• Led by Dr Rhaiadr Jones
• Initially in hut at the back of the hospital
• By end 1942 lofty entrance hall of hospital reduced in height – this floor became a large gymnasium
• 1943 rehabilitation workshop established at Austin factory, Longbridge
• Weekly visit to factories drove a prevention strategy
• Rehabilitation of people back to work as a process of continuous treatment was another example of Gissane’s contribution to the progress of medicine
• After Dr Rhaiadr Jones came Mr R B Brookes
• Physiotherapy commenced as soon as possible in hospitals and there was a physiotherapist present in outpatient clinics
• Gissane established close liaison with industrial health.  Joint clinics established at the Austin Motor Company.
• Rehabilitation of a disabled person suffering from an accident is a continuous process.
• “It commences on the day of the accident and finishes when the disabled person is again a self-supporting happy citizen, back as a useful workman with his employer.”
• Rehab is personal to each patient – organisation required to rehabilitate successfully large numbers of patients is not easy of attainment
• Surgeons responsibility – consider the immediate surgical treatment but even at this early stage he has to plan for the man’s return to full pre-accident working capacity.
• Approximately one-sixth of the whole hospital floor space is now in active use, or projected, to house special departments concerned in regaining full physical and mental fitness of the disabled following surgical treatment.
• In these new departments work the Physiotherapists, Physical Training Instructors, Occupational Therapists and Games Instructors. Also, there are a large amount of special apparatus, scientifically designed to regain full working capacity to the injured.
• In all these departments the treating surgeons are to be found supervising this phase of their patients’ recovery. 
• Throughout treatment the personal touch is continually stressed as of vital importance and this essential spirit can only be attained when the various members of the Hospital treatment staff work together as one co-ordinated team.  
• The Hospital is doing much to bridge the gap which had previously existed between the end of hospital treatment and the disabled person’s return to work.

Stages of Rehabilitation in the Injured
 
Stage one – a ward exercise class
Daily exercise classes in the ward are commenced whilst the patients are still in bed in order to
maintain physical fitness even in the earliest stage of treatment. 
 
Stage two – occupational therapy in hospital
Injured hands in the early stage of recovery regained their useful function at interesting occupations,
such as toy making and weaving.  Injured feed; worked with foot driven fretsaws
 
Stage three – the gymnasium

Here patients are seen toughening up broken hands, arms and shoulders by rope exercises or in the
case of broken ankles and feet on ladders and narrow planks.  Exercises to broken legs are carried out
whilst still in plaster
 
Stage four
For those patients working in industry rehabilitation is transferred to their place of work as soon as
recovery has reached the stage when a few hours productive work can be undertaken.  The patient
goes over to the rehabilitation workshop in industry, still under hospital guidance but the patient can
now be paid wages and so gets back to work.

Rehabilitation with Production (Austin Motor Company)

• To complete the full picture of rehabilitation of the disabled right back to work, and in pursuance of the personal quality of this service, the Hospital has always realised that an essential member of the team is the employer. 
• The employer is the expert on work and the Hospital is the expert on treatment of injuries. 
• Therefore, the employer and the Hospital can co-operate in the full solution of the rehabilitation problem.
• An experiment has been carried out between the Hospital and Austin Motor Company Limited.  It has now been in operation for ten months. 
• The Austin Motor Company fitted up a workshop at their factory and placed it under the supervision of a works engineer. 
• It is under the medical supervision of the Works Medical Officer and the Clinical Director of the Hospital. 
• All workmen in this shop are disabled temporarily or permanently. 
• When their treatment reaches the right stage of recovery rehabilitation methods are harnessed to production machines. 
• The result is that rehabilitation has greatly benefitted, and the injured workers’ production has not only helped the present national effort but is now returning the great majority of the maintenance costs of this experiment, in spite of the fact that the disabled are paid a good wag. 
• Up to date approximately 150 disabled persons have returned to normal work after passing through this shop. 
• All have been immediately employed in the factory proper. 
• Up to date no worker has been returned from the factory as a failure at his job.
• Some injuries have prevented men from going back to their old jobs, and these men have been re-trained and re-fitted for new ones.

Example

• JS, after discharge from the Army, became a power press operator. 
• His right hand was caught under the press. 
• His injuries were severe.  Plastic surgery saved the majority of the hand, but the man was permanently unfitted for his pre-accident job. 
• He spent three months in the rehabilitation shop, first learning to get the maximum use from the disabled hand, then learning to be a welder. 
• He is now earning £10 a week in the factory proper as against the £6 a week he was getting before his disability.
• The scheme of a rehabilitation workshop attached directly to industry and closely co-operating with the Hospital is a success. 
• The scheme is capable of expansion if more industrial co-operation is forthcoming. 
• The Hospital, with its new departments, can expand to deal with the whole problem of Birmingham’s injured, from the treatment and hospital rehabilitation side, and is prepared to send its surgeons out to co-operate with industry in the final rehabilitation of disabled persons on production lines. 
• From the shop the disabled go directly back to the factory proper – the cycle of treatment is then complete.
• The scheme is simple, personal and local. 
• Owing to its simplicity it has the advantage of being capable of attending to its own breakdowns and misfit.  Further, it has the advantage of fitting into the national scheme which is now before the House of Commons.

The following extract from a speech by Sir Patrick Hannon in the debate on the Disabled Persons
(Employment) Bill during its second reading in the House of Commons will be of interest.

“The Hospital is giving a lead in the rehabilitation and restoration of injured and wounded men to
make them fit for industry, and their work should be known throughout the length and breadth of the
land.  It is a particularly ambitious venture, which has received substantial support, and the success of
its experiment has been remarkable.  What has happened is that the Accident Hospital, under
admirable control and direction, is in contact with various works, and as the process  of restoration to
working capacity goes on in the Hospital the men are gradually brought back into contact with the
work in which they were engaged in the particular factory before their injury.  Even before full
capacity is reached a man may be back at work, and his work may go on side by side with the work of
restoration”.

The Physiotherapy Department

Reflection from Sarah Bache, formerly physiotherapist at the Acci

• The work at the Acci made me appreciate we really made a difference to patients and health outcomes
• We were valued and part of the greater team like nowhere I had worked previously. I felt proud when one of the consultants said “there is no point reducing a fracture without adequate rehabilitation”
• On reflection years later, I recognised the truly ground breaking and forward thinking attitude of the department achieving exceptional results
• The Acci physiotherapists provided a full 7 day service
• Rehabilitation began on admission even on the Major Injuries Unit (MIU)
• There were no waiting lists for outpatient care
• New referrals were treated on the day of referral when presenting a referral card to the department. They were discharged home with a follow up appointment and appropriate exercises
• The job satisfaction was immense
• Teamwork, complex cases, stress, extreme suffering, dedication, anxiety, pride and fun were all witnessed in equal measures
• Princess Diana, The Gladiators and Roger Black were some of the famous faces I met, however, itwas the raw humanity in its basic state that profoundly affected me and has stayed with me since
• Working at the Acci was both a privilege and an inspiration
• One of the senior physiotherapists was Mike Garmston, not only a former national athlete but also physiotherapist to the British Olympic team.
• With managerial support he regularly saw athletes during his lunch break and worked in conjunction with Keith Porter who had an interest in sports injuries. Famous names seen included Linford Christie, Steve Backley, Eliz McColgan and Roger Black to name but a few.