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abnormal occurrences of these ages. One of the side effects of the decline
in infant mortality is that an increased proportion of multi-handicapped
children has been thrown into the lap of Society for attention. These lives
will demand more therapists' time, more Schools in which to educate them,
and more highly skilled personnel to care for them. It is a bleak prospect
for the parent of such a child who is looking for expert treatment for we
physiotherapists have not considered our limited knowledge against these
enlarging horizons. We must train ourselves to think scientifically and to
encourage learning whilst we work. It is only by so doing that the therapists
of tomorrow will be prepared for greater responsibilities.
4. Basic Principles of Different Techniques now in Use.
During the last twenty-five years several new therapeutic approaches
have been devised and satisfactorily put into practice. Dr. Rabat and Miss
Knott working in California discovered that by applying maximum resistance
to weak muscles they became stronger when moved in a mass pattern.
For example, it is a familiar sight to see a man walking along a street with
a dropped foot. The muscles that help to support the foot horizontally are
weakened perhaps through paralysis or disease and therefore he wears a
brace to prevent tripping at every step. Treatment is given to the whole of
his legs, that is, the virtually normal hip and knee as well as the weakened
foot muscles. It is by this method that the strong normal muscles can assist
the weaker ones to develop. This technique known as proprioceptive neuromuscular
facilitation may be likened to running across a field as fast as
humanly possible, then suddenly running faster than is normally possible
because of a bull in full pursuit. It is that extra impetus that makes for the
improvement during treatment.
Professor Rood (a trained physiotherapist, speech and occupational
therapist) also working in the United States, realised that the majority of all
our treatment was concentrated on to the muscles and nerve pathways and
not on the skin that surrounded them. The skin in fact is a valuable medium
for re-educating parts that are not functioning normally. Stroking with an ice
cube on the skin over the lower back does influence the working of a bladder;
massaging with a vibrating brush does alleviate the pain of shingles; slow
manual stroking given very slowly down the spine does assist the process of
sleep. The realisation that the skin all over the body has different areas for
reception purposes has considerably opened up our fields of treatment.
Doctor and Mrs. Bobath, a neuro-physiologist and his physiotherapist
wife working in England mainly with the cerebral palsied, have placed the
main emphasis of their treatment on to specific positioning of the body and
limbs. Muscles which are extra tight are placed in such a posture that the
tightness relaxes. Parents are shown the value of doing this at home, explanations
are given of the treatment and little by little the treatment programme
progresses.