THE TREATMENT room at the Dikhoul Rehabilitation Centre in Moscow is a very busy place. Wheelchairs sit by benches, abandoned for the time being by their occupants, who are vigorously exercising, punctuating their efforts with gasps and grunts. Suddenly a magical silence falls as Valentine Dikhoul, the head of the centre, walks into the room. His appearance can only mean one thing: someone who has been told they will never walk again is about to take their first steps.
Everyone watches as Mr Dikhoul, heavy and bearded, walks purposefully up to a nervous Londoner and helps her from her wheelchair to her feet. Standing unsteadily at first while she finds her balance in calf-length metal boots, Rena Zdaniewicz rests her hands on Mr Dikhoul's vast shoulders as he sits in a chair in front of her, holds her hips, and engages her eyes with his own.
Determination and concentration set across Rena's face as she lifts her knee, her metal-clad foot swaying somehow forward as she takes her first faltering step. Six more swiftly follow, increasingly confident. The other clients and therapists burst into spontaneous applause and Mr Dikhoul, with Russian flair for melodrama, scoops Rena up in his arms and carries her off to watch the video that has just been made of her great achievement. 'These are the moments I live for,' he tells her.
Rena, 37, is a television editor and one of 14 British paraplegics (people who are paralysed from the waist down because of spinal injury) who have been to Moscow for treatment since an ITN crew 'discovered' the Dikhoul Centre in January (it has been going for 12 years). She had been in Moscow for a three-month preliminary session, with four days to go when the 'miracle' took place.
'It's a fantastic feeling,' she beams, taking a break in the canteen, 'especially after 11 years in a wheelchair. It's a bit like walking on stilts because I can't feel anything in my legs and I'm suddenly so high up again - I can't believe I'm five foot nine] The most curious thing, though, was how natural it felt to be making the motions of walking again . . . I almost felt ready to run.'
But it will be quite a while before Rena can run. 'This is only the beginning of a long, hard road,' she explains. 'It will be some time before I can take more than a few steps and up to three years before I can rely on walking as a practical alternative to the wheelchair. When I go back to London I have to keep up the exercise programme I've started here. I'm going to have to find the time and energy to work out for at least two hours a day on top of my shifts at work. You have to be very determined to stick with it . . . but I'll do it.'
It is not difficult to share Rena's conviction. There is walking evidence all around us that the method can work, the most spectacular example being Mr Dikhoul himself, who broke his back in 1962 when he fell from a trapeze. After five years in a wheelchair he began experimenting on himself, devising exercises, gadgets and electrotherapies. These, in their refined form, became the Dikhoul method practised at the centre that was established to share his discoveries.
After two years of his daily regime he could walk without a stick. Eight years later he was back in the circus, this time as a strong man. 'He still performs in the circus four nights a week,' says Rena. 'You'd never know he was once a paraplegic. What a role model] As soon as I came into the centre and met Dikhoul I knew I was going to walk again.'
It is the years in a wheelchair that have given Rena the courage and determination she now needs to get out of it. A car accident when she was 25 shattered her life: 'About two weeks after the accident a doctor came up to me and, without any preliminaries, said, 'Rena, you're never going to walk again.'
'I just couldn't believe it. I'd had such a great life up till then. All I could think was, 'Why me?' For two years all I wanted was to hide away. I never went out, I no longer worked, and whereas I'd always dressed rather flamboyantly, I wore dowdy clothes and no make-up.
'One day I'd had enough of escaping. I gave myself a good kick up the arse,' she says with a proud smile, wriggling in her wheelchair as she adjusts her multicoloured Lycra bodysuit. 'I decided to deal with life in a wheelchair.
'OK, it's all very awkward, rolling round on the bed for ages in the morning getting dressed and stuff, but you can't let it dominate your life. I went out and got myself a job in television - something that I'd always wanted to
do. I made a lot of very good friends and started to enjoy life again.
'Every time I felt I was giving in to self-pitying thoughts I'd give myself a shake - 'Think about something else, Rena]' Emotionally I became very independent . . . I think that's why people are attracted to me, they see me as being very strong. I'm often asked to talk to newly disabled people at spinal units - to show them that life can be fun in a wheelchair.
'Walking is not the be-all and end-all for me, but I would really like to have physical independence and freedom of movement back again. It would give me an enormous sense of achievement, too, just to be able to walk to the bar at work.'
Rena has tried other treatments and describes herself as a 'willing guinea pig'. She was the first woman to do the 'Walk Fund' programme in 1986 with the late Philip Olds (the police constable who had been shot and permanently crippled on duty), which involved walking with calipers: 'I could do it very well,' she laughs, 'but calipers up to your hips look really terrible with a mini-skirt so I gave it a miss. What they're offering here is proper walking, which is why I decided to go for it. There was only one obstacle - money.'
