Healing Their Broken Bodies: Breaking Medical Barriers Through Sport

Andres Chavez, Caia Kamplain, Henry Schuett, Angelica Trillo Senior Division Group Performance Process Paper Word Count: 498

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Process Paper

We were intrigued by early medical history topics and wanted something unique, inspirational, and that had a powerful legacy for marginalized populations. We discovered Sir Dr. Ludwig Guttmann, the father of the Paralympics, and we were captivated by his innovative therapies that revolutionized treatment of spinal cord injury patients. . We created our performance Healing Their Broken Bodies: Breaking ​ Medical Barriers Through Sport in honor of Guttmann’s success in breaking medical, ​ physical and mental barriers for patients globally.

Each team member began background research on Dr. Guttmann the history of spinal cord injury treatment. We developed timelines of Spinal Injury treatment and the history of ParaSports. There were a number of barriers as we decided to focus on the use of sport and Guttmann’s role in the creation of what became the modern day paralympics. We gathered extensive primary and secondary source materials to build our understanding of the medical, physical and mental barriers paraplegics faced during WWII. We interviewed Dr. Guttman’s daughter, Dr. Eva Loeffler who provided insight into the family, the life of her father, and an understanding of his passion to give “life back to his patients”. She directed us to an archive in England that provided digitized primary sources, unfortunately, the COVID 19 shut down meant that the archivists were unable to send digitized versions of the letter that secured the

Guttman’s escape from Germany and a copy of the board meeting notes from the approval of the first Stoke Mandeville games.

Limited visual resources and a large collection of written resources helped us determine that performance was the best category for our topic. We also felt the story would be more compelling if we could connect personally with the audience. We all Chavez Kamplain Schuett Trillo 2 worked collaboratively on research, character development, script writing, set design and creation of props and costumes. We lost access to all materials because our state locked down during Spring Break. Surprisingly, we think it forced us to improve our script because we had to be very intentional in how we planned stage direction and developed the flow of the script.

Dr. Guttmann’s spinal cord injury treatments forced the medical field to shift from hospice care to rehabilitation. He was passionate about restoring quality of life to patients, however it required that he institute methods and practices to break very real mental and physical barriers. His innovative physiotherapy methods, got patients out of bed and restored strength and restored mobility. By implementing sports into physical rehab, he gave the patients something to work toward which broke mental barriers that could limit recovery. His treatment gained global acceptance allowing patients to break previously unheard of physical barriers and engage in their own rehabilitation. His initiation of the Stoke Mandeville games changed public perception and created a sense of normalcy that broke societal barriers. His legacy includes the creation of the international Paralympic games which now includes hundreds of thousands of athletes with a broad spectrum of physical impairments to break barriers in every competition.

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Bibliography Primary Sources

Auftrag, J. N. Letter to Ludwig Guttmann, "Certificate," June 9, 1923. Wellcome Library. When the rise of the Nazi party began to discriminate against Jews many people were forced out of their professions. Among these people was a doctor named Ludwig Guttmann who would go on to be the father of the Paralympics. This notice was sent to him to inform him of his proficiency as a doctor and to eventually stop him from practicing medicine in the country of Germany.

Australian Paralympian Tony South receives his gold medal at the 1968 Tel Aviv Summer Paralympics from the founder of the Paralympics, Ludwig Guttman. ​ Photograph. What Are the Paralympic Winter Games All About? Accessed October 14, 2019. https://www.cbc.ca/kidscbc2/the-feed/what-are-the-paralympic-winter-games-all- about. This is a photograph of Dr. Guttmann presenting Tony South with the gold medal for the 1968 Tel Aviv Summer Paralympics. ​

Buckinghamshire County Council, ed. "1950s The first international games." Stoke Mandeville Legacy. Last modified March 13, 2014. Accessed May 6, 2020. http://www.mandevillelegacy.org.uk/page_id__18.aspx. This article describes how Stoke Mandeville transitioned into a small gathering into being an official part of the Olympics. The hospital would house the athletes and the crowd was mostly family members there to support. The people that helped out with the games were staff members of different hospitals that Dr. Guttmann asked to help. By 1956 the Games started to gain traction and was recognized by the Olympics. This helped my group to see how long the social change took for the Paralympics to become part of our culture.

Bull, Albert H. "Sir Ludwig Guttmann: From a Grateful Patient." Sir Ludwig Guttman: ​ From a Grateful Patient. Accessed October 29, 2019. ​ https://www.nature.com/articles/sc19796.pdf?origin=ppub. Rev. Albert Bull was a patient at Stoke Mandeville in 1945. He was an Army Champlain whose landing craft was hit with a shell during the invasion of Sicily. After that, he became a paraplegic and with no hope was transferred to Tripoli to be bedridden with no hope. He read in the times about Stoke Mandeville and soon after transferred and changed his life forever. He credits his recovery to Dr. Ludwig Guttman for helping him be more independent.

Forman, Harrison. Bombing of the Polish countryside during the September ​ Campaign of 1939. Photograph. UMW Libraries. 2009. Accessed October 22, ​ 2019. https://collections.lib.uwm.edu/digital/collection/pol/id/103/rec/6. This image shows the Nazis invading a Polish community in 1939. This image gives historical context to why Ludwig Guttmann moved to Stoke Mandeville from Poland during World War 2.

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Getty Images. International Stoke Mandeville Games. August 2, 1969. Photograph. ​ ​ Hulton Archive. This photo is of the opening induction to the Stoke Mandeville Games. Induction began with a bouquet visit from Queen Elizabeth II. Her visit was one of many famous figures in history visiting Guttmann's cause, helping show examples of social belonging. Many paraplegics were socially impacted and inspired to physically come back and overcome their physical disabilities.

Gutmann, Ludwig. "History of the National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury." Proceedings of the Annual Scientific Meeting of the ​ Society Held at Stoke Mandeville Hospital, Aylesbury, 27th to 29th July 1967, ​ July 27, 1967, 115-26. This is a report that Dr. Guttmann wrote to the Scientific Meeting of the Society and sent to the administration to show the progress of his patients. The journal reported that Guttmanns's sport-based rehab helped increase morale rates and many SCI patients no longer were dependent on morphine.

Guttmann, Ludwig. Letter to Edith Wolfsman, October 11, 1967. https://royalsociety.org/collections/wolfson-archive/stoke-mandeville/. A letter where Ludwig Guttmann is requesting money for an indoor sports stadium. He gives a brief history of the starting of his paraplegic sports movement. He shows that just because their bodies are a little broken, they're still people and they still deserve the things that other athletes get.

———. Letter to Gilbert Monckton, January 8, 1968. https://royalsociety.org/collections/wolfson-archive/stoke-mandeville/. Ludwig Guttmann wrote a letter thanking the Wolfson Foundation for supplying funds for the National Sports Centre for the Paralyzed and other Physically Handicapped. He shows his extreme gratitude for the funds that were given for his organization.

———. Textbook of Sport for the Disabled. Aylesbury, UK: HM + M Publishers, 1976. ​ ​ This book is written by Ludwig Guttmann who was the father of the Paralympics. In this book, he wrote about his discoveries and medical procedures for people with disabilities. Ludwig Guttman used many revolutionary types of medicine to help people with disabilities recover swiftly; using the incorporation of sport. This textbook helps teach future generations of doctors about his discoveries.

Guttmann, Ludwig, M.D. "New Hope for Spinal Cord Sufferers." S.A. Tydskrif Vir ​ Geneeskunde, March 23, 1946. ​ In this medical journal from the S.A. Tydskrif Vir Geneeskunde, Guttmann analyzes the spinal cord injuries through examining brain waves. In addition to examining brain-behavior from spinal injuries, Guttmann also analyzes diseases commonly caught by paraplegics before introducing the medical practices that he later experiments on his patients.

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International Wheelchair and Amputee Sports Federation. March of Nations through ​ the Years. Aylesbury, UK: International Wheelchair and Amputee Sports ​ Federation, 2017. Accessed October 29, 2019. http://www.iwasf.com/iwasf/index.cfm/games/iwas-world-games11/past-games2/ . These six pictures show the Nation Marches through the years of the Paralympic games. The third picture shows a wonderful example of the Stoke Mandeville ward playing the Paralympics.

Jane. Letter, 1940's. see and hear: museum blog. We used this letter in our script to show the reality for some of the soldiers that came back from war paralyzed.

Kennedy, Caroline. Head Porter, Tommy Ounsworth and unidentified nurse at the ​ hospital reception. Photograph. Mandeville Legacy. 1960. Accessed October 30, ​ 2019. http://www.mandevillelegacy.org.uk/page_id__16.aspx?path=0p4p13p. In this picture there is era accurate representations of how doctors and nurses dressed during the mid 1900s. This will help give us an idea of how to dress for our performance.

Loeffler, Eva. "Interview with Eva Loeffler." Mandeville Legacy. Last modified April 2011. Accessed May 11, 2020. http://www.mandevillelegacy.org.uk/documents/Eva_Loeffler_full_interview.pdf. This Interview with Dr. Guttmann's daughter about her early experiences with her father. She explains their movement from Germany to England, and her father's devoted work at Stoke Mandeville HOspital and in the development of the Paralympics.

Loeffler, Eva. Telephone interview by the author. London, England. December 19, 2019. We conducted a phone interview with Dr. Eva Loeffler, the daughter of Dr. Ludwig Guttmann. She was able to describe her father’s passion for his work and gave a first hand account of the impacts of the Stoke Mandeville and Paralympics games. She also works with neurological conditions and spent time working with her father near the end of his career. She has been a very active member of the Paralympic games and was able to help us understand the legacy as well as the barriers that were broken medically, physically and socially for the athletes. She was also able to help us understand how to develop his character for the performance.

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Ludwig Guttmann's Memorandum, August 17, 2017. Accessed December 17, 2019. ​ https://doi.org/10.1038/scsandc.2017.47. A journal is written by Dr. Ludwig Guttman describing his research and progress on paraplegics and their responses to physical therapy. Ludwig Guttman performed his research over the course of seven years while he worked at the Department of Surgery at Oxford University. This memorandum was written before Dr. Ludwig Guttman was appointed as head of the Stoke Mandeville Spinal Injuries Unit.

Mandeville Legacy. "Getting better Physiotherapy and Occupational Therapy." Mandeville Legacy. Last modified March 15, 2011. Accessed October 22, 2019. http://www.mandevillelegacy.org.uk/page_id__13.aspx?path=0p4p13p. This article is about before and after Dr. Guttmann came to Stoke Mandeville Hospital to help with the SCI patients. There are pictures of patients doing physical therapy, nurses talking about their experiences working with Guttmann, and first-hand information about the SCI unit. This will help with our performance by giving us an idea of our set and how to dress.

"Margaret Maughan interview about meeting Sir Ludwig Guttmann." Video file, 1:59. Mandeville Legacy. Posted by Mandeville Legacy, November 7, 2013. Accessed October 10, 2019. http://www.mandevillelegacy.org.uk/page_id__31_path__0p4p19p.aspx. This is a video interview of Margaret Maughan, who was treated by Dr. Guttmann and his staff. She remembers him as a doctor that was passionate about helping his patients and believed strongly in his research.

