“I have sailed the five oceans.” Ignacio Peñuelas García, 29 years old, studied nautical engineering and maritime transportation. A year of internship on a chemical tanker and his command of English helped him enter the world of cruises. He is a merchant marine pilot. He leads luxury expedition cruises that show whales and penguins in Antarctica. “I prepare the cartography, I set up my surveillance on the bridge… That’s what I did. In the future, who knows.”
“I’m from Puerto de Santa María,” he says, as he goes in a wheelchair to the physiotherapy room that, overrun with stretchers and machines, is far from his homeland and his previous life, because he is currently embarking on another one. Ignacio has a spinal injury caused by a bad dive. On vacation in Mallorca, one night with friends, he jumped into the water and wouldn’t come out… His is an incomplete spinal cord injury. He has sensitivity. Move your right leg a little. Three months ago he arrived at the National Hospital for Paraplegics (HNP) dependent on the Health Service of Castilla-La Mancha (SESCAM). You know you are in good hands because in Toledo, and for 50 years, the reason for being of this center, a reference in Spain, is to teach patients to live a new life with more than 700 professionals dedicated to generating hope, trust and patience.
With the help of María Vázquez, his physiotherapist, Ignacio climbs onto a machine, suspended by a harness, on which he trains his gait repetitively. It is a robotic system that moves its legs. “Robotic therapy is the future, the one that entails the least risks, the most advanced,” says María.
Without ceasing to monitor Ignacio, he points out that one of the worst obstacles in the relationship with patients is that “it is a medicine based on evidence and not on certainties. You have to manage a lot of uncertainty. The patient wants to know if he is going to walk, if he is going to recover, and you can’t tell him for sure. And how is all this managed? Well, what you can tell him is that you are going to do everything possible.”
Since the National Hospital for Paraplegics has existed, the life expectancy of patients has gone from just a few years to being similar to that of a person without spinal cord injury and the quality of life has radically improved.
Ignacio doesn’t stop. Weight board, bicycle, electrostimulation in the afternoons. His physiotherapist says that “he makes it very easy, because he is a person who does not depend much on circumstances to be well” and explains that after a spinal cord injury “the most difficult thing to deal with is not trying to move again, it is not the wheelchair.” . It is what is not seen. The alteration of the autonomic system entails consequences that are not obvious and greatly complicate the lives of these people. You have a body that has become rebellious, it has become independent of your head. You do not have sphincter control and the most limiting consequence is sexual dysfunction.”
Concern about sex and ‘Doctor Love’
Questions arise. What will happen to my sexuality and my relationships? What will I feel? Will I ejaculate or not? What will I feel? Will I be able to have children? After a spinal cord injury, people can still have a rewarding sex life like the one they enjoyed before.
Eduardo Vargas is a rehabilitation doctor responsible for the Sexual and Assisted Reproduction Unit, which has accumulated 5,000 stories since its launch and has brought 150 boys and girls into the world. ‘Doctor Love’ – that’s what they call him colloquially – explains that “each patient has their time and it depends on how they experienced sexuality before the injury.” In this unit, sperm recovery and assisted insemination techniques are performed. Erectile dysfunction is treated. “When oral drugs fail, there is another vasodilator called ‘Caverject’, which is injected directly into the penis.”
“Women come less, but they come. The answer to your concern about whether they will be able to become mothers is that both a paraplegic and quadriplegic woman can become pregnant. The first day I explain to the patient everything about her injury and the possible consequences. Women are fertile and damage to the spinal cord, by itself, does not cause hormonal problems. Yes, you have to prepare them for future pregnancies. If the patient is taking medication, it must be withdrawn beforehand.”
It is not difficult to imagine that a strong bond is created between Dr. Vargas and his patients. Once they are discharged, the questions continue to come and are answered by video consultation. “Here, the comprehensive treatment and rehabilitation model for people with spinal cord injury of Guttman and Roosevelt, the fathers of modern paraplegia, is materialized.”
In the hospital gym there are also fewer women who are encouraged to do a sporting activity, which is not mandatory during their stay. “I don’t have data, but there are many fewer women competing in the world of disability and that is why important campaigns have been carried out in recent years.” This is said by José Miguel López, sports instructor at the National Hospital for Paraplegics. “If for a person without disabilities sport is important, for a person with reduced mobility sport is essential.”
