Carriage driving for disabled people Jill R Brown
7 St Nicholas Road, Salisbury, Wiltshire Jill R Brown BrMedJ7 1990;301:1427-8
Carriage driving has been a means of transport as well as a sporting activity for centuries but it was not until the early 1970s that it was seriously considered as an activity for disabled people. Since then it has flourished and there are now over 90 groups of the organisation for carriage driving for the disabled in the United Kingdom. The founders were all enthusiastic members of the British Driving Society and, enjoying carriage driving themselves, they felt sure that disabled people would also enjoy and benefit from it. They had seen a high sided refuse cart with pneumatic tyres being drawn along by a man in London and this gave them the idea of taking disabled people driving in similar vehicles. These first carts were far from ideal as they could take only one person in a wheelchair, so others were designed with sufficient space for a disabled driver, if necessary in a wheelchair, together with an ablebodied whip (driver). Carriage driving for the disabled is under the control of the Riding for the Disabled Association, which covers the groups for insurance. The British Driving Society has given practical support in addition to financial help. HRH the Duke of Edinburgh has also encouraged disabled people to share his enthusiasm for driving and this has given added publicity to the activity. Carriage driving is usually an activity for adults, although some children do take part. The disability is irrelevant if a person has the desire to drive. The most common disabilities are amputation, arthritis, blindness or partial sight, cerebral palsy, deafness, hemiplegia, multiple sclerosis, muscular dystrophy, paraplegia, phocomelia, and spina bifida. There are physical, psychological, and social benefits to be gained from driving. You should sit well so that postural and back muscles, arms and legs are all exercised by the act of sitting and driving. Balance should also be improved as well as control and coordination. Although the driver is seated, it is surprising how much the legs are used for balance as the cart goes along-in fact all parts of the body are used. We had one aphasic member whose speech was
improved by the desire to give commands to the pony -a surprising outcome of carriage driving. Confidence boosted Drivers need strength in the shoulders and arms as well as the hands, and quite a good grip is required to hold the reins correctly. Another of our members who has spina bifida is convinced that her hand strength has improved with driving and as she is able to help harness the pony from her wheelchair she also gets plenty of shoulder exercise. Members find that contact with animals is therapeutic and caring for the animals as well as having control over the pony and cart increases their confidence. Driving is also stimulating mentally. In addition to concentrating on driving and learning new techniques drivers can see over hedges; they meet different people; and ablebodied and disabled drivers can enjoy an activity together. For some disabled drivers the carriage drive is their only weekly outing in the fresh air. One member who has a neuropathy and is also blind told me that driving has given her an entirely new outlook on life. Since becoming disabled, although a country lover, she had not been outdoors to participate in any sporting activity for four years. Friendships have been made between disabled people who have met at driving sessions and between disabled and ablebodied members. A young man who has myositis ossificans progressiva was isolated and lonely; now he not only enjoys his weekly driving session and related social activities but he has formed a firm friendship with another disabled person and they are doing an Open University course together. As well as driving in the summer our group had various social activities. These included a picnic drive, a barbecue, and an outing to the British Driving Society annual show in Windsor Great Park. This event has classes for many types of pony and cartsingles, tandems, randems, and trade carts-as well as classes for disabled drivers. It is an enjoyable day out and it is encouraging to see so many people of varying physical ability enjoying an activity together. At Windsor ablebodied and disabled drivers can compete together and this is important in a society which is only now accepting disabled people as part of the normal community. There is also an annual show and competition for disabled drivers which is now usually held in Windsor Great Park. During the winter our group had lectures on the theory of driving and the care of ponies which can lead to the tests for the British Driving Society. We also had a fund raising lunch party and carol singing outing; both were enjoyable and perhaps for some of the disabled members it was their only chance of participating in such events.
Ponies with a calm temperament needed Many carts now used by the carriage driving for disabled groups have a ramp at the rear to enable a wheelchair to be pushed easily into the cart; the ramp folds up to form the back of the cart. Other adaptations can be made as necessary and our group has been helped by the local Rehabilitation Engineering Movement Advisory Panel. (REMAP, 25 Mortimer BMJ
VOLUME 301
22-29 DECEMBER 1990
1427
Street, London WIN 8AB, makes or adapts any gadget or aid for disabled and elderly people.) The ponies are chosen carefully and need to be reliable with a calm temperament, fit, strong, and responsive. It is amazing how quickly rapport develops between the ponies and their different drivers-the ponies seem to sense the needs of their driver and react accordingly. Many helpers are needed in addition to the ablebodied whip who always accompanies a disabled driver. There must be helpers to hold the pony and to help the disabled person into the cart. If a wheelchair is used it must be securely clamped to the cart; the disabled person is strapped into the chair with a restraining belt for safety and to give the driver security. The disabled driver can then take the reins. Double reins are always used so that the disabled driver can take as much or as little control as is possible and desired, but the ablebodied
whip is always in ultimate control. Reins with looped hand pieces are commonly used when there is any weakness in grip. Once on the road or track the driver can appreciate everything that an ablebodied driver enjoys. There are always two helpers with each pony and cart (turnout), one in front and one behind, often on bicycles, so that they can keep up with the cart. They warn traffic of the turnout and check road conditions ahead; they also help if the disabled driver has any problems. I am convinced of the many benefits which driving provides for anyone who has an interest in ponies, disabled or not. And as one of our disabled members said, "It makes you feel good." For details of local carriage driving for disabled groups contact the Riding for the Disabled Association, Avenue R, National Agricultural Centre, Kenilworth, Warwickshire CV8 2LY.