Morley, Fred. Wheelchair Repairs before Stoke Mandeville Games. July 21, 1958. Photograph. Stoke Mandeville Games. Hulton Archive. This photograph, leading up to the 1958 Stoke Mandeville Games shows Ludwig Guttmann's project, which was used to build the legacy and growth in physical activity for paraplegics

Munro, Donald, M.D. "Tidal Drainage and Cystometry in the Treatment of Sepsis Associated with Spinal-Cord Injuries." The New England Journal of Medicine, ​ ​ July 1, 1943. This journal from the New England Journal of medicine entails all the possible diseases that are caught through spinal-cord injuries. During the rise of WWII, 165 patients were taken and diagnosed with spinal injuries that they would die from. One common way to die from your spinal cord is a disease known as sepsis, a blood poisoning disease caught when the body is unable to react to the organ's exposure to bacteria.

National Spinal Cord Injury Unit. Three male nurses turning over a paraplegic patient to heal pressure sores. 1944. Photograph. National Spinal Injury Unit, Stoke Mandeville. Two male nurses are turning and repositioning a spinal cord injury patient to help his pressure sores heal. Three male nurses are holding the patient while a doctor oversees the process in the left of the image. Chavez Kamplain Schuett Trillo 7

National Spinal Injuries Centre. "Patient in traction on a turning bed, which relieved pressure and changed position. Traction was used to reduce dislocation from movement; it has now largely been replaced by the surgical use of plates and pins so now everything happens much more quickly; previously you had to wait for the patient to heal in position". 1949. Photograph. In 1949 Dr. Ludwig Guttmann began to start teaching more and more people about paraplegics. In this picture, he is seen at a bed with a patient and an audience and seems to be explaining what is wrong or what should be done with the patient.

National Spinal Injury Centre. A pressure sore on the leg of a patient recently removed from a body cast. 1943. Photograph. National Spinal Injury Centre, Stoke Mandeville. This pressure sore on the leg of a paraplegic patient. This patient was recently removed from a body cast and is now hopefully in the process of healing all his pressure sores.

———. There Were Hoists Above Their Bed so Sometimes the First Thing You Would Do Would Be to Get Them to Hoist Themselves up from the Bed While You Moved the Packs Around. 1945. Photograph. National Spinal Injury Centre, Stoke Mandeville. When Dr. Ludwig Guttmann arrived at Stoke Mandeville they started adding more commodities for the patients. One of the essential commodities was to have bed frames that had hoists above the patients head to help them pull themselves up first thing in the morning to build upper body strength.

Newton, Joan. "Conversation with Joan Newton," Interview. Stoke Mandeville Legacy. Last modified February 13, 2011. Accessed May 7, 2020. http://www.mandevillelegacy.org.uk/page_id__6.aspx?path=0p4p13p. Joan Newton worked for Guttmann while at Stoke Mandeville and this interview helps us see what the nurses had to do everyday for the patients. She explains how many staff members had no desire to work in the spinal ward because all the patients wanted away in their beds. She talks about the mental state of the new patients and the struggles that many had to go through before accepting treatment.

———. Stoke Mandeville Nurses in 1949 at the Retirement of a Matron. 1949. ​ ​ Photograph. In 1949 in Stoke Mandeville, a matron or Nurse in charge retired and the entire hospital ward was celebrating. Nurses are all standing at the entrance of the hospital bidding her farewell.

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Northwest Arkansas Times (Fayetteville, AR). "Wheelchair Olympics." July 29, 1976, ​ 4. For the first time in Arkansas history, Paralympic Games were being played in Arkansas. This article praises Dr. Guttmann for being able to find a way for disabled veterans to have an active life again after the war. The writer is excited about the idea of being able to watch the games and wants to see where it will go from here.

NPHT. "Memories of Professor Sir Ludwig Guttmann." NPHT. Accessed October 4, 2019. https://www.paralympicheritage.org.uk/memories-of-professor-sir-ludwig-guttma nn. This article is about 3 patients' accounts of the Stoke Mandeville hospital and what Dr.Guttmann was like while in treatment. Many people expressed joy after a couple of months of staying there. Stoke Mandeville promised a different type of treatment that gave patients a chance to get out of body casts and off morphine. They talked about the rehab they went through to stay healthy and how it gave them a new outlook on life.

NPHT editors, ed. "Joan Newton." NPHT. Last modified February 2011. Accessed November 6, 2019. https://www.paralympicheritage.org.uk/joan-newton. This is a transcript of an interview with nurse Joan Newton who worked at Stoke Mandeville during 1948 to 1952.

Paisley, R. N. "New Hope for the Crippled." The Sydney Morning Herald (Sydney, ​ ​ AU), May 21, 1955, 9. https://basic.newspapers.com/image/124019555/?terms=stoke%2Bmandeville% 2BDr.%2BGuttmann. R.N Paisley is a past patient of the Stoke Mandeville Spinal Injuries Unit. He recounts his experience going through the hospital and how it helped him physically and physiologically. He believes that had it not been for the revolutionary treatment many other paraplegics as well as him would end up not recovering from their paraplegia.

PBS, ed. "Medal Quest." PBS. Accessed September 9, 2019. http://www.pbs.org/wgbh/medal-quest/past-games/. During world war II the medical practices of the time were for disabled patients to be in bed rest and those who could walk had few opportunities in life. Then Dr. Ludwig Guttmann came and changed the standard practice of medical procedure of disabled patients. He was able to make it to where they were able to do physical therapy and stay active. It also started the Paralympics and games for the disabled after his time.

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Photograph of Queen Elizabeth II presenting trophies to competitors at the Stoke Mandeville Sports Stadium, 1969, with Sir Ludwig Guttmann FRS. 1969. ​ Photograph. Accessed 2019. https://royalsociety.org/-/media/collections/wolfson/stoke-mandeville/WF_256_5 7.jpg?la=en-GB&hash=715759D81D63DE1AD5399047F5226710. A photograph of Queen Elizabeth ll giving awards to paraplegic contestants at the Stoke Mandeville sports stadium. Ludwig Guttmann is in the background smiling as the ceremony is happening.

Pinkley, Virgil. "Allies Invade France: Formations Strike Far Inland after Establishing Beachhead on Foe Coast of Normandy." The Bend Bulletin (Bend, OR), June 6, ​ ​ 1944, 1. This is a newspaper from a U.S. newspaper in Oregon, informing the public that troops are sent to invade Normandy, France. This event later named D-Day would end with over 4,000 deaths and nearly 3,000 soldiers being permanently paralyzed. Following the invasion, soldiers would either be left to die from conditions or transported to hospitals for treatment. This event would lead to Gutmann's eventual career in Stoke Mandeville, where he would help many soldiers suffering from SCIs that were considered incurable.

UK: International Games for the Paralyzed End at Stoke Mandeville 1965. British ​ Pathé, 1965. This film is a recap of the broadcasting 1965 Stoke Mandeville Games. The numbers from the first annual Stoke Mandeville Games have increased exponentially year after year. This video helps bring understanding of the legacy showing the numbers of paraplegics increase helping them emotionally comeback and be able to physically and socially come together with society.

United States Army Medical Services. Medical Department Army: Surgery in World ​ War II, Neurosurgery: Volume 2. Vol. 2 of Medical Department Army: Surgery in ​ ​ World War II, Neurosurgery. N.p., 1959. ​

Waco Tribune-Herald (Waco, TX). "In the Paralympics, Kim Pollock Finds Sports ​ Within His Reach." December 28, 1968. Accessed October 8, 2019. https://basic.newspapers.com/image/61715648/?terms=Paralympics. This newspaper shows how paraplegics are given similar academic and sporting opportunities as people without disabilities. These changes could only be made with the advancements made by Ludwig Guttmann and his sports minded treatments.

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Walton, Caz. Interview by Mandeville Legacy. London, United Kingdom. November 8, 2013. This interview from former paraplegic, Caz Walton, she talks about her life with spinal cord injuries, how she was impacted by Ludwig Guttmann. Guttmann left a big impact on paraplegics everywhere helping them feel like they belong with society, despite not being able to walk. Guttmann was capable of forming the legacy he leaves today on society based on what Walton calls his "vision", and how persistent he was in bringing this image to life and physically helping paraplegics through his different medical treatments.

Walton, Caz. "Interviews with Caz Walton." By Paul Dickenson. National Paralympic Heritage Trust. Last modified June 20, 2012. Accessed December 9, 2019. https://www.paralympicheritage.org.uk/caz-walton. This interview with Caz Walton shows her switch from rehabilitation into sports and how it affected her life. She worked with Ludwig Guttmann and went on to win in some of the first paralympic games.

Wheelpower. Teams with medicine balls at Stoke Mandeville. What started as ​ physiotherapy began to turn into a team sport. Photograph. Stoke Mandeville ​ Legacy. 1940s. Accessed May 6, 2020. http://www.mandevillelegacy.org.uk/page_id__17.aspx?path=0p4p14p21p. This photo helps my group visualize the physical therapy that Guttmann started to work at Stoke Mandeville. It also gives us an idea of how to set up our props and what is needed to make it historically accurate.

Wyborn, John. New Uniforms for the Red Cross Nurses. Photograph. Harpenden ​ ​ History. August 27, 2012. Accessed January 8, 2020. http://www.harpenden-history.org.uk/page_id__376.aspx. This image shows three nurses during World War II from the red cross. The nurses are wearing ankle-length dresses with an apron on top. This picture helps to show us what sort of outfit the nurses will need to wear in our performance to keep historical accuracy.

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Secondary Sources

Akkermans, Rebecca. "Ludwig Guttmann." The Lancet 15, no. 12 (November 1, ​ ​ 2016). Accessed November 18, 2019. https://doi.org/10.1016/S1474-4422(16)30228-9. This Lancet Journal discusses Guttmann's inspiration to go into neurology, and how he worked up to being the father of Paralympics. Working in Germany, Guttmann witnessed an athletic man slowly "deteriorate" into no movement. He would begin working for Breslau before moving to England to escape the Gestapo. After failing to save the life of aparaplegic, Guttmann was inspired to help treat paraplegia

Anderson, Julie. "'Turned into Taxpayers': Paraplegia, Rehabilitation, and Sport at Stoke Mandeville, 1944-56." Journal of Contemporary History 38, no. 3 (2003): ​ ​ 461-75. www.jstor.org/stable/3180647. During World War II there was an increase of people who survived the war but were wounded, more specifically paralyzed. Dr. Ludwig Guttmann tried extremely hard to incorporate physical therapy into the rehabilitation of patients. Through these new medical incorporations, patients saw a positive effect on their disabilities. Over the course of the treatments, Dr. Guttmann realized that by incorporating a competitive factor patients would be more motivated pushing forward his Paralympic movement.

Atos. "Paralympic Games." paralympics.org. Accessed December 13, 2019. https://www.paralympic.org/paralympic-games. The Paralympics have grown over the years. The Paralympics were held separate from the Olympics, but that has changed with the viewing of Paralympians as real athletes and the widespread support of both international events.

Avila-Martin, Gerard, Iriana Galan-Arriero, Julian Taylor, and Julio Gomez-Soriano. "Treatment of Rat Spinal Cord Injury with the Neurotrophic Factor Albumin-Oleic Acid: Translational Application for Paralysis, Spasticity and Pain." PLoS One 6, ​ ​ no. 10 (October 26, 2011). This medical journal discusses the process of what spinal cord injuries are, and the process it takes to overcome injuries like this. Unlike normal spinal cord injuries, rat spinal cord injuries (SCI), are spinal cord injuries that are incomplete and often can be more painful than normal SCIs and are similar to spasms or paralysis that are commonly found in rats. These are examples of the evolution of Spinal cord injuries, and the changes that come with injuries and how they are sustained.

