Gymnastics as a Factor in the Treatment of Mental Retardation.
- Author:
Blanche Sterling, M.D.,
Baltimore, Md.
The relation of muscular activity to mental development, recognized as it has been from the very beginning of modern psychology, teaches us that kinesthetic, i. e., motor, images are more important than visual or auditory images, and that a greater part of the sensations bringing about mental development are excited through motor activities. This is a fundamental truth, and the leaders of to-day who are doing the best work in training the mind and body of the individual are making the science of kinesiology an applied science indeed.
The natural activities of a normal individual, combined with rational exercise of some sort, help to bring him up to the highest point of mental, as well as physical efficiency. With the subnormal class, as exemplified by the feebleminded, manual training, gardening, gymnastics, and like motor agencies are accomplishing much. Johnstone states that with the feebleminded the most successful methods are the various kinds of motor and sense training, and Barr asserts that constant occupation is for them the only security from deterioration. The psychiatrist, too, has found that with many abnormal and pathological mental conditions some form of physical training,?motor activity,?is always indicated. When such an authority as Dr Adolf Meyer speaks of “exercise and its influence upon our readiness to meet the ordinary demands of life,” it behooves us to listen. We all know that readiness to meet the ordinary demands of life is the surest criterion of a normal mind, the goal towards which all endeavor in this line is directed. And it seems to be an established fact that training or treatment along motor lines is one of the well marked highways to this goal.
In view of this evidence, it would seem that the individual case of mental retardation is a most suitable field for the application of this form of therapeutics. Through some cause or causes, perhaps remediable, the child’s mind has not developed at the nor(204) mal rate. It has not yet readied the stage where its development can be best promoted by mental processes. It is now, at the very beginning of his training, that the case of mental retardation,? particularly the retarded child of the city dweller, cut off from the activities of country life,?should have the most careful and scientific motor training. Each case must be considered separately, his mental attitude towards his environment studied, and those exercises and games selected which will best tend to develop what he needs. The practitioner or trainer must be all things to all children, with a view to developing a “readiness to meet the ordinary demands of life.” His success or failure will be measured in terms of distance from this goal. The case reported below is simply to illustrate the argument, and is not given as typical or representative. In fact, when I took the case I had in mind only the improvement of his physical condition, and it was not until I saw what was being accomplished that I used about forty hours in April and May, 1908, for the purpose of making definite observations and taking notes of his training.
The report covers the period from the age of three years and four months, to five years and two months,?almost two years. During this period I saw him approximately three hours a week for one month, two hours a week for one month, six hours a week for one month, and three hours a week for seven months. I did not see him at all after this for four months, and then he came under my care three hours a week for six months, and six hours a week for three months. There were, however, interruptions during this period due to slight illnesses or other causes. When I first saw the child he was small and somewhat rachitic in appearance. He weighed five and one-half pounds at birth, and had always been delicate. Although he could walk, he would not step up an elevation of a few inches without assistance, rarely if ever ran, and in fact was almost the exact opposite of a normal active boy of his age. He was little inclined to move around unless made to do so, but he was obedient and docile. His speech was very imperfect, and his hard palate high, narrow and arched. A slight strabismus was present. His mental condition was decidedly retarded.
At five years of age, with the interrupted treatment indicated above, he could climb unassisted up the Swedish stall bars, and hang by his hands from the top bar. What is more noteworthy, his idea of his relation to this particular external thing had so developed, that instead of dropping to the floor, as he would undoubtedly have done a few months before, he knew when to put his feet on the bars as his hands grew tired. This idea, however, had to be developed for another and very different piece of apparatus. A little later, he asked permission to swing along on a bar suspended by a rope, and to pull himself up in the Sayre suspension apparatus.
Under date of April 10, 1908, his condition is described as follows: His speech is better, he talks more, runs, laughs, wants to do what he sees others do, and likes to play and look at pictures. His play is rather elemental in character.
About this time definite observations and notes began to be taken, the most important of which are given below. At five years his height and weight were normal.
April 10, 1908. Although he had fallen from the swinging bar on a previous occasion, he was permitted to use it again to-day after being told that if he let go the bar he would fall. He did not fall. The bar was hung so low that he could reach it and swing by holding up his feet.
I tried to get a quick response to a stimulus, and after repeated attempts succeeded in getting him to run across the room fairly soon after I had counted three. At first he seemed to pay no attention to the signal, but waited for me to run, when he would follow. I then sat down and tried him alone, and the result was rather satisfactory.
