Rehabilitation in industry (1950)

foreign me rehabilitation you come across the word everywhere these days it identifies a form of social and medical service that is becoming more widely practiced every day today we want to show you what actually takes place in a modern industrial rehabilitation workshop or as we prefer to call it the retraining shop that serves the foxhole motors community a miniature township of 12 000 people with its own doctors surgeries and physiotherapy department efficient safety precautions have reduced the accident rate to a remarkably low level but accidents at work at home or in the street still occur and men fall ill the scheme caters for everyone collaboration between the factory medical department and the local hospital ensures immediate and continuous treatment for rehabilitation is an essential part of treatment and only terminates with recovery the retraining shop which handles over 300 cases a year is set among gardens cared for by the men themselves some patients need special conveyances and here is one man arriving in a motor chair specially modified for him in the retraining shop after six years on his back following a fractured spine he is now able to drive himself to the factory each day and can transfer himself unaided into his working chair easy does it he is paralyzed from the waist downwards but recently he was fitted with special splints and taught to stand and walk with the aid of crutches he comes to the retraining shop to do light assembly work and we see him here cheerful and happy a stimulating example to his fellow patients there's plenty of life in the shop for the men realize that they are not only speeding their own recovery but at the same time doing useful work the exercises prescribed by the orthopedic surgeon are carried out on the trained eyes of the rehabilitation superintendent and his assistant such light bench work as this allows patients to sit when necessary and provides clean dry jobs essential where unhealed wounds have to be treated this patient dislocated the outer end of his collar and is being treated in a collar and cuff sling there is no question of his having to stay away from work he is using his injured arm in the assembly of petrol tank filler caps note how this movement brings all the muscles of the arm and shoulder region into play though there is no movement of the shoulder joint itself this means that the wasting and stiffness that usually occur after prolonged immobilization never have a chance to develop here is an example of early rehabilitation following rupture of the supraspinatus muscle at the shoulder requiring operation five days after the injury the patient returned to work wearing an aeroplane splint to support the weight of the arm he has avoided several weeks on the sick list possibly followed by stiffness and wasting of the arm muscles at a later stage the splint is discarded and the shoulder gradually mobilized by using an extensible handle attached to the operating lever of a drilling machine the injured arm is assisted as the two operating levers move together still later muscle power as well as movement are developed in the shoulder region by means of this bar bending fixture the lever in addition to bending a 3 8 of an inch steel bar has to be pulled against the resistance of a graduated counterweight suspended from a pulley and the lever can be adjusted for height thus increasing the range of movement at the shoulder joint the height of the lever here has been raised to increase shoulder movement the force required to bend the bar has been stepped up by hanging graduated weights over the pulley attached to the end of the lever another example of early rehabilitation this man fractured his spine on thursday and was back at work in the retraining shop the following monday usually such an injury keeps a man away from work for weeks or even months while he stands at work in a spinal jacket he bends pipes to exercise the spinal muscles in a manner essential for full recovery pipe bending is also a value because of the range of movement it gives to the finger wrist and arm joints the man on the left severed some extensor tendons of his left hand and also fractured his left thumb we shall see a close-up of his hand at work in a moment the fractured spine case in the center we've already met their companion on the right has eye trouble but he has been trained for work which can be done by the sense of touch pipe bending which by the way is standard productive work is progressive the patients start with soft copper pipes and as the range of power and movement improves pass on to pipes of steel it is work which is particularly valuable in cases of stiff fingers caused by injury or sepsis but it stimulates the blood supply and improves muscle tone all the pipes are used on the cars and trucks the man on the left is recovering from severe shoulder and head injuries the other man fractured the scaphoid bone in his wrist his plaster has been cut away to allow freedom of movement to the fingers which encourages more rapid and certain healing of the fracture this is an instance of how standard hospital methods are modified to fit in with industrial experience here is a later stage in the treatment of a fractured spine by pulling on this forefoot bar like an oarsman the spinal muscles are repeatedly contracted probably the most important single factor in the treatment of a fractured spine the piece of straight metal has now been bent to become the stem of a break or clutch pedal the retraining shop is available just as freely to clerical and executive members of the company as to manual workers this man a senior clerk had a street accident which resulted in fracture of the shoulder on one