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Back up editors, ed. "Wacky Wednesdays: Working with National Spinal Injuries Centre in Stoke Mandeville." Bach up Transforming lives after spinal cord injury. Last modified August 11, 2016. Accessed October 9, 2019. https://www.backuptrust.org.uk/blog/children-and-young-people/wacky-wednesd ay?gclid=EAIaIQobChMIz4LfwsCP5QIVF9tkCh14igfqEAAYASAAEgKF-fD_BwE . Back-Up writes about what the spinal injury ward at Stoke Mandeville does to improve the lives of children with SCI. The website explains the amazing opportunities there are for young individuals that suffer from SCI. Dr. Guttmann's legacy was the Spinal injuries unit at Stoke Mandeville and the success of the Paralympics.

Bellis, Mary. "History of the Wheelchair." ThoughtCo. Last modified July 1, 2019. Accessed July 1, 2019. https://www.thoughtco.com/history-of-the-wheelchair-1992670. This website shows the history of wheelchairs and their developments. Most of these changes occurred after major wars.

The Best of Men. Produced by Harriet Davison. Aired August 25, 2019 (first ​ broadcast August 16, 2012), on BBC. The movie, The Best of Men, is a film in 2012 factually based on Ludwig ​ ​ Guttmann's life, his efforts at Stoke Mandeville, and the legacy he left in paraplegia. The movie was insightful in providing a visual idea of how Guttmann treated his patients-like normal human beings and took them off of any assisting drugs- along with reactions from nurses and other faculty members.

Brewster, Singe. "This $40,000 Robotic Exoskeleton Lets the Paralyzed Walk." MITTechnologyReview.com. Last modified February 6, 2016. Accessed November 21, 2019. https://www.technologyreview.com/s/546276/this-40000-robotic-exoskeleton-lets -the-paralyzed-walk/. This website shows the advancements in technologies for paraplegics. These would not be possible if it weren't for the efforts by original doctors like Munro and Guttmann. While widely unavailable now, innovations are quickly being made to help the paralyzed move and feel again.

Brittain, Ian. "The Evolution of the Paralympic Games." In Benchmark Games: The ​ Sydney 2000 Paralympic Games, by Richard Cashman, 19-34. Sydney, AU: ​ Walla Walla Press, 2008. This chapter discusses the Paralympic games, and its evolution from its "humble" beginnings. The chapter includes the evolution of wheelchair sports and the development of how common sports such as basketball and hockey, were turned into games that can be played in wheelchairs.

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Brittain, Ian. From Stoke Mandeville to Stratford: A History of the Paralympic Games. ​ ​ Champaign, IL: Common Ground Publishing, 2012. Since the induction of the Paralympic Games from the Stoke Mandeville games they have evolved. Over the years they have changed competitions, competitors, and standards. Each year something new has been added to the games and has become increasingly popular and is now equally as popular as the Olympics.

Brought to life editors, ed. "Ludwig Guttmann (1899-1980)." Brought to life Exploring the history of Medicine. Accessed September 12, 2019. http://broughttolife.sciencemuseum.org.uk/broughttolife/people/ludwigguttmann. Ludwig Guttmann was a Jewish neurosurgeon who changed the standard treatment of spinal cord injuries and paralysis. He prescribed therapy to help veterans retain upper body strength and physical activities to give them a better life expectancy rate. His discoveries lead to the founding of the Paralympic games and broke major medical barriers during his time.

Buckinghamshire Healthcare NHS Trust. "Our History." Buckinghamshire Healthcare NHS Trust. Last modified 2019. Accessed October 3, 2019. https://www.buckshealthcare.nhs.uk/NSIC%20Home/About%20us/nsic-history.h tm. The National Spinal Injuries Center in London, England is the oldest and biggest spinal cord treatment center in the world. Buckinghamshire Healthcare explained the effects the spinal cord unit had on paraplegics in the entire world and how Dr. Ludwig Guttmann's "ground-breaking medical techniques" helped revolutionize treatment for World War II veterans who were hurt in battle and could no longer walk.

Cara. "Our History : Cara." Cara. Last modified 2019. Accessed October 10, 2019. https://www.cara.ngo/who-we-are/our-history/. This webpage shows the history of the program that supported Ludwig Guttmann in getting to England. They help academics get out of dangerous places, and in Guttmann's case, Nazi Europe.

Christopher and Dana Reeve Foundation. "History of SCI Research." Christopher and Dana Reeve Foundation. Last modified 2019. Accessed October 3, 2019. https://www.christopherreeve.org/research/history-of-spinal-cord-research. Over the course of multiple years and centuries, the treatment of Spinal Cord Injuries never continued to progress. Axon growth has become a new technology recently that is believed by many doctors to be able to possibly cure paralysis in the spine completely. This helped me learn a little more about how spinal cord injuries develop and become severe to the point of paralysis.

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Cogswell, Betty E. "Rehabilitation of the Paraplegic: Processes of Socialization." onlinelibrary.wiley.com. Last modified January 1967. Accessed December 13, 2019. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1475-682X.1967.tb00635.x. This document shows how much being a paraplegic affects a person's mental health and all the help that is needed to get them through it. Spinal injuries are a huge shift in someone's life and they need help to get through it,

Darcy, Simon, and David Legg. "A brief history of the Paralympic Games: from post-WWII rehabilitation to mega sport event." The conversation. Last modified September 6, 2016. Accessed November 5, 2019. http://theconversation.com/a-brief-history-of-the-paralympic-games-from-post-w wii-rehabilitation-to-mega-sport-event-64809. World War II had an impossible number of veterans with spinal cord injuries in the United Kingdom that gave hospitals a crisis. Dr. Ludwig Guttmann was the first doctor to promise results and use unorthodox methods that increased the life expectancy of SCI patients. His research became the standard practice for SCI patients and his methods are still used today.

Dezarnaulds, Annalisa. Psychological Adjustment after Spinal Cord Injury. ​ ​ Chatswood, New South Wales, AU: Agency for Clinical Innovation, 2014. Accessed October 29, 2019. https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0010/155197/Psychos ocial-Adjustment.pdf. This pamphlet published by the Agency for Clinical Development in 2014 gives health professionals how to deal with Paraplegics to help improve and understand their psychological situation. Every different stage of a Paraplegics recovery plays an essential role in how it will affect their mental health. We now understand that if we begin to start positive psychological environments for paraplegics their overall mental health will remain healthy.

Donovan, William H. "Spinal Cord Injury - Past, Present and Future." US National Library of Medicine. Last modified 2007. Accessed September 5, 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2031949/. Paraplegics throughout history have not always gotten equal treatment and or help. In the past victims of an SCI or Spinal Cord Injury have been left for dead or been experimented on for medicine or the lack of medicine. Before doctors were afraid to help SCI patients fearing that if they failed their name would be tarnished. When Dr. Ludwig Guttman decided to dedicate his life to helping paraplegics and established the first paralympic games to help his patients reintegrate into society.

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Early, Chas. "What Were the Stoke Mandeville Games? Celebrating 70 Years since the First Paralympics." BT. Last modified June 26, 2016. Accessed September 6, 2019. https://home.bt.com/news/uk-news/what-were-the-stoke-mandeville-games-113 64279856401. The Paralympic games progressed from different stages and grew over the course of twenty years. The games originally started with just 16 athletes competing in archery in the Stoke Mandeville Hospital courtyard. After that the first international team to join was the Netherlands and from there the games continued to grow. Eventually, the games became fully international to nearly the same scale as the Olympics that would come to be known as the Paralympics.

Edwards, P. Letter, "Obituary: Sir Ludwig Guttmann," March 18, 1980. Department of Sport and Recreation Studies, Liverpool, ENG. Dr. Edwards, a doctor who worked with Ludwig Guttmann, wrote a very inspiring a beautiful obituary for Sir Ludwig Guttmann talking about his achievements and inspirations as well as his great trials and tribulations. In 1948 Guttmann graduated from the University of Freiburg where he earned his Medical Doctorate leading the way for his Neurosurgical career.

Eltorai, Ibrahim M. "History of Spinal Cord Medicine." History of Spinal Cord ​ Medicine, 2003, 8-12. Accessed October 10, 2019. ​ http://www.demosmedical.com/media/wysiwyg/pdf/LinChapterOne.pdf. During the twentieth century, great advances were made towards helping people with spinal injuries causing paralysis. Advances in the field surgery, rehabilitation, education, urology, pharmacology and research in spinal regeneration greatly helped people understand how to help paraplegics.

Encyclopedia Britannica. "Spinal Cord Injury." Encyclopedia Britannica. Last modified March 17, 2016. Accessed September 5, 2019. https://www.britannica.com/science/spinal-cord-injury#ref1191209. Spinal Cord Injuries happen when the spinal cord is hurt and causes paralysis in the bottom half of a patient. Patients are affected physically and face many mental barriers as well to continue to assimilate into society.

The Express (Lock Haven, PA). "They Started Rolling Ten Years Ago Today." ​ September 1, 1949. Accessed October 7, 2019. https://basic.newspapers.com/image/5726559/?terms=Nazis%2Binvade%2BPol and. This newspaper examines the Nazis invading Poland. This is useful background information to prove that Ludwig Guttmann moved away to England to escape Nazi rule and oppression. Him escaping to England ended up allowing him to work at Stoke Mandeville and use practices that would become world famous.

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Farrar, Renee. "Ludwig Guttman and the Paralympics: From Law to Stadium." The Lancet. Last modified September 8, 2012. Accessed October 10, 2019. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%29614 91-3/fulltext. Renee Farrar was the author of this article. She recounts the brief life of Guttmann's life and how he ended up founding the Paralympic Games. When the situation in Nazi German was just heating up, Dr. Guttman protected 60 people in his hospital proving that they all needed medical attention when the Gestapo asked him why they were there.

Fink, Jenni. "D-Day Remembrance: Facts, Casualties, Why Invasion Is Called D-Day." Newsweek. Last modified June 6, 2019. Accessed October 22, 2019. https://www.newsweek.com/d-day-remembrance-facts-casualties-why-invasion- called-d-day-1438759. This web page describes the amount of soldiers killed or injured during D day. This gives historical context to the amount of people coming into Stoke Mandeville during and directly after World War II. Many people were injured during D day and some of them came to Stoke Mandeville to be treated by Ludwig Guttmann.

Frankel, H. L. "The Sir Ludwig Guttmann Lecture 2012: The Contribution of Stoke Mandeville Hospital to Spinal Cord Injuries." Nature. Last modified October 9, 2012. Accessed February 18, 2020. https://www.nature.com/articles/sc2012109. H.L Frankel the author of this article worked with Dr. Ludwig Guttmann at Stoke Mandeville for a few years. In this article, he summarizes some of the research in medicine that Dr. Guttmann made in the medical field that helped to advance medicine to help provide a better future for paraplegics.

