Page 6 P H Y S I O T H E R A P Y March, 1963 WHERE THERE'S A WILL THERES A WAY By G ISE L A ST EY N and C H R IS T IN E JU N A K Mrs. T. was born in 1928 in R ichm ond, Surrey, England, o f South A frican parents. A t the age o f 20 M rs. T. graduated from the L ondon University w ith a special H onours degree in Chemistry. Shen then w orked for tw o years as an Industrial Bio-Chemist in London. H aving com e o f age, M rs. T. now decided the time had come for her to jo in her family in South Africa. O n their farm she spent the first three m onths packing grapes, after which she started w ork as a chem ist for Fishing Industry R esearch In stitu te in M ay, 1950, until February, 1952, in C ape Town. F ro m here she was transferred to Walvis Bay where she was in charge o f the laboratory having to act as chemist, typist, sam pling officer, canning inspector, etc. In Septem ber o f th a t year M rs. T. gave up her jo b to get m arried. H er first child, a daughter, was born in 1955, and in the following year a second daughter was born. In M arch, 1957, three m onths into her th ird pregnancy, she becam e ill. F o r one week she was a t home w ith severe backache and high tem perature b u t n o definite diagnosis m ade as paralysis had n o t yet set in. As they were living in Velddrift, the d octor decided to move her to the City H ospital, Cape T ow n. I t was then, th a t trying to walk to the car, her legs gave way under her and she collapsed. N o longer could there be any d o u b t; she had become a victim to the dreaded disease poliomyelitis. Tw o hours later her legs were totally paralysed. T he following day her arm s becam e weak, and th e lungs deteriorated to such an extent th a t she was pu t into an Iro n Lung. She had to be p u t on intravenous feeding as well, as she regurgitated all her food. Physiotherapy treatm ent was started with passive move­ m ents and breathing exercises to help prevent com plications setting in. As the weeks passed, her respiratory muscles gradually im proved, and she spent increasing periods out o f the Iron Lung. A fter 2 \ m onths, Mrs. T. was transferred to G roote Schuur H ospital with the following rep o rt: 1. T o tal paralysis o f legs except for som e retention of p lantor— and dorsiflexors o f feet. 2. Paralysis o f abdom inal muscles. 3. P o o r diaphragm atic action. 4. W eakness o f intercostal muscles. 5. W eakness o f left shoulder girdle and triceps. 6. Slight weakness in both hands. 7. Severe urinary infection—a catheter was inserted. By this time the patient was six m onths pregnant. She spent m ost o f the time out o f the Iro n Lung but returned to it at night. H er general condition was poor. 20/6/57: Patient developed pneum onia and became so ill th a t she was put back into the Iro n Lung. 29/7/57: M rs. T .’s baby daughter was born w ithout com ­ plications and w ithout the Iro n Lung. F rom th a t time onw ards her condition improved rem ark­ ably. She to o k a great interest in occupational therapy, and here her degree in F ine A rts stood her in good stead. H er arm showed rapid im provem ent and soon became quite strong. T he triceps muscle, however, still retained some weakness. A ugust, 1957: th e Iro n Lung was discarded completely. Physiotherapy treatm ent continued daily to strengthen her arm , tru n k and legs. O ctober, 1957: Mrs. T. now m anaged controlled upright sitting in a wheelchair fo r a short time. Functional exercises such as typing, weaving plus resisted strengthening exercises im proved her general condition tremendously. T hroughout her illness, she rem ained cheerful and co-operated at