side and of the wrist on the other with the aid of a collar and cuffed sling for his injured shoulder and plaster for his wrist he is able to continue with much of his normal work and three times a week he receives physiotherapy treatment which helps to speed his cure as his recovery advances he attends the retraining shop each day to exercise his injured shoulder on a drilling machine the range and power can be increased by changing the component for one that needs a larger and deeper hole notice how man is able to use his arm even though it is immobilized in plaster the additional exercise afforded by the constant raising and lowering of the transparent guard of the machine is of considerable value sometimes damage to a nerve leads to paralysis of the muscles in this instance it resulted in an inability to extend the wrist giving rise to the condition known as wrist drop to remedy this and to prevent over stretching of the paralyzed muscles the patient has been fitted with a special perspex splint with elastic bands attached to each finger he still retains his gripping power and can therefore operate this hand milling machine which also gives rotary exercise to his injured shoulder joint the re-education of movement by controlled exercises under the skill supervision of the physiotherapist is an essential part of treatment during the initial stages of recovery at fox hall a well-equipped physiotherapy department works in close association with a retraining shop in this factory sixty percent of the industrial injuries involve the hands let's have a look at two or three typical examples the first man has had a repair operation for a severed flexor tendon to his thumb we shall see him a little later using a remedial appliance attached to his machine the other two we shall also see in the retraining shop busy on productive work specially selected to give the repetitive exercise which will assist their recovery electrical stimulation is employed for maintaining muscle tone and improving circulation in weak or paralyzed muscles as recovery advances this is followed by set exercises designed to bring the affected muscles into play so minimizing the wasting which would otherwise occur delicate movements cannot always be reproduced mechanically through the medium of machine or bench work here is a case where special exercises for each individual finger are carried out under supervision hot wax baths are of particular value where there is stiffness of joints or when wounds after healing have resulted in scarring contracture or cold blue fingers as a result of vascular disturbance the man with wrist drop has now fully recovered careful splinting in combination with electrical treatment and remedial exercises in the retraining shop have accelerated the natural process of cure special splinting with prospects can reduce immobilization to a minimum following an extensive operation on the palm the patient had his hand splinted gradual flexion of the fingers being encouraged by using grips of diminishing diameter the plastic material known as perspex is extensively employed in splint making the material arrives in large transparent sheets from which the rough shape of the sprint required is cut a template or blank shape is used for marking out before the perspex is sawn through the edges are then trimmed smooth by filing off the material is heated with an oxy acetylene jet or in an electric oven to soften it before molding the molding process is carried out over a wooden pattern shaped roughly to resemble the limb required to be splinted these wooden models were carved out by a skilled pattern maker during a spell of treatment in the retraining shop the splint is finally molded to fit the patient accurately by local heating and quenching in cold water before being tried on holes are then drilled in the splint to make it lighter in weight and to allow perspiration to escape finally the securing straps are fixed in position with aluminium rivets here is the completed splint being fitted accurate molding of this material can give almost complete immobilization and because the splint is easily removable local examination and treatment which will be impossible with plaster present no difficulty this patient is receiving short wave therapy for his painful wrist which is being treated at rest in a perspective splint the removal and replacement of the splint is a matter of seconds when it is no longer required it will be stored ready for use again after remolding to fit a different patient another advantage of perspex is that it is unaffected by oil or water it thus provides an ideal splinting material for patients who have to work at wet or oily jobs this man is suffering from a painful condition of both wrists known as pinocynovitis treatment by splinting usually clears up this condition in about 10 days without the patient having to cease work and not infrequently as in this case the man can continue his normal job when skilled tradesmen such as this one require rehabilitation we try to put them on work which involves the making of remedial appliances all the appliances in use are designed from anatomical blueprints by the retraining shop staff guided by the surgeon the one being built here is known as a duplex horizontally opposed drilling machine it's a case of all hands to the pump during the operation of scraping the bed of the machine when completed this machine will give abduction or shoulder raising exercises to both arms simultaneously the skilled inspector in the foreground suffers from a nervous disease and has lost the use of both legs he is doing precision work seated at a bench in preparation for doing a similar job in the factory the machine is now approaching its final stages