Furlan, Julio C., M.D., Sivakumar Gulasingim, M.D., and Beverly Catharine Craven, M.D. "Epidemiology of War-Related Spinal Cord Injury among Combatants: A Systematic Review." Global Spine Journal 9, no. 5 (May 23, 2018). ​ ​ Julio Furlan's journal entailed research about the history of spinal-cord injuries, and its increasing frequency through time. During its rise, SCI wounds are not the only wounds received that influence its fatality rate. Explosions are the most common causes of SCI injuries that sustain other painful injuries, such as chest pains from sepsis, or other illness occurring in the chest.

Godwin, Natalie, ed. "JPL and Partners Study Device to Help Spinal Cord Injuries." Jet Propulsion laboratory. Last modified July 19, 2006. Accessed November 4, 2019. https://www.jpl.nasa.gov/news/news.php?feature=1134. This is an article from 2006 talking about using technology to replace the scarred cell tissues on spinal cord injuries to help them have movement. Before the 50's SCI was considered an illness that was untreatable because there was nothing doctors could do. With further research and encouragement now we are using advanced technology to help them walk again. Because of Dr. Guttmann, people are now spending more time helping SCI patients learn how to live a productive life after injury. Chavez Kamplain Schuett Trillo 17

History Press. "Dr. Guttman and the Paralympic Movement." The History Press. Last modified 2019. Accessed September 9, 2019. https://www.thehistorypress.co.uk/articles/dr-guttman-and-the-paralympic-move ment/. The Paralympics started with a man named Dr. Guttman who was a Jewish doctor during World War II who later escaped to England where he was put in charge of the new Spinal Unit at the Stoke Mandeville Hospital in London, England. The first-ever Paralympic games were known as the Stoke Mandeville games.

The History Press. "Sir Ludwig Guttman – the 'father of the Paralympics' – Is Credited as the Man Responsible for Founding the Paralympic Games and the Paralympic Movement as a Whole." The History Press. Accessed November 20, 2019. https://www.thehistorypress.co.uk/articles/dr-guttman-and-the-paralympic-move ment/. This website accurately depicts Guttmann's timeline of the profession, along with how he was sent to Stoke Mandeville. Hired by the British Government, Guttmann would form his own special wing, The Spinal Injury Centre would be underway as the gateway to helping treat Spinal Cord Injuries. Despite having insufficient staff and room size, Gutmann would expand on arguments within the hospital.

Hook, Michelle. "The Impact of Morphine after a Spinal Cord Injury." Behavioral Brain ​ Research, May 16, 2007. ​ This science research journal, written by Psychology professor, Michelle Hook, entails the overall history of morphine and side-effects that come from morphine on patients with spinal cord injuries. Based on Hook's research, it supports Guttmann's claim from his medical treatment saying that while morphine helps relieve pain, it restricts movement for spinal cord injury leading to an increase in fatality rate.

International Paralympic Committee, ed. "Stoke Mandeville 70: The lasting legacy Sir Ludwig Guttmann's daughter reflects on father's accomplishments 29 Jul 2018." International Paralympic Committee. Last modified July 29, 2018. Accessed September 18, 2019. https://www.paralympic.org/news/stoke-mandeville-70-lasting-legacy. Eva Loeffler is the daughter of Dr, Guttmann and was only six years old when her father started to work with paraplegics in Britain. She remembers helping her father organize the Stoke Mandeville Games and with the athletes. She grew up helping her dad break barriers in medical treatments and life expectancy rates.

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Interview by Jon Newman. September 27, 2013. This interview from Sir Phillip Craven discusses his life story, his long journey to finding the Paralympics as his gateway into sports. He didn't begin his involvement in sports until the age of 16. In addition, he talks about the innovation and progression the Paralympics has made since its first games, in 1960.

Jewish Virtual Library. "Ludwig Guttmann." Jewish Virtual Library. Last modified August 6, 2012. Accessed October 23, 2019. https://www.jewishvirtuallibrary.org/ludwig-guttman. Ludwig Guttman was a German boy who was born in Germany. In 1924 he graduated from the University of Freiburg and received a Medical Doctorate. When the Nazis took power he saved the lives of many by protecting them by admitting them into his hospital. In 1943 when he was asked by the British government to make a spinal unit in the Stoke Mandeville hospital to help paraplegics.

J Spinal Cord Med., ed. "The SCIRehab project: treatment time spent in SCI rehabilitation. Occupational therapy treatment time during inpatient spinal cord injury rehabilitation." Europe PMC. Last modified 2011. Accessed October 22, 2019. https://europepmc.org/articles/pmc3066503. This article focuses on the effects of Occupational therapy on SCI patients and what it helps them accomplish. The article gives us data on how many hours of therapy are given to the patients, what they do, and how the mobility is after the therapy.

Karger. "The Origins of the Treatment of Traumatic Spinal Injuries." Karger. Last modified 2014. Accessed October 8, 2019. https://www.karger.com/Article/FullText/365287. This website shows the history of spinal injury developments. Most of these were made during the Great War, but not put into effect until WW2 by Ludwig Guttmann and Donald Monro.

Kinney, Brian. Paraplegic Car Transfer. 2011. Accessed October 24, 2019. ​ ​ https://www.youtube.com/watch?v=iJ8shk40dnI. This video demonstrated how paraplegics have to adapt to doing simple things like getting into a car. The amount of change that happens after a spinal cord injury is enormous. Dr. Guttmann's constant watching over of his patients allowed them to learn to adapt to their everyday lives and have the skills necessary to continue their working lives.

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Knight, Will. "The Exoskeletons Are Coming." MITTechnologyReview.com. Last modified July 16, 2015. Accessed November 21, 2019. https://www.technologyreview.com/s/539251/the-exoskeletons-are-coming/. This website shows the advancements in technologies for paraplegics. These would not be possible if it weren't for the efforts by original doctors like Munro and Guttmann. While widely unavailable now, innovations are quickly being made to help the paralyzed move and feel again.

KÜSCHALL, ed. "When Rainer met Sir Ludwig Guttmann." KÜSCHALL. Last modified September 3, 2015. Accessed September 23, 2019. https://kuschall.com/international-en/news/when-rainer-met-sir-ludwig-guttmann. Rainer was paralyzed in a car accident and two years after lying in a bed without the opportunity to move, he was admitted to Dr. Guttmann's clinic for rehabilitation. Rainer life was changed by this clinic and was soon breaking records in wheelchair races. This article gave us an idea of what type of miracle work Dr. Gutmann was for people with disabilities.

Lee, Timothy B. "75 years ago, Hitler invaded Poland. Here's how it happened." Vox. Last modified September 1, 2014. Accessed October 4, 2019. https://www.vox.com/2014/9/1/6084029/hitlers-invasion-of-poland-explained. This website shows the invasion of Germany to Poland. Ludwig Guttmann left Poland in 1939, before this happened. This helps give more of a historical context to why Dr. Guttmann moved to Britain and started working at Stoke Mandeville.

Lifshutz, Jason, and Austin Colohan. "A Brief History of Therapy for Traumatic Spinal Cord Injury." History of Spinal Surgery 16, no. 1 (January 2004). ​ ​ This medical journal from the Journal of Neurosurgery includes the overall history of spinal cord injury, along with the evolution of treatment progressing from the Egyptian period to today's modern medical treatments. The mentality physicians had at the beginning was a sense of doubt, and lack of confidence in patients surviving from SCIs. That mentality would be carried over for nearly three thousand years. This journal helps bring more understanding of the overall history of medicine for SCIs, along with the mentality most physicians had and how the mindsets would progress the more innovative progressions.

Lubbock Evening Journal (Lubbock, TX). "Handicap does little to slow down ​ wheelchair-bound amputee." May 3, 1983. Accessed December 13, 2019. https://basic.newspapers.com/image/13704858/?terms=invention%2Bof%2Bwh eelchair. This newspaper tells about a man who is wheelchair-bound, but he perseveres through it. He thinks of ways to get around his problems much like paraplegics have to.

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Magee, Will. "How The Paralympics Came To Be: Remembering The International Stoke Mandeville Games." Vice. Last modified September 8, 2016. Accessed November 5, 2019. https://www.vice.com/en_au/article/kbdz59/how-the-paralympics-came-to-be-re membering-the-international-stoke-mandeville-games. This article gives statistical evidence of the overwhelming rates of Spinal injuries during World War II. Spinal injuries had little research on how to treat patients and many were put in a ward to die instead of getting treatment. Dr. Ludwig Guttmann invested his life to help veterans that return to society and gave them a second chance at life.

Mandeville Legacy. "1940s Development of the Paralympic Games." Mandeville Legacy. Last modified 2014. Accessed October 10, 2019. http://www.mandevillelegacy.org.uk/category_id__21_path__0p4p14p.aspx. During World War II many soldiers were injured and left without the function of their legs. In 1943 Dr. Ludwig Guttmann established a Spinal Unit Center in Stoke Mandeville under the request of the government. During this time he established new forms of rehabilitation for paraplegics including the incorporation of sports. He made a hybrid of polo and hockey that could be played by people in wheelchairs.

National Paralympic Heritage Trust Fund. "Professor Sir Ludwig Guttmann." Paralympic Heritage. Last modified April 2012. Accessed February 18, 2020. https://www.paralympicheritage.org.uk/professor-sir-ludwig-guttmann. The Paralympic Heritage trust fund provides a bit of who Ludwig Guttmann was and how he helped people all over the world to learn more about paraplegia and how to help those suffering it. This article specifically looks at Ludwig Guttmann's life and how he came to become the father of the Paralympics.

NCBI. "From the age of the pyramids to the superfast world–what has changed in the management of spinal injuries." Royal College of Physicians. Last modified February 12, 2012. Accessed October 29, 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4953422/. This website talks about the treatment of SCI throughout history and what has changed since the first SCI patients. These types of injuries were always seen as an injury that wasn't treatable. Many doctors believed that they could only prolong their deaths with treatment and many of the patients gave up on life. Now we have more research on SCI and are finding new ways to treat patients because of Dr. Guttmann's experience at Stoke Mandeville Hospital.

Nicholson, Richard. "First person: how the Paralympics changed my life." The Conversation US. Last modified September 13, 2016. Accessed October 9, 2019. http://theconversation.com/first-person-how-the-paralympics-changed-my-life-65 047. This website about an author in the paralympics shows how Ludwig Guttmann's treatments became the norm everywhere. Going into sports as a paraplegic is a pursuable dream, because of Ludwig Gutmann. Chavez Kamplain Schuett Trillo 21

NPHT, ed. "Professor Wagih El-Masri." NPHT. Last modified March 2011. Accessed October 25, 2019. https://www.paralympicheritage.org.uk/professor-wagih-el-masri. Professor El-Masr studied under Sir Ludwig Guttmann at Stoke Mandeville and after he retired. Professor El-Masri has many memories of his time with Guttmann and knew him very well. This is his personal account of what he experienced working with Guttmann and has pictures of his time working with patients.

NPHT editors, ed. "Joan Scruton." NPHT. Accessed November 6, 2019. https://www.paralympicheritage.org.uk/joan-scruton. Joan Scruton was the personal assistant to Dr. Guttmann and later was Secretary-General for the International Stoke Mandeville Wheelchair Sports Federation. She plays an important role for our performance so this will help give us some of her personal background and help us to understand the type of character that she would be.

