History Topics Guttmann's rehabilitative regime One of the major changes that Guttmann introduced at Stoke Mandeville was the regular exposure of spinal injuries patients to physiotherapy. His new regime would not merely be medical and surgical; it would also be rehabilitative. As he himself said, the main aim was to get patients back into life outside the wards. Professor Wagih El-Masri: You succeeded in managing patients adequately when they became taxpayers again. A new regime Before Guttmann spinal injury patients had been seen as incurable medical and surgical problems. Joan working as a nurse on the wards in the late 1940s recalled the psychological effects of this: They had got used to lying immobile for months on end. And then suddenly here were these nurses saying, ‘You can do this’. ‘We’ve got to get you up’… We were there to badger them, to encourage, to explain, to gently nag. And of course first of all most of them said, ’I can’t be bothered’. ‘I’ve never sat up since I had my injury; why should I start now?’ Physiotherapy on the wards of Stoke Mandeville Hospital in the 1950s. ©NSIC By contrast for patients like Margaret Maughan and Jane Blackburn, coming to Stoke Mandeville in the late 1950s and the 1960s, the new regime of rehabilitative physiotherapy meant that there was almost too much that you were expected to do. “Once you could move about the whole day was full from very early. I might start with woodwork. I remember learning how to turn wood and making a lovely wooden bowl; then there would be swimming; then “down the hill” to physiotherapy which you had every morning and afternoon. We thought they had positioned it on purpose; it was at the bottom of a big slope and you had to push all the way back to the ward afterwards. And no one would help you, they had been told not to; you had to struggle your own way back up.” I remember my mum saying to Sir Ludwig, Why do you focus so much on her arms when we want her to walk? Guttmann’s check up round For some, like 19 year old George injured in a mining accident, this regime could feel a bit like his recently-completed National Service. Whenever it was his [Guttmann’s] day for the round everyone was flying around getting the ward ready. The staff would come and tell you to get ready when he was coming and we patients would all be sitting by the side of our beds waiting for him; it was like being in the Army. He would walk around stopping at each bed. Your physio would be there with him and a whole army of other people as well; we called it the Circus. Then he would ask the physio what I had done that week and how I had done and she would tell him if I had completed the task for that week. For example one of the tasks you had to do was learn how to transfer yourself from your wheel chair on to a bench and then see if you could sit up and balance on the bench. Once I had done that then Guttmann would tell her to try me on the next task. So then you would have to learn how to get out of your chair on to the floor; your physiotherapist would tell you to do some press ups; then you had to try and get back in your chair, that was so that if you did happen to fall out of your wheelchair at some time you would be able how to get back in.