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The Canadian Stâtesman. Bowmanville, January 21, 1976 Physiotherapy Department is a Busy Place Three members of the Memorial Hospital Physiotherapy Department demonstrate various treatments available at the second floor centre. Peter Jones bathes his shapely leg in the whirlpool bath, Liz Miller pedals the ergometer (a fancy bicycle which measures the patient's energy output) and Audrey Fredericks soothes her fingers in the hot wax machine. The Intermittent Traction Machine pulls on a patient's spine to help open up the spaces between the bones and allow more fluid to enter. This brings relief in cases of dise degeneration and nerve compression. Morris Weston is the patient getting stretched. By Liz Armstrong Several years ago there was Peter Jones, now Chief If you walked into the a shortage of qualified physio- Physiotherapist, arrived from Physiotherapy Department at therapists in Ontario and in Wolverhampton after re- MemorialHospital with your order to complete the staffing sponding to an advertisement eyes shut and just sat and of the department, two mem- placed in an English medical listened to the staff for a bers of the Memorial Hospital Journal by the hospital. while, you'd almost think you administration flew to Britain Liz Miller heard about were in Britain. in 1972 in an effort to attract Memorial through Peter (they Four out of five of the employees to Bowmanville. attended the same college in employees in that department The trend has continued the Midlands) and she emi- came to the hospital frQm though the original Britons grated to Canada four months England and Scotland. drawn to Memorial as a result ago to join the staff. It's not all coincidence of that mission have since Gary Moncton, a native of either. departed Kent in the south of England, beat the rush; he arrived in this country in 1964 and worked for several years in Oshawa before moving to the Bowmanville hospital four and a half years ago. He was head of the department here until a year ago when he opted to devote more of his time to a private physiotherapy prac- tice. Audrey Fredericks made her move even earlier than the rest. Originally from Edin- burgh, she came to Canada 27 years ago and has served on the Memorial staff as a, nursing assistant and physio- aide for more than 13 years. The only native is Barb Ha yne, who works part-time in the department. She's from Port Credit and now lives iii NeWcastle. But, as Peter pointed out, there's no reason why 'physios' from any part of the world shouldn't feel just as comfortable performing their skills in Bowmanville - or anywhere else for that matter. It's not the sort of work that's' strictly bound by language or culture as many other occupations are....a physio can just as easily administer a whirlpool treat- ment to someone from Nairobi as he can to someone from North Bay. Aside from the accents, another thing you'd notice right away is the easy-going atomosphere in the depart- ment. Patients are made to feel very comfortable during visits and the staff is on a first name basis with most of the people who are referred for therapy. The informal approach has other merits too. Peter feels that it helps him to get a maximum effort out of his patients. (Corne to think of it 'Push harder Phyllis" does sound a little more encour- aging than "Please exert somewhat more pressure, Mrs. Higginbotham.") From Melted Wax To Microwaves To define it simply, physio- therapy is the treatment of muscular-skeletal disorders through manipulation and exercise. It also includes the application of a whole range of intriguing devices which can heat cool, compress, vibrate, streich, suport and stimu- late the afecteci area, of the body in order to speed the patient's cure (or relieve his pain). A description of three diffe- rent treatments will help to give a better idea of how the physiotherapist can assist the healing process. One of the oldest and simplest methods used to reduce swelling is by applica- tion of hot wax to the affected area. It is particularly effec- tive in treatng awkward parts of the body (such as the hand) which are otherwise difficult to heat uniformly. Patients suffering from diseases such as rheumatoid-arthritis bene- fit from this ancient remedy because it increases the mobi- lity of the soft tissues sur- rounding the joints. The patient dipshis hand in and out of a container filled with melted wax and after several layers have been applied, his hand is wrapped in towels (to retain the heat) for about 20 minutes. The heat from the wax helps to reduce swelling and stimu- late circulation around the joints. The wax bath is regulated at temperatures between 105-120 degrees Fah- renheit so that the treatment will not burn the patient's skin. After trie treatment is finished, tre wax is peeled off and discarded. The hot bath is one of the simplest devices used by physiotherapists. One of the most complex utilizes micro- waves. Tie microwave appli- cator is an aparatus that is used to heat up trie water molecules and provide relief from pain.1 Peter noted that it works on the same principle as a microwave oven, the main difference being that it has a than trie home appliance. Trie penetration can be adjusted to specific levels so that a deep muscular pain can Audrey Fredericks plays the role of patient while Peter Jones illustrates use of the Short Wave Diathermy machine. The machine produces an electrostatic field to alter the orbit of electrons and give off energy in the form of heat. It's good for increasing the blood supply in cases of arthritis and providing heat therapy for deep internal organs. be reached b ythe microwaves emitted by the machine. The treatment increases blood supply to the muscles and it's effective on joints whi.ch have a high fluid concentration. Stretching the Spine Another device frequently used in the department is the Intermittent Traction Ma- chine, affectionately known as 'The Rack.' This treatment can be applied either while the pa- tient is sitting up (as shown in the photo) or while he is prone on a special bed which separates in the middle. The machine pulls on J:he spinal column to increase'the spacèbetween the bones and a low more fluid to enter the dises. The additional fluid serves as a cushion to bring relief from nerve compression caused by degenerative discs. Peter explained that nerves from the spine provide motor supply, muscular supply and sensation to both upper and lower limbs. Neck traction will relieve pains in the arms by de- creasing pressure