Nuseibeh, Isaac. "Dr Hans Frankel President of the International Medical Society of Paraplegia 1996." International Medical Society of Paraplegia, 1997. ​ ​ This medical journal talks about Hans Frankel, his life, and his involvement in paraplegia. Born 1932 in Danzig, Germany, Frankel worked with Ludwig Guttmann as his senior registrar in 1957 helping run the Spinal Cord wing at the hospital. Frankel helped Guttmann until Guttmann's retirement and eventually took lead in the wing discovering and treating bladder diseases on paraplegia helping solve cardiovascular and urinary infections on patients with spinal cord injuries.

Office of Communications and Public Liaison, National Institute of Neurological Disorders, and Stroke National Institutes of Health. "Spinal Cord Injury: Hope Through Research." National Institute of Neurological Disorders and Stroke. Last modified July 2013. Accessed September 9, 2019. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Hope-Through -Research/Spinal-Cord-Injury-Hope-Through-Research. This web page describes the modern treatments of spinal cord injury as well as the different information given on types of bones and injuries in the spinal cord. This shows the advancements made by Ludwig Guttmann in the treatment of Paraplegics

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Official Website of the Paralympic Movement. "HISTORY OF THE PARALYMPIC MOVEMENT." International Paralympics committee. Accessed September 6, 2019. https://www.paralympic.org/ipc/history. The Paralympics history website goes into the history of the start of the Paralympics games and video of the games. How the name of the Paralympics changed over time and how Ludwig Guttmann was able to make medical discoveries in this area. He was able to create a different way of treating disabled veterans.

Olsen, Master Sgt. Mark. "New Jersey Guard recruiter knows disabilities inside and out." National Guard. Last modified October 30, 2018. Accessed November 4, 2019. https://www.nationalguard.mil/News/Article/1676665/new-jersey-guard-recruiter- knows-disabilities-inside-and-out/. This is a personal story of National Guard Capt. Domenico Lazzaro who fell in training and fractured his T8 vertebrae. Though the chances were that he would never walk again, he wasn't going to give up on his dream about being in the National Guard so he worked hard in physical training. 17 months after his accident he was able to walk with one cane and was able to help with recruitment for the National Guard.

The Olympians. "Dr Ludwig Guttmann." The Olympians. Last modified November 15, 2017. Accessed October 4, 2019. https://theolympians.co/tag/dr-ludwig-guttmann/. This news website features articles about Dr. Ludwig Guttmann and a clip from the movie "The Best of Men". It goes into his life in Germany and how he was able to escape with his family to England during World War II. How he came to Stoke Mandeville Hospital and what he worked for the disabled patients in his ward.

"Paralympic Summer Games: Tel Aviv 1968." Paralympics.ru. Accessed December 18, 2019. http://paralimpiada.ru/paralympiyskie_igry/letniye-rezultaty/tel-aviv-1968. This web page talks about the 1968 Summer Paralympic Games, events held, date of opening and closing ceremony, and number of participants and medalists. The games took place from November 5th-14th in Tel Aviv, Israel. Twenty-eight countries participated with over seven-hundred athletes participating with 188 medals on the line. The United States prevailed, winning the most medals at the games with 99; Italian athlete Roberto Morson participated in six out of the 10 competitions, winning the most among individual athletes with 13 medals and most gold medals overall with 5.

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Paralyzed veterans of America. "Spinal Cord Injury and Diseases." New England Paralyzed Veterans of America. Accessed September 19, 2019. http://www.nepva.org/sci_injury.html. Spinal cord injuries affect people's everyday lives including their life expectancy. According to the website, before the 1940's the average amount of time a person lived was less than a year. Life expectancy soon started to rise in years by newly discovered antibiotics and therapy to strengthen the body. With the new advances in medical practices, life expectancy went up and people with SCi were able to live a modified life.

"Personal Experience Videos About Spinal Cord Injury." facingdisability.com. ​ ​ https://facingdisability.com/video-interviews. This is a collection of video interviews with people with either paraplegia, or tetraplegia. This helps us understand the difficulties of being a paraplegic and the changes from their old life to their current one after injury. This also helps us understand the difficulty of Ludwig Guttmann getting his patients to change their mindset and convince them they can have a life after their injury.

Physiopedia editors, ed. "Physical Activity Guidelines for Spinal Cord Injury." Physiopedia. Accessed October 23, 2019. https://www.physio-pedia.com/Physical_Activity_Guidelines_for_Spinal_Cord_In jury. This website is dedicated to SCI patients and what their struggles are. In this article it talks about the guidelines for SCI patients in physical therapy and what they go through to find a good place to help them with rehabilitation.

Putukian, Margot. "Mind, Body and Sport: How being injured affects mental health." NCAA. Accessed October 28, 2019. http://www.ncaa.org/sport-science-institute/mind-body-and-sport-how-being-injur ed-affects-mental-health. This article shows how injuries can affect mental stability and health. This shows the difficulties of paraplegic's position and doctors that may work with them. Their long term injuries can cause mass amounts of depression and causes the loss of motivation to get better.

Rank, Scott Michael, ed. "The Olympics - Paralympics." History on the Net. Last modified 2009. Accessed September 5, 2019. https://www.historyonthenet.com/the-olympics-paralympics. The Paralympic games began when Dr. Ludwig Guttman saw the effects that physical activity could have on patients confined to the wheelchair. All the participants in the Stoke Mandeville Games were British World War II veterans who had been admitted into the Stoke Mandeville hospital spinal injury unit.

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Reeve, Christopher and Dana, ed. "Spinal Cord Injury." Christopher and Dana Reeve ​ Foundation. Accessed March 14, 2020. ​ https://www.christopherreeve.org/living-with-paralysis/health/causes-of-paralysis /spinal-cord-injury. This article goes into specifics about what a spinal cord injury is and what is affected in the spinal cord. It debunks myths about an SCI and gives scientific research to help people understand what to expect with an Spinal Cord Injury. The article also gives a brief history of previous methods of treatment.

Rivera, JC. "Spine-Related Disability following Combat Injury." Journal of Orthopedic ​ Advances 136, no. 9 (Fall 2014). ​ JC Rivera talks about the use of researching soldiers diagnosed with permanent spinal injuries. Many soldiers were permanently damaged with average disability at 77%.

Roberts, Glenys. "The Inspirational Doctor Who Saved Fellow Jews from Nazis before Fleeing Germany to Start the Paralympic Games After WWII." Daily Mail. Last modified August 29, 2012. Accessed October 10, 2019. https://www.dailymail.co.uk/news/article-2195037/London-Paralympics-2012-Lu dwig-Guttman-duped-Nazis-gave-Britain-Paralympics.html. This article credits Dr.Guttmann's love for sports for creating the concept of using physical therapy on Spinal Cord Injury patients. They believe that he revolutionized the standard practice for SCI patients, his practices have increased life expectancy rates, and he has a lasting legacy for creating the Paralympic Games.

Schlosser, Andrew. Interview by the author. Raymond G. Murphy VA Medical Center, Albuquerque, NM. October 18, 2019. Mr. Andrew Schlosser is an occupational therapist, and Spinal Cord Injury Seating & Mobility Specialist at the VA hospital's spinal unit. Our interview was very enlightening in painting the perspective of a typical environment and day for members in the spinal unit, treating their patients. In addition, Mr. Schlosser talks about the evolution and history of spinal injuries dating back to the Ancient Roman era. This interview helped create a better understanding of the trials and tribulations of being a paraplegic, or nurse taking care of the patient.

Scuton, Joan. "Sir Ludwig Guttmann: Creator of a World Sports Movement for the Paralysed and Other Disabled." Nature. Last modified 1979. Accessed September 23, 2019. https://www.nature.com/articles/sc197913.pdf?origin=publication_detail. Sir Ludwig Guttman created a movement for the disabled over the course of multiple decades. He created a whole new set of Olympic games for only disabled people. Although Guttman was still alive at the time this article was written, he continued his work until his death helping establish the official International Olympics.

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Shaviv, Miriam. "How Nazi Persecution of a Jewish Doctor Led to Paralympics — and a Revolution in Treating Spinal Injury." The Times of Israel. Last modified August 27, 2012. Accessed September 18, 2019. https://www.timesofisrael.com/how-nazi-persecution-of-a-german-jewish-doctor-l ed-to-the-paralympics-and-a-revolution-in-treating-spinal-injury/. Dr. Guttmann was hated and loved by many. He had a very tyrannical way of running his Spinal Unit that sometimes made his patients and nurses angry. Despite all this by the time his patients left they loved him because he had changed the way they would continue to live their lives by helping the human want to live in order to live and to thrive in the world after recovery.

Silver, J. R. "History of the Treatment of Spinal Injuries." History of the Treatment of ​ Spinal Injuries 81, no. 952 (2005). Accessed October 10, 2019. ​ https://pmj.bmj.com/content/81/952/108. This journal by Dr. J.R Silver recounts spinal injury treatment through the ages starting from Egyptian Journals on Papyrus to Ludwig Guttmann's revolutionary work with patients that suffered paralysis. The aftermath of a Spinal Injury often resulted in great blood pressure in the spinal cord and these lead to patients having pressure sores which cause immense pain to patients these ideas were discovered by a doctor named Wilhelm Wagner.

Silver, John Russell, M.D. History of the Treatment of Spinal Injuries. N.p., 2003. ​ ​ Dr. John Silver, a British spinal injury consultant analyzes and researches the history of spinal injuries from the ancient world, and its development into modern medicine today. During World War II, soldiers would receive spinal cord injuries from trauma to the spinal cord caused by gunshots, or explosions during the war. An estimated 75% of soldiers diagnosed with SCI would survive the aftermath, a number higher than the survival rate of SCIs from World War I.

Society of Neurological Surgeons. "Donald Munro, MD." The Society of Neurological Surgeons. Accessed October 23, 2019. https://www.societyns.org/society/bio.aspx?MemberID=7629. This web page gives a historical overview of an American neurologist, Donald Munro, who had the same ideas about paraplegics as Guttmann did. He believed that they were still people and could have lives after their injury.

SpinalCord.com, ed. "Mental Health Care after SCI." Spinalcord.com. Accessed December 10, 2019. https://www.spinalcord.com/mental-health-care-after-sci. The website talks about the mental health of paraplegic survivors and the mental journey they go through to get back to life. After surviving their spinal cord injuries, paraplegics would suffer from much mental health with a spike of mental health issues. Percentages include 48% suffering from depression 37% suffering from anxiety, and 8.4% experiencing post-traumatic stress disorder.

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"Spinal Cord Injury and Mental Health." Sane Australia. Accessed October 24, 2019. https://www.sane.org/information-stories/facts-and-guides/spinal-cord-injury-and -mental-health. This web page discusses the effect of spinal cord injuries have on the mental health of paraplegics, quadriplegics, and tetraplegics. According to Sane Australia, when there are no physical effects that SCIs have on paraplegics, the next part of health that is at risk is the mental health of paraplegics. Most common mental diseases that paraplegics suffer from after sustaining spinal injuries are Post-Traumatic Stress Disorder (PTSD) reliving memories of the cause of the injury, along with depression, when they mentally do not believe they are able to overcome their injuries and lose motivation.