all times. H er willpower to overcom e her weakness did much tow ards helping her rehabilitation. D ecem ber, 1957: A brace and calipers were fitted. A t this stage Mrs. T. learned to balance on her feet and attem pted a few steps. This was extremely difficult as both hip extensors were paralysed. H er back extensor muscles improved rapidly but the abdom inal muscles rem ained weak. Emphasis was placed o n teaching the patient independence in daily activi­ ties. In M arch, 1958, Mrs. T., after spending a year in hospital, returned home. Mrs. T. had started using a wheelchair in O ctober, 1957. L ater she acquired her own chair, a collapsible model, and soon becam e quite proficient in its use. F rom the beginning she to o k over the cooking, and could get in and out o f bed by herself, and use the toilet unaided. She only had to be lifted in and ou t o f the bath. In July, 1958, M rs. T. got her car with hand controls where necessary. H er right foot had ju st enough strength to m anage the accelerator. N ow she could attend the out­ patient departm ent for exercises and do shopping, go to the hairdresser and lead a fully norm al social life. T o prevent contractures occurring at hips, knees and feet was part of the treatm ent, and Mrs. T. was instructed in how she could stretch these joints herself a t home. In spite o f all possible effort, severe flexion contractures o f the hips and knees developed. Once again she had to be adm itted to G roote Schuur where a Sutter Slide and Fasciotom y was done to relieve the contractures. Mrs. T. spent tw o m onths in hospital. A fter returning hom e she once again to o k up her visits to the O ut-Patients D epartm ent, G ro o te Schuur Hospital, and later to the Clee R oad Clinic o f the School o f Physio­ therapy for daily treatm ent. H ere she joined the Class for Poliomyelitis patients twice a week, and because o f her undaunted enthusiasm she soon becam e a firm favourite o f the students. She now m anaged to get into the bath and out again by means o f a rope from the ceiling and the aid o f planks and boxes o f varying height. F o r the rest, no alterations were necessary in her home. O n several occasions she spent holi­ days in the homes o f friends w ithout inconvenience to herself o r them , as special alterations were unnecessary. H er w onderful sense o f perseverance and adaptbility stood her in good stead, and because o f it in a rem arkably short time she was back to leading a norm al life. In M ay, 1961, Mrs. T. began attending the Physiotherapy D epartm ent o f the Princess Alice O rthopaedic Hospital just to keep fit and prevent further contractures. A t these visits she walked in calipers and w ith crutches. By this time she had given up walking at home, as it required too much time and the apparatus proved cum bersom e, She also made use o f the H ydrotherapy pool, and soon was swimming q uite well. Being by nature a good social mixer she soon m ade m any friends in the hospital and in this way started helping one o f them —an elderly patient with severely crippled hands through R heum atoid A rthritis, to while the time away by making baskets. T he a rt o f cane w ork was only one o f the m any skills M rs. T. had learnt at the O ccupational T herapy Departm ent in the G ro o te Schuur H ospital, and every day after treat­ m ent she w ould wheel herself to the w ard where her visits were looked forw ard to by all the patients. As the hospital had great difficulty in finding an O ccupational Therapist to open the new departm ent, Mrs. T. was approached with the suggestion th at she should tem porarily take up