on pinched or compressed nerves in the first nine vertebrae. The pull on the neck and upper back can be varied between 8 and 40 pounds of pressure. Although the force can be held constangt,it is iore comnion to exert it intermit- tently as the name of the .device suggests. On an aver- age the pressure is applied for 12 seconds and relaxed for three. If the source of the pain stems from the lower back, causing difficulty with leg movement, the patient is strapped to the separating bed and the traction machine exerts between 50-200 pounds of pressure on the lower spine. Peter said that the treat- ment has been administered to patients experiencing such severe pain that they can hardly walk. After treatment the change is often dramatic. Not ony can the patients walk wi greater ease, the relief from pain is obvious in their facial expressions--they go home smiling. More Outpatients Approximately 61 per cent of the patients who come for treatment in the physiothera- py departments at Memorial are outpatlents. The remaind- er are hospital patients who g to the centre located on t e second floor or receive care right on the ward. Most of the equipment is portable, mak- ing the physio's job less restricted. Physios either receive spe- cific orders from the doctor, or for more routine physical complaints, the treatment is left to the discretion of the staff in the department. On my request, Gary and Peter concocted a 'typical' case to illustrate how the physiotherapist functions within the hospital as a whole. It begins with a man who has been shoveling snow at the front of his house. As be bends to heave a shovelful onto the road, he pulls a muscle (or so he thinks) in his back. When he tries to straighten up he experiences a sharp pain in the lower area of his spine. To relieve the discomfort, he gQes inside and lies down with a heating pad applied to the affected region of his back and stays in bed for the rest of the day. The next day when~he wakes up, the pain is much worse despite the heat treatment. His wife decides that he should be examined by a doctor and they set off to the Emergency Department at Memorial Hos- pital. By now the pain is unhear- ab e and it is aggravated by the jostling he receives in the car en route. When he arrives in Emer- eney, the doctor on call decides that hie should be admitted with acutelow back ain. The doctor orders total ed rest, which means that he must not get out of bed or move around too much while he's in bed. Th ain' w eera l then contacts thie Physiothera- py Department with a requisi- tion for therapy to rehieve the pain. The physiotherapist locates the patient on the ward, introduces himself, asks ques- tions about his symptoms and finds out what treatment the patient has already received. Applies Ice Packs On examination, the physio finds a local spasm and notes that the patient has pain radiating down his leg when ie moves. Since heat has had no èffect on the pain, the therapist decides to apply crushed ice (wrapped in terrycloth towels) to the lower part of his back. The ice pack is left on until the skin goes bright red--at which point maximum therapeutic value of the treat- ment is received. The ice is applied twice a day and it is followed by treatment from an ultra-sound machine or Sonostat. This applicator creates a vibration on tissue underneath the surface of the skin, like a massage on a miniature scale. Specialist Notified The general practitioner, meanwhile, has contacted an orthopedic surgeon who gives the patient a total physical to determine the pain range. From this examination, the doctor can find the level of the nerves which are causing the problem and can specify exactly where the nerve lesion is. If the patient appears to be getting relief from pain with ice and the Sonostat treat- mpent,,the physio continues it and adds exercises to mobilize and strengthen muscle sup- port in the spinal region. Usually after a period of several days, the patient is mobile and ready to be discharged. Even after he's home the patient continues therapy on a regular basis. The outpatient routine includes exercises, a re-education of the patient's posture and techniques for the prevention of similar pro- lems. In addition, the physio teaches the patient how to lift properly and use his back muscles correctly. Sometimes the problem turns out to be more serious than strained muscles and the pain remains acute. In this case, the orthopedic surgeon will take x-rays to determine whether or not a disc has ruptured by injecting a dye loto the meninges (the cover- ing of the spinal column). In the post operative period, the physio will start off treatment by strengthening the muscles which were se- vered in surgery. Static exer- cises are continued for about 10 days or until the stitches have been removed. Then the exercises are gradually in- creased until the patient is on his feet again, and after his discharge, he returns to the physiotherapy department for treatment on an outpatient basis. High Quality Care From -the 'rack' to the whirlpool and all of the other treatments i between, the Physiotherajpy Department at Memorial is a fascinating place to visit, though the perspective probably changes a littie when you're a patient. As well as the frierdly atmosphere the quality of care in the department is high too. Hundreds of patients benefit from the service each year; each of them going home feeling a little (or a lot) better than before. Without trying to sound like an insurance advertisement, y oure in good hands with Peter, Gary, Liz, Audrey and Barb. Hope for Further drop in Snowmobile Collisions Fewer deaths and injuries could result if snowmobile drivers continue the trend indicated last winter, says Transportation and Commun- ications Minister James Snow. "Last winter, between Oct. 20 and Feb. 8, there were 12 fatalities, 262 personal injur- ies and 115 property damage collisions involving snow- mobiles, on and off the highway," reports Mr. Snow. 'Compared to the same period for the previous season, this was a reduction of 52 per cent in fàtalities,,39 per cent in collision injuries and 31 per cent fewer property damage collisions. "Its a sign snowmobilers are showing more care and common sense when handling their vehicles," said Mr. Snow. "And this year, the new legislation should result in even more control, without dampeniný the fun of this popuar winter recreation." M r. Snow reminds snow- mobilers the new regulations require-all rotorized snow "i ides Io be registered. 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