"Story of Paralympics Founder Sir Ludwig Guttmann." Video, 03:12. BBC. Posted by BBC News, August 24, 2012. Accessed October 8, 2019. https://www.bbc.com/news/av/uk-england-oxfordshire-19368602/story-of-paraly mpics-founder-sir-ludwig-guttmann. Dr. Ludwig Guttmann was a Jewish German refugee from the Nazi Regime that moved to England to escape persecution. Guttmann actually had to pay for his visa in order to be able to stay in the United Kingdom. Dr. Guttmann paid 250 pounds in order to receive his visa. Today 250 pounds is worth way more than back then.

Swartz, Leslie, Xanthe Hunt, Jason Bantjes, Brian Hainline, and Claudia L. Reardon. "Mental Health Symptoms and Disorders in Paralympic Athletes: A Narrative Review." British Journal of Sports Medicine 53, no. 12 (May 16, 2019). ​ ​ This science journal reviews Paralympic athletes' mental health and possible reasons for Paralympians continuing to sustain mental pain. The journal drew no definitive conclusion from the report as it could not accurately scale the percentages of certain mental health issues that Paralympic athletes suffer from and could not find statistics compared to everyday paraplegics. The journal suggests it affects individuals differently and how they react to different stereotypes.

Tomizawa, Roy. "The 1964 Tokyo Paralympic Games Part 7: Dr. Ludwig Guttmann, the Breslau Savior of Kristallnacht." The Olympian. Last modified November 16, 2017. Accessed October 1, 2019. https://theolympians.co/2017/11/16/the-1964-tokyo-paralympic-games-part-6-dr- ludwig-guttmann-the-breslau-savior-of-kristallnacht/#more-14154. This web page article from the Olympian talks about Guttmann's life before moving to England. This source provided insight to Guttmann's battle to live in Germany and struggles he faced along his journey. Guttmann, a Jewish doctor survived a visit from a Gestapo tank defending his claim that he needed to hospitalize the sixty-four other patients in his hospital, ending with only four of the patients being taken by authorities. This story brings into question if these medical advancements would be discovered if Guttmann had died in concentration camps, instead of escaping from Germany to England.

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Tomizawa, Roy. "The 1964 Tokyo Paralympic Games Part 6: Dr. Ludwig Guttmann, Father of the Paralympic Movement." The Olympian. Last modified November 15, 2017. Accessed October 4, 2019. https://theolympians.co/2017/11/15/the-1964-tokyo-paralympic-games-part-6-dr- ludwig-guttmann-father-of-the-paralympic-movement/#more-14141. This article also from The Olympian discusses Guttmann's life of medicine, more specifically his story of developing his medical movement through competition. Starting at age eighteen, witnessing a spinal-injured patient die from paralysis, he would become a neurosurgeon bringing a new idea of treatment to spinal victims to physically and mentally bring them back into society.

Topping, Alexandra. "How Paralympic foundations were laid by a maverick doctor who fled the Nazis." The Guardian (blog). Entry posted August 27, 2012. ​ ​ Accessed October 4, 2019. https://www.theguardian.com/sport/2012/aug/27/paralympic-foundations-maveri ck-doctor. This blog was about how Dr. Guttmann changed the medical treatments for spinal cord injury patients. The blogger writes about the experiences of some of the patients and how Dr.Guttmann's therapy changed many peoples' lives. That there wasn't a lot of support from outside the hospital and many people didn't understand what he was doing for the patients.

Trauma Institute and Child Trauma Institute. "Exercise to Support Trauma Healing." Trauma Institute and Child Trauma Institute. Last modified October 8, 2018. Accessed October 8, 2019. http://www.childtrauma.com/blog/exercise/. This website shows how exercise benefits people with people that went through traumatic experiences. Ludwig Guttmann believed that paraplegics' bodies were broken, not their minds. Physical activity helped benefit their mental state and made them realize that there was more to life than lying in a bed waiting to die.

United Spinal Cord Association. What Is SCI/D? Jackson Heights, NY: United Spinal ​ ​ Cord Association, 2007. Accessed October 29, 2019. https://www.unitedspinal.org/pdf/what_is_scid.pdf. Spinal Disorders and Spinal Injuries are two different things. A spinal injury is usually due to an injury during which the spinal cord went through great physical trauma and was unable to recover completely. A spinal disorder is a disease in which the spinal cord has not developed correctly or has contracted some sort of disease. This brochure was put out by the United Spinal Association to inform the public more about spinal injuries and disorders, this shows how much the mentality of the public has changed from before Ludwig Guttmann.

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UPMC, ed. "Psychosocial Issues of Spinal Cord Injury." UPMC. Accessed October 30, 2019. https://www.upmc.com/services/rehab/rehab-institute/conditions/spinal-cord-inju ry/education-spinal-injury/psychological-issues. Our project deals with the Psychosocial aspects along with the physical therapy. Patients have to be able to talk to people about their problems due to their new disability. Go through huge mental and physical blocks because of having to change their whole lifestyle and knowing that they won't be able to do things they used to. They often go through Depression and anxiety which is considered normal when dealing with this type of change.

U.S. Department of Veteran Affairs. "Spinal Cord Injury/Disorders Care Line." U.S. Department of Veterans Affairs. Accessed December 9, 2019. https://www.albuquerque.va.gov/services/NMVAHCS_Spinal_Cord_Injury_Disor ders.asp. This government page shows the amount of treatment and effort that goes into helping spinal cord injury victims today. They have greatly increased since the times before Guttmann and Munro. These men helped establish spinal cord injury victims as still human and they needed to be treated better than just leaving them for dead.

Villines, Zawn. "Tetraplegia vs. Quadriplegia vs. Paraplegia: What Is The Difference?" SpinalCord. Last modified September 9, 2015. Accessed October 22, 2019. https://www.spinalcord.com/blog/tetraplegia-quadriplegia-paraplegia-what-is-the -difference. This web page tells the difference between tetraplegics, quadriplegics, and paraplegics. Ludwig Guttmann saw hope in paraplegics and tetraplegics, because there was a great chance that they could return to their lives and work. They still had mostly functioning bodies.

Vinegar, Dick. "A Sincere and Heartfelt Homage to the Founder of the Paralympics." The Guardian. Last modified September 10, 2012. Accessed September 17, 2019. https://www.theguardian.com/healthcare-network/2012/sep/10/homage-founder- paralympics. During World War II Dr Ludwig Guttmann was assigned to create a spinal unit in the Stoke Mandeville Hospital. He helped rehabilitate many paraplegics and believed in multiple ways to heal. He thought that although they were physically injured they also needed to be cured psychologically.

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Waxman, Olivia B. "The World War II Origins of the Paralympic Games." Time. Last modified March 6, 2018. Accessed September 5, 2019. https://time.com/4480655/paralympics-history/. Dr. Ludwig Guttman, who was a neurosurgeon escaped Nazi Germany and let go of his job at Oxford to go pursue a career at the Stoke Mandeville Hospital's National Spinal injuries Center in London, England. The first game was held at the Spinal Injuries Center in 1948 with 16 patients competing in an archery competition. The games have come a long way since then, and now over 200 countries participate every four years at the Paralympic games.

Westie, Katharine S. "Psychological Aspects of Spinal Cord Injury." O&P virtual library. Last modified 1987. Accessed October 30, 2019. http://www.oandplibrary.org/cpo/1987_04_225.asp. This article goes through the stages Spinal Cord Injury patients go through mentally. The six stages are:(1) shock and denial, (2) depression, (3) anxiety, (4) anger, (5) "bargaining," and (6) adaptation. Not all patients go through all six but will go through at least 3 and some go through it more then once.

White, Peter. "Disabled people divided over Paralympics effect." bbc.com. Last modified August 30, 2012. Accessed December 13, 2019. https://www.bbc.com/news/uk-19428263. This web page explains how the Paralympics may not be the best for disabled people. Many people including former Paralympians explain how the Paralympics increases the amount that they are seen as "different" and often undermine the incredulous amount of hard work that comes with being a disabled athlete.

WordPress. Paralympic-Anorak. Last modified October 2, 2012. Accessed December 6, 2019. https://paralympicanorak.wordpress.com/2012/10/02/1952-the-stoke-mandeville -games-go-truly-international/. This website talks about Sir Ludwig Guttman's first nationally published Stoke Mandeville Games in 1952. The first country outside of England to participate in international games was the Netherlands. The website also gives the result that came from the games. The many sports they participated in that Guttmann used as physical therapy included table tennis, netball, snooker, and archery.

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NHD PERFORMANCE SCRIPT COVER PAGE

Please Note: All text in this template must be in 12 point font. ​ Times New Roman, Arial, or Calibri fonts accepted.

PERFORMANCE INFORMATION Project Title Healing Their Broken Bodies: Breaking Medical Barriers Through Sport Student Name(s) Angelica Trillo, Caia Kamplain, Henry Schuett, Andres Chavez Division Senior Group Performance Performance 9 minutes 47 seconds Runtime Dr. Ludwig Guttmann, a Jewish, German neurosurgeon wanted to change the way spinal cord injuries were treated. Paralysis patients at the time were placed ​ in full-body casts designed to limit physical trauma, however, they perpetuated a rapid decline of their mental health. Permanent Morphine drips were used to ​ ease the pain of victims expected to die within weeks of sustaining spinal cord Thesis injuries. The British government made Guttman director of the UK’s first Spinal ​ ​ ​ ​ ​ Injury Unit at the Stoke-Mandeville Hospital. This led to Ludwig Guttmann providing research and progress toward the treatment of paraplegics and others injured in battle through the use of physical activity. His innovative work ultimately broke physical barriers for patients, saved countless lives, and led to the establishment of the Paralympic games.

PERFORMANCE OVERALL SCENARIO Story Setting(s) Timeframe At the Stoke Mandeville Hospital for scene 2 and 3 1943-1960 In Rome for scene 4 Story Synopsis During the 1940s and the 50’s, Dr. Ludwig Guttman broke medical barriers by introducing physical therapy into the rehabilitation of paraplegics. He started his practices at the Stoke Mandeville hospital and his therapy soon became the standard for treating SCI patients. Dr. Guttmann is known as the father of the Paralympics after creating the Stoke Mandeville Games and making it a standard sporting event on the national level. He’s innovative work caused a change in how people saw paraplegics and how they were treated.

CHARACTERS Character Performance Description/background for the character Dr. Ludwig Scenes 2,3 Dr. Guttman was a prominent German neurosurgeon. He was ​ Guttmann Jewish, and was forced to escaped from Nazi persecution and ​ relocated in England during World War II. At the Stoke Mandeville Hospital, he led a revolutionary new treatment that Chavez Kamplain Schuett Trillo 31

restored the quality of life to patients and is credited as the father of the Paralympic games. Nurse Mary Scenes 2,3,4 Brennan was a nurse at the Stoke Mandeville Spinal Injury Brennan Unit and worked with Dr. Guttman from 1953- 1992 and witnessed the development of the paralympic games, we integrated her character earlier in the timeline as a blending of a few individuals. Private William Scenes 2,3,4 A soldier who fought for Great Britain in World War II. Fighting Heath on the frontline during D-Day, he suffered a spinal cord injury and remained permanently paralyzed at the legs. Nurse Joan Scene 2 Was a nurse at the Stoke Mandeville Spinal Injury Unit and Newton worked with Dr. Guttman until 1952. John Miller Scenes 3 A soldier who fought during World War II and came to stoke Mandeville after sustaining a spinal injury. Ottavio Moscone Scene 4 Member of the 1960 Italian team at the Paralympics NBC Reporter Scene 4 This character is based on Jim McKay who was the first to broadcast the games in 1972, we are maintaining the same reporter throughout even though we have the character beginning in 1960. Narrators Scene 1,

OVERALL STAGE SETTING Describe the Stage(s) of the Performance Color Use Scheme Add Photo of Stage (if possible) Background Backdrop in the center. Design Backdrop 1: (painted) Stoke (No image, access to set and props at school was Mandeville spinal Injury ward, denied) Backdrop in the center. Characters will with two rows of hospital beds stand in front and extra podiums and broadcaster occupied by patients in body booths will be off to the side. casts with drips attached in Three backdrops used in four scenes. foreground, window painted at Backdrop 1: Front Side far end of the ward, gray overcast light visible. Backdrop 2: Rolled up and secured with velcro at the top. Backdrop 3: Back side Back Drop 2: Painting of a patient in an upright physical One military cot with charts placed at angles stage therapy device based on right and left. images of Guttman’s actual Three wheelchairs, lined up just outside of stage therapy methods. area stage right Back drop 3:Painting of Acqua Folding podium for broadcasters behind set Acetosa Stadium, Rome with an olympic torch painted center image.

