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All of these different principles of treatment have a tendency to converge;
it is hoped that they are not ignored, violated or even dismissed.
All too often we do not consider what is happening to our patients as we
physically handle them.
5. General Considerations involved in the Application of these Principles
to the Case Load of the School Health Service.
The majority of cases in the School Health Service for which rehabilitative
procedures are devised come within the bounds of Spina Bifida,
Cerebral Palsy, the brain damaged child with varying degrees of neuromuscular
dysfunction, and long term Orthopaedic cases. A brain that is
injured after maturity is very different from a brain that is injured during
its development. Physiotherapists are so involved with the functional
aspect of their patients' treatment, that the developmental process which
after all is the foundation, is completely forgotten. Sometimes the best
treatment for severely handicapped Spina Bifida and Cerebral palsied
children is limited to the provision of tailor-made appliances and specific
training in feeding and dressing; particular skilled motor function is not
the most desirable objective. In such cases we frequently ask our patients
to perform the impossible. Many of the reflexes and built-in motor patterns
which form the basis of willed movement follow a definite pattern of development.
This realisation is important because either by stimulating or
suppressing these reflexes we are given a means of influencing abnormal
conditions of the body. Relative to cerebral palsy and spina bifida, abnormal
reflex activity prevents the retraining of normal movement. We all recognise
the wild, uncontrollable gestures of spastic children and feel inadequate
that neither they nor we can control them in order to make their appearance
socially presentable.
Finally, when considering what type of treatment a patient should receive,
the value of repeated assessment deserves greater emphasis.
Physiotherapists must become critical evaluators and routinely acquire the
correct information from the examination of a patient. What amount of tightness
is present in a muscle? What awareness is there of feeling? What
developmental level has been physically reached? What involuntary movements
are present? What types are they? Is the demand for stimulus or
suppression and in what order? Those are the questions we should ask ourselves
in order to plan a treatment programme.
6. Integrated Approaches with Speech and Occupational Therapy
The nervous system, the muscular system and the feeling side of the
body functions as a whole; therefore a particular therapist must be aware
of the problems outside her specialised field. It is known that incapacity
of limb movements hinders normal speech development. When special
postures are adopted in treatment to release tightness of the limbs,