Pioneer Work with Cerebral Palsy
- Author:
Eirene Collis
Chief Cerebral Palsy Therapist to the London County Council
A quarter of a century ago pioneer work in Cerebral palsy was begun in America by Dr. Winthrop Morgan Phelps. He realized what ~r- Little had had an inkling of in 1830?that ‘he child with cerebral palsy is not necessarily Mentally affected by the damage to his brain; the right hands his condition can be considerably Meliorated.
In 1941 the present writer returned from America, having studied Dr Phelps’ work at his private school, near Baltimore, from the angle of the therapist. it Was not possible to arouse any interest, In that year of war, in children with a long recognized c?ndition of cerebral damage. Many people were sympathetic, but no more.
In 1942 the then Medical Superintendent of VUeen Mary’s Hospital for Children, Carshalton, decided to give experimental facilities for cerebral Palsy work along Dr Phelps’ lines of treatment. u% a few children could be taken and they were jjnselected cases. Work had to be done in a hospital ward and under the very difficult conditions 01 wartime. Staff was unobtainable for special care of these children, and, previously, the habit ^ the hospital had been to regard them as mentally elective chronics. After more than a year of ard work, results, even under wartime difficulties a vvart* routine, were far in excess of those of ther methods, and interest was aroused, resulting J1 the formation of the Cerebral Palsy Unit, the Fst of its kind in the country. The children were fyen a block to themselves. A teacher was ejected to become conversant with their special tj?e<^s ?nc* to work with them in school. Assistant , erapists were appointed. Ward routine was one away with and a normal child’s day was r8anized. Unfortunately, the long waiting list ?uld only slowly be reduced, and a selective cthod of admittance had to be introduced in rder to cope with increasing demands. To have 0 Work slowly was disheartening, but a good deal pKm keen done to lead the way to better things for h^dren with this disability.
tarly on it was suggested to some of the parents at they should form themselves into a club and 0rk for the good of all cerebral palsies. This
was done and a large Association has grown out of that small Parents’ Club. The staff of the Unit had often to break off work to give details and information to parents, doctors, teachers, educationists, physiotherapists, occupational therapists and speech therapists who wanted to gain information about the new work. Some of these decided to set up on their own and others decided to practise some of the methods in their own hospitals. Such things as walking ” skis” were much admired and made use of as adjuncts.
The children in the unit multiplied and gradually hospital difficulties were overcome by increasing freedom. The staff and children learned to work together happily ; but there were not enough of the former and too many of the latter waiting for help. It is only possible to treat a certain number of children with a certain number of staff ; cerebral palsies who are helpless require a good deal of looking after outside treatment times. During the war it was not always possible to have ideal conditions in a new departure of this kind. Now that so much interest has been aroused and so many people, official bodies and unofficial individuals, have seen and accepted and are starting work on children with cerebral palsy, staff will rapidly become available and more children taken in and more parents made happy in the knowledge that everything possible is being done to ameliorate their child’s condition.
The Unit is in the closest possible touch with the great pioneer in this work, Dr Phelps, and an effort is made to adhere as closely as ever to his teaching and to carry on his therapy. The work has now passed beyond the experimental stage. There is no doubt whatever of the improvement in the children’s motor behaviour, and psychologically they are different beings. From helpless invalids tied down in bed and treated as sick and of poor mentality, they have become children with a full and happy life, engaged upon overcoming a disability while filling in a normal day with school, outdoor play, indoor amusements, meals in a special dining room, where they can win promotion to the ” big table ” by learning the art of self-feeding at individual tables specially equipped to help them to help themselves; and at night they sleep in their own dormitory, boys on one side, girls on the other.
The health and physique of these children rapidly improved and they put on weight after removal from a hospital ward to a special unit. They are always hungry for their meals and ready to join in all activities. One keeps rabbits, another collects toy motor cars, another is a balletomane, practising arm movements whenever she has a spare moment. A rhythm band was started and the first concert was given over a year ago. The parents were invited and many of them could not believe what they saw and heard their children do. Eurythmy is also taught and the children love it. They had a nice garden before they left the ward conditions, and now they are hoping to cultivate a larger bit of ground.?
Treatment routine is very strict, though it is not as frequent as it will be when more staff can take it over. The children have physiotherapy, occupational therapy, activities, speech therapy and school. On admission to the unit each child is examined and his type and degree of disability assessed. A treatment scheme is devised and routine work begun. Studies of the child are made at frequent intervals, graphs being made to demonstrate the rate of progress in the different aspects of work. It is recognized that the child must inevitably do his own work ; he is guided and taught by the therapy staff, but control of his body cannot be achieved for him. This, and the development of his mind, are what he learns during his life in the unit. Service to the child with cerebral palsy is the aim of the unit and each child contributes to the service of the others. By this means he becomes independent and loses the sense of frustration so common in the child with this kind of disability. Cerebral palsy is a general term to designate motor and sensory disturbances which result from brain damage ; it is not a diagnosis of the particular condition of each particular child. The therapist must know the total handicap in each case, and to obtain a picture of this the five classifications made by Phelps are strictly adhered to. These are made on a motor basis and are determined by detailed neurological and functional examinations, carefully interpreted in each case. A certain amount of research has been possible and it has been found that movement, both of normal persons and of cerebral palsied persons, tends to be distinguishable into differently controlled broad types, and such movement is affected by the various cerebral condi* tions of these children and can only be trained satisfactorily by persons who are students of muscle and movement. Dr Phelps has laid down basic principles of training for these children, and the therapy findings of the present writer completely bear out his divisions and classifications according to which treatment is differentiated. Sensory disabilities have been similarly worked upon and with concurrent findings. The psychological differentiations worked out by Phelps are allied to the types of difficulty experienced by each individual, and it is consistently found that there is no true psychological problem with the cerebral palsy child per se, and that behaviour abnormalities clear up so soon as the disability is handled with understandingNew findings are to be published elsewhere in due course and it is hoped that they will prove helpfu’ to all who enter the cerebral palsy field.
For best results therapy should be begun early in life, and intensive training for the child and concurrent training for the parent carried out until a satisfactory routine has been established. In the first cerebral palsy unit in this country> there have been very happy relations with all parents whose children have been in training and it is the confidence and tact they have shown that has smoothed some difficult passages in this pioneer work. To them and to their children we are indebted for showing us the way to a correct routine. Their loyal co-operation has helped their children as nothing else could have done during the difficult first years of establishing something new and different in an old and long standing hospital regime. The cerebral palsy unit is still housed in the grounds of the hospital, but in a separate building, with its own playground, garden and schoolrooms. It is hoped to make it a model unit and to give every chance to as many children as possible now that the war is over and the spade work done.
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