The Dikhoul Centre was recognised and supported by the then Soviet government since its establishment in 1980. Recent political changes, as well as the economic crisis in Russia, have resulted in foreigners being received for treatment - but at a price. It costs dollars 7,500 ( pounds 3,750) for the three months' stay. Rena was pleasantly surprised when London Weekend Television, her employer, offered to foot the bill.
Despite reports about rising crime and street violence, Rena had no qualms about the prospect of living in Moscow. 'Yes, you are more vulnerable in a wheelchair,' she concedes, 'but I knew if I was careful I'd be fine and I've been proved right. I have found people extremely helpful.
'Moscow is appalling for disabled facilities - there's only one loo and that's in McDonald's - but the attitude to people in wheelchairs is much better. I went to the first ever Russian Acid House Rave last week and after getting over their initial amazement the young Muscovites formed a circle around my wheelchair on the dance floor and we danced the night away]'
There is not much time for partying, however. Clients (Mr Dikhoul hates the word 'patient') are expected to exercise six hours a day, five days a week, working one-to-one with a personal physiotherapist. The Dikhoul system, as a visiting British physiotherapist pointed out, is neither new nor revolutionary: it is in essence intensive physiotherapy, building muscles through selective and progressive exercises.
'In Britain these methods are used, for example, on someone who is paralysed from the neck down - they rehabilitate one arm so that the person can operate an electric wheelchair. But there is nowhere at home where you get the chance to do the same on two paralysed legs.'
What is new about the Dikhoul method is that its aim is unequivocally to get paraplegics walking again. Valentine Dikhoul works on the principle that 'there is no limit to human potential'; and of the 2,000 people who have passed through his doors, he claims that 60 per cent have succeeded in walking unaided.
Legs that have wasted away after long periods of disuse gradually regain muscle as they are forced into action again, initially through bench exercise and then through standing and walking, using the supportive standing frames and metal boots that are Mr Dikhoul's own invention.
When clients can lift 65 per cent of their body weight with their legs they are ready to dispense with the boots. There are clients at all stages of treatment in the centre; those who are walking completely unaided provide the greatest inspiration for the rest.
Electrotherapies are also used in an attempt to stimulate nerve contact and regenerate sensation. Rena has regained some feeling 'inside' one leg and can now feel her left buttock. 'Most people don't get much feeling back,' she says. 'Even Dikhoul still has some areas of paralysis . . . but you don't need feeling to walk]'
Rena's therapist, a stocky young woman called Margarita, comes up to our table and taps her watch. As Rena obediently wheels herself back into the treatment room she points out how important the relationship that develops between client and therapist is.
Therapists maintain almost unbroken eye contact during exercises, as if infusing the client with willpower. 'You become very involved with your client,' confirms Margarita, who is paid 1,000 roubles (about pounds 50) a month for her dedication. 'You feel everything with them. When Rena damaged her knee and couldn't do very much for six weeks she was far more patient than I was, waiting for it to heal. It becomes the most important thing to you - to see your client walk again.'
The support of family and friends is an essential part of the Dikhoul formula, for, as Rena points out, it is the post-Moscow period that is hardest. 'Without the motivation and inspiration of other people around you doing the same programme, and without your physiotherapist bossing you about, it could be very tough keeping the regime up.
'Dikhoul insists that every client from abroad should come with at least one companion who can learn how to help with the exercises back home. I've been very lucky, my mother and several friends have been over during my stay here. They're going to take turns at being my physiotherapist back in London. If it was just a matter of loved ones wishing you could walk, I'd have been walking years ago. Now they can actually help me to achieve that dream.'
HOPES FOR A UK CENTRE
SPORTABILITY, a British organisation established to promote sport for the disabled, has been making the arrangements for British paraplegics to go to the Dikhoul Centre. Sportability hopes to establish its own Dikhoul Centre in Britain as early as next year. Valentine Dikhoul has agreed to train personnel and Sportability is seeking funding in the private sector.
Richard Thompson, the co- founder of Sportability, explains: 'It costs clients about pounds 10,000 to go to Moscow for a three-month programme. And ideally they should return for further treatment. We have a waiting list of about 250 people wanting to go for the initial programme - that number will increase dramatically as more and more paraplegics return from Moscow having started to walk.'
Dr John Outhwaite, senior registrar in rehabilitative medicine at the Nuffield Orthopaedic Centre, Oxford, is in discussion with the group and is likely to give the project his backing. Dr Outhwaite stresses that it is too early to comment on the extent of recovery achievable by the Dikhoul method. A British specialist has yet to visit the Moscow centre.
Richard Thompson says: 'The Dikhoul method is not for everybody, just as running marathons is not for everybody. The system in no way constitutes a 'cure', but simply aims to achieve maximum physical potential.
'Five people a day in the UK are paralysed from spinal injury. Eighty per cent of them are aged between 16 and 24. At the moment they are told to shut up and accept the fact they'll never walk again.'
Sportability: (0502) 741072.
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