soon it will be ready for trial operating under the direction of the shop foreman the resources of the retraining shop are sometimes called upon in the design and manufacture of intricate apparatus for experimental work this example was made at the request of a consulting surgeon it will be used in a study of the effects of graduated stresses and strains on the vertebral column here is a youngster who is not undergoing rehabilitation one of the leads from the company's apprentice school the resources of the retraining shop are used to supplement the school's work in two ways first to introduce the boys to the company's rehabilitation work and second to give them experience of a wide variety of machine tools in a short space of time this lad is enlarging his knowledge of a center lathe used for the manufacture of remedial equipment and for experimental and development work this ingenious mechanism designed by the shop foreman gives active flexion to the terminal joint of the thumb in order to avoid a bad anatomical position a full downward movement of the operating lever must be avoided this is prevented by a freewheel device which allows the drilling operation to be completed with a relatively small excursion of the lever another highly skilled patient his technical knowledge is frequently called upon for the setting up of machines and for the instruction of apprentices convalescing after a long illness he is instructing another patient in the use of a capstone layer and inspecting the components as they leave the machine not all the patients are familiar with machine operating but if certain remedial exercises can best be obtained from machines the necessary instruction can be given the patient we saw earlier in the physiotherapy department is now on production work at a drilling machine this machine has been fitted with a grip specially designed for him which moves the thumb in a downward direction every time he pulls the operating lever towards him the range of movement can be increased or diminished by means of an adjusting screw different grips are used for exercising other joints this one operates by a downward thrusting movement of the lever and is designed to give passive extension to the terminal joint of the thumb in this way the patient is re-educated into the feeling of natural movement as a preliminary to active exercises at a later stage stiff joints and local disturbances of circulation the result of injury are greatly benefited by remedial exercise in a warm atmosphere one way of doing this is to insert the injured part into a perspex box which surrounds the operating lever of the drilling machine warm air is driven by a fan from an electrical heating device attached to the machine a typical example of this treatment is shown here a patient who suffered a crash injury to his fingers resulting in compound fractures this patient sustained a severe laceration of his left wrist severing the muscles tendons and nerves of his forearm these were sutured at operation in hospital five weeks later he returned to selected work in the retraining shock he had extensive scarring of the forearm and was unable to straighten the wrist or fingers a special grip was designed for him and attached to the operating lever of his drilling machine and the lever was altered from the normal position on the right to the left hand side he is obviously trying very hard to get more movement into his wrist and fingers no easy task on his first attempt at machine work after such a severe injury the grip is designed to assist in straightening out the wrist and fingers gradually but surely as he operates his drilling machine on normal production processes later a further operation was performed by the plastic surgeon designed to give him a more useful hand increased movement is required in the fingers and this is being assisted by means of a special rolling grip attached to the lever of his machine this grip alternately closes and opens his fingers every time he drills a hole injuries sometimes result in amputation of one or more fingers this man who lost his left forefinger and severely lacerated another is back at work in his dressings on the same day having lost no time later on when his amputation stump is healed it must be hardened off and encouraged to move as much as possible this is assisted by a padded grip with a soft rubber diaphragm attached the stump is repeatedly pressed into this diaphragm so as to mobilize it while operating the machine the results of such treatment are well shown here the patient now has a mobile useful finger stump which will not get in the way while is at work though there is still some scarring of the middle finger which will require further attention to prevent contracture and deformity in this case the scar must be stretched by using the hand and fingers on a swivel type of grip as the hand is depressed the fingers and amputation stump are repeatedly straightened out so that the scar tissue has no opportunity to contract and cause deformity this appliance is also useful for mobilizing a stiff wrist joint as an index of the rate of recovery from hand and arm injuries the patient's gripping power measured in pounds is recorded daily or weekly by means of this apparatus bench equipment such as this hand press which is adjustable for range of movement gives exercise to the wrist joint and this ingenious tapping device was designed to develop rotary movement of the forearm this patient sever the flexor tendon of his left thumb he has to depress the spring-loaded plunger in order to position the next hole for tapping a perspex splint is fitted around the thumb to ensure that only the affected joint is used greater power can be developed by increasing the