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Props 2 Medical bed (military cot) clipboard, 2 Wheelchairs (one real and one made by attaching false antique looking wheels to sides), 2 white blankets, 2 wedge pillows.small folding table, antique metal bedpan and catheter, 1960s era microphone

COSTUMES & PROPS BY SCENE Scene # 1 Costume(s) Visual(s) or Costume(s) Description(s) Set Design & Props Narrator (Andres) - Dressed as Dr. Guttmann for Background Backdrop 1: (painted) Stoke Scene 2 and is speaking in the first scene as a Design Mandeville spinal cord ward, narrator. Wearing brown dress pants, a white with two rows of hospital beds button-up shirt, white lab coat, brown dress shoes, occupied by patients in body stethoscope casts with drips attached in foreground, window painted at Narrator (Henry) -Dressed as Pvt. William Heath for far end of ward. scene 2, Speaking as a narrator in scene 1 wearing Props Set upstage center, white pajama pants, white t-shirt, no shoes. Shorts Medical bed #1 (cot) angled out and teeshirt with British flag under stage left, Medical bed #2 (cot) angled out stage right, Narrator (Angelica) - White button-up shirt with blue clipboard on stands at foot of tabs on shoulders, white skirt, white apron with a red beds, wedge pillows and cross, black flats, white nurse’s cap with a red cross blanket on each. Catheter and on it. (Pajama tee shirt and pants worn under nurse bedpan on empty bed Stage costume) right

Narrator (Caia) - White button-up shirt with blue tabs on shoulders, white skirt, white apron with a red cross, black flats, white nurse’s cap with a red cross on it. Shorts and tee shirt with Italian flag under

COSTUMES & PROPS BY SCENE Scene # 2 Costume(s) Visual(s) or Costume(s) Description(s) If costumes and props remain the same, write “same Set Design & Props as scene # in the boxes below” Background Same as Scene # 1 Same as Scene # 1 Design Props Same as Scene #1 Chavez Kamplain Schuett Trillo 33

COSTUMES & PROPS BY SCENE Scene # 3 Costume(s) Visual(s) or Costume(s) Description(s) If costumes and props remain the same, write “same Set Design & Props as scene # in the boxes below” Background Back Drop 2: Duplicate Stoke Design Mandeville spinal cord ward layout, with two rows of Pvt. William Heath, Dr. Guttmann, and Nurse Joan, hospital beds. Bed stage right Same as Scene # 2 is occupied by patient who is out of a body cast and reading, Patient John wearing white pajama pants, white patients in wheelchairs in t-shirt, no shoes foreground, window painted at far end of the ward, sunlight visible Props Same as Scene # 2 Add Wheelchair next to bed Stage Left

COSTUMES & PROPS BY SCENE Scene # 4 Costume(s) Visual(s) or Costume(s) Description(s) If costumes and props remain the same, write “same Set Design & Props as scene # in the boxes below” NBC News Broadcaster: Brown suit and clip on tie Background Stadium with the olympic torch Design in the center image. All Nurse Mary Brennan:1960s Slim fit pant, striped paraplegics will be sitting in blouse chairs. Props Medals, 2 Wheelchairs, 1960s era microphone William Miller: Shorts and teeshirt with British flag

Ottavio Moscone: Gold medal, Shorts and teeshirt with Italian flag

COSTUMES & PROPS BY SCENE Scene # 5 Costume(s) Visual(s) or Costume(s) Description(s) If costumes and props remain the same, write “same as scene Set Design & Props # in the boxes below” Chavez Kamplain Schuett Trillo 34

Same as scene #4 Background Acqua Acetosa Stadium with Design the olympic torch in the center image. Props N/A

PERFORMANCE SCRIPT BY SCENES Please add or remove scene pages as needed. This is only a template.

SCENE 1 - SCENARIO Purpose of the Scene Key Elements Our first scene is introductory, establishes the None, stage is set for up for next theses and establishes the basis for the scene: Backdrop 1, 2 cots with blanket beginning of the historical presentation. Setting stage right and stage left, bed pans and catheter on small table next to bed stage Right Timeframe None Characters Four Narrators Summary of the Scene All actors stand in a line at the front of the stage to introduce the topic and thesis as narrators.

DIALOGUE - SCENE 1 Character & Action Dialogue Henry: Henry Schuett (All in costume for scene two, all actors lined up evenly spaced down stage center, standing, hands behind back.) Caia Caia Kamplain Angelica Angelica Trillo Andres Andres Chavez Caia Healing Their Broken Bodies All Breaking medical Barriers Through Sport (say line and all heads lower, eyes on floor in front in unison) Narrator (Andres) “If I ever did one good thing in my medical career it was to introduce sport into the rehabilitation of disabled people” - Dr. Ludwig Guttmann. (looks up while delivering ​ line and head lowers at end)

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Narrator (Angelica) Dr. Ludwig Guttmann, a Jewish neurosurgeon from Germany, (looks up while delivering escaped Nazi persecution to England in 1939, and was appointed line and head lowers at end) head of the Stoke-Mandeville Hospital Spinal Injury Unit in 1943. Narrator (Henry) Bedridden patients faced insurmountable barriers to healing because (looks up while delivering they were trapped in full body casts that increased death rates and line walks to bed and lays perpetuated a rapid decline of their mental health. (Step back, turn down under a blanket.) and exit behind set stage left) Narrator (Andres) Dr. Guttmann faced extensive professional resistance from colleagues (looks up while delivering to his unorthodox spinal cord injury treatment approach which focused line then exits upstage right on physical and skills-based activities. and steps behind set.) Narrator (Caia) Guttman’s treatment ultimately broke physical barriers for patients, (looks up while delivering, saved countless lives, and led to the establishment of the Paralympic walks to patient bedside) Games.

SCENE 2 - SCENARIO Purpose of the Scene Key Elements This scene illustrates the medical practices Stoke Mandeville Hospital- Spinal Setting used to treat paralysis causing spinal cord Injury Unit. Same set as scene #1 injuries before the innovations and Early 1944 Following the allied approaches introduced by Dr. Guttmann. It Timeframe highlights the use of body casts and opioid invasion of France (D-Day) painkillers for comfort as well as the challenges of caring for patients and Dr. Guttmann, Nurse Joan, Nurse addressing daily needs of individuals were Characters considered terminal at the time. Mary, William Heath

Summary of the Scene The scene opens on the Spinal Cord injury ward while nurses care for patients. It establishes the treatment methods that include; confining patients to beds in body casts, caring for bodily needs and pain management. It established that the nurses believed it was long term end stage hospice care rather than recovery treatment. Dr. Guttmannis introduced as the new head of the Stoke Mandeville Hospital’s Spinal Injury Unit and makes it clear that the current form of care is unacceptable and that patient care is going to radically change under his direction. He meets resistance to the changes from the nursing staff.

DIALOGUE - SCENE 2 Character & Action Dialogue William (Henry) Oooo, Nurse, Aaaaa! (Moaning loudly in pain ​ quietly as Nurses deliver lines) Chavez Kamplain Schuett Trillo 36

Nurse Joan (Caia) Get me 50 CCs of morphine. We need to sedate him immediately to (adjusts blanket on patient) reduce his pain. Nurse Mary(Angelica) I have a bedpan and catheter. (Handing metal bedpan and to Nurse Joan) Nurse Joan (Caia) Start morphine drips for the rest of the patients before we attempt to (attending to patient) use that rigid metal bedpan. It is our job to keep them comfortable until they die. Nurse Mary (Angelica) Patient numbers rose exponentially after the June 6th, 1944 Allied (Shaking head, holds up Invasion of France. It is hard to keep up with their needs. The antique metal catheter. Dr. catheters give them life threatening infections but the morphine dulls Guttmann enters stage the pain. I am sure this new German doctor, Ludwig Guttmann will right, listening in to the appreciate the comfort we give our patients. Nurses) Dr. Guttmann (Andres) Hello ladies, I am your new German Dr. Guttman. I was at Radcliff ​ Hospital in Oxford most recently. I’m sorry, but the morphine is killing (Talking assertively with ​ ​ passion, walks to end of them. It is clear from their charts that this is not recovery treatment. bed and picks up chart) They are immobile in body casts, and riddled with infected bedsores. Nurse Joan (Caia) We keep these men alive for much longer than expected. Their spinal (Talking towards Guttmann cord injuries make them unable to function and that is what leads to with anger) their deaths. William (Henry) I’ve been lying in this infirmary for months, stuck in this useless body (Speaks with sorrow) of mine! Death is better than this anguish! ​ ​ Dr. Guttmann (Andres) The old treatment methods leave patients to waste away in their beds. (speaking to both nurses Remove the body casts, turn them every two hours to avoid bedsores. while reading chart) We need the rubberized bedpans that can be easily used. They need to get out of these beds, to heal their bodies and use their minds! Nurse Mary (Angelica): The methods in Germany must be vastly different from ours. These (places hand on hips while men are here because there is nowhere else to send these terminal looking at Dr. Guttman patients angrily) Dr. Guttmann (Andres) I have put my theories to practice for 15 years and have seen many (Speaking confidently while improvements in health, they can be rehabilitated and lives can be referring to chart) restored! William (Henry) What’s the point? I will never run and play futbol again! I’m nothing (frustrated/desperate tone) without my legs. Nurse Joan (Caia) This plan will only prolong pain and over extend our nursing staff. (Forcefully) Nurse Mary (Angelica) The medical board determined the care based on the needs of these (aside to Nurse Joan, exits poor lads! I’ll not be a party to harming them! stage left, costume change remove nurse costume layer) Chavez Kamplain Schuett Trillo 37

Dr. Guttmann (Andres) I am in charge of this unit and we must work as a team to make (At the end of the line, changes. I will request more staff and necessary supplies. ​ Guttmann exits stage left) William (Henry) My broken body is a barrier I can’t get past Doc, I am dying here. (frustrated/desperate tone) Dr. Guttmann (Andres) You men have life to live! The barrier is your mind. Your legs may be (passionately) compromised, but the spirit and upper body can be saved, you will get up! I will fight for approval to remove the body casts, catheters and morphine drips. The board will reluctantly release funds for rehabilitative equipment but they will demand to see results before anything else would be approved Transition Narrator (Caia) “Essentially if they went anywhere else for care, the spinal injuries (Narrator Walks to center patients died. He exerted a total, obsessive control over all aspects of stage front) care at the hospital, whether it was him coming round in the middle of the night to make sure that the nurses had turned patients, or checking on the quality of the cleaners’ work or that of the food served on the wards. Everything was his responsibility. This was such an enormous contrast with consultants in other hospitals.” Dr. John Silver

SCENE 3 - SCENARIO Purpose of the Scene Key Elements This scene depicts the frustration and In the ward where they attend to the Setting hopelessness patients felt early on as well as patients. the shift in attitudes to support treatment by the staff and some patients. It also Timeframe Late 1944 establishes the societal barriers paraplegics Dr. Guttmann, William Heath, John faced when trying to grasp reintegration into Characters daily lives. Miller, and Nurse Joan Summary of the Scene After weeks of being removed from morphine drips and receiving hourly turnings from Dr. Guttmann’s medical regiment, Guttmann begins physical rehabilitation for his patients by moving them into their wheelchairs and providing physiotherapy and activities designed to restore physical strength and mental wellbeing. The patients begin intensive physical rehabilitation and Guttman decides to integrate sport competition to rehabilitation.

