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16
Orthopaedic Defects
There are significant reductions in the number of defects reported in
each of the three categories of orthopaedic defects. This decline in
incidence is particularly marked in the categories of posture and flat foot,
which suggests that a change may be occurring in the pattern of defects
now thought worthy of attention. The Physiotherapy Service has moved away
from the somewhat restricted emphasis upon exercises to correct a particular
deformity towards a more dynamic approach which assesses the total
needs of the child. Active participation by the child and active encouragement
by the parents are now seen to be the keys to successful treatment,
and every effort is made to ensure that such objectives are achieved.
Medical officers differ concerning the significance of minor postural
defects, and of symptomless flat foot. There is a suggestion that the
correction of the former have not been assisted by the changes in methods
of physical education in schools. Whilst the physiotherapist may rightly
argue that training in routine gymnastic exercises is a waste of her valuable
therapeutic time, the absence of such exercises at school may result in the
child receiving no treatment whatever. The danger to health probably lies
not in the actual defect but in the apparent approval by default of unhealthy
habits. At a time when health is becoming a matter of conscious choice,
requiring certain specific actions by the individual, the encouragement of
such attitudes is clearly unfortunate.
Similarly, in the condition of flat foot, Dr. Roberts, a school medical
officer, working in secondary boys' schools, points out that the condition
is relatively frequent at the medical inspection on admission to secondary
school. By the time of the examination in the final year at school, flat
foot is less common, but those that remain show permanent deformity, with
a slightly awkward gait and a tendency to callouses (corns, etc.) The condition
is largely preventable by regular exercises designed to strengthen
the arch of the foot. Both the number of children involved and the long
term nature of the exercises make it quite impracticable to use physiotherapists
in the alleviation of the condition, and it is to teachers of physical
education that the service must look for assistance with this aspect of
preventative medicine.
Defects of the Nervous System
There was no significant change in the pattern of these defects during
the year. The number of children with minimal evidence of epilepsy sometimes
causes surprise, and it is useful to compare the incidence in Croydon
in 1969 (3.2/1,000) with the most recently available fiaures in England and
Wales which show an overall incidence in 1967 of 3.7/1,000
It will be seen from page 28 of this Report that there has been a sharp
increase in the number of children referred to the service for an intelligence
assessment. The Table shows that this is not due to an increasing
recognition of educational subnormality in anticipation of the opening of