tension of the spring for manual workers injuries to the shoulder and elbow joints may be followed by considerable incapacity graduated movement through the medium of this spring-loaded riveting machine affords an excellent means of exercising these joints the retraining shop is not regarded as a special unit isolated from the rest of the factory the patients have a steady stream of visitors shop managers foreman and fellow workers who take a keen interest in their progress along the road to recovery at any given time there are about 60 men in the retraining shop and they all take their morning and afternoon tea breaks just like everyone else in the factory these chaps don't seem to be worrying their troubles are being dealt with they don't take them to tea with them and what is far more important they don't take them home with them cheers everyone detachable walking boots designed and manufactured in the retraining shop for leg plaster cases were formally fitted with side irons later these were discarded in favor of a stouter boot with a wooden sole cushioned above by sauber rubber like this one before this patients were equipped with a walking iron incorporated in the plaster itself giving an awkward gate with a pronounced outward swivel the present box hole boot is made from scrap leather material cut to shape and designed to fit over the plastered leg and foot so that it is detachable it is light in weight too and the latest model has a strip of spring steel in the sole to facilitate a natural heel-to-toe method of walking the entire boot is manufactured in the retraining shop the two men making them are medical cases convalescing from cardiac and chest trouble for which bench work of this type is very suitable in all over 300 cases have been successfully treated with these boots which have now replaced the older walking arm this ambulatory method of treatment for fractures of the lower extremity allows the patient to remain at work and by keeping the leg muscles exercised it prevents them from wasting and speeds up the healing rate of fractures this man has a fractured ankle after his plaster has dried hard the boot is slipped on and laced in position and he is able for the first time to bear weight on the injured limb thus equipped he walks naturally and briskly back to his ordinary job on the factory workshop floor with little or no inconvenience and with a minimum of time away from work the boot allows an easy natural method of walking even stairs present no difficulty because the boot combines lightness with strength as a result of a street accident this patient has a severe fracture of both lower leg bones although in hospital with his leg in a splint he is managing to keep his muscles exercised later he is allowed up in plaster and after a short period in the hospital rehabilitation center which is an extension of the outpatient department he is ready to leave the hospital and return to active work at the factory that of course means reporting to the retraining shop although it is still necessary for him to wear a long leg plaster stretching from ankle to thigh he is able to walk quite well without sticks or crutches with the aid of a box hall boot he can even go up and down steps later still the knee joint must be free to move so the patient now wears a special walking caliper splint designed and made in the shop this is another example of the way in which surgeon and engineer working together are evolving appliances that are speeding recovery in almost every type of limb injury the hinged knee caliper splint also enables patients with fractures of the lower leg to cycle to and from work even children can be successfully treated in the box hall boot this little chap can now ride his bicycle despite a fractured ankle and walking presents no difficulty either very rarely a leg has to be amputated and later on the amputation stump must be hardened off before fitting an artificial limb the interim period is often troublesome and the patient has to get around with crutches to avoid this he is fitted with a temporary artificial leg or pylon made of light material here is the same patient fitted with his artificial leg his residual disability is small and for all practical purposes he can compete on an even footing with other workers knee injuries suffered at football and elsewhere sometimes mean that a cartilage has to be removed and to safeguard the stability of the knee joint the thigh muscles must be maintained in good tone by knee and leg exercises the operation of this bench vise ensures full movement of the knee every time the vice is closed the knee is made to work against the resistance of a weight slung over a floor pulley notice how the muscles are brought into action against the resistance of the weights six pounds 12 pounds and 20 pounds specific exercise for strengthening the thigh muscles is important in all injuries to the leg this bench press used for an assembly operation is a good example it requires full extension of the knee joint against a spring resistance of 70 pounds each time a component is assembled a similar exercise can be adapted for use when working a drilling machine again powered by the operator's legs look at that smooth rhythmical movement of the leg see how that excursion brings a full movement of the knee and ankle joints into play as well as exercising every muscle in the leg such treatment is invaluable in leg injuries it can be put to good use as a toning up measure of the thigh muscles before operation or removal of a knee cartilage or as a strengthening measure after the operation this machine was entirely designed and manufactured in the retraining shop this machine is riveting brake shoe linings for passenger cars the motive