DIALOGUE - SCENE 3 Character & Action Dialogue Dr. Guttmann (Andres) Convincing the nurses and physiotherapists that rehabilitation hinged (speaking to the audience on integrating the full staff as a team quickly earned everyone’s trust while pushing wheelchair to and my direct but caring manner the patients’ trust and the nickname William’s bedside) “poppa.”

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(Angelica as patient John get in bed stage right) Dr. Guttmann (Andres) Alright William you have been attending daily physiotherapy. Now I Helps William sit up while want to see you move from your bed to the wheelchair on your own. speaking to him.

William (Henry) Okay, Poppa. (struggles to get out of bed stage left and falls) Dr. Guttmann (Andres) William, I have told you before that you can’t use your legs. Try (Goes to help William get off focusing on using your arms and core to pull yourself into the the floor and into a wheelchair. wheelchair) John (Angelica) (Talks Poppa, how are we supposed to shoot targets when we can’t even get ​ distressed, turning into out of bed? anger) Nurse Joan (Caia) “You have gotten used to lying immobile for months on end... And (Speaking to John while then suddenly here we are saying, ‘We’ve got to get you up.” Joan ​ helping William up, break Newton. I know it is hard, but William here was practicing archery ​ character and look at yesterday and he beat Sam’s scores! audience for citation,) William (Henry) If I can get from my bed to my wheelchair, I can learn how to live on (Sitting in a wheelchair, my own. looking hopefully up at Dr. Guttmann) John (Angelica) ‘I’ve never sat up since I had my injury; why should I start now?’ (lines quoted by Joan ​ Newton) Dr. Guttmann (Andres) By targeting muscles in your upper body we can make your body (Speaking to John) stronger to do tasks by yourself. Using sports is an easy motivator for all of you to stay active, but whether you make the most of this treatment is up to you. Nurse Joan (Caia) We turned you every 2 hours to heal your bed sores. Soon you will be ​ learning how to do woodwork, swimming and going “down the hill” for physiotherapy. Dr. Guttmann (Andres) We are doing everything we can to increase your life expectancy and independence. John(Angelica) We still wouldn't be accepted back into society. My fiance left me (Speaks Hopelessly to because she can’t stand to be with a cripple. Nurse Joan) William (Henry) I used to think that way, but I bet I could hit a Nazi with an arrow. (Speaking with morale.) John(Angelica) A lot of good archery will do. You can’t hunt in a wheelchair and you (Obnoxious teasing tone) can’t be an Olympian. (Henry, Angelica place props on cots and move Chavez Kamplain Schuett Trillo 39 cots to backstage area and change into new costumes) Dr. Guttmann (Andres) As a young man in Germany I participated in the Jewish sporting (Speaking aside to Nurse leagues. Competition restored the hope that Anti-Semitism threatened Joan) to destroy. I think a competition would do some good here. Nurse Joan (Caia) Men do love competition but the board will be hard to convince. Dr. Guttmann (Andres) Leave the convincing the board to me, when I succeed it will break a (Speaks aloud to everyone) great barrier of these men. Transition Narrator Unwavering support from the nurses, doctors and therapists on the (Angelica) team helped Guttman convince the board to allow for a sporting (Enter Stage left, Andres competition. On July 29, 1948, Stoke Mandeville held its paraplegic moves wheelchair to stage first game in which 16 men and one woman athletes participated. In right exit stage right, rotate 1952 they welcomed their first international competitor. Press the backdrop, Andres puts coverage of the event played on the lawn paved the way for on coat and clip tie, Caia acceptance of the games and within 12 years the games went takes off nurse clothes international. layer.)

SCENE 4 - SCENARIO Purpose of the Scene Key Elements This scene demonstrates how parasport has The Paralympic Games in Stadium transitioned from a simple competition at Setting with an Olympic torch in the center. A Stoke-Mandeville to an international Broadcaster is off to the side. Paralympic Games, It demonstrates the significance of the barrier that was broken as Timeframe September 25th, 1960 a result of Dr. Guttmann’s revolutionary new NBC News Broadcaster, Ottavio form of treatment. It also demonstrates the ​ impact it had on the worldview and lives of Characters Moscone, William Heath, Nurse paraplegic individuals. Mary Brennan Summary of the Scene The scene opens on the 1960 Paralympic Games. A Reporter interviews two actual athletes from the games and Nurse Brennan who attended Stoke mandeville and later competitions. They discuss the importance of the games, the international attention and how Guttmann's treatments had broken barriers for paraplegics and athletes worldwide. It establishes the games as an Olympic event.

DIALOGUE - SCENE 4 Character & Action Dialogue Narrator (Henry Schuett) In September, 1960 the first ever quadrennial Paralympic Games ​ (Henry Enter stage Left with were held in Rome alongside the Summer Olympics. There were 350 second wheelchair, place athletes, from 24 countries on the roster. NBC sports reported on the chairs next to each other) events. NBC Broadcaster Hello everybody, today men’s and women’s archery is underway! (Andres) Joining me now are, Mary Brennan who worked at Stoke Mandeville Hospital, athletes William Heath from Great Britain, and Octavio Chavez Kamplain Schuett Trillo 40

(Enter Stage right to center Moscone from Italy who just won the gold in the Men’s 25M. ​ stage while beginning line, Congratulations! holding microphone. Henry sits in far chair, Caia enter stage left and sit in closest chair, Angelica enter Stage Right, stands next to Andres) Ottavio Moscone (Caia) Thank you! It is an honor to demonstrate what paraplegics are (Enthusiastically, Andres capable of! I was just speaking with Engle Globus from Israel. We points microphone in cannot imagine any of this without Dr. Guttman’s physiotherapy general direction ) treatment being accepted and used around the world. William Heath(Henry) Poppa helped us break the mental and physical barriers that allowed (Andres points microphone us to restore our lives. in general direction ) NBC broadcaster Nurse Brennan, I know you have been working with Dr.Guttmann. Is it (Turning to Brennan and true that he purposely held these games alongside the 1960 Summer points microphone in Olympics? general direction) Nurse Mary Brennan The Stoke Mandeville games were a great start, but we have (Angelica) thousands of former servicemen and people impacted by spinal cord (Conversation gestures) injuries that are capable and impressive athletes. My husband and I have worked very closely with Dr. Guttmann. It is an honor to see the level of competition. By choosing to play the games alongside the Olympics, it ensures international focus on the physical and societal barriers paraplegics face. William Heath(Henry) People no longer consider me as a lesser man when they see me compete. The international attention will further spread therapy advancements to patients worldwide. Our training included years of ​ therapy allowed us to get stronger and retrain our bodies to function. Ottavio Moscone (Caia) I am a member of the International Working Group on Sport for the (informative but positive Disabled. We have studied issues impaired athletes face. We are tone) creating the International Sport Organisation for the Disabled or ISOD to expand membership to athletes who are vision impaired, amputees, persons with cerebral palsy and paraplegics. Nurse Mary Brennan None of this would have been possible without Dr. Guttmann’s (Angelica) persistence. He stated “the meaning of the Games cannot be (explanatory tone to measured in terms of athletic performance. This sports movement has audience) a greater meaning: it is a source of hope for thousands of people whose life has been shaken by illnesses and injuries.” His vision is grander than what you see today NBC Broadcaster I need to get to the Wheelchair Basketball gold medal match between (Andres) the Netherlands and Great Britain and can’t miss fencing! Thank you all. Doctor Guttman’s vision is clearly making history! Chavez Kamplain Schuett Trillo 41

All Goodbye! (Characters wave good-bye while walking to the edge of the stage area.)

SCENE 5 - SCENARIO Purpose of the Scene Key Elements This scene refocuses the audience to the Setting N/A narrators and is a formal statement of the theme and Guttmann’s legacy. It Timeframe Present Day establishes the importance and impact of the topic. Characters Four narrators Summary of the Scene All actors stand in a line at the front of the stage areas. They connect directly with the audience while they explain that the work of Dr. Guttman broke barriers and has become a global sports legacy.

Character & Action Dialogue Narrator (Henry) Guttmann used forms of physical activity and movement in order to (All Actors have hands promote an infectious mindset of work and progress across the behind back all looking at hospital ward. His research standardized treatment that redefined audience) patient outcomes and broke previously unimaginable physical barriers. He was the first to integrate medical and surgical and therapeutic ​ disciplines. ​ Narrator (Caia) Professor Wagih El-Masri who trained with Guttman stated. “His ​ (everyone is standing front philosophy of dedicated management of spinal injury patients from center stage looking straight injury to the grave is still credible today and has whenever possible ahead) been adopted around the world…Guttmann made Stoke Mandeville into a successful model for others to copy. Among the techniques that ​ he established arguably the most important was his multidisciplinary approach that recognised that a combination of all disciplines – medical, nursing, physiotherapy, OT, social worker – was needed to simultaneously address a patient’s needs..” ​ Narrator (Angelica) The International Paralympic Committee historical timeline notes that (everyone is standing front by By 1964 the ISOD was organized. Vision impared and amputee center stage looking straight athletes were included in the 1976 Toronto Games and the first winter ahead) games were held. By 1980 the organization included athletes with cerebral palsy and deaf athletes joined in 1988. On September 22, 1989, the International Paralympic Committee was founded and became the global governing body of the Paralympic Movement. Narrator (Andres) Guttman’s legacy has been commemorated on postage stamps and everyone is standing front numerous institutions named after him globally. In 1960 Queen center stage looking straight Elizabeth knighted him for his contributions and a Bronze statue was ahead) dedicated to him in London during the 2012 London Paralympic games. Chavez Kamplain Schuett Trillo 42

Narrator (Henry) Daughter Eva Loeffler said, "I think he would be immensely proud of (everyone is standing front what has happened. For future Paralympic Games it shows they are in center stage looking straight no way second class Games, they're parallel Games.Paralympians ahead) are not disabled people doing sport, they are sportsmen who happen to be disabled." Caia Healing Their Broken Bodies (strong) All Breaking Medical Barriers Through Sport (In unison, say line strong and drop heads at end)