Getting better

Physiotherapy and Occupational Therapy

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. "You succeeded in managing patients adequately when they became taxpayers again". Professor Wagih  El-Masri

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?’"

Photo:Physiotherapy on the wards, 1950s

Physiotherapy on the wards, 1950s

photo, 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?" Jane Blackburn

Photo: Illustrative image for the 'Getting better' page
Watch Jane Blackburn describing the Physiotherapy and Occupational Therapy at Stoke Mandeville that took place in the 1960s here

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 physio 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." George Brogan, patient, 1960s

Patients and their Physiotherapists

Photo: Illustrative image for the 'Getting better' page

photo Dot Tussler

"The relationship you had with your physio was very special. You saw them twice a day; and they were so much better at explaining things. Some really close relationships developed and a number of patients married their physios. I remember my very first outing was to my physio’s house; two or three of them shared a bungalow nearby in Stoke Mandeville and they took us there. That was the first time I learnt how to transfer from a wheelchair to a sofa. They really helped us with practical things like that." Margaret Maughan, patient

"Guttman said to me, ‘Rainer, I am not going to try and kid you about any miracle cures. The only thing I will be able to do for you is to get you so that instead of lying on your back you can sit in a wheel chair.’ And that is the first thing I learnt to do. It was really hard; I felt like I wanted to die, I hadn’t sat up for so long that all the blood ran out of my arms and went into my feet. I had this fantastic physiotherapist, Margaret Roberts, “Robby”, and she made me do this stuff and it was hard and so painful that I wanted to kill her; in fact I tried to put my hands round her throat and strangle her. But she was laughing and smiling at me, so I said, ‘Why are you doing this, smiling?’ And she told me that it was the first time she had seen me try to do anything for myself, so it was good, progress." Rainer Kuschall, patient


Photo: Illustrative image for the 'Getting better' page

photo Dot Tussler

"I came to work at Stoke Mandeville as a physiotherapist in May 1982. I wanted the experience of working in spinal cord injury rehabilitation which appealed to me as an area of work where my input would make a difference.  I arrived as a rather nervous and shy person but soon integrated to the all encompassing and demanding role that each physiotherapist had with their patient caseload. I immediately became interested in the use of sport within rehabilitation." Dot, physio

Photo:"Correction of Deformities"

"Correction of Deformities"

photo NSIC

 "This is interesting as it was then a very new technique, using gravity to stretch him out and deal with 'contractures'. It is the correction of spinal deformities of someone who has spent too long in a chair and has got shortened muscles. We learnt from this condition to use more preventitive treatments - making a patient sleep on their stomach or by the use of standing regimes. People used to use standing frames in their own home. It was a way of dealing with spasticity. It's a nice image because it sums up the changes in the history of physiotherapy." Ebba, physio.


"He is having his hips straightened; he probably got like that from spending too long sitting in a chair. My problem was the reverse. I was suffering from curvature of the spine and had to lie on sand beds to correct the curve.  It was dreadfully, dreadfully painful!" Sally Haynes, patient

Using Crutches

Photo: Illustrative image for the 'Getting better' page

photo NSIC

"Then they put full callipers on me then I had to lift myself up on to these bars, just like the lad in the photo; once you mastered that you were given crutches, and then the fun began. I was 6ft 2ins and they didn’t have any crutches long enough for me. They had them in the last hole but they were still too short, so it very awkward for me, bent over like an old man.  I was like a tree in a strong wind swaying back and forth, but I got walking on them. " George Brogan, patient

The Gym

Photo: Illustrative image for the 'Getting better' page

photo D. Tussler

 "This early image of the gym shows a lot of empty spaces and very little equipment. Also the wearing of trousers by female Physios only began in the 1970s. Much of the change and the growing use of technology has been driven by manual handling legislation: the use of hoists and lifts, weight suspension treadmill. Today individual Physios assess the risks of 'therapeutic handling' but many staff at Stoke Mandeville still do far more manual handling of patients than in other branches of physiotherapy." Hanna, physio

The Bell Inn at Stoke Mandeville

The Bell Inn was, and still is, the closest pub to the hospital and was popular with staff and patients. It was sufficiently far from the hospital to provide newly mobile patients with a challenge and physiotherapists would encourage their patients to try and make their own way there. 

"I remember pushing the spinal patients in their chairs down to the pub. Very often it was  their  first time  out. They were a regular fixture in the Bell where they were welcomed. Sometimes we would make them try and walk there or, failing that, wheel them down there but make them stand at the bar to order their beer. It was very relaxed then." Brom, physio 

Photo:The Bell Inn, Stoke Mandeville

The Bell Inn, Stoke Mandeville

photo Centre for Buckinghamshire Studies

"One Friday evening one of the physiotherapists pushed me out to the local pub, the Bell in Stoke Mandeville. It was winter and she wrapped me up in jackets and blankets – though compared to Switzerland it wasn’t so cold. But I remember it as a magical evening; it was the first time in two years I had been outside at night and seen the stars in the sky. And we went into the Bell and I saw all these jars of pickled eggs and onions on the counter – that I had never seen before – and I drank a dark brown, sweet beer – the like of which I had never tasted before. It was a sudden and great pleasure. So I started looking forward to being alive for the first time. And afterwards it was an adventure for us; a bunch of us would try and go there on a Friday or Saturday evening. It became THE challenge to find ourselves a way to get to the Bell; sometimes a freshly-injured paraplegic would push me with my minor help; it was the first WIN in my new life!" Rainer Kuschall, patient

