Paralympics, POSSUM and Stoke Mandeville
The Paralympics is the biggest multi-sport event for disabled athletes in the world today, with the opening ceremony this year at the Stoke Mandeville Stadium, Buckinghamshire, 28 August. Hard to believe that just over 50 years ago patients with spinal injuries had only a two-year life expectancy. Ward X at Stoke Mandeville Hospital opened in 1948 and blazed a trail for the revolution of care for spinal injury patients and for athletes with disabilities.
The children’s charity Action Medical Research funded Stoke Mandeville’s Dr Ludwig Guttmann in his pioneering work to rehabilitate patients, to develop life-changing innovations for disabled people, and to develop the very foundation on which today’s Paralympic movement stands.
The origins of the Paralympics date back to Britain during the Second World War. In preparation for an influx of injured and paralysed servicemen, the Government decided a special spinal ward to cater for casualties should be opened. Ward X at Stoke Mandeville Hospital opened in September 1943.
Dr Ludwig Guttmann was employed to take charge of Ward X and worked hard to overcome the widely held belief, both within the medical profession and among the public, that paralysed patients faced a bleak future and could never be reintegrated into society.
Despite being initially very poorly resourced, the medical need was clear and within six months Guttmann had nearly 50 patients on the ward.
Hope through rehabilitation and sport
Treatment for people with spinal injuries in the 1940s was still basic. These patients had only a short life expectancy due to the risks of pressure sores and urinary tract infections.
Restoring faith and self belief in people with these injuries was Dr Guttmann’s main objective. He did this first by changing the way they were treated - he had them moved regularly to avoid the build up of sores and the possibility of infections developing.
Second, he engaged his patients in physical and skill-based activities. Learning new skills, like woodwork, clock and watch repair and typing, would ensure future employment.
The children’s charity Action Medical Research funded trailblazer Dr Guttmann, knighted in 1966, in his pioneering work to rehabilitate patients through sport. The aims of sport were to develop self-discipline, self-respect, competitive spirit and comradeship - mental attitudes that are essential for the disabled person's integration into the community, Guttmann passionately believed.
The Paralympics were born
On 28 July 1948 Guttmann hosted an Archery event between two teams of disabled athletes at Stoke Mandeville Hospital – the same day more than 4,000 non-disabled athletes took part in the Opening Ceremony of the XIV Olympic Games at Wembley.
16 former service personnel (14 men and two women) took to the lawns for the contest – on one side, the Star and Garter Home in Richmond, Surrey, on the other Stoke Mandeville. The Star and Garter won, a cup was presented and the first recorded competition between disabled athletes had been held.
Four years later competitors from Holland joined the games at Stoke Mandeville and the international movement, now known as the Paralympics, was born. Olympic style games for athletes with a disability were organised for the first time in Rome in 1960. Guttmann founded the British Sports Association for the Disabled in 1961.
One man who was also closely involved in the revolution of care for spinal injury patients is Dr John Silver. In 1955 he went to work with Dr Ludwig Guttmann at Stoke Mandeville.
Dr Silver takes up the story: “Guttmann’s unit was a fantastic place to work. He was a hugely exciting and stimulating man to work for. You did feel like you were in the middle of something special. And because Guttmann himself was a refugee (from Nazi Germany) he tended to employ other refugees. It certainly wasn’t the usual straight laced environment you found in teaching hospitals at the time!”
Action Medical Research funded Dr Silver in 1962 to investigate the physiology of spinal injury patients. “A broken spinal cord affects so many of the body’s natural mechanisms. My research helped our understanding, and did affect how patients were managed.” Later work by Guttmann investigating the pathology of spinal injury patients was also supported by a grant from the charity.
In 1961 the Action Medical Research funded two other researchers at Stoke Mandeville, the late Reg Maling and Derek Clarkson, to develop ‘Patient Operator Selector Mechanisms’, (POSM).
Paralysed patients would use whistles from their beds to attract the attention of medical staff. Maling and Clarkson felt that if patients were able to control the air in their mouths to blow a whistle, then the same process could be used to operate micro-switches enabling them to control electrical appliances.
Within six months of the charity grant award the first POSM instrument was made, giving the patient control over bells, lights, radios, telephones and televisions. The late and great Reg Maling spoke to the charity in 2004, “We made a real difference. I remember one lady who had literally only a flicker of movement in one toe. She went on to write a beautiful book of poems – it was quite extraordinary.”
Guttmann was also awarded a grant from Action Medical Research in 1965 to continue work on POSM and electronic controls for chairs used by tetraplegics*. A company was set up to develop and manufacture the equipment – and Possum Ltd. still exists today, winning the Queen’s award for innovation in 2009. ‘Possum’ in Latin means ‘I can’.
Broadening the reach
Action Medical Research is proud of its history with the world-leading National Spinal Injuries Centre at Stoke Mandeville, with the inspiring pioneer Guttmann and link with the Paralympics. From the humble beginnings of an archery contest on the lawns of the hospital, the 2012 Paralympics will feature more than 1,100 competitors (740 men, 360 women), competing in 170 medal events, watched by television audiences around the world.
In 1970 and 1973 the charity awarded further grants to Guttmann to support the writing of his seminal book, Textbook of Sport for the Disabled. The title, reviewed by the British Journal of Sports Medicine in 19781 was described as, “a comprehensive handbook of sport for the disabled.” In the same review the author talks of Guttmann’s, “wonderful pioneering spirit” which “serves as an inspiration for his successors.”
The book focuses on the technicalities of the rules of many sports for children and adults with disabilities, including amputees and the blind (visually impaired). In 1976, two new athlete classes were added to the Paralympics; athletes with a visual impairment and athletes who were amputees.
In 1980 athletes with cerebral palsy were added and in 1984 a fifth class, 'les autres', was added which covers athletes who do not fit into the other categories. In 1996 the sixth, and to date, final impairment group was added for the first time, athletes with an intellectual disability, known in the UK as learning disability.
Still more to do
More than £100 million has been invested by Action Medical Research into vital medical research over the past 60 years, which has led to some key scientific breakthroughs and helped thousands of babies and children.
The charity today funds research that continues a proud history of helping to reduce the suffering endured by children with disabilities caused by conditions such as cerebral palsy, muscular dystrophy, blindness or learning disabilities.
Although the research funded has helped save and change so many children’s lives, there is still so much more to learn about what triggers disability causing disease, how to prevent these and how to develop effective new treatments and technologies.
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NOTES FOR EDITORS:
*Tetraplegic – tetraplegia (another term for quadriplegia) is injury to the spinal cord in the cervical region, with associated loss of muscle strength in all four extremities. http://emedicine.medscape.com/article/322480-overview
1. PN Sperryn. Br J Sports Med. 1976 December; 10(4): 241. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1859522/pdf/brjsmed00275-0050a.pdf