The surgeon's scissor-jaw reflex W A McFadzean, J D C Bennett An anaesthetist's time in theatre is spent watching many things, not least the surgeon. In over 10 years as an anaesthetist WAM noted that about three quarters of surgeons exhibit what might be called the scissorjaw reflex (fig 1). This phenomenon consists of the surgeon's mouth opening in unison with the opening of the scissors when they are used for dissection. This reflex has not previously been described, and to our knowledge there has been no reference to any similar phenomenon in published reports. A close approximation is found, however, in mothers feeding their children. Here a mother will open her mouth in an attempt to encourage the child to imitate her so as to take food from a spoon. Furthermore, it is acknowledged that mouth and tongue movements are associated with mental application.
British Military Hospital, Rintein W A McFadzean, FFARCSI, senior specialist, anaesthetics J D C Bennett, MB, researcher
Correspondence to: Major J D C Bennett, Department of Military Medicine, Royal Army Medical College, London SW I P 4RJ. BrAled] 1990;301:1428-9
.........
FIG 1-Scissor-jaw reflex (SJR)
1428
Patients and methods Over a period of 12 months we observed four groups: general surgeons, orthopaedic surgeons, neurosurgeons, and ear, nose, and throat surgeons. Ophthalmologists were excluded as preliminary
analysis proved that it was too difficult accurately to monitor the opening and closing of their tiny instruments (p=001). Gynaecologists were similarly excluded as in their case both jaw and instrument movement were too fast for accurate observation (interobserver error significant at p=0 05). 0 v 0
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p
7 St Nicholas Road, Salisbury, Wiltshire Jill R Brown BrMedJ7 1990;301:1427-8
Carriage driving has been a means of transport as well as a sporting activity for centuries but it was not until the early 1970s that it was seriously considered as an activity for disabled people. Since then it has flourished and there are now over 90 groups of the organisation for carriage driving for the disabled in the United Kingdom. The founders were all enthusiastic members of the British Driving Society and, enjoying carriage driving themselves, they felt sure that disabled people would also enjoy and benefit from it. They had seen a high sided refuse cart with pneumatic tyres being drawn along by a man in London and this gave them the idea of taking disabled people driving in similar vehicles. These first carts were far from ideal as they could take only one person in a wheelchair, so others were designed with sufficient space for a disabled driver, if necessary in a wheelchair, together with an ablebodied whip (driver). Carriage driving for the disabled is under the control of the Riding for the Disabled Association, which covers the groups for insurance. The British Driving Society has given practical support in addition to financial help. HRH the Duke of Edinburgh has also encouraged disabled people to share his enthusiasm for driving and this has given added publicity to the activity. Carriage driving is usually an activity for adults, although some children do take part. The disability is irrelevant if a person has the desire to drive. The most common disabilities are amputation, arthritis, blindness or partial sight, cerebral palsy, deafness, hemiplegia, multiple sclerosis, muscular dystrophy, paraplegia, phocomelia, and spina bifida. There are physical, psychological, and social benefits to be gained from driving. You should sit well so that postural and back muscles, arms and legs are all exercised by the act of sitting and driving. Balance should also be improved as well as control and coordination. Although the driver is seated, it is surprising how much the legs are used for balance as the cart goes along-in fact all parts of the body are used. We had one aphasic member whose speech was
improved by the desire to give commands to the pony -a surprising outcome of carriage driving. Confidence boosted Drivers need strength in the shoulders and arms as well as the hands, and quite a good grip is required to hold the reins correctly. Another of our members who has spina bifida is convinced that her hand strength has improved with driving and as she is able to help harness the pony from her wheelchair she also gets plenty of shoulder exercise. Members find that contact with animals is therapeutic and caring for the animals as well as having control over the pony and cart increases their confidence. Driving is also stimulating mentally. In addition to concentrating on driving and learning new techniques drivers can see over hedges; they meet different people; and ablebodied and disabled drivers can enjoy an activity together. For some disabled drivers the carriage drive is their only weekly outing in the fresh air. One member who has a neuropathy and is also blind told me that driving has given her an entirely new outlook on life. Since becoming disabled, although a country lover, she had not been outdoors to participate in any sporting activity for four years. Friendships have been made between disabled people who have met at driving sessions and between disabled and ablebodied members. A young man who has myositis ossificans progressiva was isolated and lonely; now he not only enjoys his weekly driving session and related social activities but he has formed a firm friendship with another disabled person and they are doing an Open University course together. As well as driving in the summer our group had various social activities. These included a picnic drive, a barbecue, and an outing to the British Driving Society annual show in Windsor Great Park. This event has classes for many types of pony and cartsingles, tandems, randems, and trade carts-as well as classes for disabled drivers. It is an enjoyable day out and it is encouraging to see so many people of varying physical ability enjoying an activity together. At Windsor ablebodied and disabled drivers can compete together and this is important in a society which is only now accepting disabled people as part of the normal community. There is also an annual show and competition for disabled drivers which is now usually held in Windsor Great Park. During the winter our group had lectures on the theory of driving and the care of ponies which can lead to the tests for the British Driving Society. We also had a fund raising lunch party and carol singing outing; both were enjoyable and perhaps for some of the disabled members it was their only chance of participating in such events.