April 11. He cared more for swinging than for anything else to-day, but he pulled himself up in Sayre’s suspension apparatus very well, and ran at signal fairly well. I introduced a new signal, holding up my finger, and he soon learned to respond to this stimulus. I then alternated the stimuli (sound and sight) and he did fairly well.
I tested his recognition of colors, using strips of red and green paper, but he gave no indication of recognizing any difference between them. April 13. He pulled up in Sayre very well, but the swing was higher to-day and he fell off once. His running at signal was pretty good, but he gives no indication of being able to tell red from green.
I introduced a simple little game to-day. We stood at opposite ends of a large rug and rolled a ball back and forth, each trying to keep the ball from going off the rug as it came towards him. This was intended to train the child’s perception and judgment. I made the work very easy to-day, sending the balls almost directly to his hands, and he kept them on the rug fairly well. During the winter, when he said he wanted to tell me something, he usually told me the same thing each time. This morning he told me something new, mentioning something he had seen in the street.
April 11/.. To-day he told me of a little event that had taken place this morning before he came to me. While doing one of his exercises he told me which one he was going to do next. In running at signal I asked him to touch the bars when I counted three, and to touch the door when I held up my finger. He was not able to make this differentiation, and that I was going too fast was shoAvn by the fact that my explanations confused him, and two or three times afterward he failed to start at the signal. When I saw this, I had him simply run to the bar at both signals, and was as successful as usual.
In playing the ball game his perceptions and judgments were not quick enough to prevent the ball from going off the rug when it rolled a little way from his hands. He would, however, reach out his hands to stop it when it went just a little beyond the middle line. I had no success in getting him to distinguish colors. April 15. He was not so cheerful and interested as usual. He did not want to do Sayre at first, but did it pretty well when I insisted. His swinging on the bar was not so good, and his attitude and expression when I explained this to him and he had made several failures, were ample proof, to my mind, of the opinion held by Dr Meyer that the useful things in mental hygiene are the things that can be done, the successful things. This is a very important point in the treatment.
The patient climbed up the bars and made his first attempt to turn around, and did so with a little assistance. In playing the ball game, after one or two throws he watched the ball roll past him without making the slightest effort to stop it. He made fewer mistakes in his color work, but seemed to be chiefly guessing. April 16. His Sayre and swinging were poor, but in the ball game his work was better. He would walk to get the ball when I rolled it to him. I then suspended the ball from the swing and told him to bat it with his hand. He did it fairly well and seemed to enjoy it. He throws a ball very awkwardly. In trying to toss a small ball he holds his arm very close to the body, and makes several efforts before letting go of the ball.
April 17. He had a bad cold and coughed several times. seemed tired and listless, and wanted to sit down. He did not care to play ball, but finally did so and played better than usual, going to meet an oncoming ball and not letting it roll off the rug very often. I gave him little to do because of his physical condition, which has evidently influenced his work during the last three days.
April 22. The patient came back to-day after recovering from his cold. He was lively and seemed to enjoy doing things. There was no improvement in his swinging. (I mention the swing repeatedly because I believe an adjustable swinging bar has many possibilities for mental training.) In running at signal he responded very promptly. We had no success with the red and green colors.
April 23. I gave him a little work in articulation to-day. April 21. A twelve-year-old girl came in while the patient was present, and he pulled up very well in Sayre. He likes to show people what he can do. In swinging to-day he made a great advance. While swinging alone he caught the trick of standing far back and letting himself go from there. He asked me to sit down while he went to swing alone. This time when he began he had lost the little trick of starting himself, and he evidently realized that he was not doing what he meant to do. He hung on the swing a few times, and each time he failed to start himself swinging he would say “not yet” and try again. After several attempts he succeeded.
In running at signal he started well, but could not yet separate the different actions for different signals. In playing ball on the rug he seldom let it roll off, and seemed to enjoy the game. I placed some bits of paper on the table, and asked him to bring me two pieces. He brought me one the first time, but after being corrected he brought two each time thereafter. He always does a number of his usual exercises.