force being applied by the operator's legs this movement performed against a spring with a resistance of 45 pounds gives exercise to the thigh muscles and also mobilizes the knee joint the range of movement can be altered by a simple adjustment to minimize fatigue and produce a natural rhythmic movement the machine is arranged so that it can be operated by either leg in turn or by both legs at the same time the design and manufacture of this kind of equipment demands considerable skill and ingenuity on the part of the rehabilitation superintendent and the shop foreman the retraining shop produces brake lining assemblies for box hole cars making and assembling standard components instead of doing the usual type of work done in an occupational therapy center helps to smooth out the changeover from convalescence to full work the men know that they're doing something useful and that means a lot more production work these machines worked by a rotary movement of the foot and leg are used for deburring or countersinking operations on small components the exercise in each is slightly different the machine on the right giving a greater range of movement the ankle they provide an extremely valuable turning up exercise for the whole of the leg as a preliminary to discharge from the retraining shop after injury or operation notice how all the muscles of the leg are brought into play a spell on these machines takes the place of set non-productive exercises which would otherwise have to be carried out at this stage in the physiotherapy department each week the rehabilitation superintendent attends the hospital outpatient department with a group of patients who require further investigation or treatment at the same time in consultation with the surgeon he sees new cases in the wards and the outpatient department during the early stages of recovery by arrangement with a patient's doctor these cases can then either be admitted to the retraining shop or return to selected work in the factory consultation between members of the rehabilitation team is the key to success this team includes the consulting orthopedic and plastic surgeons who undertake the management of injury cases they also guide the rehabilitation superintendent who by the way is a skilled engineer in the choice of work and in the type of remedial equipment to be employed the other members of the team seen here are the factory medical officer the physiotherapist and the shop foreman every week the complete team does a round of the retraining shop to see each patient actually at work in this way the rate of progress towards recovery can be estimated in relation to the remedial work performed sometimes a grip or a gadget must be altered or the type of exercise changed and these consultations between surgeon doctor engineer and physiotherapist are of the greatest value each learning something of the other's problems the patients benefit too because they realize that the solution to their problems lies on the workshop floor rather than in the consulting room here we see a decision being taken to incorporate a plastic grip in a wrist cluster a weekly follow-through clinic attended by the sun and other members of the rehabilitation is held in the factory physiotherapy department at this clinic all cases under treatment whether in the retraining shop or in the factory are kept under observation treatment is prescribed and when necessary the rehabilitation superintendent arranges suitable work to be done in the factory this patient is a canteen worker suffering from a fractured leg and selected work has been found for her in her own department this young man sustained the severe compound fracture of his lower leg in a road accident he has been fitted with a knee caliper splint designed to facilitate walking while at the same time giving support to the knee joint it is important in such cases to get movement into the knee joint as early as possible as this prevents the stiffness and muscle wasting which result if the leg is not being used in certain cases occasional training is carried out at the same time as physical rehabilitation this man as a result of an injury seven years ago was left with a painful crippled and useless hand through the art of the plastic surgeon the hand was restored to almost full function all the time this treatment was going on the man was being trained for a special assignment as an inspector we see him here with a rehabilitation superintendent filing templates to blueprint instructions work which demands a high degree of training under skilled supervision this type of work was specially selected to maintain the gripping powers that have been restored to his fingers after many months of patient work gone for this man are the days when it seems that the future held only the bleak prospect of a one-handed job and so to the end of the day the end of the week wages entered except that new bonuses paid instead of in this way working with as little as possible normal work normal pay and normal hours except that the men in the retraining shop knock off five minutes early so that the main exodus can be avoided economic and psychological factors are of the utmost importance in any rehabilitation scheme because the patient must never mope about at home in idleness and his thoughts must be kept on recovery the patient with his spine in cluster still throws a nifty dot as the rehabilitation superintendent and the ambulance driver find out to their cost while a cartilage patient after fun and games in the retraining shop gets back to serious business for the patients another day has ended another day near a recovery to the other members of the team it means a new tomorrow with fresh problems and fresh opportunities you