Ponies with a calm temperament needed Many carts now used by the carriage driving for disabled groups have a ramp at the rear to enable a wheelchair to be pushed easily into the cart; the ramp folds up to form the back of the cart. Other adaptations can be made as necessary and our group has been helped by the local Rehabilitation Engineering Movement Advisory Panel. (REMAP, 25 Mortimer BMJ
VOLUME 301
22-29 DECEMBER 1990
1427
Street, London WIN 8AB, makes or adapts any gadget or aid for disabled and elderly people.) The ponies are chosen carefully and need to be reliable with a calm temperament, fit, strong, and responsive. It is amazing how quickly rapport develops between the ponies and their different drivers-the ponies seem to sense the needs of their driver and react accordingly. Many helpers are needed in addition to the ablebodied whip who always accompanies a disabled driver. There must be helpers to hold the pony and to help the disabled person into the cart. If a wheelchair is used it must be securely clamped to the cart; the disabled person is strapped into the chair with a restraining belt for safety and to give the driver security. The disabled driver can then take the reins. Double reins are always used so that the disabled driver can take as much or as little control as is possible and desired, but the ablebodied
whip is always in ultimate control. Reins with looped hand pieces are commonly used when there is any weakness in grip. Once on the road or track the driver can appreciate everything that an ablebodied driver enjoys. There are always two helpers with each pony and cart (turnout), one in front and one behind, often on bicycles, so that they can keep up with the cart. They warn traffic of the turnout and check road conditions ahead; they also help if the disabled driver has any problems. I am convinced of the many benefits which driving provides for anyone who has an interest in ponies, disabled or not. And as one of our disabled members said, "It makes you feel good." For details of local carriage driving for disabled groups contact the Riding for the Disabled Association, Avenue R, National Agricultural Centre, Kenilworth, Warwickshire CV8 2LY.
The surgeon's scissor-jaw reflex W A McFadzean, J D C Bennett An anaesthetist's time in theatre is spent watching many things, not least the surgeon. In over 10 years as an anaesthetist WAM noted that about three quarters of surgeons exhibit what might be called the scissorjaw reflex (fig 1). This phenomenon consists of the surgeon's mouth opening in unison with the opening of the scissors when they are used for dissection. This reflex has not previously been described, and to our knowledge there has been no reference to any similar phenomenon in published reports. A close approximation is found, however, in mothers feeding their children. Here a mother will open her mouth in an attempt to encourage the child to imitate her so as to take food from a spoon. Furthermore, it is acknowledged that mouth and tongue movements are associated with mental application.
British Military Hospital, Rintein W A McFadzean, FFARCSI, senior specialist, anaesthetics J D C Bennett, MB, researcher
Correspondence to: Major J D C Bennett, Department of Military Medicine, Royal Army Medical College, London SW I P 4RJ. BrAled] 1990;301:1428-9
.........
FIG 1-Scissor-jaw reflex (SJR)
1428
Patients and methods Over a period of 12 months we observed four groups: general surgeons, orthopaedic surgeons, neurosurgeons, and ear, nose, and throat surgeons. Ophthalmologists were excluded as preliminary
analysis proved that it was too difficult accurately to monitor the opening and closing of their tiny instruments (p=001). Gynaecologists were similarly excluded as in their case both jaw and instrument movement were too fast for accurate observation (interobserver error significant at p=0 05). 0 v 0
30 28
c
E
p