duty until such time as a fully trained person could be found. Mrs. T. enthusiastically accepted and in N ovem ber, 1961, started w ork as a part-tim e A rts and Crafts Instructress. Soon she became a fam iliar visitor in all the wards, and in no tim e at all the w ards became a beehive o f activity, whereas before m any patients had dismally counted the hours till their discharge, having nothing to do, and no inspiration. N ow , seeing som eone m ore severely handicapped than 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. ) March, 1963 P H Y S I O T H E R A P Y Page 7 M r s . T. p r a c ti s i n g f o r t h e I n t e r n a t i o n a l S t o k e M a n d e v i l l e G a m e ' f o r W h e e l c h a i r S p o i ls m e n . t h e m s e l v e s c o m i n g t o g i v e t h e m a s s i s t a n c e , t h e n w h o l e o u t ­ l o o k c h a n g e d , a n d t h e y s o o n , w i t h i n c r e a s i n g e n t h u s i a s m , j s t a r t e d w o r k . S o g r e a t b e c a m e t h e d e m a n d f o r w o r k t h a t r s o o n a s e c o n d p e r s o n h a d t o b e e m p l o y e d t o c o p e . A t t h i s t i m e w e w e r e f o r t u n a t e t o h a v e a f o r m e r W o r l d A r c h e r y C h a m p i o n j o i n t h e h o s p i t a l s t a f f a s a n a i d 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 . S h e s t a r t e d t h e p r e s e n t P r i n c e s s Al i c e A r c h e r y C l u b , a n d q u i c k l y its p o p u l a r i t y s p r e a d t h r o u g h t h e h o s p i t a l , a n d p a t i e n t s f l o c k e d t o t h e s h o o t i n g r a n g e . O n e o f it s m o s t e n t h u s i a s t i c m e m b e r s w a s M r s . T , a n d it s o o n b e c a m e a p p a r e n t t h a t s h e h a d t h e q u a l i t i e s o f a f i r st - cl ass a r c h e r . M r s . T . n o w' b e g a n t r a i n i n g in e a r n e s t , a s w e h a d r e c e i v e d a n i n v i t a t i o n f r o m t h e D i r e c t o r o f S t o k e M a n d e v i l l e H o s p i t a l S p i n a l I n j u r i e s s e c t i o n i n A y l e s b u r y , E n g l a n d , t o s e n d a t e a m o f w ' h c e l c h a i r s p o r t s m e n t o t h e y e a r l y i n t e r n a t i o n a l g a m e s h e l d a t S t o k e . S o u t h A f r i c a h a d n e v e r a s y e t c o m p e t e d a s a t e a m a t t h e g a m e s , a n d it w a s d e c i d e d “ n o w o r n e v e r ” . E v e r y l u n c h t i m e a n d e v e r y w e e k - e n d M r s . T . p r a c t i s e d , u n m i n d f u l o f w i n d a n d w e a t h e r , as o n l y 2 \ m o n t h s r e m a i n e d b e f o r e t h e g a m e s . D u r i n g all t hi s p r e p a r a t i o n s h e r a n h e r h o m e a s u s u a l , w o r k e d i n t h e m o r n i n g s a t t h e h o s p i t a l , h e l p e d t h e c h i l d r e n i n t h e a f t e r ­ n o o n s a t h o m e a n d d i d t h e c o o k i n g a s b e f o i e . D u r i n g t h e e n d o f J u n e t h e t o u r i n g A m e r i c a n w h e e l c h a i r a t h l e t e s v i s i t e d o u r h o s p i t a l a n d M r s . T b e c a m e a f i r m f a v o u r i t e w i t h t h e m . T h e y a r e a l w a y s q u o t e d a s e x a m p l e s o f we l l r e h a b i l i t a t e d p e o p l e , b u t o n e a n d al l w e r e i m p r e s s e d b y M r s . T "s r e m a r k a b l e p e r f o r m a n c e n o t o n l y i n h e r s p o r t s m a n s h i p b u t m o s t l y in t h e c a p a b l e w a v s h e r u n s h e r s o c i a l l i fe a n d h o m e . T h e e v e n t u a l G o l d M e d a l t h a t M r s . T w o n i n t h e A r c h e r y a t t h e I n t e r n a t i o n a l G a m e s is m u c h m o r e t h a n j u s t a G