Wenela physiotherapy and rehabilitation centre

T h i s C e n t r e is p a r t o f t h e W e n e la H o s p i t a l in 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 le f r o m th e c e n t r e o f t h e c i ty on it s s o u t h e r n s ide n e a r B o o y s e n s R a i lw 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 th e new s e c t io n a n d the o l d e r p a r t . I t c o m p r i s e s 37 w a r d s — s u rg ic a l , m e d ic a l , eye, s p in a l i s o la t io n a n d p n e u m o c o n i o s i s m e d ic a l b u r e a u x , o p e r a t ­ in g th e a t r e s , r e c o v e r y r o o m a n d spcc ia l c a r c u n i t . X ray 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 off ices. T h i s h o s p i t a l is c o n n e c t e d w i th th e S o u t h A f r i c a n C h a m b e r o f M in e s . It s e rves a s t h e m a j o r c e n t r a l h o s p i ta l o n th e e as t , c e n t r a l a n d west R a n d a n d o t h e r p la c e s in th 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 . Its m e d ic a l s taf l ' is c o m p o s e d o f t h e C h i e f M e d ic a l Officer a n d ten o t h e r m e d ic a l off icers . It a l s o h a s a t its 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 io lo g i s t s a n d p h y s ic i an 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 ic a l t e c h ­ n o lo g i s t s a n d a d e q u a t e n u r s i n g s ta 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 serv ices .

T he hospital com plex consists o f the new section an d the older part. It com prises 37 w ards -surgical, medical, eye, spinal isolation an d p n e u m o co n io sis medical bureaux, o p e ra t ing theatres, recovery ro o m and spccial carc unit. X-ray dep artm e n ts an d ad m inistrative offices.
This hospital is connected with the So u th A frican C h am b er of M ines. It serves as th e m ajo r central hospital on the east, central and west R an d an d o th er places in the T ransvaal. O range Free State and N o rth e rn N atal. Its m edical stafl' is com posed of the C hief Medical Officer an d ten o th er medical officers. It also has at its disposal o rth o p aed ic surgeons, neurosurgeons, E.N .T . surgeons, o p h th a lm ic surgeons, thoracic surgeons, general surgeons, radiologists and physicians. Physiotherapists, rad io g rap h ers, m edical tech nologists an d ad eq u a te nursing staff represent param edical and nursing services.

T Y P E S O F P A T I E N T S T R E A T E D
T  T h e orderlies further help us w hen w alking the patient with crutches. T h e physiotherapist stan d s in front o f the patient giving orders a n d direction while a n orderly is behind the patient for su p p o rt to prevent the patient falling backw ards. T h e orderlies also act as porters, tran sp o rtin g the spinal cases from and to the Centre.

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
All the orderlies are m ale except o ne lady w h o is em ployed as crafts instructress. She atten d s mainly to the a rm and hand injuries by show ing them knitting, painting, beadw ork, m odelling, etc.

Physiotherapist (National Diploma)
P art of W enela Hospital.
T h e Specialist in Physical M edicine, D r. C. A dler, holds a weekly review and discharge clinic and a clinic for assess m ent o f spinal cases.

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 physiotherapy d e p artm e n t is equipped with the usual physiotherapeutic m achines such as F aradic and Faradic-G alvanic and o ther muscle stim ulators, short-w ave dia therm y, infra-red lam ps. K ro m a y e r a n d m ercury vapour ultra-violet lam ps, ultra-sound and w ax baths. F o r strengthen ing m ovem ents we have weights and pulley systems, springs, suspension units, special boots and sand bags. Further, we have plinths, beds with w ooden crossbars on top so arranged that we can use them for suspension therapy. These types o f beds are still kept in use to be show n to the students who c om e here for their lectures so that if it happens that after com pletion of their studies they are em ployed in an outside hospital w here G u th rie Sm ith suspension fram es are not easily obtainable, they can im provise such beds which serve alm ost the sam e purpose. W e have a stationary bicycle and tw o bed cycle exerciser so that the patient can cycle while lying on the bed. These are used for m obilisation and strengthening m ovem ents in lower lim b injuries. Wall bars, parallel bars, back entension exerciser, tilting tables for postural drainage and for standing the patient up for the first time a n d walking aids.
F o r the rehabilitation of the spinal cases we have the tilting table used as ab o v e; walking m achines, crutches, calipers and boots, wheel chairs, stable beds, stairs, stable Standing a p p aratu s in which the patient can be fixed with belts and play table tennis, throw javelin, discus and shot-put. Playing in the erect position helps the patient to practise balance and strengthen the a b d om inal wall muscles a nd finally gives the patient a chance to see himself in the standing position and com peting with norm al persons.

For encouragement of 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 of alu minium elbow crutches, a pair of calipers complete with boots. The patient may be issued with a spinal brace depending on the stability of 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 of the pelvis is usually supplied with a pair of 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 of 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 of 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 of 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.
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. 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 of this depart ment. I have found that my previous training has stood me in good stead and is respected by the other members of the staff.