April 27. He was not present on Saturday, and I was afraid he had forgotten how to start himself swinging. He had not forgotten, however, and did it very well. He asked to be allowed to kick the wall opposite the swing, which he succeeded in doing in a small way. He asked me to give him a push, which I hesitated to do because a few days ago he would get off the swing almost as soon as I touched him. To-day he kept on swinging after the push. Evidently his new idea of kicking the wall was stronger than the old association of coming down from the swing after he was pushed.
Running at signal was performed about as usual, but I noticed that his attention was soon distracted. At the ball game on the rug he did pretty well, but soon began to show signs of wanting to do something else, so I suggested that we throw the ball at the swing. Pie had already walked up and touched it with the ball. He succeeded in striking the swing two or three times. The swing is a little higher than his head, and he stood about three feet from it. The ball is a large rubber one, about four and one-half inches in diameter.
To-day for the first time he showed that he could distinguish colors. I added pink strips of paper to the red and green ones, mixed them all together, and then separated one of each color as nuclei of three piles. I then gave him the rest of the paper and told him to put the strips in the proper piles. He did remarkably well. He made some mistakes, but was always able to correct them. Sometimes I had to call his attention to a mistake, but at other times he discovered it himself and corrected it. I did not try to teach him. the names of the colors.
He has a small amount of adenoid growth, and very often I notice that his mouth is open and the tip of his tongue at his lips. April 28. His color work was excellent until two little girls came in, and his attention becoming distracted he mixed the colors. April 29. His swinging was better than usual. The ball playing was poor,?in one instance he moved his hand back and forth seven or eight times before he let the ball go. Running at signal has been a little hesitating since I have been trying to get him to go to different places at different signals. He has not yet learned to make this differentiation. His color work was good, although he made one or two mistakes. I told him the names of the colors to-day. He was given a brief drill in articulation. He tells me at times of outside things, and in doing one of his exercises he likes to play that he is swimming in the water at Cape May, where he spent the previous summer.
April 30. He pulled himself up very high in Sayre, climbing until I stopped him. He has quite got the knack of swinging While throwing the ball at the swing, he once made as many as fifteen motions of throwing before he actually threw it. In rolling the ball on the rug he has improved greatly, and to-day he did not let it roll off on his end at all. He had his daily brief drill in articulation.
May 2. He did not go so high in Sayre as he sometimes does, but his swinging and kicking were very good. He discovered that if his swing forward did not carry him near enough to the wall to kick it, he could send himself nearer by bringing his left foot down on the floor as he swung over towards the wall. Thereafter he made practical use of this discovery in gaining his end. May 5. In Sayre to-day he let himself down in his own way, pulling up his knees and slipping low on the rope, and acting much as any child might have done.
May 6. I added blue to the colors, and he distinguished them all very well.
May 9. He has not learned the names of the colors, but I found that he memorizes sentences very well. May 20. His mother came to-day and spent an hour with him. He did fairly well in his exercises and rolling the ball, and separated the colors properly, but did not know their names. He does not yet match the colors correctly when articles of various kinds are given him.
He got off the table unaided, for the first time. May 22. Yellow was added to his colors with the usual good result.
May 26. He seemed to have a rather better appreciation of where to run at different signals, but the weather was too warm to permit of enough running to make a really good test. May 27. A thirteen-year-old boy was present, and at times the patient’s attention seemed rather distracted. May 28. A very warm day, but he was lively and apparently unaffected by the heat.
May 29. He did very well. His cousin, a boy of fourteen, came with him, and he was glad to show his relative what he could do. He really appeared to know which place to run to at the different signals, but I did not try having him run without first asking him where he was going. I asked him this question each time I changed the signal, and he gave correct answers.
May 30. This was the last day the patient was seen before he left the city for the summer. Nothing of importance occurred. The above report is given in spite of its crudeness,?the crudeness which is apt to accompany the application of new methods, or new and different applications of old principles. Many of the simple facts stated above will be very suggestive to the psychologist. Dr Margaret K. Smith has found certain forms of motor training of great value in her work with the backward boy at New Paltz. There is a wealth of material available in this motor pharmacopeia. Let us make use of it all as occasion demands.
The interest of this report does not lie in what has been, or what is being accomplished in this particular case. It is simply a broadening of the way for a wider application of this powerful force in mental development. More important still, is its suggestion of a splendid field for research in what Witmer has aptly termed the “psychology of movement.” This field is lying fallow for the worker whose knowledge of psychology, medicine, kinesiology, and practical gymnastics gives him the tools for its cultivation.
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