t F rankie sat in a chair, n o t even a wheelchair, with an am putated leg, a withering left leg with hip contractures, an increase in girth size, loss o f muscle tone an d a m ental outlook which debarred him from any sort o f social life. So, F rankie h a d n o t w alked fo r 30 years. On- the 6th o f February, 1953 this patient entered AVA LO N with new hope o f walking again. . Sling exercises were comm enced an d although the bone in the hip was very osteoporosed, the risk o f attem pting to straighten the" leg in o rder to fit a weight bearing caliper was taken, an d active assisted exercises were begun. D uring thisjj period the Physiotherapy D epartm ent a t the Johannesburg^ G eneral H ospital very kindly assisted A valon by giving u ltra violet light w ith the K rom ayer to the hip twice weekly f o r a period o f three m onths. (It is interesting to n o te that the hip has been clear fo r 6 m onths). T he Social W elfare D epartm ent during this period, set to w ork to obtain th e approval o f the H ealth D ep art­ m ent fo r the m aking o f a prosthesis for the right leg and a caliper for th e left leg. Once this o rder was sanctioned, the G overnm ent Artificial Lim b Factory m ade the necessary appliances and then the teaching o f w alking started. F rom th e anti-social'view point, ways and means to break down a 30 year old barrier had to be brought into the program m e. This was started by introducing strangers to him , encouraging him to talk ab o u t his disability and encouraging him to attend places o f entertainm ent in public. O utings in the com pany o f o ther patients were constantly organized, various ■ public bodies visited th e C entre, and soon Frankie n o t only started to talk a b o u t himself, but actually enjoyed doing so. The final scene in his rehabilitation was when the Superintendent took him o n a holiday, which m ade him 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. )