The Toledo hospital has been recognized in 2024 by the Higher Sports Council as a Sports Technology Center for people with disabilities, the only one in Castilla–La Mancha.
With a wide catalog of sports disciplines, “we receive patients in the first stage when doctors begin to refer them to the complementary rehabilitation section. We introduce the philosophy of play as fun and although the objectives are rehabilitative, we are the support to help them improve every day as if it were the gym in their neighborhood or town. Whoever comes down gets hooked and then, if they want, they jump into the competition. Once the patient is discharged, we have agreements and agreements with the Paralympic Committee, with federations and foundations. The normal thing is that it goes hand in hand with other entities.”
Adapted wheelchairs are distributed throughout the pavilion along with ping-pong tables and “orthopedic material that is very expensive” and 90 percent of which is acquired through financial donations. External collaboration is important, given that the Administration has limited resources.
The rehabilitation process and an opportunity for personal growth
Emotional support and mental health are essential in the recovery process. Both care are combined at the National Hospital for Paraplegics because people are suffering a lot when they arrive at this center. “Emotionally, it was very hard at first,” recalls Ignacio, the patient in this report, almost four months after his admission.
“You go from the ICU to the ward, from one hospital to another” (he was first admitted to Mallorca) and he says that “chemically it is quite hard on the brain, but the days go by and the body adapts. We are in a small bubble and when you leave it is a shock, but for now I am here very well mentally. I try not to think about the future because if I do I don’t focus. Present and near future. The other one will arrive.”
Patients and their families receive attention to their psychological needs and the Complementary Rehabilitation Service promotes therapeutic pedagogical, leisure and free time activities, which have a positive impact on recovery. Its coordinator is Cristina Vicente. “From here we make your stay more dynamic. They must be encouraged to go out because in the hospital everything is adapted, but outside the reality is something else. We do many excursions, and each one usually involves between 10 and 15 patients who use an adapted bus. Accompanied by a family member and health personnel, most of the outings are to Toledo, Madrid and nearby towns, because they are patients who are still in an acute phase.”
All injured people have to re-examine their driving license. The theory is not necessary, but the practical exercise is and this is another of the most demanded activities because great autonomy is achieved. We work with a driving school and patients who are victims of a traffic accident can get it at no cost.
Help to face the great challenges of patients
When the patient begins to use the wheelchair, he enters the “sitting” phase and is trained to be independent in daily life. “The goal is to achieve the greatest possible autonomy,” says occupational therapist Esmeralda Martín, while pointing out the air and anatomical cushions that adapt to all wheelchairs. “It is important to position yourself well in the chair: the hips, the trunk, the armrests, the footrests… They are taught to make postural changes. A pressure study is done because poor sitting implies scoliosis. A pressure ulcer, I would say, is the number one enemy of a spinal cord injury.”
From their different departments, professionals ensure the well-being of the patient. In Occupational Therapy, basic challenges are trained, so that the person can get dressed, can go to bed, can pick up things… The hospital is at the forefront of technological advances and materials, with therapies such as virtual reality or 3D printers, which They manufacture everything from devices for using the toothbrush to eating cutlery, among many others. The creation of splints and pieces adapted for each patient with mobility limitations requires materials such as thermoplastic or “orficast”, with the same use, but similar to a textile on a roll. “For me this material is wonderful,” says Esmeralda.
In the functional room, the hands and arms are worked on as well as trunk balance when it comes to cervical injuries or incomplete injuries like that of Ignacio, who “is working on his hands because he does not have enough strength in the index thumb clamp and wants to learn. to probe himself. It is incredible what he is achieving.” Stopping being dependent on probing is one of the first challenges of a paraplegic person.
I ask him how time passes in the hospital. “Pretty fast,” he says. “It seems like it was yesterday when I entered and it’s been almost four months now. My parents rented a house on the first day and at first they came every day to spend the afternoon with me. I even had them in the soup. Now my father, who is already retired, has returned to the Port and my mother is enjoying Madrid with her ten grandchildren. They come on weekends. Many friends come to see me. They have made a calendar to organize themselves. It seemed like this Easter, me with the chair and them behind.” Smile.
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