A few days ago, I responded to a Tweet from Glyn Blakey (@saebouglyn) and Mary Banks (@MaryBanksy) after Mary had posted up a paper suggesting that the Saebo Mobile Arm Support (SaeboMAS) had reduced tonic muscle activity across all muscles, and that this had had a positive influence on corticomotor selectivity of biceps brachii during a counterbalanced movement tasks.
This all sounds very fancy, but what it basically means is that if you support the arm, the patient who is having difficulty moving, can concentrate on one joint activity while the rest of the limb is supported. You’ll get a better idea if you see a picture of the SaeboMAS at work:
Seeing the paper made me wonder whether there are physiotherapists who look at this and think that it seems like a great new way to approach the problem, and wish that we had more tools like this to hand?
Well, although the Critical Physiotherapy Network is very much about looking to the future, many of the members of the CPN are historians, because, as everyone knows, looking to the future presupposes some understanding of the past.
And when it comes to body-weight supported training, we have a perfect example of a technology that past generations of physiotherapists developed and used extensively, but then largely abandoned as the profession’s priorities changed.
True to form though, therapies that worked before will always find ways of working their way back into the professional practitioner’s portfolio.
Olive Guthrie-Smith is one of the few people in the first half of the 20th century who can truly be said to have been a real innovator in physiotherapy. So much of the work between 1900 and the end of World War II was concentrated on the orthopaedic management of injured servicemen (particularly amputees and fractures), and the management of devastating polio epidemics after WWI, that there was little call for any other work and little need for innovative new treatments. Massage, a bit of electrotherapy and some judicious exercises were enough.
The sheer workload of the masseuse in WWI was truly astonishing however. Sarah Chuck, Head Masseuses at Alder Hey Special Military Surgical Hospital, provides a good example:
The Massage Department had its inception in February 1915 when two masseuses (Miss Smith and myself) treated daily about thirty to forty cases. At the present time the treatment staff at Alder Hey and its two Auxiliaries, Highfield Military Hospital and Dawpool Auxiliary Officers’ Hospital, consists of fifty-eight masseuses and five masseurs. The number of cases treated daily during the current week amounts to 1,540 made up as follows:-
Massage – 800
Electrical – 380
Hydrotherapy – 170
Gymnasium – 190
See full report at http://www.scarletfinders.co.uk/180.html.
Efficiency was the key. In 1919, for example, ‘Major Souttar of Netley described machines to exercise 12 men at once which could be made from old packing cases and pulleys for 30s (Journal of the Incorporated Society of Trained Masseuses, May 1919, 257).
Lanckenau describes four main uses for the Guthrie-Smith suspension system:
- Relaxation as a preliminary to exercise, and interspersed with bouts of exercise
- Suspension for weightless exercise
- Auto-assisted exercise for joints
- Graduated resistance exercise for muscle training and muscle toning (Lanckenau 1943; 615).
Key here was the ability to get the patient to ‘work hard and do [the work] himself while he is carefully kept under supervision, so that adjustments and suspensions may be corrected’ (Lanckenau 1943; 615).
*Guthrie-Smith passed the Society’s examinations in massage (with distinction) and exercises in 1912 and joined the Almeric Paget Massage Corps in 1914 (Barclay 1995, 56). Head Masseuse at the London Command Depot in Shoreham, Sussex during WWI, Smith introduced the use of pulley and sling apparatus to help in the rehabilitation of servicemen through active and passive exercise. Some servicemen nicknamed the devices ’strafes’ from the German Gott strafe England (God punish England) (Barclay 1995, 67).
There is also a connection from Guthrie-Smith back to the work of another physical therapy pioneer – Dr Jonas Gustav W. Zander (1835-1920) – who developed fantastically elaborate (and expensive) exercise equipment that is redolent of the kinds of equipment you find in gymnasiums today. Thomas Terlouw, Nils Hanssen and Anders Ottosson have written some wonderful pieces on Zander, who ‘was a very strong candidate for the Nobel Prize in 1916’ (Hansson and Ottosson, 2015; 3).
So perhaps if we are looking for inspiration for future physiotherapy practice, we could do worse than dust off some old physiotherapy books and see what previous generations of physiotherapists had to deal with. You might be surprised what you find.
Barclay, J. (1994). In good hands: The history of the chartered society of physiotherapy 1894-1994. Oxford: Butterworth Heinemann.
Hansson, N., & Ottosson, A. (2015). Nobel prize for physical therapy? Rise, fall, and revival of medico-mechanical institutes. Physical Therapy. doi:10.2522/ptj.20140284
Lanckenau, N. I. (1943). Rehabilitation by modern methods of exercise. In W. B. Doherty & D. D. Runes (Eds.), Rehabilitation of the war injured, a symposium (pp. 614-21). New York, Philosophical Library.
Terlouw, T. J. (2004). De opkomst en neergang van de zander-instituten rond 1900 in nederland. Gewina/TGGNWT, 27(3), 135-158.
Terlouw, T. J. (2007). The rise and fall of zander-institutes in the netherlands around 1900. Medizin, Gesellschaft, Und Geschichte : Jahrbuch Des Instituts Für Geschichte Der Medizin Der Robert Bosch Stiftung, 25, 91-124.