o l d M e d a l , it is t h e r e w a r d o f e n d l e s s p e r s e \ e r a n c e a n d c o u r a g e in t h e f a c e o f e x t r e m e a d v e r s i t y N o t o n l y c a n s h e c o m p a r e l a v o u r a b l y w i t h a n y r e h a b i l i t a t e d p e r s o n c o n f i n e d t o a w h e e l c h a i r , b u t e \ c n w i t h n o i m a l h e a l t h y p e r s o n s s h e c a n h o l d h e i o w n , a s in t h e i c c e n t W e s t e r n P i o u n c e A r c h e r y c h a m p i o n s h i p s s h e w a s a m e m b e r o f t h e w i n n i n g L a d i e s ’ t e a m o f t h r e e , a n d t h e o n l y w h e e l c h a i r a i e h e i o n t h e s h o o t i n g l i ne. W h a t a p e i feet e x a m p l e t h i s is o f w h a t c a n b e a c h i e v e d b> a d i s a b l e d p e r s o n w i t h a l i t t l e c o u r a g e a n d p e r s e v e t a n c e LETTERS TO THE EDITOR 2 8 t h D e c e m b e r , 1962 E d i t o r , P h i s i o t h e i a p \ , I a m m u c h i m p r e s s e d b y t h e lei lei in t h e D e c e m b e r P h v ' i o t h e r a p i by G . S. S c h c r m b r u c k e r o n C h i r o p r a c t i c a n d t h e C o m m i s s i o n o f E n q u i r y . R e g i s t e i e d M e m b e r s s h o u l d p r e p a i e t o m e e t t h i s c h a l l ­ e n g e ; b u t . w h o wi l l bel l t h e c a t ? U T h a n t i n hi s a d d r e s s t o t h e G e n e r a l A s s e m b l y o f t h e U n i t e d N a t i o n s s a i d h e b e l i e v e d e v e r y n a t i o n h a d its h o n e s t d i f f e r e n c e o f o p i n i o n . I feel w'e m u s t n o t t r y t o b e l i t t l e o u r o p p o s i t i o n , b u t t r y t o f i n d a w a y f o r t h e C h n o p r a c t o r s t o f o r m t h e i r o w n R e g i s t e r It wi l l b e a m a t t e r f o r t h e G o v e r n ­ m e n t t o d e c i d e w h e t h e r t h e i r c l i e n t s a r e t o q u a l i f y f o r a n y b e n e f i t s u n d e r s u c h s c h e m e s a s I n s u r a n c e a n d W o r k m e n ' s C o m p e n s a t i o n . It s h o u l d b e p o i n t e d o u t t h a t t h i s i s s u e h a s o n l y v e r y r e c e n t l y a r i s e n , a n d b e a r s n o t u s t i f i a b l e w e i g h t t o p r o v e t h a t n o n - q u a l i f i e d p e r s o n s s h o u l d b e p l a c e d o n t h e M e d i c a l a n d D e n t a l R e g i s t e r o f S o u t h A f r i c a . It s h o u l d a l s o b e p o i n t e d o u t t h a t t h e C h i r o p r a c t o r s i n d u l g e i n s e l f a d v e r t i s e m e n t , t h e y d o t h e i r o w n d i a g n o s i n g , a n d h a v e n o t k n o w l e d g e o r a c c e s s t o m e d i c a l t e c h n i q u e s , t o w a r n t h e m w h e n g i v i n g m a n i p u l a t i o n s in c a s e s w h i c h a r e d e f i n i t e l y c o n t r a - i n d i c a t e d f o r m a s s a g e , s u c h a s T u b e r ­ c u l o s i s o f t h e S p i n e , o r c a n c e r o u s k i d n e y . It is o u r d u t y t o s a y t o e v e r y p a t i e n t , " I a m a l l o w e d t o g i v e t r e a t m e n t o n l y u n d e r m e d i c a l s u p e r v i s i o n , ” a n d it is o u r e a r n e s t d e s i r e t o k e e p t h i s p r i n c i p l e e v e r f o r e m o s t . T h e b u r e a u c r a t i c m i n d r e q u i r e s c o n c r e t e e x a m p l e s . I h o p e i h a t p a t i e n t s a n d d o c t o r s , a n d p h y s i o t h e r a p i s t s , wi l l c o m e f o r w a i d , t o p r o v e t h a t t o p r o t e c t t h e p u b l i c , w e m u s t n o t h a v e u n q u a l i f i e d p e r s o n s o n t h e r ol l . W e wi l l , i n f u t u r e , h a v e m o r e c u l t s a n d t r e a t m e n t s c r e e p i n g i n , w