Occupational Therapy

In the various Scottish hospitals in which I worked it was always the Occupational Therapy staff who had responsibility for doing sports with the patients... The other difference was that lots of the OT departments would have men on the staff who used to get involved in the different sports. For example at Eaton Hall one of the remedial gymnasts there just happened to be a fencer, so as a result all the patients going through rehab there got to do fencing.  Physiotherapy was still largely a woman’s profession. I think Guttmann’s model at Stoke Mandeville where the physiotherapy department – rather than the OT – was responsible for all the sports rehabilitation was quite unusual at the time. But then Guttmann could never see the point of OT and didn’t invest in it in the same way at Stoke. Jean, Occupational Therapist

"Guttmann favoured physiotherapy over occupational therapy and the latter service was very under resourced at Stoke Mandeville. This was largely his personal belief; other hospitals took Occupational Therapy a lot more seriously. Part of the problem was what was on offer: basketry! If you give people useful things to do then they will enjoy it. When I subsequently became director I introduced the first computer room as part of OT and it was extremely popular." Dr. John Silver

Photo:Leather bag made in OT in 1964

Leather bag made in OT in 1964

photo, G Brogan

"You also had workshops there that you used as part of OT (Occupational Therapy).  I made a shoulder bag for my wife from real leather in one of the workshops. I think the making of things was just to keep you busy; you started at 9am and finished about 4pm each day and you were expected to take part just as an exercise in keeping you going all the time you were in hospital.  One of the other things I helped with was to make the medals for the disabled games. They were cut out of a big round bar of brass. They would cut these slices off the bar and then I would put them into a lathe and then turn the handle to mill the rim of the medal and create the indent. This was prior to the engraving that someone else did. I think these were the medals they gave out at the National Wheelchair Games at Stoke Mandeville. I didn’t mind making things; I have never been a one to sit still and watch the grass grow, so doing things like making the bag and medals and some engraving was fine by me." George Brogan, patient

Photo: Illustrative image for the 'Getting better' page

photo NSIC

"I absolutely hated Occupational Therapy and making things. I used to avoid doing it whenever possible. There was a basket at the end of my hospital bed that I never finished. I couldn't bear it. All patients had this card which was marked off when you went to different activities and my card showed I never turned up for Occupational Therapy. I remember Guttmann once giving me a long lecture on this. I had decided that if I was going to do anything at all then I wasn't going to make a basket or a leather purse. Instead I was going to make a bridle for my horse. My ambition was to ride again." Sally Haynes, patient


Photo:"Domestic Duties"

"Domestic Duties"

photo NSIC

 "Occupational therapists still do kitchen practice; this was an adapted kitchen with a pull-out work face and a hole for bowls used in the 1950s. It was part of teaching life skills, reintroducing patients to household work. This particular system is not used now, although they still do use adapted kitchens. It was a good technique that should be re-introduced." Ebba., physiotherapist

Halfway House

An important innovation at Stoke Mandeville was the creation of a hostel within the hospital to which recovering patients could go and stay in order to develop the ability to live more independently prior to moving out alogether. Many also worked in the workshops attached to the hostel: clock mending and wheelchair repairs were specialities. Sister Mary Brennan ran this hostel with her husband Jimmy after it opened in 1970.

Photo:Ludwig Guttmann and Lady Hamilton Smith at theopening of the Rehabilitation Hostel at Stoke Mandeville in 1970. Jimmy Brennan who was to manage the unit with his wife Mary is standing behind.

Ludwig Guttmann and Lady Hamilton Smith at theopening of the Rehabilitation Hostel at Stoke Mandeville in 1970. Jimmy Brennan who was to manage the unit with his wife Mary is standing behind.

photo M Brennan

 "In  1970 I was given a part-time sisters post so that I could join my husband Jimmy and help  run the new rehabilitation hostel, what became the “Sir Ludwig Guttmann Hostel”. This was a sort of half-way house for rehabilitated spinal injury patients where they would learn life skills before moving back out to their families or to start living independently. It was quite a revolutionary thing at the time. There were patients studying there for open degrees and other qualifications. I remember there was one tetraplegic patient there who was writing a book; and in his room there was this elaborate piece of equipment that allowed him to type using his mouth as he had no movement below his neck. He would blow into a tube and the air pressure would then make a projector shine letters of the alphabet onto the wall in front of him; as he blew harder it moved through all the letters of the alphabet, shining them on the wall in turn; when he arrived at the letter he wanted he would stop blowing and his machine would type that letter.  I think this was a machine developed by someone who had connections with the hospital." Mary Brennan, nurse

This page was added on 15/03/2011.

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